The COVID Roller Coaster Climbs Again

T here’s a lot of news on the COVID-19 front. A third wave is building momentum, President-elect Joe Biden promises a more aggressive federal approach to the virus, a Biden adviser has endorsed a national lockdown, and a vaccine looks to be on the horizon.

To warp the words of a great American poet, there’s a light at the end of the tunnel and a freight train headed our way.

Let’s start with the vaccine news, because a vaccine is what will ultimately set the timetable here. Pfizer and BioNTech have announced that their vaccine appears to be “more than 90% effective” — and that “no serious safety concerns” have yet been observed. Later this month they should have more safety data, and if that looks okay, they will seek an emergency-use authorization from the U.S. government. Rival vaccine developer Moderna also plans to have some results by the end of the month. For good measure, Eli Lilly just got a new antibody treatment authorized, though it’s in short supply and can’t be used on patients who are already hospitalized.

That’s all fantastic news. But it doesn’t get us out of our current predicament. Once a vaccine is approved, millions of doses will need to be distributed, a process that will take time and pose logistical challenges. The Pfizer vaccine, for example, needs to be kept at such low temperatures — minus 94 degrees — that it will be shipped in special containers with dry ice and has to be given out within 15 days even if the ice is replenished. (It can be stored in special freezers for longer, but health facilities generally don’t have these.) It also requires two doses about a month apart and comes in shipments of 1,000 or more. Rural areas especially will have trouble, and states are struggling to work out distribution details.

So what does a realistic timetable look like? Alex Azar, the secretary of health and human services, has laid out a three-stage process: The most vulnerable people, including those in nursing homes, could get the vaccine by the end of the year; front-line workers could get it by the end of January; and the general public could get it sometime in spring.

Vaccinating the most vulnerable will be a huge step, because COVID-19 is far, far more dangerous to the elderly and sick than to anyone else. Once they’re safe, it will be incredibly difficult to justify extreme, economically damaging restrictions on the populace at large. But that won’t start happening for six weeks or so, even assuming everything goes as planned. And the third wave is hitting now.

Here’s the most recent set of charts from the COVID Tracking Project. The seven-day average of daily deaths has once again topped 1,000. And the trend, for the time being, is clearly upward.

At the federal level, this will be Trump’s problem until he leaves office January 20. He is probably not going to be launching any big push for lockdowns or other restrictions. And as I’ve noted in the past, we have a federalist system, and the federal role here is limited no matter who’s in charge. At most, perhaps a lame-duck round of economic relief could be in the offing if things get bad enough and the parties are highly motivated to compromise, but for now even those negotiations are deadlocked.

It falls to state and local governments to decide what, if anything, to do to stop the spread.

A few states are nearing 90 percent of their intensive-care capacity, according to data from the Department of Health and Human Services. There are serious concerns about hospitals exceeding capacity in numerous places, including northwestern Wisconsin; Flint, Mich.; northern Idaho; Oregon; and Utah. And it would of course be a humiliating national failure to suffer a catastrophic COVID wave just as a vaccine seems close.

But the measures we’re taking now are obviously not controlling the virus, and the public has quite understandably lost its appetite for lockdowns. Back in spring, two-thirds of Americans told Gallup they were very likely to shelter in place for a month if public-health officials recommended it. (Indeed, many people stopped going out before official lockdown orders arrived.) Now that number is just under half, though another fifth say they’re “somewhat likely” to comply. Lockdowns rely largely on voluntary obedience, and such compliance gets harder to come by the longer this drags on. And shutting down businesses without plans to bail them out would be a political and economic disaster.

Nonetheless, many places are rolling out fresh restrictions, including a stay-at-home order in Chicago, and I suspect lockdowns may become more common if the trends don’t turn around soon. I have no idea how effective they will be at changing behavior, especially at Thanksgiving and Christmas.

We’ve built up some immunity since March, we’ve gotten better at treating COVID cases, and temperature in itself doesn’t seem to be a huge factor in the virus’s spread, so this wave could prove relatively mild. On the other hand, the cold will certainly drive people indoors, where the virus does spread more easily, and this is a time of year when people gather with their extended families, a high-risk activity that business shutdowns can’t touch. I guess we’ll know how bad it can get soon enough.

Then what’s in store for us next year? If the most vulnerable people are already getting vaccinated, we could be in a good place. Either way, we’ll have a new president in mid-to-late January who promises a different federal approach.

There’s a lot of concern that Biden could try to implement major restrictions from the federal level, which is understandable because folks in Biden World keep talking about things such as national mask mandates and even national four-to-six-week lockdowns. But Biden himself has flip-flopped on mask mandates, conceding at times that the president has no such authority and that the most he can do is to encourage states to implement such measures. His current plan does not include one, and a presidential lockdown would be even more constitutionally suspect. These kinds of comments are mainly bluster.

Biden’s actual COVID plan is much less objectionable. He wants to beef up the provision of testing and treatment, and to work with Congress to provide more relief. These kinds of things can help us transition to a world with a vaccine, especially if things don’t move as quickly as Azar hopes.

Anyhow, there’s an end in sight here. We just have to survive the winter first.

Editor’s note: This article has been updated since publication to reflect new information.