The U.S. Is Likely Headed for a ‘Dark Winter.’ Here’s What That Means

U.S. President Donald Trump has been quoted during his campaign rallies saying the country is “rounding the corner” on COVID-19 cases.

Trump’s opponent, former Vice President Joe Biden, however, indicated at the last presidential debate that we may be facing a “dark winter.”

Which candidate is correct? The statistics seem to favor Biden’s assessment.

As of Oct. 30, 2020, the Centers for Disease Control and Prevention (CDC) was reporting 537,501 new cases in the past 7 days. In addition, the agency was reporting 5,655 new deaths in that time frame.

What’s more, data compiled by Johns Hopkins University shows a rising trend in the number of cases over the past month, with the 7-day average of daily new cases going from 44,765 on Oct. 1 to 78,981 on Oct. 28.

To get an idea of what a “dark winter” might mean in the United States, Healthline consulted two experts: Wesley Long, MD, PhD, a researcher at Houston Methodist Hospital in Houston, Texas, and Susan Hassig, DrPH, MPH, a researcher at Tulane University in New Orleans, Louisiana.

Are we going to see more cases, hospitalizations, and deaths this winter?

According to Long, it depends on what part of the country you live in.

“We are seeing increasing cases now in some areas, especially in the northern Midwest states, where COVID-19 rates have for the most part been low,” Long said.

“As cases increase, hospitalizations will likely start to increase as well,” he said.

Hassig added, “Remember, we are dealing with multiple, site-specific epidemics occurring simultaneously, which will ebb and flow independently but also may be influenced by neighboring areas/cities/regions.”

Why are we seeing a rise in the number of cases?

Long said there are many factors at play.

With the colder weather, people are spending more time indoors, he said. COVID-19 tends to spread more effectively inside.

Hassig noted that factors like physical proximity, not wearing masks in personal spaces, smaller air volumes indoors, and less effective air exchange in private homes all make COVID-19 more easily transmitted during the winter.

Also, there is “COVID fatigue,” Long added. As people become tired of physical, or social, distancing, wearing masks, and other preventive measures, they may begin to ignore precautions.

Is it possible that we may see overwhelmed hospitals and a rationing of care?

“It is certainly a possibility at a local level due to staffing shortages, more than physical space/equipment constraints,” Hassig said. “And when a local area cannot transfer patients because surrounding areas are also heavily overburdened, more likely.”

“No physician wants to be in that position, and they will do everything to prevent it,” Hassig added. “But even a much-used practice of stopping elective surgeries or care in times of high COVID burden is a form of care rationing.”

She also pointed out that “healthcare resources are not unlimited.”

Long added, however, that “throughout the pandemic, we have seen a variety of measures taken to add hospital capacity in response to surges in different states.”

“These may take the form of ‘field hospitals’ or temporary medical facilities set up in tents or other buildings,” he said. “In addition, doctors, nurses, and other healthcare providers may be brought in from around the country to help staff these facilities.”

“All of us need to do our part to help prevent the spread of COVID-19 to help our communities’ healthcare providers cope with increasing cases,” he said.

Are we at risk for a ‘twindemic’ of flu and COVID-19?

“This is certainly a concern,” Long said, “as influenza can provide added healthcare demand, and infection with COVID-19 plus influenza could result in poor outcomes.”

“However, evidence from the Southern Hemisphere suggests that all of the precautions we take for COVID-19 have also helped them have a very mild influenza season,” he added.

Long said that “this makes masking, social distancing, and avoiding crowds doubly important this winter.”

He added, “It also stresses the importance of getting your influenza vaccine or ‘flu shot’ if you have not already done so this year.”

Should we be avoiding holiday gatherings this year?

“Holiday gatherings definitely present a risk,” Long said. “Even more so if they are held indoors, without masks, and social distancing cannot be maintained.”

Since COVID-19 is still spreading in communities and many areas are seeing an increase in cases, Long advised that this is why it’s important to still maintain these preventive practices.

He pointed to the examples he’s seen of “gatherings where masks and distancing are not maintained,” and those events ended up leading to “large clusters of COVID-19 infections.”

“This holiday season, the best practice would be to celebrate only with members in your household and to consider connecting with other relatives or higher-risk family members via phone calls or video chat apps,” Long said.

How likely is it that we will see the arrival of an effective treatment for COVID-19 this winter?

“We are still awaiting clinical trial data on most,” Hassig said. “The steroid therapy (dexamethasone) is approved for severely ill patients to downregulate the immune overreaction that has been problematic for so many patients.”

She warned that quantities of potential medications, if/when they’re approved for use, will also not be very large at first. Distribution will be controlled and rationed.

“Some may have some benefit, but there is no single ‘magic bullet’ therapy available,” Long added.

“Also, we are still coming to terms with the long-term effects of COVID-19 infection on patients who do survive and recover,” he added.

What about a vaccine?

“There are multiple vaccines in various stages of clinical trials and development, with several candidates nearing possible EUA (emergency use authorization) approval,” Long said.

“Once they are available, they will definitely help us build immunity safely in our community to help fight the spread of COVID-19,” he said.

Long also pointed out that the effectiveness of a potential vaccine can be measured in a variety of ways, “but at the bare minimum, a reduction in hospitalization for COVID-19, similar to what we see with influenza vaccination, would be very beneficial.”

“Shortening of illness, prevention of long-term side effects, and preventing transmission could all be potential benefits of different vaccines,” he said.

Long cautioned, however, that national distribution would take time.

“Vaccines are theoretically a very important tool, but right now they are still theoretical,” Hassig said. “If, and when, a vaccine candidate makes it through the approval process, we will have some sense of how beneficial, and in what way beneficial, it will be.”

“Then, people will need to be willing to take it,” she said.

What should we be doing to protect ourselves this winter?

Hassig suggested that we continue to wear masks in public spaces, maintain physical distancing, and use good hand hygiene.

She also advised that we should remember that even if our experience with the new coronavirus isn’t severe, we may still pass the virus along to someone who will have a negative outcome.

“Unfortunately, the direct consequence of not following recommendations is the continued spread of COVID-19 in our communities with all of the resulting negative impacts, not just to ourselves and our immediate families but to others as well,” Long said.

“By following all of these best practices, you are not only protecting yourself and your immediate family, you are actually helping to protect your friends, family, and loved ones, and those of your neighbors and co-workers, from COVID-19 and potentially devastating outcomes,” he said.

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