Listen: How Bad Will Winter Get?

Your cold-month questions, answered

Experts have long feared that the virus will peak again in winter. The days are now getting shorter, life is moving indoors, and the pandemic isn’t contained. How bad could the next few months get?

Katherine Wells wants to know what to expect and how to prepare. She was joined at a live Atlantic Festival taping of Social Distance by her co-host, staff writer James Hamblin, and Alexis Madrigal, staff writer and co-founder of the COVID Tracking Project at The Atlantic.

Listen to the episode here:

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What follows is a portion of their conversation, edited for length and clarity:

Katherine Wells: We’ve reached a pretty grim milestone. Two hundred thousand deaths, and we’re heading into winter. I’ve been worried about winter since the beginning. We’re so dependent on being outside right now. A couple of months ago, the Centers for Disease Control and Prevention director, Robert Redfield, said the winter is “going to be probably one of the most difficult times that we’ve experienced in American public health.” That’s terrifying.

James Hamblin: Yeah, it seems like the writing is on the walls. As you go through New York, the solution to so much life has been: Just do it outside. Open windows. Push people into empty parking spaces that are makeshift restaurants. And now, fall is starting to be in the air. Restaurants are starting to allow for 25 percent [indoor] capacity. Schools are reopening. Kids—not all kids, but some kids —are meeting in class. It’s this sort of perfect storm that makes a lot of people worry about resurgence.

Wells: There’s so much regional variation and there’s so much uncertainty. Alexis, you’ve been following the numbers the whole time. What do you think the winter is going to look like?

Alexis Madrigal: I think the base case here, the default scenario, is that things get a lot worse. There is an alternative scenario, though. If we really look at what happened during the Sun Belt surge, we were actually better able to contain it than I thought as we were going through it at the time. A lot of overlapping half steps and a lot of imperfect but smart things came together to bring transmission rates down and eventually contain those outbreaks in Arizona and Texas and Florida without very extreme measures. We didn’t actually get rid of the virus. But we stopped runaway growth.

I think the big question for me this winter is whether that same thing will happen. We know cases are going to grow. If we’re sitting on this plateau of 40,000 cases a day, the virus is pretty much everywhere. So if you’ve got community transmission everywhere, and you then increase the mobility and interaction that people have, you’re going to see more cases. It’s just happened time and time again.

There is a scenario in this pandemic, though, where masking helps not only with COVID-19, but also with the flu, where testing begins to catch more contagious people, where a vaccine rolls out among crucial populations. And maybe you don’t see the darkest winter in public health. When I really look at the scenarios, you see this tremendous divergence. Maybe it’s only 500 people dying a day at the end of December. Or maybe it’s 1,500. That’s a huge difference. You’re talking 80,000 people in the hospital at any given time versus 20,000 people in the hospital. These are hugely different on-the-ground realities, and it’s very hard to know precisely how to weight them. Though, like I said, I think the base case here is that things don’t go well.

Wells: There’s no scenario where we get this under control soon. This is definitely with us through the winter in a devastating way. Is that your sense?

Madrigal: That would be my sense, yeah.

Hamblin: If Alexis said anything other than that, I would jump in and correct him. The talk of a vaccine existing has been conflated with the idea of a vaccine being widely distributed. We need to plan for a winter where a vaccine is not part of our lives. [Anthony] Fauci said that he would be happy if the vaccine were 50 percent effective. Ideally, it would be closer to 75 percent. Right now you have polls saying about 50 percent of Americans would try a vaccine if it were available now. So a vaccine is not going to get rid of this. Alexis is following cool testing developments, which can help, and we’re hoping in November there are rollouts of rapid tests, but those are not going to be perfect. They’re not going to be instantly everywhere. And the confluence of weather and a lack of economic stimulus ... I think people are reaching a breaking point. There are going to be a lot of things coming together right at the same time.

Wells: On the vaccine, Jim, you mentioned that it may only be 50 percent or 70 percent effective. Can you explain what that means?

Hamblin: No vaccine is perfect, just like no medicine is perfect. No test is perfect. At best, a vaccine offers you a really good shot that if someone coughs in your face while they’re infectious, that you’re going to be protected. But our best vaccines are not 100 percent. There will always be some people who don’t mount an effective immune response or whose immune response fades. There’s been discussion about what the effectiveness of these vaccines against this coronavirus will end up being, and how effective they would need to be to even be worthwhile.

We don’t know yet. We’re waiting on these clinical trials. It’s very possible, even likely, that that effectiveness will end up being between 50 and 75 percent, meaning that you’re very likely to be protected if you have it, but you would probably still want to avoid really high-risk scenarios. Once you get a whole population that’s vaccinated at that level, it’s effectively gone. But when you’re just rolling it out to start with, it doesn’t mean that you go back to doing things exactly like you used to. It would be miraculous in terms of the number of cases dropping, number of fatalities dropping, but as long as there’s still that possibility, it means life does not go back totally to normal.

Wells: Right. Okay, let’s talk about testing. What are the realistic prospects of mass availability of cheap, rapid, at-home antigen testing? Is this the kind of thing where, in December, I’ll be able to go into a drugstore, buy a box of paper-strip antigen tests, and test myself every day? Is that going to happen, or are we really far away from that?

Madrigal: I think there will be something available, maybe not in December. But later in the winter and into the spring, I think there’ll be such tests available. One hope might be that the antigen test can soak up some of the less vital demand for tests so that PCR tests can be targeted at people who did have a high-risk exposure or who have presented with symptoms.

And other technologies are coming along. For schools in particular, pooled testing, where you take a bunch of different samples and run them through the same machine in one test. This technology is kind of, like, coming along and has some features that are quite nice for workplaces and schools—places where you know the group, you can assign risk factors to them, and you know you’re going to have continued interaction. This goes back to my main theme, which is: You have all of these things coming online that could help in some way, and when you layer them all on top of each other, does that get you somewhere?

That really is the question for me. I don’t think there’s any way that all those things are going to knock the virus out. But does it get you to what we’ve been doing so far: bumping along with a rate of transmission about one, which means each person that gets infected basically infects one other person? You don’t get runaway growth of transmission, but you also don’t really suppress the thing, and you continue to have community transmission out there. We’ve just been balanced on this knife edge of Rt=1. And over the winter, are we going to see that go way up or are we going to see it go way down? Or are we going to be able to stay balanced on this knife edge even as winter comes because we have this set of tools that help us stay close to that number?