Experts: If coronavirus cases rise to 100,000 daily, some health care systems could be overloaded

Intensive care unit staff talking at hard-hit Brooklyn Hospital Center in New York City during the dark days of the pandemic earlier this year.Victor J. Blue/NYT

What would it mean if the United States was seeing 100,000 cases a day of coronavirus?

Experts say it could mean health care systems getting overloaded in the hardest-hit areas of the country. And they underlined the need for continuing vigilance in places like Massachusetts, where the pandemic is currently dwindling.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said Tuesday at a congressional hearing, “We’re now having 40,000-plus new cases a day. I would not be surprised if we go up to 100,000 if this does not turn around, so I’m very concerned. "

He declined to estimate how high the death toll from the pandemic could rise, saying it depended on how the country responded. But he said, “I think it’s important to tell you and the American public that I’m very concerned, because it could get very bad. ... Clearly, we’re not in control right now.”

Marc Lipsitch, a professor of epidemiology at Harvard’s T.H. Chan School of Public Health and director of its Center for Communicable Disease Dynamics, said Wednesday that the 100,000 figure seemed “reasonably likely to me” based on current trends. Infections have been on the rise in much of the country, particularly in the South and West.

If the 100,000-case scenario happens, he said, “I think that the most likely scenario ... is that it will be quite variable regionally. We won’t necessarily see every place struggling, but we will see some places struggling. It seems most likely to me that there will be parts of the country where the health system will be overwhelmed with that kind of level.”

“Certainly, if parts of Texas went to 2.5 times their current caseload, that would be disastrous,” he said.

He speculated that the areas that would be slammed by the virus would “be different from the ones that struggled the first time because people seem to learn lessons very locally. And I think at least some of the jurisdictions that were hardest hit on the first round are being much more cautious at this point.”

He said the country could see a “geographically more widespread” version of the nightmare that happened in New York when it saw its surge of cases earlier this year.

Plans to reopen schools would have to be dropped, he said, and lockdowns might need to be reinstated.

“At the rate things are going, it’s going to be necessary in some places. I hope not in all places,” he said.

Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy, told STAT that the United States could reach 100,000 cases daily within three to six weeks.

He also warned that hospitals would be overwhelmed.

“We have to understand if we have 100,000 cases a day, we will have a crisis in intensive care units around the country,” he said.

Dr. Thomas Tsai, a surgeon and assistant professor at the Chan School, said Fauci’s remarks should be a “wakeup call” to take measures to prevent the pandemic from growing. But he also said it was time to start planning for the possibility that it could happen.

He said if the 100,000-case scenario happens, “it may mean that in local areas there will be a return to shortages of masks, personal protective equipment, hospital beds, and ventilators.”

“This is a time — when we are not at 100,000 cases — to put in place the plans and planning to deal with that. The hope is that day never comes,” he said. “But we’ve seen just two months ago what can happen when there’s not enough coordination around personal protective equipment, ventilators, and therapeutics.”

He called for “federal coordination and guidance” in the response.

Some states have been planning for a “very real scenario, where they may have to implement crisis standards of care,” which are effectively plans to ration care, he said.

He said he was particularly worried about the virus spreading into more rural areas.

“For a small rural hospital of 25 beds, even one or two COVID-19 patients who need intensive care can rapidly overwhelm the hospital,” he said.

Tsai warned that Massachusetts and other states that have been successful at this point in reducing the pandemic need to remain vigilant.

“The virus doesn’t respect any boundaries, whether it’s national, state, or county,” he said, and “could spread back north again.”

“Today’s cold spots could be tomorrow’s hot spots,” he said.

The United States has seen more than 2.6 million cases of the coronavirus and more than 127,000 deaths due to it, according to Johns Hopkins University.

While US cases are generally on the rise, deaths have been trending downward. Experts have cautioned that there is a delay between the time cases are reported and the time the most severely ill people die from the disease.