VENICE — The U.S. set records for new COVID-19 cases this week, logging more than 200,000. It also set the record for hospitalizations at more than 100,000, and deaths, with more than 3,000 this week.
And things may get worse.
Centers for Disease Control and Prevention Director Robert Redfield said he believes December, January and February are "going to be the most difficult time in the public health history of this nation."
"We really have a very extensive pandemic now throughout the nation," he said in an online interview Wednesday with the U.S. Chamber of Commerce Foundation. "I think this virus is the closest thing to measles we've ever seen."
The death toll was more than 270,000 then, and Redfield said the country could see another 150,000-200,000 fatalities by Feb. 1.
Hospitalizations peaked at about 30,000 in the spring, he said — less than one-third of the record hit this week, and hospitals aren't having to deal with the usual influx of flu patients because rates are historically low.
Ninety percent of the country's hospital's are in high-transmission areas, as are 90% of its long-term-care facilities, he said. At this point, it's no longer possible to shift resources to meet demand, as was done earlier in the year, he added.
It's a very critical time for the resiliency of the country's health care system, he said.
Although the emergency approval of two vaccines appears imminent, their impact will initially be limited, with widespread availability coming in the second or third quarter of 2021, Redfield said.
The manufacturers, Pfizer and Moderna, expect to be able to produce only about 40 million doses by the end of the year — enough to immunize about 20 million people because each vaccine requires two shots.
A CDC advisory panel voted Tuesday to recommend that frontline health care workers and residents of long-term-care facilities be given priority for immunization.
Florida Gov. Ron DeSantis said at a news conference on Wednesday the state would be relying on a federal contract with CVS and Walgreens to administer the vaccines in LTCFs first, then to health care workers and then, if supplies are available, to people over 65 or with conditions that make them high-risk.
The state will likely receive between 1 million and 2 million doses at the outset, he said. Whether to get vaccinated will be left up to the individual.
"No one will be mandated to take the vaccine," DeSantis said. "This will be available but not mandated."
The state health officer has the authority to order people to be immunized, though a bill has been filed for the March legislative session to do away with that power.
The public isn't defenseless while waiting for vaccine production to ramp up, Redfield said, because social distancing, hand-washing and masks are proven to reduce transmission of the coronavirus.
"The time for debating whether masks work or not is over," he said. "We clearly have scientific evidence."
He cited a Nov. 27 CDC Morbidity and Mortality Weekly Report analyzing the impact of a local-option mask order in Kansas. In the counties that opted in, transmission of the disease went down by 6% while in the ones that rejected it cases went up by more than 100%, he said.
These mitigation efforts are "very powerful tools and have an enormous impact," he said.
The problem remains compliance.
The current mitigation effort is enough to control the flu but not COVID-19, which is far more contagious, he said.
"It's not going to work if half of us do what we need to do," he said. "It's not even going to work if three-quarters of us do what we need to do."
According to AARP, 37 states now have a mask order. Florida has some local ones essentially rendered unenforceable when the governor banned the imposition of fines but has never had one that applied statewide, and won't, DeSantis said on Wednesday.
While acknowledging that personal mitigation works, he said that there will be "no lockdowns, no fines, no school closures … I don't like mandates, period. I don't think they work."
Redfield didn't call for a mandate and also didn't advocate for a lockdown or school closures.
It's actually home gatherings that have become a major driver of new infections, he said. People let their guard down because a lot of people carrying the virus are asymptomatic.
That's partly why COVID-19 is "really, really, really infectious" — it's a "silent" epidemic, compared to SARS or the flu, he said.
"The way they work is, they make you sick," he said, whereas COVID-19 is mostly transmitted by people who aren't sick, "so you don't know who's infected and who isn't.
"The instrument of transmission is not a sick person. The instrument of transmission is an asymptomatic 23-year-old that feels great."
The data aren't showing significant transmission within schools, he said, so face-to-face learning can be done safely. And if schools can operate safely, businesses can learn to do it as well.
At most, he said, some strategic closings — such as limiting the hours bars are open — should be enough.
Redfield said there are three lessons to learn from the pandemic. The first is that the U.S. was "severely underprepared" for it, having failed to invest to create "not only the public health system that we need but that we deserve."
Estimates of the economic impact of the pandemic are more than $20 trillion, compared to $100 billion to improve the system, he said.
The second lesson is the need for "clear, unified, reinforced messaging." Masks are a public health tool, not a political issue, and still to be arguing about them is a problem, he said.
Third, the response to the next pandemic should be "thoughtful, surgical interventions based on data," rather than lockdowns, he said.
"And there will be a next time," he added.
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