COVID-19 is racking up a horrible toll. Staying safe now requires more care than ever before

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On Thursday, the United States racked up over 231,000 new cases of COVID-19. Over 3,200 people died. These are hideous numbers, not at all made better by the fact that Wednesday was worse. Right now across the country, the 7-day moving average puts the number of new cases at 220,000. That’s 40,000 cases a day higher than it was on the day before Thanksgiving. The 7-day average for deaths is 2,600. That’s 900 more each day than on the day before Thanksgiving.

And still, there are people pointing at the fall in reported cases in several states over that period and somehow breathing a sigh of relief. Sure, cases are up in places like Texas, California, and Florida. But smaller states like Iowa and South Dakota—both loaded down with COVID-19 right before the holiday—have actually seen case counts falling steadily for almost a month. Where is that Thanksgiving surge that concerned so many? 

The answer is that it’s right here, on Johns Hopkins test tracking site. In 47 out of 50 states, testing declined, not just last week, but the last two weeks straight. The CDC suggests that an adequate level of testing includes a rate of positive returns less than 3%. By that measure, the states that are currently testing at a level sufficient to describe what’s happening in their boundaries are: Vermont and Hawaii. That’s it. Every other state is operating in the dark about what’s really happening.

For some of them, like the supposedly improving South Dakota, week over week declines in testing rates have the state at 41% positive test rates. The actual rate of hospitalization in South Dakota, as reported by The Covid Tracking Project, remains above that of either California or Texas. As their nationwide data shows, the U.S. has seen an overall slight rise in testing since Thanksgiving (which can be spotted by the sharp recent dip on most of the charts below). While the peak on the daily new cases may appear to be somewhat blunted, the peak on hospitalizations and deaths is not. This is because the nation is once again test constrained. Many states are back to reporting numbers of COVID-19 cases that are roughly equivalent to those self-reporting illness.

The word for what the data is showing is a very high order of “bad.” And it’s not just that the current numbers are awful, they are also foreboding. Because when it comes to the numbers on the two charts to the right—hospitalizations and deaths—we are far from through seeing what Thanksgiving delivered. For everyone who picked up COVID-19 in that period following November 27, the first symptoms should have appeared by now. Median onset of first symptoms would have had those people getting sick last week. But severe illness typically comes later. From first symptoms to severe respiratory distress typically take 3 to 10 days (moving from onset to severe faster than a week is a bad sign when it comes to eventual outcome). Those people who were hospitalized for severe symptoms usually had a hospital stay of 10 days to two weeks. It’s around that same point—a total of 20 days after first symptoms—that patients either recover … or don’t.

The people who are dying today got infected before Thanksgiving. The price to be paid for those turkey dinners isn’t yet known. But it will be. Soon.

What is clear is that case counts and deaths are still at the highest levels they have been at any point since the pandemic began. Do not be fooled by a declining number of cases in specific locations, or reports of an improving “trend.” As the matching hooks in the testing and cases above indicate, the only sure trend is that less testing generates lower numbers. 

Right now, hospitalization rates in particular are a huge concern. Not only are there numerous states where capacity is being strained, this is happening after states have put in place both formal and informal standards that mean many of those who might have been hospitalized a month ago are being sent home. Vaccines for healthcare workers are great, and absolutely necessary, but they will not generate more healthcare workers, or alleviate the exhaustion generated from unbroken weeks of overwork.

This next week could bring a happy surprise, with cases genuinely beginning to drop. However, there is very little cause to think this is true. What is more likely is that the toll from Thanksgiving will become apparent, just in time for it to be compounded by Christmas. Joe Biden could easily walk into a situation in January in which Americans are dying at a rate of 5,000 or more each day. That may sound horrific, but what’s happening now would have sounded horrific to anyone a month ago. And what was happening then would have been horrific to anyone from a month before that.

We’re at a situation now where it can be assumed that every social situation involves exposure to the coronavirus. There is no such thing as a safe gathering. People who have been “pretty good” through this whole affair are not being good enough. Routines that have been good enough to protect most people to this point are no longer good enough.

The time to take extreme caution was weeks ago. But if you haven’t started, start now.