As the number of confirmed COVID-19 cases, hospitalizations, and deaths in the United States continues to climb, the country may be headed for a ‘full-blown’ outbreak. Getty Images
  • Experts have voiced concerns that the recent spike in COVID-19 cases could indicate the United States is heading toward a “full-blown” outbreak.
  • In some states, the number of people who are getting sick and going to the hospital has exponentially increased.
  • A number of hospitals in some counties are at, or near, ICU capacity, meaning they can’t admit additional patients.
  • Experts say maintaining good hygiene, physical distancing, and wearing face masks are the best way to help stop the spread of COVID-19.

More than 130,000 people in the United States have died from COVID-19, and more than 3 million people have had an infection, according to the Johns Hopkins Coronavirus Resource Center, which tracks the virus worldwide.

Hot spots in the South and West have helped the United States maintain its global COVID-19 lead, with confirmed cases, hospitalizations, and deaths continuing to rise even as other countries see their numbers dropping.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said on Monday that the coronavirus situation in the United States is “really not good,” and more work is needed to slow the spread of the virus.

Florida and Texas both broke single-day records over the weekend, according to NPR. Florida reported 11,443 new cases and Texas 8,258 new cases on Saturday. 

Texas Gov. Greg Abbott warned on Monday of “greater fatalities” due to COVID-19 in coming weeks.

Other hot spots have seen weeks-long spikes, with California reporting 5,410 new cases and Arizona 3,536 new cases on Sunday, says NPR.

Houston Mayor Sylvester Turner pushed back on President Donald Trump’s assertion over the weekend that 99 percent of coronavirus cases are “totally harmless.” Trump didn’t provide any evidence to back up this claim.

“The number of people who are getting sick and going to the hospitals has exponentially increased,” Turner told CBS. “The number of people in our ICU beds has exponentially increased. In fact, if we don’t get our hands around this virus quickly, in about two weeks our hospital system could be in serious, serious trouble.”

Many experts are similarly worried about what the coming weeks will bring in America’s runaway COVID-19 pandemic. Some have voiced concerns that the United States could be heading toward a “full-blown” outbreak.

Although the South and West are seeing the sharpest surges, infections are rising in most states, according to data compiled by the volunteer COVID Tracking Project

“We are in free fall,” Dr. Rochelle Walensky, chief of infectious diseases at Massachusetts General Hospital, told CNN.

And we have yet to see the impact of the holiday weekend, when many Americans crowded together without masks to celebrate.

It can take up to 14 days for people exposed to the new coronavirus to show symptoms. Similarly, there’s a lag between newly confirmed infections and hospitalizations, and between hospitalizations and deaths.

Many hospitals at or near ICU capacity

As we saw in New York City and Italy, there are limits to what the healthcare system can handle. Some hospitals in the United States are quickly reaching that line.

Hospitals in at least two counties in South Texas were at full capacity before the weekend. Judges in those counties urged residents to shelter in place, although this wasn’t a mandatory order.

The Texas government stopped releasing information about hospital capacity, but the Texas Tribune reports that many areas of the state — including Austin, Dallas, and Houston — are near their limit.

Likewise, Florida has seen spikes in COVID-19 hospitalizations, as well as patients in intensive care units (ICUs) or on ventilators. As of Monday, 44 Florida hospitals had reached their ICU capacity.

Florida Gov. Ron DeSantis said last week that the state is “not going back” on reopening, saying younger people were driving the rise in cases and that they are less at risk from COVID-19.

But as Sweden discovered with outbreaks in its long-term care homes, it’s difficult to keep the virus from spreading from lower risk to higher risk groups. Especially since people without symptoms can easily infect others.

Dr. Rajiv Bahl, an emergency medicine physician in Orange City, Florida, says more older people with COVID-19 are now showing up at hospitals, many of them with comorbidities, such as high blood pressure or diabetes.

“Because of those extra comorbidities, they are starting to require hospitalization, and many times they end up on vents in the intensive care unit,” he said.

However, younger people aren’t immune from the virus, especially if they have underlying health conditions such as obesity, diabetes, or kidney disease.

Dr. Matthew G. Heinz, a hospitalist and internist at Tucson Medical Center in Arizona, says on a recent weekend, four of his sickest patients were 45 years old or younger, including a 24-year-old with no risk factors for COVID-19.

“Younger people are less likely to go on a ventilator and never come off, compared to a 78-year-old with four or five comorbidities,” he said. “But [younger people] are also at risk, and they can die from this.”

On Thursday, 86 percent of in-patient hospital beds in Arizona were full, with 89 percent of ICU beds were occupied, reports Arizona Republic.

“We have record high usage of ventilators, hospital beds, and intensive care beds,” Heinz said. “We’re increasing rapidly, and it doesn’t appear that there’s any real sign of that altering course.”

While hospitals track the availability of ICU beds, this is just one measure of a hospital’s ability to take care of a surge of patients with COVID-19.

“We can find places to safely take care of critical patients,” Heinz said. “What we can’t generate out of thin air are nurses and enough critical care doctors.”

Hospitals in Arizona have taken steps to expand their “surge” capacity by putting a hold on elective surgeries, adding hospital beds to rooms and bringing in healthcare staff from other states.

“We have an emergency response team of doctors, nurses, and respiratory therapists coming in to help expand our capacity for the next couple of weeks,” Heinz said. “This is very welcome.”

With no signs that the current surge will abate anytime soon, the state is also preparing for the worst.

Dr. Cara Christ, director of the Arizona Department of Health Services, authorized hospitals last week to activate “crisis care standards.” 

These practices, similar to those used at the peak of the outbreaks in New York and Italy, allows hospitals to make decisions about which COVID-19 patients get ventilators and other care if there are shortages.

The state hasn’t yet had to ration care, but one health official believes that hospitals in the state are days away from having to make those tough decisions.

Hospitals in some parts of Texas are also rapidly expanding capacity to meet their surge — converting recovery rooms and pediatric ICU rooms to handle adult COVID-19 patients, canceling some elective surgeries and hiring more staff.

But hospital administrators already report shortages of protective gear, coronavirus testing supplies, vital-sign monitors, and other supplies — exactly where we were at the start of the pandemic.

Surges of COVID-19 hospitalizations also put people with other medical conditions at risk.

In March and April, as hospitals became overwhelmed, deaths increased in the United States. This included people with severe COVID-19 but may also include people with unrelated illnesses too afraid to seek medical care due to the pandemic.

“One concern is that we won’t be able to adequately take care of people who come to the hospital,” Heinz said, including people who have had a massive stroke or heart attack and need ICU care.

“We’re not at that point yet, but I can see us getting to that point very soon,” he added.

Hot-spot states taking steps to slow coronavirus

Bahl is also concerned about rising cases in Florida, but he says we won’t know right away how bad things will get.

“It’s tough to speculate at this time because we are so early into this [surge],” he said. “The coming weeks will definitely give us a better picture of whether Florida is going to look like New York.”

But he adds that the numbers in Florida are still rising, so people need to be prepared for things to get worse.

How much worse is difficult to say.

Fauci told the Senate Health, Education, Labor and Pensions Committee at the end of June that unless the steep rise isn’t slowed, the country may soon exceed 100,000 new cases a day.

However, it’s not just the surge in cases that has experts worried. It’s where they’re happening.

When the United States first peaked in early April, cases were concentrated in a few hot spots, such as New York City and Seattle. Now 10 times as many counties are hot spots. 

Americans traveling this summer also risk spreading the virus to areas of the country that have been largely untouched, or reintroducing it to places like New York City that were hard-hit earlier in the pandemic.

Some states with low case numbers are taking steps to prevent this from happening.

New York Gov. Andrew Cuomo announced on June 25 that people from 19 states, including Arizona, Florida, and Texas, are now required to self-quarantine for 14 days when traveling to New York, Connecticut, or New Jersey.

As we learned earlier in the pandemic, the longer it takes to control the coronavirus, the harder it becomes to change the trajectory of infections and deaths.

“Soon we’re not going to be able to mitigate anything because the community spread has been so large,” Heinz said.

As a result of recent surges, at least 16 states paused or rolled back their reopening plans leading up to the Fourth of July holiday weekend.

In Arizona, Florida, Texas, and other states, bars were directed to close back down. Miami-Dade County instituted a 10 p.m. curfew over the holiday weekend. Many beaches in South Florida were closed.

Even states that aren’t current hot spots are playing it safe. New Jersey Gov. Phil Murphy delayed indoor dining at restaurants. Cuomo said he may do the same.

With no guarantee of an effective vaccine against the coronavirus anytime soon, public health measures such as physical distancing, handwashing, and cloth face coverings are the best way to slow the spread of the virus.

Abbott issued an executive order on Thursday requiring Texans in counties with 20 or more coronavirus cases to wear a face covering while in public. 

Florida and Arizona don’t have statewide mask requirements, but some cities in those states, such as Phoenix, have passed mask orders.

What about lockdowns?

During the earlier peak of the pandemic, at least 316 million people in at least 42 states were urged to stay home.

New York state, which enacted strict stay-at-home orders in April and May, reported its lowest number of COVID-19 deaths on June 28.

There’s no sign that governors in hot-spot states are considering new stay-at-home orders, preferring to keep their economies running at mostly full speed.

Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, described this on Twitter as “Operation Cake and Eat It.”

“The gamble of the Southern Governors: If we increase mask compliance and shut down the bars, that will slow the acceleration, so that we can still open the economy,” he wrote.

However, it will take a few weeks before we know whether the mask orders — without a lockdown — have succeeded in blunting the spread of the coronavirus in hot-spot states.

Preparing for full-blown COVID-19 outbreak

Bahl is also concerned that not everyone in Florida is taking the new coronavirus seriously.

“People are starting to get a little bit more lax with their practices,” Bahl said. “They aren’t practicing social distancing. Not everybody is wearing a mask when they go out.”

“We’re recommending that if you don’t have to go out, then you don’t,” he added. “And if you do have to go out, you should be wearing a mask.”

However, he cautions people against stockpiling food and supplies, as happened earlier in the pandemic, saying most companies are keeping up with demand — as long as everyone only takes their “fair share.”

Heinz says the best way to prepare for the worst is by stepping up to help protect those in their community who are most at risk from the coronavirus.

“Until we can get an adequately immunized population through a vaccine, the only way to stop the virus from spreading is to keep people from mingling and interacting in a way that helps the virus spread,” he said.

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