Even as the nation’s attention is focused on the as-yet unresolved presidential election, the coronavirus has quietly raged on, with no signs of abating. No matter which candidate ultimately prevails, either would confront the challenge of trying to rein in a public health crisis that has grown increasingly dire.
Just after Election Day, the United States reported a record-shattering daily count of infections, with new cases topping 100,000 for the first time on Wednesday. More than 230,000 Americans have died.
“Our need to commit our attention to the pandemic has not changed. In fact, with rising case numbers, we need to redouble our efforts," said Jennifer Nuzzo, a Johns Hopkins University epidemiologist. Nuzzo has watched daily case counts and hospitalizations rise with increasing alarm over the past several weeks. “We have crossed really perilous thresholds," she said.
No matter who wins the election, she said: "There is still a lot of work that needs to be done and resources that are needed in order to control this virus. That’s going to persist, and it’s going to persist for weeks and months to come.”
COVID-19 cases have peaked twice before in the United States: in early April, when about 30,000 new infections were reported daily, and in late July, when each day brought between 60,000 and 70,000 new cases.
The most recent increase in infections has already eclipsed previous records, with no signs that trends will reverse and abundant reasons for worry. COVID-19 transmission is rising in many states, including Massachusetts, which on Thursday reported 23 new deaths and 1,761 new confirmed cases, the highest count since early May. As winter weather tempts people to socialize indoors and cold and flu season sets in, the virus could move even more rapidly through families, workplaces, and communities.
Adding to uncertainty about the pandemic’s direction are the divergent approaches President Trump and former vice president Joe Biden took on the campaign trail.
Trump, who fell ill with COVID-19 in early October, repeatedly downplayed the disease’s threat and touted the country’s response, insisting on Oct. 27 amid rising cases that “we are rounding the turn.” The Trump campaign also held large rallies in recent weeks, with most supporters attending unmasked.
Until November 4th., Fake News Media is going full on Covid, Covid, Covid. We are rounding the turn. 99.9%.— Donald J. Trump (@realDonaldTrump) October 27, 2020
The Biden campaign took a decidedly different tone. Both he and his running mate, Senator Kamala Harris, avoided gathering large groups of supporters and emphasized the pandemic’s gravity. In response to record-setting case counts, the team held a COVID-19 meeting on Thursday.
Politicization of the virus has only served to heighten public health professionals' concerns about worsening metrics. It has also meant that election results weigh heavily on many experts' minds.
“The fact that this has been politicized is offensive," said Shawnita Sealy-Jefferson, an Ohio State University epidemiologist and professor. “People have died. Even for people who were exposed and didn’t die, there are going to be consequences, long-term consequences that we don’t even know.”
Sealy-Jefferson expressed frustration that the election did not deliver a stronger rebuke of the Trump administration. She also noted that communities of color stand to lose the most if the nation does not course-correct. “Proportionally, Black and brown communities have shouldered a greater burden of COVID,” she said. “We need the people most impacted by this to be leading the conversation."
Months into the pandemic, the federal government has largely failed to prioritize the four methods known by public health workers to be effective in response to a pandemic — community education, contract tracing or surveillance, testing, and treatment, said Dr. Adam Levine, who directs the global emergency medicine division at Brown University’s medical school.
That failure, Levine said, “means that the epidemic is going to be much worse than it would be otherwise.”
Like others in his field, Dr. Georges C. Benjamin, executive director of the American Public Health Association, has found the Trump administration’s response to the pandemic concerning. At the same time, he held out some measure of hope that if Trump’s approach to the virus in recent months has been politically motivated — as many believe — then the conclusion of the election might spark new motivations, such as legacy, that could lead him to change course.
“But who knows,” he quickly added. “I can’t get in this guy’s head.”
If Biden were to win the election, Benjamin said, it would be crucial for his team to immediately begin building a pandemic response team and put itself in position to hit the ground running following January’s inauguration.
The uncertainty over what a shifting political landscape will mean for the pandemic has reached the hallways of the country’s hospitals, where some medical workers — who were routinely under-resourced during the virus’s first wave last spring — lack confidence that the current administration is prepared to handle what’s coming. With hospitalizations surging, they cannot afford to wait — whether for two months or several years — for a change in approach.
“The general sense from both me and my colleagues is even if we have a new president coming in, until he’s inaugurated, the current administration’s plan hasn’t been shown to be effective,” said Dr. Ali Raja, executive vice chair of the department of emergency medicine at Massachusetts General Hospital. “And that concerns me.”
Though Raja praised Massachusetts’ approach to the pandemic, and that of some other states, he said the need for a sound national strategy is tantamount. “When you look around the world at countries that have done this well, it’s because they have a national leader who outlines a strategy that is then carried out by its citizens,” he said, citing New Zealand and Australia as examples. “[It’s] places that have not had piecemeal strategies.”
Helen Jenkins, a Boston University epidemiologist, said there is still reason to be hopeful about Massachusetts' ability to weather the current surge without resorting to strict lockdown measures. The state has kept some known high-risk settings such as bars closed, she said, and on Monday, Governor Charlie Baker rolled out a raft of new restrictions, including a mandate that all residents wear masks while in public, even when social distancing is possible. Still, she said, she has watched with alarm as numbers in the state and country rise.
Jenkins said there are certain clear steps any presidential administration can take to support governors: Listen to scientists. Help pay for widespread testing and contact tracing. And the economy and COVID-19 "are completely interlinked.” "What we’ve seen in other places is that if they didn’t respond to this virus thoughtfully and carefully . . . they ended up having to shut things down completely,” she said.
Jenkins said Americans also have a role to play: staying vigilant no matter who the next president is.
“The virus doesn’t stop just because we’re focused on election results. It is still taking opportunities to transmit whenever it can," she said. “There is no magic solution."
Dasia Moore is the Globe Magazine's staff writer. E-mail her at email@example.com. Follow her on Twitter @daijmoore. Dugan Arnett can be reached at firstname.lastname@example.org.