Un-Normalizing America’s Third Wave

Frontline health-care worker Joanne Grajeda administers a nasal swab test at a drive-in COVID-19 testing site in El Paso, Texas, on November 13 amid a surge of new cases in the area. Photo: Getty Images

“The cases are going vertical,” wrote Eric Topol, the head of Scripps Research Translational Institute and not temperamentally an alarmist, on Thursday. In the spring, Americans nervously following the course of the pandemic heard a lot about the risks of “exponential growth,” but outside of New York, the first-wave epicenter, the country’s experience with spread of this speed was rather limited. Now almost the entire country is there, with COVID-19’s spread in 47 of 50 states currently “uncontrolled,” according to Covid Exit Strategy. In the world of AI speculation, this vertical portion of a curve is sometimes described as “the singularity,” a threshold past which growth in computing power is so rapid its effects cannot really be predicted beforehand. With the virus, we do know what is ahead: much larger charts, with much longer y-axes, tracking much, much more sickness. Looking at the national map on Wednesday, Ebola doctor Craig Spencer joked, the pandemic “currently has 531 electoral votes and is a strong favorite for all four in Maine.” Each of the next two days, the new case total grew again.

Over the last few months, election-preoccupied Americans have normalized what was once an unthinkable, and certainly an unconscionable, level of death and suffering. There have been a thousand deaths from the coronavirus a day, roughly speaking, producing a cumulative total that is today approaching 250,000 — more than the number of people who died in the atomic bombings of Hiroshima and Nagasaki. “I just keep thinking about this epidemic — on our soil, in our country,” the Harvard epidemiologist Michael Mina told me last month. “What would the government do if we had 200,000 people die from bombs being dropped on us? You know we would not be sitting idly by.”

Since then, while we were sitting idly by, the pandemic did not merely continue unabated, it tidal waved. Just over a week ago, the country set a record with 100,000 new cases; Friday, it recorded more than 170,000. Just over a week ago, it might have seemed alarmist to warn of bunkering in through the winter; on Thursday, Chicago, America’s Second City, instituted shelter-in-place guidance, and right now, in New York City, the nation’s largest school system is on the brink of shutting down again. Zeynep Tufecki, the pandemic’s premier journalistic prognosticator, has just called on the country to “hunker down.”

The presidential election is now mostly behind us, but the country is still several months from new national leadership and probably several months more from the real interventions that change of leadership will bring. Dr. Anthony Fauci predicted last week that vaccines could be in wide distribution throughout the country by April, but that is almost half a year from now. In the meantime, two pressing questions loom. The first is, if we have normalized once-unthinkable suffering, can we un-normalize this third wave and actually engineer a meaningful response, rather than continuing to relax into tragic complacency? And the second question is, assuming we can respond, how much of a difference can be made?

It’s unwise to bet against normalization, which is so strong and pervasive a force in our culture that it muddies our ability to respond to any growing threat (like climate change or the degradation of democracy). But I think the answer to the first question is that, yes, we can un-normalize and choose to at least try to respond. There is already plenty of evidence to support that, not just in the policy turns of Chicago and New York, but in the headline space of our major newspapers and the anxiety space of our social media. (As it was in the spring, the speed with which anxiety about what might happen arrives, spreads, and is displaced by the nightmare actually happening, has been dizzying). The evidence is even clearer in Europe, where the pandemic has been tracking about a month ahead of ours, and where over the last week, many of countries worst-hit by the coronavirus have finally turned the curves of new infections down again — though it is only marginal improvement from some very high peaks. In France, for instance, new cases grew from a rolling seven-day average of about 4,500 new cases in the spring to about 55,000 new cases earlier this month, and has now drawn down close to 40,000 new cases daily. Belgium, Spain, the Netherlands, and the Czech Republic, among others, all have followed similar patterns — fall waves that dwarfed the spring ones now beginning to crest. But this can only count as “progress” if you are grading on a very steep curve, or making a very short-term assessment. And it has been devastating to those who had hoped — as recently as a few weeks ago — that herd immunity or community protection might kick in at relatively low levels of exposure, since many of the same places that were hit hardest in the spring are being hit hardest again now. But the European data does show that at high levels of infections, even those countries and cities exhausted by earlier pandemic waves have proven themselves capable of turning the corner and bringing caseloads down again — and given Americans some hope that our capacity for normalization, while distressingly high, may not be infinite.

But the experience of Europe also provides a distressing answer to the second question, about what difference such interventions can make. While the story of those countries’ fall wave is still ongoing, at the moment nobody has managed to really suppress the pandemic to anything like even the “manageable” levels experienced in the summer. Australia, after a second wave in July and August, has brought its pandemic down to almost zero again — but September is the beginning of spring Down Under and brings with it the relief of seasonality. Here, the fall surge has come to pass almost precisely as we were warned in the spring, and we find ourselves, despite the six-month head start, largely impotent to respond. This is not because the country has done nothing to prepare, though in certain areas of course the preparation has been tragically inadequate. It is because we have allowed the pandemic to get this big in the first place. Disease spread of this size, in this season, would overwhelm almost any preparation.

Consider the tools at hand. Especially compared with the spring, our testing capacity is now quite large — though perhaps not at an ideal, surveillance-scale level, which would allow us to catch asymptomatic cases. (Rapid testing, which could make that kind of real-time surveillance-style feedback possible, has been woefully underproduced and almost certainly can’t be scaled in time to respond to this surge, especially given the total void of federal leadership extending into late January.) Contact tracing, which technocrats have hoped would fill that gap and allow the tracking of asymptomatic cases, has basically failed everywhere in the U.S., even those places where whole disease-detective armies have been stood up at some scale. There are today, still, some issues with PPE availability in certain places, but not the widespread shortages we saw in the spring. While many hospital systems are — terrifyingly — approaching capacity now, it is much harder to reallocate resources to help when the shortages are so widespread, in so many parts of the country.

Of course, public policy matters, especially now at the local level — and American parents are right to be outraged that, in many parts of the country, bars and restaurants remain open for indoor business while in-person schooling is being shut down. Mask mandates are still patchwork across the country, but new ones are likely around the corner. We are also likely to see now a wave of new restrictions — probably less like the blanket shutdowns of the spring but nevertheless more meaningful intrusions into everyday life than most Americans have experienced in months. But it is also striking how much of the present guidance — from COVID president-to-be Joe Biden, for instance, or from Obama’s CDC chief Tom Frieden — reflects social behavior rather than public policy: mask-wearing, hand-washing, social distancing. Those measures work to suppress the spread rather than defeat it, but at this point, for the time being, they might be the best tools we have. At the height of its summertime second wave, which produced a local peak of pandemic hysteria, the U.S. hit a rolling seven-day average of 67,000 new cases a day. It will likely be quite a while before we can even glimpse that level again.

Un-Normalizing America’s Third Wave of the Pandemic