As cases resurface in the United States, millions of people are expected to travel for the Thanksgiving holiday, and health workers and hospital jobs systems are now bracing for an influx of Covid patients after only a few months to recover from the summer surge.
Last year, there was a significant increase in cases around the holidays. New tools, however, may be able to slow the spread this year if they are quickly adopted. Boosters for all adults six months after mRNA vaccination was recommended by US scientific agencies on Friday, and children over the age of five are now eligible for vaccines.
Existing treatments, such as monoclonal antibodies, are highly effective when administered early, and two promising antiviral medications from Merck and Pfizer jobs could be approved in the coming weeks. However, the new treatments may be introduced against the backdrop of rising cases during the holiday season.
"It's a race against time," said Kyle Enfield, associate chief medical officer of critical care at the University of Virginia Health. According to the US Centers for Disease Control and Prevention, more than 92,000 Americans are now testing positive for Covid-19 every day, and more than 1,000 people are dying from the virus every day. Cases are increasing in the vast majority of states, with hotspots in the Midwest, Northeast, and parts of the Southwest.
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Due to the more transmissible Delta variant and low vaccination rates across much of the country, there have already been more Covid deaths this year than in 2020, and total Covid-19 deaths in the US may reach 1 million by spring. Nonetheless, the US Transportation Security Administration (TSA) announced last week that approximately 20 million passengers are expected to fly this Thanksgiving. These figures are approaching the all-time high of 26 million people screened for flights around Thanksgiving in 2019.
“We anticipate that travel may be very close to pre-pandemic levels this holiday,” David Pekoske, administrator of the TSA, said in a statement. Given the cooler weather and upcoming holidays, “I do think that we are likely going to see an increase in cases over the next couple of weeks,” said Enfield. “Winter can be a busy time in the hospital because of the regular flu and pneumonia [cases] that people get, but this year, I think we’re going to add in ongoing Covid transmission.”
However, predicting the size of the next wave is difficult, he said, and much of this calculation is dependent on vaccination rates as well as existing and potential medications. According to Emily Rubin, a pulmonary and critical care physician at Massachusetts General Hospital, many hospitals in Massachusetts, which have some of the fastest-growing cases and hospitalization rates in the country, are already at or over capacity.
It’s not just Covid filling the wards. “We have a large number of ICU jobs patients who are in the hospital with non-Covid illnesses,” she said. Part of the reason has to do with delayed care during the pandemic that leads patients to get sicker than they would have otherwise been.
Experts are hoping that even if Covid cases rise, the vaccines will help keep hospitalizations and deaths lower than last year. “It gives me a little bit of hope that we’re seeing some breakthrough infections that are not as severe as the ones that we’ve seen in the past,” Enfield said. “But I think that the next couple of days and weeks are really going to be telling for what the real impact is going to be.”
Meanwhile, hospitals are hiring as many nurses and clinicians as they can and expanding the number of patients who can receive monoclonal antibodies at infusion centers. People who exhibit Covid symptoms should be tested right away, and those who test positive and are at high risk of severe illness should receive monoclonal antibody treatments right away.
But providing the monoclonal treatment is challenging because it usually requires an hour-long infusion at a specialty center. “We have increased capacity substantially over the past couple of months, and we are doing everything we can to extend that to keep up with demand. But the demand has grown substantially as we’ve seen the rising cases,” Rubin said.
Having enough staff for these centers has been difficult, Rubin said, as health systems across the country face worker shortages. “Since the whole system is very stressed, every step along that chain can take some time,” Rubin said.
New antivirals could be much easier to give to patients, and the Biden administration has set aside billions for the new medications. First, however, they need to be authorized by the US Food and Drug Administration and then distributed throughout the country.
“We’re eager to see them. We’re also eager to see the data in more detail,” Rubin said. “We haven’t, of course, seen published, peer-reviewed data, but we will be eager to see those.”
Antivirals, like monoclonals, appear to work best early in the course of an illness, so getting test results quickly and then receiving medication quickly would be critical. Antivirals that are easily accessible would also help in rural areas and places without infusion centers, addressing inequities that have plagued some communities – particularly communities of color, which have been hit disproportionately hard by the pandemic.
