Both Texas and California have passed over 1,000,000 cases total.

In this new upsurge, for the first time all areas of the U.S. are affected.

This new wave is growing fast and shows no indication of slowing down. It isn’t known how high it will go.

Hospitalizations lag behind infections as it takes time for symptoms to emerge and then become sufficiently severe to require hospitalization, but have reached 70,000, ten thousand more than in the summer peak.

Deaths lag hospitalizations for obvious reasons, but are now at 1,400 per day. This less than the daily rate last March-April of 2,200, due to the work of medical workers and drug companies in learning how to care for hospitalized patients since. However, deaths per day is expected to reach new highs as hospitalizations soar.

One example is in El Paso, Texas. “There have been so many deaths in recent days” says an article in the New York Times, “that the county medical examiner parked five mobile morgue units – the size of trucks – outside its doors. Legacy Mortuary Service, a company that transports bodies from hospitals to funeral homes, is busier than ever, carrying 40 to 50 bodies most days now, its owner, Pilar Contreras said.”

Experts foresee a “horrifying” toll in coming months, according the article. Hospitals are reaching capacity in some regions. Even the best medicines and techniques lose their usefulness if too many people get sick at the same time, taxing staffing and supplies. “When you’ve overwhelmed the health care system, nobody is going to get optimal care,” said Dr. Jessica Justman, an epidemiologist at Columbia University. “We can expect the case and death count to continue to rise exponentially unless we take serious measures to mitigate the virus,” said Dr. Howard Merkel, a historian of epidemics at the University of Michigan.

A new survey by National Nurses United found that hospitals are still failing to provide adequate Personal Protective Equipment and workplace protections. Nurses say hospitals are unprepared as the surge gets worse during the flu season. Nurses also report mental health struggles from the stress of dealing with so many patients, and the danger of becoming infected themselves, according to Democracy Now.

One cause of this new upsurge was the relaxation of restrictions on social distancing, using masks when in public places, and large public gatherings. This was exacerbated by Trump’s refusal to advocate these policies, resulting in Republican led states and local governments ignoring them. Most of his tens of millions followers did the same.

There are reports of some patients – Trump believers — dying of the virus in hospitals refusing to believe that the virus was killing them, angrily saying to doctors and nurses that there is no such virus.

Now many states, but not all, are reimplimenting these policies and imposing again restrictions on businesses where people congregate. There may have to be new lockdowns. But unless enough of the states and local governments and of the population actually do comply, the new upsurge will not begin to be brought down.

In the best of cases, that will take months.

New vaccines based on a new technology using the virus’ genetic RNA, report encouraging initial findings from mass testing, of over 90 percent effectiveness. They still have to be tested for safety before they can be certified. When they are, a small amount will first be used on medical personnel and vulnerable populations on an emergency basis, the Trump administration says.

But this projection faces many hurdles, and inoculating the whole population even more.

Assuming the vaccine can be deployed for emergency use by year’s end, another article in The New York Times said, “While the Trump administration has showered billions of dollars on the companies developing the vaccines, it has left the logistics of inoculating and tracking as many as 20 million people by year’s end – and many tens of millions more next year – largely to local governments without providing enough money, officials in several localities and public health experts involved in the preparations said in interviews.

“Public health departments already strained by a pandemic that has overrun hospitals and drained budgets, are racing to track and share information about who has been vaccinated; to recruit and train thousands of doctors, nurses and pharmacists to give people the shot and collect data about everyone who gets it; to find safe locations for mass vaccination events; and to convince the public the importance of getting immunized.

“The federal Centers for Disease Control and Prevention (CDC) have sent $200 million to the states for the effort, with another $140 million promised in December, but state and local officials said that was billions of dollars short of what what would be needed to carry out their complex plans.” Estimates are that 6 to 8 billion are needed.

It’s good to recall that one billion is a thousand times greater than one million.

There are myriad other costs too – including for paying for secure convoys to transport the vaccine once it gets to states. “We can’t just throw it into Bob’s pickup truck and drive it down the road” said one state’s director for its CDC.

There are many companies involved, including makers of syringes and other medical equipment all of which have to be coordinated.

Moreover, the first vaccine developed by Pfizer, which the administration has already paid billions to manufacture, requires two shots weeks apart, requiring additional record keeping and follow-up.

Moreover, this vaccine needs to be kept at -103 degrees Fahrenheit (-75 C), a logistical difficulty in itself. Another new vaccine developed by Moderna, can be kept at -4 F (-20 C) so wouldn’t face that hurdle, but which vaccine will be deployed hasn’t been announced.

The billions necessary to carry out the first emergency use will not likely be allocated by December, given Republican opposition.

It will take many months, at least to the end of 2021, for a vast program of vaccinations of the entire U.S. population, the largest by far in U.S. history, to be implemented.

It also is not known how long a vaccination will remain effective. Will it be like the flu – six months, requiring another mass vaccination then? (The flu season only lasts until from fall to the next spring. We know the coronavirus is infectious year round.)

So a vaccine will not be a silver bullet obviating the need for implementing what we know works: masks, social distancing, no large gatherings, etc.

Barry Sheppard

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