Coronavirus updates Thursday: Coronavirus death toll in US might be 35% higher, new study says The Register-Guard
On any given day, somewhere in the United States, someone is going to wake up, leave the house and get in a huge argument with a stranger about wearing masks.
Grocery store managers are training staff on how to handle screaming customers. Fistfights are breaking out at convenience stores. Some restaurants even say theyd rather close than face the wrath of various Americans who believe that masks, which help prevent the spread of coronavirus, impinge on their freedom.
Joe Rogers, 47, a resident of Dallas, said that just last week, he had gotten in a physical fight over masks.
In line at a Mini-Mart, he spotted a customer behind him not wearing a mask, he said, and he shook his head. The man asked why Mr. Rogers had been looking at him and Mr. Rogers, again, shook his head.
I wear a full face guard, the mask that they use when they spray pesticides, he said. He reached for my mask and tried to pull it off. Mr. Rogers said his natural instinct came out and he put his hand up and knocked the man to the floor.
In Dallas, beginning June 19, businesses were required to ensure customers and staff wore masks. Mr. Rogers said that though he had not hit another person in a decade or so this was not the first altercation hed had over masks.
Ive already been in several, he said. Ive been in shouting matches with people at CVS. People just dont understand it. If everyone just wore a mask, this would be over.
Mr. Rogerss brother, Jason Rogers, a Democratic candidate in Texas 57th House District, said that he was aware of the confrontation and expressed support for his brother. This is Texas, you know, he said. Stand your ground.
Masks were already a political flash point, and months of mixed messages about their usefulness have contributed to the confusion. Now, theyre also fodder for viral videos.
A surge of reported cases of coronavirus in states like California, Texas and Florida has led authorities in those states to issue new guidance on masks. Evidence suggests masks can help prevent transmission of the virus even when worn by seemingly healthy people.
Early in the pandemic, the Centers for Disease Control and Prevention said several times that those without symptoms did not have to wear masks. On April 3, the agency shifted, saying that masks should be worn in public.
But President Trump, announcing the new guidance, said, Somehow, I dont see it for myself and has continued to appear in public without a mask. On Sunday, after months of shunning a mask himself, Vice President Mike Pence urged Americans to wear them.
Orders regarding masks that carry the force of law have been left to individual states. And in states where altercations over masks have been reported, those orders have recently changed.
Gov. Gavin Newsom of California ordered the mandatory wearing of masks in public on June 18. A little more than a week later, Hugos Tacos, a taqueria with two locations in the Los Angeles area, announced that it would close temporarily because its staff was exhausted by the constant conflicts over guests refusing to wear masks.
The chief executive of Hugos, Bill Kohne, said that it was only in the last few weeks that the encounters had become so vitriolic. His staff had been confronted with racist language, he said, and he was concerned for their safety. Recently, one of Mr. Kohnes facility managers supervising one of the storefronts observed five confrontations over masks in a single hour.
The one that we most viscerally remember is that a customer at the pickup window who was asked to wear a mask literally threw a cup of water through the window at the clerk, Mr. Kohne said.
He provided The New York Times with an email from a customer that he said was representative of many customers attitudes.
Why is it the responsibility of a taco stand to dictate to its customers a personal freedom of choosing to wear or not wear a mask! it said, concluding: Go to hell taco man. Close permanently! Do us all a favor!
(The person who sent the email did not respond to a request for comment from The Times.)
Public fights over masks have occurred with extraordinary frequency, service workers say, and far exceed the large number of those already captured by smartphones in viral videos.
Confrontations are taking place even in states that have been more consistent in guidance about masks. Massachusetts required that residents wear masks in grocery stores starting in early May. Still, Alli Milliken, 20, who returned to her job at a grocery store chain in the state several weeks ago, has already seen a conflict. She said that recently a customer wearing a mask called out another customer who was not.
The unmasked guy shrugged at him and was like, Its a free country. The virus isnt real. I can do what I want, Ms. Milliken said. The masked guy then says, I work in a hospital. Ill be seeing you soon, buddy.
Ms. Milliken said that she had not been given any training or direct instruction on de-escalating conflict between customers.
I dont know how to go about saying, Oh you should be wearing a mask, she said. I dont know what my place is.
The conflicts over masks have been particularly difficult for essential workers, who have been working long shifts and dealing with frazzled and frenzied customers throughout the pandemic.
Londyn Robinson, 26, a medical student in Minnesota, said that her mother, a manager at a big box store in South Florida, was now having to instruct her staff on how to defuse tense situations, along with working long shifts and sanitizing the store.
I never in a million years would have thought that working in a grocery store would have been considered a high-risk job, she said. It breaks my heart.
Ms. Robinsons mother, who asked to be kept anonymous for fear of losing her job, said that in the last two to three weeks, fights over masks had become astonishingly frequent. It was not uncommon for the police to be called to her store three to four times a day, she said.
Weve had shoppers go after each other, she said. Pushing matches, running carts into each other, running over peoples feet, ankles.
She said that many of the staff members she supervised were already working 12 to 14 hour days and had been doing so since March. (There were physical conflicts with shoppers then, too; Ms. Robinsons mother said she was slapped in the back of a neck by a customer who was frustrated that the store had run out of toilet paper.)
Even offering masks to customers did not work, she said: Theyll outright decline or theyll show you a fraudulent card that says, You cant ask me to do this.
The fighting between customers creates a tension that does not dissipate once the altercation has ended, she said. She no longer feels comfortable walking to her car alone after the store closes, concerned that an aggravated customer may be waiting for her there.
Now we go two to three employees at a time, she said.
In Florida, where cases of the virus have been rising rapidly, the state had not issued any official rules on masks as of Tuesday morning, leaving the decision in the hands of counties, localities and small businesses. (The states department of health issued a public advisory on June 20 recommending masks.)
Chris McArthur runs Black and Brew coffee in Lakeland, Fla., which is in a county where Mr. Trump won 55 percent of the vote in 2016. Mr. McArthur decided on Monday to begin requiring customers to wear masks at the businesss two locations.
We had actually been mulling it over for a couple of weeks, he said. We were hoping that our city commission would pass an ordinance that would require it locally. Our fear was that if we went out on a limb, because it wasnt the norm, we would receive a lot of backlash from our customers.
Still, Mr. McArthur made the decision. We felt like if we did that, other businesses might follow our lead and our customers might appreciate the extra precautionary measures that we were taking, he said.
He said that he hoped that conflicts would not arise. But he expects them to, and has coached staff on how to respond. If a customer becomes belligerent, he said, We would have to call the nonemergency line and hope that the police are available to come help us out.
A 30,000-patient trial of Modernas coronavirus vaccine candidate, expected to start next week, has been delayed, a potential hurdle in the companys ambitious effort to deliver key data by Thanksgiving.
Moderna is making changes to the trial plan, called a protocol, which has pushed back the expected start date of the Phase 3 study, according to investigators. The investigators, who spoke on condition of anonymity, emphasized that protocol changes are common but said its not clear how long the start will be delayed.
My understanding was that they wanted to get the first vaccines given in July, and they say theyre still committed to do that, one investigator said. As best I can tell, theyre close to being on target for that.
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Investigators at the University of Illinois at Chicago had previously said Modernas trial would begin July 9. On Thursday, NIH Director Francis Collins also told lawmakers in Washington that the study would begin this month.
Moderna did not respond to multiple emails asking about how long the delay will last, the nature of the protocol changes, or whether they have anything to do with the vaccines safety or manufacturing. After publication, CEO Stphane Bancel told CNBC that Moderna still intends to start the trial in July. In a statement posted to Twitter on Thursday afternoon, the company said it has worked closely with the National Institutes of Health, which is funding the Phase 3 study, to align the final protocol in order to begin the trial on time.
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The intense focus on the exact timing of the trial stems from the tight nature of the race to develop a vaccine for the novel coronavirus and the fact that any delay could imperil Modernas pole position. Pfizer, working with the German firm BioNTech, plans to start a 30,000-patient study of its own later this month. AstraZeneca and Oxford University are slated to begin a similarly sized trial in August, followed by Johnson & Johnson in September.
All of the companies are working at unprecedented speed to advance their vaccines, and Moderna may not be the last to see its timeline delayed.
Developing and manufacturing vaccines at scale is always a challenging endeavor, with unexpected hitches the norm rather than the exception. Candidate vaccines that looked promising in animals can fail to deliver the same results in people. Production problems arise.
During the 2009 H1N1 flu pandemic, U.S. officials confidently predicted there would be a vaccine in the early autumn, in time to fend off an expected second wave of infections. But the new virus grew poorly in eggs, the substrate used in influenza vaccine production. By the time mass amounts of vaccines were ready for distribution, the peak of infection in the country had already passed.
Matthew Herper and Helen Branswell contributed reporting.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told ... [+] JAMA's editor Thursday, July 2, that the safety and effectiveness of a Covid-19 vaccine should be known by early winter with 200 hundred million doses available for U.S. use by early 2021. In this photo, Fauci speaks during a Senate Health, Education, Labor and Pensions Committee hearing on June 30, 2020 in Washington, DC. (Photo by Al Drago - Pool/Getty Images)
Dr. Anthony Fauci said the safety and effectiveness of a vaccine for the coronavirus strain Covid-19 should be known by early winter with 200 hundred million doses available for U.S. use by early 2021.
In an interview Thursday with the editor of JAMA, Fauci said several Phase 3 trials testing experimental Covid-19 vaccines in tens of thousands of patients are beginning later this month and into August across the U.S. Among them are candidate vaccines being developed by Moderna and AstraZeneca.
We may be able to at least know whether we are dealing with a safe and effective vaccine by the early winter, late winter, beginning of 2021, Fauci, who is the director of the National Institute of Allergy and Infectious Diseases, told Dr. Howard Bauchner, editor of JAMA, during the interview, which was live Thursday afternoon.
Multiple (vaccine) candidates are at different stages of development, Fauci said. We are hopeful that one or more of them may actually show a good degree of safety. . . and efficacy.
Several of the manufacturers are already producing the vaccines at risk thanks to the help of U.S. taxpayer dollars. Fauci wouldnt name the companies making the vaccines, but said these manufacturers are promising that they will have a couple a hundred of million doses as we go into the early part of 2021.
After a year, (vaccine manufacturers are) saying they likely could get a billion doses, Fauci said.
The update on vaccine development from Fauci came a day after the U.S. reported nearly 50,000 new cases of Covid-19 on Wednesday as the pandemic worsens, particularly in the South and West.
Last month, Fauci told JAMAs Bauchner that a trial of Modernas candidate vaccine will include primarily U.S. sites, but also include international sites enrolling 30,000 individuals in a randomized placebo controlled trial of Modernas vaccine against the Coronavirus strain Covid-19. Modernas vaccine candidate is considered in the lead among several efforts by drug and vaccine makers in the battle against the deadly virus.
On Thursday, Fauci said several of the vaccines heading into the final stage of clinical trials are going to be similar in their effectiveness and these phase 3 trials will be ramping up from July through September.
Because there are several late-stage trials, Fauci is optimistic a successful vaccine will emerge by the end of the year. And the U.S. should benefit.
When you have two or three companies which you hope will be successful, they are going to be making vaccine not only for their own country, but availability in other countries, Fauci said.
There is this misperception that everybody is racing to be the winner, Fauci said. Theres not going to be a winner. Hopefully, more than one of them will be successful.
Watch the full video below:
The news: An experimental covid-19 vaccine being developed by Pfizer and BioNTech provoked immune responses in 45 healthy volunteers, according to a preprint paper on medRXiv. The levels of antibodies were up to 2.8 times the level of those found in patients who have recovered. The study randomly assigned 45 people to get either one of three doses of the vaccine or a placebo. But there were side effects like fatigue, headache, and feverespecially at higher doses. The researchers decided to discontinue with the highest dose, 100 micrograms, after the first round of treatments.
Some caveats required: Its promising news,but this is the first clinical data on this specific vaccine, and it hasnt been through the process of peer review yet. Higher antibody levels in patients whod received the vaccine are a useful proxy for immunity to covid-19, but we dont yet know for sure that they guarantee immunity. In order to find out, Pfizer will start conducting studies in larger groups of patients, starting this summer. It says its goal is to have 100 million doses of a vaccine available by the end of 2020.
A common approach: Pfizer is using the same experimental technique as Moderna, one of the other pharmaceutical companies developing a vaccine. Both vaccines are designed to provoke an immune response against the coronavirus through its messenger RNA, the genetic instructions that tell the virus how to replicate inside the host. The method could provide a rapid way to develop a vaccine, but its yet to lead to a licensed one for sale. Currently, 178 vaccines are in various stages of development; 17 are now going through clinical trials.
When the World Health Organization (WHO) says that a given anti-coronavirus product is a leader, that's about as official as it gets in the fast-moving world of COVID-19 therapies and vaccines.
Earlier this year, a top WHO executive stated that Gilead Sciences' remdesivir was the leading therapy targeting COVID-19. Remdesivir, of course, has now become the de facto standard of care for the novel coronavirus disease.
Last week, WHO chief scientist Soumya Swaminathan stated in a news conference that one experimental COVID-19 vaccine appears to be "probably the leading candidate." Which vaccine is it?
Image source: Getty Images.
Swaminathan thinks that the COVID-19 vaccine being developed by AstraZeneca (NYSE:AZN) and the University of Oxford should be viewed as the top contender right now. There are two main reasons why.
First, the AstraZeneca-Oxford AZD1222 vaccine is already in a phase 3 clinical study. No other COVID-19 vaccine candidates have yet advanced to late-stage testing. Swaminathan specifically noted "how advanced they are" and "the stage at which they are" in naming the vaccine being developed by AstraZeneca and Oxford as the likely leader.
Second, Swaminathan said that she thinks "AstraZeneca certainly has a more global scope at the moment in terms of where they are doing and planning their vaccine trials." The late-stage testing of AZD1222 will be conducted in several countries, with trials already in progress in the United Kingdom, Brazil, and South Africa.
The vaccine candidate was originally developed by the University of Oxford's Jenner Institute. AstraZeneca teamed up with Oxford in April and owns the rights to distribute the COVID-19 vaccine globally. AZD1222 was one of only a handful of novel coronavirus vaccines selected by the Trump administration to receive federal funds as part of Operation Warp Speed, an initiative to rapidly develop a safe and effective COVID-19 vaccine.
Another COVID-19 vaccine is a close No. 2, according to the WHO chief scientist. Swaminathan views Moderna (NASDAQ:MRNA) as "not far behind" AstraZeneca and the University of Oxford in the race to develop a COVID-19 vaccine.
Moderna's messenger RNA (mRNA) COVID-19 vaccine mRNA-1273 is currently in phase 2 clinical testing. The biotech plans to begin a phase 3 study of the vaccine in July. Like AZD1222, Moderna's mRNA-1273 was included in the select group of COVID-19 vaccine candidates that are receiving federal funding in the Operation Warp Speed program.
Stephane Bancel, Moderna's CEO, is optimistic about the chances of success. He said in a CNBC interview recently that he believes that the probability of mRNA-1273 going on to win approval from the U.S. Food and Drug Administration is between 80% and 90%.
Investors should be wary of banking on AstraZeneca to emerge as the winner in the COVID-19 vaccine race just because it's the apparent leader right now. Nearly 150 COVID-19 vaccine candidates are currently being researched. Seventeen of those are in clinical trials, with more on the way.
It's impossible to know which, if any, of these experimental vaccines will be successful. It's not out of the question -- and perhaps even likely -- that multiple drugmakers will eventually win regulatory approvals for their COVID-19 vaccines.
The biggest winners from an investing perspective could very well be the small biotech stocks in the race. Novavax, for example, has a phase 1/2 clinical study underway for its COVID-19 vaccine candidate. BioNTech, like Moderna, is testing an mRNA COVID-19 vaccine with its partner, Pfizer.
AstraZeneca claims a market cap of nearly $70 billion. Success for its COVID-19 vaccine would definitely be a major catalyst for the stock. But success for a small drugmaker like Novavax or BioNTech would almost certainly be transformational for either company.
Global markets are on the rise Thursday on news of a potential effective vaccine for the novel coronavirus.
European markets are continuing to make gains in mid-morning trading the FTSE in London is up 0.8%, Pariss CAC-40 index is up 1.4%, and the DAX index in Frankfurt is 1.6% higher.
Asian markets posted a clean sweep of gains to begin the trading day. Japans benchmark Nikkei index finished 0.1% higher, while the Hang Seng in Hong Kong earned 2.7% and the Shanghai Composite closed 2.1% higher.
Australias S&P/ASX index was 1.6% higher, the KOSPI index in South Korea closed up 1.3%, and Taiwans TSEC index rose 0.8%. The Sensex in Mumbai is up 1.2% in late afternoon trading.
Investors were optimistic after U.S. pharmaceutical giant Pfizer and Germanys BioNtech said preliminary data from early-stage human trials of a new vaccine showed promise.
Oil markets are also trading well Thursday. U.S. crude is selling at $40.05 per barrel, up 0.5%, while Brent crude, the global benchmark, is selling at $42.29 per barrel, up 0.6%.
All three U.S. indexes are trending positively in futures trading ahead of Thursdays announcement of the latest U.S. unemployment figures.
Factually is a newsletter about fact-checking and accountability journalism, from Poynters International Fact-Checking Network & the American Press Institutes Accountability Project. Sign up here
Last month, FactCheck.org debunked a meme, still floating around on Facebook, that had a couple of made-up quotes attributed to the U.S. governments top infectious disease official. It was called The two faces of Dr. Anthony Fauci.
The first quote falsely had him saying that even though hundreds of doctors have cured people with the drug hydroxychloroquine, it still needs to be studied some more. The other face of Fauci had him saying this: As soon as a COVID-19 vaccine is manufactured, it must be delivered to healthcare professionals for immediate human injection. Proper studies can be done later. Fauci never said that either.
The meme was a triple play on anti-vaccine emotions anger that government officials are hypocrites, fear that they are trampling on individual liberties with the diktat that the vaccine must be deliveredfor human injection, and distrust in the government to implement proper safety studies.
Its this kind of emotional manipulation that scientists like Fauci are up against. The New York Times Kevin Roose recently called it the vaccine information war.
The anti-vaxxers, Roose wrote, are savvy media manipulators, effective communicators and experienced at exploiting the weaknesses of social media platforms.
But if government health officials are outgunned in this conflict, at least they are now acknowledging it. They have indicated in recent days that they are forming their messaging for when a COVID-19 vaccine is ready, perhaps late this year or early in 2021.
At a Senate hearing Tuesday, Fauci and other public health officials said the government would be putting boots on the ground in community engagement efforts to ensure that people understand the importance of getting the COVID-19 vaccine once its developed and shown to be safe.
There are similar issues in Canada, where a vaccine expert at the University of Toronto told the CBC that the public health community was facing a major, major challenge given how early the anti-vaxxers have geared up their campaigns. And in Africa, an early trial was marked by a worrying level of resistance, the Associated Press reported.
The stakes are high. If not enough people get the vaccine, populations will not reach the herd immunity needed to halt the spread of the virus.
Getting there will involve careful messaging. While Faucis been wildly popular among people who like his focus on facts and science (there are positive Fauci memes, too, and even Fauci cupcakes and candles) he thinks he might not be the best messenger for everybody.
They may not like a government person in a suit like me telling them, even though I will tell them, Fauci told CNN this week. They really need to see people that they can relate to in the community sports figures, community heroes, people that they look up to.
That is especially true if the government person in a suit is also portrayed in a manipulative meme that falsely quotes him. People will get confused about which quotes are real and which arent. Which, of course, is the point.
Susan Benkelman, API
A hoax circulating in Spain falsely alleged that COVID-19 is mainly spread by contaminated flu vaccines. The claim further asserts the flu vaccine contains portions of other viruses such as HIV and herpes, and advocates the public should pass on the flu naturally saying the vaccine will only weaken ones immune system.
Spanish fact-checking organization Agencia EFE pointed out the genetic differences between the flu and the novel coronavirus, and pointed to European Union quality controls to reaffirm the safety of vaccines. EFE also noted that most flu vaccines were administered in September and October, but Spains spike of COVID-19 patients occurred several months later.
What we liked:
This fact-check helps readers distinguish between COVID-19 and seasonal flu. It also serves as a warning for fact-checkers and members of the public that this kind of misinformation could become more prevalent as we get closer to a COVID-19 vaccine.
Harrison Mantas, IFCN
Thats it for this week! Feel free to send feedback and suggestions to factually@poynter.org. And if this newsletter was forwarded to you, or if youre reading it on the web, you can subscribe here. Thanks for reading.
Susan and Harrison
The biohacker who injected himself with CRISPR is back. This time, hes setting out to solve a problem at the forefront of everyones mindthe need for a COVID-19 vaccineand he thinks he can beat biopharma to it.
Nevermind that companies like Moderna and AstraZeneca are racing vaccine candidates into and through the clinic at a speed never seen before, and the U.S. government has set up a Manhattan Project-style initiative aptly dubbed Operation Warp Speed, which aims to deliver 100 million doses of a viable COVID-19 vaccine by the end of the year. Thats still too slow for Josiah Zayner.
This is the perfect opportunity for biohackers, Zayner told Bloomberg. We can move science faster.
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RELATED: COVID-19 vaccine leaders talk up the need for partners, potential for a working vax by October
His plan is based off a Science paper published in May showing that a DNA vaccine seemed to provoke an immune response against SARS-CoV-2, the virus that causes COVID-19. The researchers developed multiple vaccines expressing different forms of the virus spike protein and tested them in monkeys.
RELATED: After Operation Warp Speed picks 5 finalists, experts question why some vaccines were left out
Along with collaborators in Mississippi and Ukraine, Zayner wants to reproduce that experiment in humansthemselvesand livestream the process over several weeks, Bloomberg reported.
They said specifically what they used, which is really easy to recreate, Zayner told Bloomberg, speaking from the West Oakland, California, headquarters and lab of his company, The Odin. You know, it works in monkeys. Let's test it on humans.
RELATED: Pfizer, Merck, AZ, J&J and Moderna selected as 'Warp Speed' finalists: NYT
The scheme, dubbed Project McAfee, after the antivirus software, is possible thanks to the availability of new tools and technologiesincluding viral DNAto the general public. Zayner ordered the same spike protein the researchers used in their DNA vaccine from a DNA synthesis company, having it put in a solution that could be injected into his muscles, Bloomberg reported.
RELATED: Biopharma's no-holds-barred fight to find a COVID-19 vaccine: The full list
Zayner and his partners plan to inject themselves with the vaccine and then take antibody tests regularly to see if their bodies mount an immune response, Bloomberg reported.
Zayner and David Ishee, one of his partners and a self-taught scientist in Mississippi, think the project could pierce the veil on biotech research and scientific experiments.
I want people to learn something from this, he said, So it's no longer this big black box of what science, clinical trials and all this stuff is, Zayner told Bloomberg.
I would like to see a future where biotech is less arcane, Ishee said. But the most realistic thing that will come of this is that maybe people will understand the news theyre reading better.
But Hank Greely, a bioethicist at Stanford University, said the approach has its limits.
If he has and uses the appropriate biosafety precautions, I see nothing wrong with his efforts to replicate the macaque work in living human cells, Greely told Bloomberg. If he can do that, it might be a somewhat useful scientific finding.
The keywords are living human cells. Compare that to the massive clinical trials underway, or soon to be, for vaccines from Moderna, AstraZeneca, Pfizer and BioNTech. Earlier this month, Moderna finalized the design for a 30,000-patient phase 3 study, while AstraZeneca and the University of Oxford have already started a phase 2/3 study involving more than 10,000 people.
At best hell have three people who have received this DNA vaccine, he said.Its hard for me to see his administration of a vaccine to three people as producing any useful scientific knowledge, except perhaps in the unhappy result that they have terrible reactions to it. But even then, its just anecdotal, a caution but not a proof.
And thats not allZayner may pull off his experiment, but copycats may not.
Even if he does it well, people copying him poorly could be hurt. And for what? Greely said. Uncontrolled experiments with doubtful, non-standardized ingredients and conditions are not likely to lead to scientific knowledge that will produce vaccines faster.
Six months. That's all it took for a new virus to circle the globe and infect more than 10 million people, including 2.5 million in the U.S.
That period of time could have been enough to slow or even stop the spread of COVID-19, the disease caused by the new coronavirus. Some countries, such as New Zealand, have succeeded so far.
Full coverage of the coronavirus outbreak
But six months since the first report of a new virus emerging in Wuhan, China, on Dec. 31, the U.S. and other countries worldwide are experiencing surges in new cases.
On Monday, the World Health Organization marked the six months since a cluster of cases of a mysterious pneumonia in China was reported with a warning that the pandemic is "actually speeding up."
"We all want this to be over. We all want to get on with our lives," WHO Director-General Tedros Adhanom Ghebreyesus said in his opening statement. "But the hard reality is: This is not even close to being over."
The aggressive spread of the coronavirus in the U.S., particularly in the Southern and Western states, is a reality many American health care providers face with humility and disgust as they look toward the second half of 2020. The physicians and public health experts who were interviewed hesitated when asked whether they had hope that the U.S. could overcome COVID-19 over the next six months.
"I'm discouraged and demoralized," said Dr. Michael Saag, associate dean for global health at the University of Alabama at Birmingham. "When you compare our case numbers to almost any other industrialized country, we are getting clobbered."
At least 126,332 deaths had been reported in the U.S., with 500,000 lives lost worldwide.
COVID-19 is a respiratory virus, which means it spreads most effectively through sneezing, coughing, talking, even singing. Staying at least 6 feet away from others and wearing fabric face coverings in public can help reduce the spread, experts say.
But encouragement to wear masks has been inconsistent, especially from the U.S. government.
President Donald Trump has refused to wear a mask in public settings, although he did wear one during a private tour of a plant in Michigan several weeks ago. It wasn't until last weekend that Vice President Mike Pence publicly encouraged use of masks.
"There is no time like the present for us to get our act together and have uniform messaging coming from all public officials," Saag said. "We have to start singing from the same sheet of music. Otherwise, we're just sowing more division."
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Dr. Tom Frieden, a former director of the Centers for Disease Control and Prevention who is president of Resolve to Save Lives, a global public health initiative, said, "We are becoming, as a nation, a laggard and a pariah."
Despite months of partial lockdowns in the U.S., there is worry that Americans simply haven't taken COVID-19 seriously.
"They think that after 'shelter in place' that it's OK to go back to normal," said Dr. Colleen Kraft, associate chief medical officer at Emory University Hospital in Atlanta. "People aren't taking personal responsibility and protecting themselves on a day-to-day basis."
Saag warned about a "laissez-faire attitude."
"Sorry," he said. "This thing isn't going away."
Looking ahead to the fall, the coronavirus adds a worrying level of uncertainty to the 2020-21 flu season. According to the CDC, as many as 62,000 people died of flu-related complications during the 2019-20 season. More than 700,000 Americans were hospitalized with flu during that time.
Experts simply don't know yet how the two viruses will interact.
"Could it be that if you were infected with influenza, then several days later infected with COVID, that you might be protected from the worst of what COVID could do? Or would it be the opposite?" asked Dr. Gregory Poland, an infectious diseases expert who is director of the Mayo Clinic's Vaccine Research Group in Rochester, Minnesota.
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Experts say the U.S. health care system isn't prepared for a simultaneous influx of COVID-19 and influenza.
"We know that flu will be around, and that pushes our hospital systems to operate at a hectic level," said Crystal Watson, a senior scholar at the Johns Hopkins Center for Health Security. "We're going to be very stressed with the combination of COVID-19 and the flu."
Flu vaccines, even though they're less than 50 percent effective, will be strongly encouraged this fall to ease the impact on health care systems.
As hospitals in states like Arizona, California and Texas work to contain new cases of the coronavirus, hospitals in the Northeast are preparing for what might come next.
New York's Northwell Health treated 17,000 COVID-19 cases in the spring. Now, the system is preparing for a possible second uptick by making sure it has enough ventilators, medication and staffing.
"We're preparing for the worst, hoping we're wrong," said Dr. Mangala Narasimhan, a pulmonologist who is regional director of critical care medicine at Northwell Health.
"Given everything that's happening in Florida and Arizona and the fact that New York gets flights from everywhere," Narasimhan said, "things will get bad here."
The hospital system is also focused on its staff members' mental health, working in counseling and extra days off. No matter what's planned for the fall, staffers may never feel ready for a second wave in New York City hospitals.
"We have a lot of PTSD," Narasimhan said. "None of us will ever feel that we are completely prepared."
While there are still many unknowns why some people who have been exposed have no symptoms or very mild illness, while others require hospitalization or die scientists are working rapidly to develop effective treatments and a vaccine. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, predicted a vaccine by the beginning of next year.
"I am hopeful, based on the level of scientific inquiry that I see going on," Saag said. "We have learned over the last 35, 40 years an awful lot about viral infections. We're piling every ounce of energy and knowledge into trying to decipher what this virus does and how we can stop it. That gives me some hope."
All agreed that the world needs to focus on a singular enemy: the virus.
"This is not one party against another or one state against another," Frieden said. "This is about humans against a virus."
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