Vaccines offer hope for end to pandemic, but experts say brutal months lie ahead

Coronavirus vaccines are poised to be approved and distributed in the coming weeks in the United States, but that promising news comes amid record levels of infections and hospitalizations, with experts warning that the most brutal period of the pandemic lies ahead.

This is a split-screen moment: Progress on vaccines means people can now plausibly talk about what they will do when the pandemic is over. But with new infections topping 212,000 Thursday—another daily record, topping one set Wednesday—it won’t be over in a snap. This remains a dismal slog.

“The vaccine has not come in time to do much about the winter wave,” said Christopher Murray, director of the University of Washington’s Institute for Health Metrics and Evaluation. “Vaccination is coming too late even if we do a really great job of scale-up. It’s coming too late to do much by March 1, or really by April 1.” Only at that point, he added, will the widespread distribution of vaccines begin to crush the virus.

In the meantime, the country faces what could turn out to be the most challenging few months in the public health history of the nation, Centers for Disease Control and Prevention director Robert Redfield warned in a speech Wednesday. That kind of dire language is increasingly coming from the top experts in the field and from the highest levels of the federal medical establishment. “We are in a very dangerous place,” declared a White House coronavirus task force document circulated to governors earlier this week.

To date, at least 275,000 people in the United States have died of the virus, a toll that includes more than 2,700 deaths reported Thursday, according to health data tracked by The Washington Post. That is among more than 14 million confirmed infections.

A new national ensemble forecast—an aggregation of 37 models sent to the CDC—projected that 9,500 to 19,500 people would die of COVID-19, the disease caused by the virus, in the week encompassing Christmas. Murray’s institute, meanwhile, has been putting the final touches on a new forecast that he said would show an increase from its Nov. 19 projection of 470,000 deaths by March 1.

Two vaccines are being reviewed by the Food and Drug Administration and expected to receive clearance in the coming weeks. One of them, from Pfizer and the Germany company BioNTech, was approved this week in the United Kingdom. Four more vaccine candidates are in late-stage trials. Later this year or early next year, there could be more than a million doses of vaccines going into arms every day in the United States.

But it will take time to change the trajectory of the epidemic. The fall wave of infections that began in September in the Upper Midwest and Northern Great Plains is now crashing across much of the country, including in the high population centers of California and the Northeast, such as metropolitan New York City, which was pummeled by the virus in the spring.

“The assessment does indeed look pretty frightening when you see how this is spreading now not just in a subset of the country but across most of the landscape,” Francis Collins, director of the National Institutes of Health, said Thursday. “We are seeing a person dying every minute. We have an enormously significant challenge here to try to get this turned around.”

In some of the worst hit hospitals in the country, health care workers are navigating a punishing surge in cases that has left them short on beds and staff. In Jackson, Miss., the University of Mississippi Medical Center on Thursday had 35 more patients than beds, said Vice Chancellor LouAnn Woodward. Those patients are being held for now in the emergency department and in the recovery room. And because the hospital is the premiere destination for specialized medical care in Mississippi, like trauma and transplants, the COVID surge has also placed significant pressure on all facets of health care in the state.

“It is challenging all the way around. It is alarming. It is a very uncomfortable place for us to be,” she said.

Woodward noted that the exhaustion felt by medical staff, and in particular nurses, is afrightening component of this latest surge that sets it apart from the most difficult peaks in the spring and summer.

“They feel defeated. They are working so hard. Their concern and dedication for their work hasn’t changed, but they are tired and they are worn out. And they just don’t feel like they can catch a break,” she said. “And the piece that is so hard to describe is that you literally go through hell taking care of these patients . . . and then you leave work and your friends are talking about going to a wedding the next weekend.”

She said the vaccine news has been a “bright spot,” and is “the best news we’ve had in awhile,” but she stressed that the problems confronting the country will not ease up with the early vaccine distributions.

For now, the message from infectious-disease experts and a growing number of governors and mayors is that everyone needs to mask up, stay at home as much as possible, and hang on.

“Help is on the way,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said Thursday on MSNBC. “We’re going to be giving vaccines towards the middle and end of December, and then more in January and then more in February. . . . If we can just hang on and do those fundamental public health measures to try and blunt some of these surges, ultimately we can get out of this. It isn’t all despair.”

Fauci said he intends to stay at his institute and help with the coronavirus response from the Biden administration. Later in the day, President-elect Joe Biden on CNN confirmed he had asked Fauci to stay in his role and be “a chief medical adviser for me as well.”

Biden also said that on the day of his inauguration he will ask Americans to wear masks for 100 days. “Just 100 days to mask—not forever, just 100 days. And I think we’ll see a significant reduction” in infections, Biden said.

It’s unclear how much of impact that request will have. Every state except South Dakota already has some kind of face-covering policy.

On Thursday, California Gov. Gavin Newsom, a Democrat, announced that regions in the state where intensive care unit capacity fell below 15% would be put on strict shelter-at-home orders for three weeks. As of Thursday afternoon, about 18,600 new COVID-19 cases were counted in the state, the second-highest single-day record, which was set Wednesday. About 9,700 people in California are currently hospitalized with COVID-19.

The mayor of the city of Los Angeles, Eric Garcetti, has forcefully urged the city’s residents to stay at home except for essential activities like buying food.

“My message couldn’t be simpler. It’s time to hunker down. It’s time to cancel everything. And if it isn’t essential, don’t do it,” Garcetti said during a news conference. “Don’t meet up with others outside your household, don’t host a gathering, don’t attend a gathering.”

Even if vaccines roll out quickly, daily death tolls may not peak in the United States until mid- to late January, Murray said.

Emily Allen, a registered nurse at St. Joseph’s Hospital in St. Paul, Minn., said the intensive care unit where she works the night shift has become a “revolving door” of increasingly sick COVID-19 patients. If the trajectory of the pandemic was grim in the spring, she said, it has reached an altogether new low in recent weeks. To meet demand in her region, her hospital will soon accept only COVID patients.

“We cannot get beds cleaned fast enough by the time we have another patient coming in. On the night shift we have two doctors for 50 ventilated patients. We can have three patients crashing at the same,” she said. “It’s every single shift that is overwhelming. It doesn’t shut off.”

Patients are now sometimes held in the emergency room because beds are not readily available, she said. Others are sent to rural hospitals. There is often not enough space to readily accept transfer patients who need specialized care.

She described the exhausting process of correctly handling a COVID patient with severe lung problems who must be placed carefully on his or her stomach.

“We just took a patient from a facility 15 minutes from us and right away we were proning, which takes 11 or 12 people do safely. The patient took a very, very fast turn,” she said. “We don’t have a team of people just waiting around to help prone.”

Redfield, the CDC director, has joined the chorus of experts saying that what the country needs desperately is a unified message on how to respond to the virus, and in his speech Wednesday he expressed dismay over the debate about whether masks are helpful in limiting the contagion. Officials in some states, including ones slammed badly by the virus, continue to resist enforcing mask mandates or other restrictions, such as limiting indoor dining.

But the CDC says these measures produce results. That’s been seen in North Dakota, where Gov. Doug Burgum, a Republican, three weeks ago announced limits on indoor dining and a public mask mandate. Since then, the state’s average number of new cases has dropped from 1,400 per day to about 700 per day, according to data tracked by The Washington Post.

Trisha Jungels, a nurse in Jamestown, N.D., credits those steps with bringing some much needed relief to health care workers at Jamestown Regional Medical Center, a critical access hospital with 25 beds where she is chief nursing officer. Two weeks ago, the hospital came close to shutting down other units to create more beds to host incoming coronavirus patients.

She noted that COVID-19 patients take more time and resources than others to care for, which in turn puts a strain on medical staff that can also affect the quality of care non-COVID patients receive.

“We still have other illnesses happening. It’s not just COVID,” she said. “It’s COVID on top of the work that we were already doing, making sure that we have resources to take care of people that have a heart attack.”

It is impossible to know when life will get back to normal, or something that feels close to it. The vaccine rollout will take many months under even the most optimistic scenarios. But the vaccine news has boosted optimism even among the experts who are warning of a rough winter.

“We can be in baseball stadiums in the summer,” Murray said. “By July we can be very back to normal. Personally I’m starting to think we have a very bad three months ahead—actually four months ahead—and then things start to look more optimistic.”

William Schaffner, a professor of infectious disease at Vanderbilt University Medical School, said doctors are “all kind of grimly prepared” for what this cold-weather surge in cases will mean for the country. But he welcomed the recent news about the vaccines.

“No magic wand here. It’s still going to take months. But hey, long journeys take first steps,” Schaffner said.