President Trump was right.
On July 21, in the first televised briefing on the coronavirus pandemic held by the White House since April, he projected that America “will probably, unfortunately, get worse before it gets better.” Unlike some of his prior assessments of the situation, this one is right on the mark. As bad as the situation is right now, it will probably get worse. But whether it will get better is by no means for certain.
More than 80 percent of the states are reporting increased numbers of COVID-19. Those numbers are now reaching all-time highs — exceeding those reported pre-shutdown. Some states are seeing more cases than hard-hit New York overall. Deaths and hospitalizations, which initially appeared to be lower than those reported in the spring, are starting to rise, as public health experts cautioned these lagging indicators would.
As bad as the spread of the coronavirus is, there is reason to believe it will get worse.
There are ominous signs on the testing front. Though the number of tests have been greatly expanded — from under 30,000 tests per day in the spring to now over 700,000 tests per day — the spread of the coronavirus has outpaced these efforts. The overall percentage of tests coming back positive has increased from a low of less than 5 percent in early June to close to more than 8 percent in recent weeks. This means the number of infections has grown more quickly than the number of tests, and states would have to increase testing to catch up.
Finally received my (negative) COVID test results from the DC government today...28 days after I took the test.— Susan Davis (@DaviSusan) July 30, 2020
Unfortunately, it may not be possible to increase the number of tests that states need, due to the high demand for testing as well as shortages in testing supplies that were never fully addressed. Meanwhile, states are reporting delays in getting back test results. In some cases, it exceeds a week. Getting results back this late, possibly after someone is no longer contagious, makes it near impossible to use targeted public health tools like isolating cases and contact tracing to interrupt the spread of the virus. Without functional use of such targeted interventions, states are left only with shutdowns as a tool to combat the spread of disease.
If these trends continue, the nation is in store for a difficult fall. COVID-19 cases will continue to climb at alarming rates. Deaths and hospitalizations may lag, because it takes time for an infected person to become severely ill and/or die. Right now, the virus is being spread primarily by young, healthy people, which may now be causing fewer deaths. But young people tend to have large numbers of contacts, which can accelerate the spread of COVID-19. The virus will then move into into more vulnerable populations, such as the elderly, which are most likely to be hospitalized and die.
On top of all of this, seasonal influenza will arrive and, as it usually does, will further strain health care resources. The need to differentiate between influenza and COVID-19 will place additional strains on laboratories. Clinicians will have to find hospital beds and ventilators for severely ill patients. Though a vaccine will be available to protect people from several strains of seasonal influenza, there will still be people who contact the flu and become severely ill. This will increase the strain on hospitals, which will now have to find additional beds, ventilators, and other elements of critical care for flu patients while caring for COVID-19. A greater number of people experiencing serious viral infections will place further strain on medical supplies like PPE, which have historically been in short supply.
In response to these challenges, states that haven’t already paused the phased reopening of their economies will have little choice but to do so. Many will probably implement additional restrictions, such as again closing schools, stores, restaurants, and bars. This will once again exacerbate economic harms.
It will take weeks for the impact of these shut-downs to be felt. People will continue to get sick, be hospitalized, and die.
It’s starting to feel like America is stuck in that bad, recurring dream. The one where disease rates are once again soaring so quickly that states are again shuttering businesses and issuing restrictions. Just when we start to think we might be safe, it looms again.
But it doesn’t have to be like this. We don’t have to accept a choice between perpetual anxiety and freedom. Other countries, such as France and Germany, have done the work and are now enjoying low levels of infections and safely reopened schools, businesses, and entertainment.
Getting out of this nightmare will require more than just stopgap measures. The federal government needs a national strategy to equip all 50 states with the resources they need to identify and isolate people who are infected with COVID-19 and to trace and quarantine their contacts until we can be sure they aren’t contagious. States have been working hard to increase supplies of testing materials and PPE, and to hire contact tracers. But these piecemeal, state-by-state efforts are now straining under the weight of the pandemic.
Trump is certainly right about the pandemic’s worsening trajectory. But based on the current inability to test, trace, and isolate, the prospects of life getting better is an open question. It will get better only when our national leaders decide to act.
Dr. Jennifer Nuzzo is an epidemiologist and the senior scholar at the Johns Hopkins Center for Health Security. Her column appears regularly in the Globe.