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Covid-19: US faces “surge upon a surge”

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4693 (Published 01 December 2020) Cite this as: BMJ 2020;371:m4693

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  1. Janice Hopkins Tanne
  1. New York

The US is likely to experience “a surge upon a surge” of covid-19 cases as a result of millions of people traveling over the Thanksgiving holiday weekend (26-29 November) to celebrate with family and friends, the leading US expert on the disease has predicted.1

Although the Centers for Disease Control and Prevention (CDC) asked people to stay home for the holiday, the Transportation Security Administration screened more than eight million Americans flying between 20 and 28 November. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, urged travelers to quarantine and be tested after returning home. If the virus was spread during family gatherings cases would begin to rise in a week or two, he said.

Fauci also expressed concern that cases would continue to increase as people traveled and got together during the December holidays.

President Donald Trump did not encourage mask wearing or social distancing but concentrated on trying to overturn the election, which he lost by six million votes. He will leave office on 20 January. His controversial adviser, the neuroradiologist Scott Atlas, who is not an infectious diseases expert, resigned on Monday 30 November.

The US recorded more than four million cases during November, double the October number. On 29 November it reported 136 313 new cases, lower than the average of 162 000 daily cases in the previous two weeks, but reporting may have been delayed by the holiday.

More than 13.6 million cases have been reported since the beginning of the pandemic, and nearly 268 000 people have died.2

Stretched resources

Cases of covid-19 are rising in all but 10 of the 50 states. A record 93 000 people are currently in hospital, and hospitals around the nation are facing potentially overwhelming numbers of cases. Janis Orlowski, chief medical officer of the Association of American Medical Colleges, said she expected that hospitals would have to start implementing “crisis standards,” stretching resources in ways not seen in normal times.3

Governors in several states have called for increased restrictions and more mask wearing. Governor Gavin Newsom of California said that he was considering a stay-at-home order if cases continued to rise in some areas.4 Governor Andrew Cuomo of New York has called on retired doctors and nurses to return to work. New York state was helped by volunteer healthcare workers from other states during its severe outbreak in the spring, but now other states have too many cases of their own to share workers.5

The good news is that some vaccines may be available as early as later this month. Both Pfizer and Moderna have applied to the Food and Drug Administration for emergency approval. The FDA will consider Pfizer and BioNTech’s vaccine on 10 December and Moderna’s vaccine on 17 December. Both companies have started manufacturing the vaccines even before approval and could together provide 40 million doses—enough to vaccinate 20 million people, since both vaccines require two doses given about a month apart.6 Pfizer has already flown some supplies from Belgium to the US.7

On 1 December the CDC’s advisory committee on immunization practices will consider priorities in distributing the vaccine. Probably first in line will be about 21 million healthcare workers, followed by residents of long term care homes, essential workers, adults with high risk medical conditions, people over 65, and then the rest of the population.

Distribution of the vaccines, their administration, and building public trust will be the next issues to be tackled. Pfizer’s vaccine must be kept extremely cold. Healthcare workers can be reached for vaccination through their workplaces and residents of care homes through their facilities, but members of the public will seek vaccination through doctors’ offices, clinics, pharmacies, and large retailers with onsite clinics, and the vaccine must be distributed to all of those places—which must keep records of who received what vaccine and whether they received a second injection.

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