Vaccines Are Coming, but Pandemic Experts Expect a ‘Horrible’ Winter

Each week, good news about vaccines or antibody treatments surfaces, offering hope that an end to the pandemic is at hand.

And yet this holiday season presents a grim reckoning. The United States has reached an appalling milestone: more than one million new coronavirus cases every week. Hospitals in some states are full to bursting. The number of deaths is rising and seems on track to easily surpass the 2,200-a-day average in the spring, when the pandemic was concentrated in the New York metropolitan area.

Our failure to protect ourselves has caught up to us.

The nation now must endure a critical period of transition, one that threatens to last far too long, as we set aside justifiable optimism about next spring and confront the dark winter ahead. Some epidemiologists predict that the death toll by March could be close to twice the 250,000 figure that the nation surpassed only last week.

“The next three months are going to be just horrible,” said Dr. Ashish Jha, dean of Brown University’s School of Public Health and one of two dozen experts interviewed by The New York Times about the near future.

And the common-sense evidence that masks work has become overwhelming. Dozens of “superspreader events” have taken place in venues where most people were not masked — in bars and restaurants, at summer camps, at funerals, on airplanes, in churches, at choir practice.

In contrast, none have been known to occur in venues where most people wore masks, such as grocery stores. One well-known C.D.C. study showed that, even in a Springfield, Mo., hair salon where two stylists were infected, not one of the 139 customers whose hair they cut over the course of 10 days caught the disease. A city health order had required that both the stylists and the customers be masked.

Even in the most dangerous environments — hospital emergency rooms — there have been no reported superspreader events since personal protective gear became widely available. (Many individual doctors and nurses have been infected, however; an incident in South Bend, Ind., in which multiple nurses were infected turned out to be related to a wedding.)

By contrast, the White House, where masks have been shunned, has been the scene of at least one, and possibly more superspreader events.

A study by the Institute for Health Metrics and Evaluation at the University of Washington estimated that 130,000 lives could be saved by February if mask use became universal in the United States immediately. Masks can also preserve the economy: A study by Goldman Sachs estimated that universal use would save $1 trillion that may be lost to business shutdowns and medical bills.

“We’re facing extremely complex and poorly understood dynamics around disinformation, conspiratorial theories, paranoia and mistrust,” Dr. Lincoln noted.

Mr. Biden’s plan for tackling the pandemic is outlined on his website.

It calls for far more widespread testing, delivered free; a ban on out-of-pocket costs for medical care for the virus; having the military build temporary hospitals if necessary; cooperation with American businesses to create more personal protective gear and ventilators; more food relief for the poor, and other measures.

Mr. Biden has said he supports a national mask mandate, although his plan calls on governors to impose state ones.

All the experts interviewed by The Times praised the plan, but several felt it was not aggressive enough. The pandemic is raging so far beyond control, they argued, that it can be contained only with deeply unpopular but necessary measures, such as rigorously enforced mask laws, closing bars and restaurants, requiring regular testing in schools and workplaces, isolating the infected away from their families, prohibiting travel from high-prevalence areas to low ones, and imposing quarantines that are enforced rather than merely requested.

Many other countries have imposed such measures despite fierce opposition from some citizens, they said, and they have helped.

“Colleges are the Wuhans of this fall surge,” said Dr. Howard Markel, a medical historian at the University of Michigan’s medical school. Universities, he and other experts said, must stop students from going back and forth between their hometowns and college towns, both of which have many vulnerable residents.

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