A Tragic Beginning to a Presidency

Joe Biden's head, in blue, divided into vertical slats, in front of a coronavirus
Shutterstock / The Atlantic

Tomorrow, America inaugurates a new president. With the transfer of power comes the transfer of responsibility for the COVID-19 pandemic. On the eve of Joe Biden’s inauguration, the toll of the pandemic stands at 23.9 million cases and 392,428 deaths, according to the COVID Tracking Project at The Atlantic. There are 123,820 people hospitalized. Today alone, states reported 144,047 cases and 2,141 deaths.

Ron Klain, the incoming president’s chief of staff, has warned that, by the end of February, COVID-19 may have taken 500,000 American lives. To reach that marker, the country would have to average 2,689 deaths every day until then, all too plausible a scenario. The seven-day average of deaths in the U.S. first surpassed that number on January 7. It’s currently at 2,988.

Some modest signs do indicate that the country could be reaching a plateau or peak after nearly four months of climbing daily cases and hospitalizations, followed by more than three months of climbing daily deaths. Cases are falling in the overwhelming majority of states right now, and hospitalizations are falling or holding steady in most.

If the country has reached a peak of COVID-19, however, this peak is the highest of the pandemic so far. And the more infectious B.1.1.7 variant, which has been found across the United States, could drive the peak higher, just as the first signs of its retreat have begun.

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Current hospitalizations are always the most stable indicator of the pandemic’s progress, and after peaking at 132,474 on January 6, they have declined more than 6 percent—meaning that 8,654 fewer people are in the hospital now, compared with two weeks ago. Hospitalizations have declined, too, in every region for at least the past week or so. Still, they are more than twice as high as the spring and summer peaks combined, both of which stopped just short of 60,000. And if the current peak follows the path of the previous two, the decline will be slow; the spring and summer peaks took about a month to build from the previous low, and then about two months to subside to the next low.

Across the country, though, regional cases per million have been declining, with a substantial drop in the Midwest since late November and recent, short-term declines in the other three U.S. regions. Deaths, a lagging indicator, may be reaching a plateau in all regions as a result; there are the first hints of it in the seven-day average—ever-so-slight changes in momentum visible at the edge of the graphs below.

Much of what happens next will depend on conditions in some of the country’s largest statesCalifornia, where the seven-day average of hospitalizations peaked at 22,703 on January 12; Arizona, which has the highest per capita hospitalization rate in the country and has of late had the worst outbreak in the world; Texas, where hospitalizations and deaths are well above prior peaks and climbing; and Florida, where hospitalizations and deaths may be peaking after a steady rise going back to late fall. New York may be hitting a second peak or plateau of hospitalizations, at a seven-day average just under 9,000, about half of its awful spring peak. New cases and hospitalizations are climbing in Virginia, which is at about twice its previous hospitalizations peak, in May. North Carolina’s seven-day average of hospitalizations has been climbing continuously since early November.

But at the state level, peaks are not necessarily followed by an immediate decline. Missouri has had a seven-day average of hospitalizations between 2,500 and 2,800 since late November. New Jersey has remained between 3,600 and 3,700 since December 16. Even assuming that we are at a peak, unwinding the damage will take long enough as it is—at least a couple of months, if the previous lower peaks are any indication.

The Biden administration inherits a mess, and now the B.1.1.7 variant of the virus, which may be 50 to 70 percent more transmissible, has been found in many states, suggesting that it’s widespread. But the administration also has the tools to clean this mess up. It has promised new, seemingly more aggressive action. The vaccine is rolling out, at an estimated rate of nearly 777,000 doses administered a day. We may still hope that this will be the worst point of the pandemic—the peak of this horrifying wave—and that from here the numbers will drop slowly but inexorably down.