In July, leading public health expert Dr. Peter Hotez proposed a national plan that would allow America to begin a safer and more open life by October 1.
Within a few weeks [August], we will reach the awful milestone of 100,000 new COVID19 cases per day, next 225,000 deaths by October 30, and possibly 300,000 deaths by the end of 2020. However, it is not too late to chart a different course. By October 1, we could safely reopen our schools, colleges, and businesses. Potentially we could even launch a college football season or the NFL?
It appears that the projection of 225,000 deaths by October 30 was accurate. Today, 36 states have increasing cases, while none have fewer. Schools, colleges, businesses, college football, NFL? Some moving forward, some limping along, some still at a standstill.
Is it too late to start a plan targeted to October 1 in mid-October? Any science-based national plan would be better than none, anytime. Is it likely we will have a national plan anytime soon? If you are an American or an America-watcher, you know the answer. Will there be 300,000 dead by the end of the year? At least.
For what it’s worth, below is a rerun of Dr. Hotez’s plan.
COVID19 in America: An October Plan
Within a few weeks, we will reach the awful milestone of 100,000 new COVID19 cases per day, next 225,000 deaths by October 30, and possibly 300,000 deaths by the end of 2020. However, it is not too late to chart a different course. By October 1, we could safely reopen our schools, colleges, and businesses. Potentially we could even launch a college football season or the NFL?
Our homeland security threat
COVID19 has gone beyond dangerous levels in America. We just surpassed 65,000 new cases per day, and I estimate that currently one-quarter of all the world’s COVID19 cases now occur in the Southern US. Soon we will reach Dr. Anthony Fauci’s projected apocalyptic benchmark of 100,000 new cases per day (https://www.nytimes.com/2020/06/30/us/politics/fauci-coronavirus.html). In addition, we are experiencing dramatic increases in hospitalizations and ICU admissions across the southern half of the United States, and as predicted, the number of deaths has spiked. The University of Washington just estimated that 225,000 Americans will die by October 30 (https://covid19.healthdata.org/united-states-of-america), and potentially that number could reach close to 300,000 by the end of 2020. To place that number in perspective the terrible 1918 influenza pandemic that lasted until 2020 (or some say 2022) caused 675,000 deaths in the US (https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html). This COVID19 public health impact does not include the many “recovered” patients with long-lasting disabilities resulting from virus injury to their lungs, vascular system, and heart, as well as potentially long-term neurologic and cognitive deficits.
Soon, practically every American will personally know someone who has gotten very sick or hospitalized with COVID19.
Still another aspect is my concern that low-income neighborhoods across the South – where social distancing is often more difficult and essential workers must physically be in their place of employment – are now being decimated. COVID19 is a health disparity, and LatinX, African American, and Native American people are pouring into emergency rooms, hospitals, and ICUs. For me this is the most heart-wrenching aspect of COVID19 and a reason I speak out.
It is more than public health
Beyond the dire public health impact of the 2020 COVID19 epidemic in America are the socioeconomic effects. The impact on jobs and the economy has been well-reported, but equally important is the fact that now millions of Americans feel unsafe. Many of us are fearful of leaving our homes or having our children in school. It is also impossible to imagine how schools can be considered safe in areas of the country where virus transmission is accelerating. Within a few weeks of opening schools in the South, teachers, staff, bus drivers, parents will become ill, and require hospitalization. School staffs will become demoralized, and schools will again close. In time, a collective feeling of futility and hopelessness will become pervasive. Our nation will be left vulnerable due to internal unrest, cybersecurity attacks, and more, as COVID19 transitions to a homeland security threat.
We do not have to live this way
Adding to America’s frustration is the knowledge that many European and other nations are now returning to normalcy in the aftermath of their springtime COVID19 epidemic. Transmission is way down, allowing schools and colleges to reopen safely, while people return to work and enjoy cafes (https://www.bbc.com/news/world-europe-52935145), and restaurants.
What went so terribly wrong?
Why did Europe successfully emerge from its COVID19 epidemic while America still struggles and even faces a much larger threat in the coming weeks and months?
The successful nations implemented a national plan and roadmap with a target date and target goals of reaching defined levels of virus containment.
There are different metrics used to define containment. For some it means, one prevalent COVID19 infection per million residents (http://www.healthdata.org/sites/default/files/files/Projects/COVID/Estimation_update_041720.pdf). For others, one new case per million residents per day. Under these circumstances, public health measures, including testing, contact tracing, syndromic surveillance, and effective public health communication can would prevent a resurgence.
In contrast, the US never really had a federal plan and roadmap. There was no federal directive or visible champion for implementing a national strategy. In its place, our federal government ceded control to the states. It forced the states to make its own decisions, while the US government provided important FEMA and other support, including ventilators, protective equipment, and supply chain management.
This approach was doomed to fail from the beginning:
- Many states did not have the epidemiologic knowledge and models to make informed decisions about when it is safe to loosen social distancing and other measures.
- States lacked detailed information about the impact of selected measures on the projected number of cases, ICU admissions and deaths.
- Back in April (and still today) Governors were under intense political pressures to make decisions that go against public health recommendations.
- They needed the cover of the federal government, especially the CDC, to say to lawmakers, “look I hear what you are saying, but the CDC tells me if I don’t do this or that, thousands of people will die in our state”. I believe those conversations rarely happened.
The result was predictable: A fragmented, arbitrary, and broken COVID19 response.
The consequence: The US is the epicenter of the global COVID19 pandemic, and we will maintain this status in the future.
In the current trajectory, COVID19 will only get much worse as we head into the fall and winter. Compounding our epidemic is the likelihood that season influenza will soon return, and we could see another measles resurgence given the decline in vaccination rates (https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e2.htm).
The default is that we might soon endure the greatest public health catastrophe in the history of the United States over the last hundred years.
The Fix: A New National Plan
We have an option. Through federal leadership and guidance, we could bring our entire nation towards a level of containment sufficient to safely open schools, colleges, and even host sporting events. We could return Americans safely to the workplace.
To do this by October 1 we now need to do the following:
- Shape a national plan with an objective of a national level of containment.
- Some experts benchmark containment as one case per million residents per day, but we might select less strict criteria.
- Upon achieving this level, it would be possible to reopen schools, colleges, and businesses safely, provided a full and functioning health system is in place.
- With containment, contact tracing actually becomes feasible, whereas this is not the case currently across most of the nation.
- Each state would either agree or be required to meet that containment benchmark.
- Some of these states, such as those in northern New England (NH VT ME) might already be close to that level. Others, such as FL TX AZ may require aggressive stay-at-home measures.
- Starting October 1, we could begin a national re-opening for schools, colleges, and even outdoor high school (“Friday Night Lights”), collegiate and professional sports.
We have few choices
Doing nothing or continuing a strategy based on states in the lead will only invite further tragedy. By late in the fall every American will personally know someone who is severely ill or hospitalized with COVID19. Hospitals across America will be overrun, hospital personnel will become sick in droves, and we might experience 300,000 deaths by the end of 2020. Moreover, we won’t have a safe and effective COVID19 vaccine anytime soon. My earliest timetable is the middle of 2021, and even then, that timeframe would be a world land speed record.
This will become one of the most unstable times in the history in the United States.
Implementing the October 1 plan will force America to make some difficult choices, but none as devastating as the mounting deaths if we choose to simply stay the course.
Peter Hotez MD PhD is Professor of Pediatrics and Molecular Virology & Microbiology, and Dean of the National School of Tropical Medicine at Baylor College of Medicine where he is also Co-Director of the Texas Children’s Center for Vaccine Development.