SALT LAKE CITY -- Voting will look different this November as infectious-disease experts warn of a potential cold-weather surge of coronavirus cases. States are turning to stadiums, drive-thrus and possibly even movie theaters as safe options for in-person polling places.
Already this year, the primary season took voters to an outdoor wedding-style tent in Vermont and the state fairgrounds in Kentucky.
The Nov. 3 general election is expected to include voting in NBA arenas around the country, part of an agreement owners made with players to combat racial injustice.
Large venues and outdoor spaces allow for social distancing to help prevent the spread of the virus, though there are questions about keeping people warm as the weather gets cold and the possibility that fewer traditional neighborhood polling places will mean lower voter turnout.
Also, Election Day is expected to bring a surge in mail-in ballots. But U.S. Postal Service changes and resulting mail delays have raised concern that ballots won't arrive at clerks' offices in time to be counted, so some people may feel the need to cast their ballots in person.
Several states conduct their elections almost entirely by mail, and mail-in voting is well established in others.
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In June, Utah didn't open traditional polling places because of the virus but broke voter turnout records despite that. In-person voting will be back in November, but rather than using only schools, churches and public buildings for polling places, clerks are permitted to set up drive-thru or outdoor polling places.
Also, the family that owns the NBA's Utah Jazz has a chain of movie theaters and offered three of those as voting sites in November.
In the primary, one suburban Salt Lake City area ran a polling place where voters drove through an indoor convention center to pick up their ballots, completed them in their cars and dropped them off in an outdoor parking area. Davis County Clerk Curtis Koch said the system will be in place for the general election, too.
Chad Berbert, a 46-year-old Republican, said he'll probably vote by mail in the fall, but he's glad officials are offering alternative voting methods.
"The more options for voting in terms of mechanisms or ways that people can exercise their franchise I think is helpful," said Berbert, who lives in Layton, Utah, and works at a management consulting firm.
Less than 1% of Utah voters chose in-person options in June, according to election officials.
IN-PERSON OPTIONS
In states where voters are less familiar with mail-in voting, unorthodox in-person options will provide a safe alternative, said Charles Stewart, a political science professor at the Massachusetts Institute of Technology.
In Los Angeles, Dodger Stadium will be used as a voting center as part of a joint effort with More Than A Vote, a voting rights organization launched by LeBron James that's dedicated to maximizing Black turnout in November.
Several teams, including the Milwaukee Bucks, Detroit Pistons and Atlanta Hawks, had already committed their arenas to be voting sites before the NBA's announcement last week. Madison Square Garden also will be among the sports stadiums used.
The idea to use large spaces for in-person voting started in Kentucky, where Louisville's only option in the June primary was an exposition center at the state fairgrounds. Organizers carefully laid out chalk markings where voters could safely stand in line, though there were complications as voters struggled to find parking at the end of the day.
In Vermont, the tiny town of Lincoln voted during an August primary in a wedding-style tent, clerk Sally Ober said. Being outdoors in the summer gave Ober some unexpected brushes with nature. As she was setting up, she picked up a baby robin from the street and rescued a speckled fawn that got stuck in a fence. A toad also hopped through the tent during voting.
The primary set turnout records, largely driven by mail-in voting. All active Vermont voters will get mail-in ballots for the November election, and lawmakers have allowed for outdoor and drive-thru voting systems.
Ober is again preparing for people who want to vote in person, but in a state where below-freezing temperatures are normal in November, the tent likely won't make another appearance.
SECOND WAVE
The second wave of covid-19 outbreaks could begin well before Election Day, Nov. 3, although researchers assume the crest will come weeks later, closer to when fall gives way to winter.
"My feeling is that there is a wave coming, and it's not so much whether it's coming but how big is it going to be," said Eili Klein, an epidemiologist at Johns Hopkins University School of Medicine.
The pandemic is already a dominant campaign issue, and even a spike in deaths might not apply much torque to the presidential race. But outbreaks in some states could produce pressure further down the ballot and conceivably affect turnout if there is so much community spread that voters who planned to cast ballots in person feel unsafe going to the polls.
The warnings from researchers come at a moment when, despite a rise in cases in the Upper Midwest, national numbers have been trending downward at a slow pace for several weeks following the early summer surges in the Sun Belt.
Respiratory viruses typically begin spreading more easily a couple of weeks after schools resume classes. Although the pandemic has driven many school districts to remote learning, there is a broad push across the country to return to something like normal life.
The Labor Day holiday weekend is a traditional time of travel and group activities, and, like Independence Day and Memorial Day, could seed transmission of the virus if people fail to take precautions. Also, viruses tend to spread more easily in cooler, less humid weather, which allows them to remain viable longer. As the weather cools, people tend to congregate more indoors.
The coronavirus has a relatively long incubation period, and the disease progression in patients with severe illnesses tends to be drawn out over several weeks. As a result, any spike in deaths will lag weeks behind a spike in infections, and the infection surges have consistently followed the loosening of shutdown orders and other restrictions.
"I firmly believe we will see distinct second waves, including in places that are done with their first waves. New York City, I'm looking at you," said Andrew Noymer, an epidemiologist at the University of California at Irvine who studied the October surge in cases when the mild pandemic influenza virus circulated in 2009.
"I expect fall waves starting in mid-October and getting worse as fall heads into winter, and reaching a crescendo certainly after the election," he said. "Some places will peak around Thanksgiving, some places will peak around Christmas, some places not until January and February."
TIMING UNCERTAIN
If that's correct, the worst effects will occur after the campaigning is over and the ballots have been cast. The exact timing may be moot in any case, said David Rubin, the director of PolicyLab at Children's Hospital of Philadelphia, who contended that most people have already made judgments about how the candidates have handled the pandemic.
"I wouldn't foresee anything happening between now and the election that would change the dynamics of the election," Rubin said.
President Donald Trump's approval rating has been consistent through the pandemic, noted Kyle Kondik of the University of Virginia Center for Politics. Though Trump lost some ground in May and June, he is no less popular than he was last fall, when the economy was strong and people could travel freely.
"There has been a little bit of erosion, but not a ton," Kondik said. Of course, in a close election, even a small shift "could be a difference between victory and defeat."
Rubin raised another possible consequence of increased viral transmission in advance of the election: Candidates could become sick.
"The candidates are campaigning. They're mixing with people," Rubin said. "I would not be surprised to see a couple people get sick, and whether that goes all the way to the presidential candidates could be a game changer. This virus has got pretty close to the president a couple of times."
The timing of the pandemic remains unpredictable in part because it is not a seasonal virus. Seasonal viruses, such as those that cause influenza, and the coronaviruses that cause common colds, are faithful to the calendar, with most typically flaring in the fall a couple of weeks after children go back to school and start bringing their newly acquired infections into their homes, said Ellen Foxman, an immunologist at Yale School of Medicine and expert on respiratory viruses.
But most people have no immunity to the novel coronavirus. It spreads opportunistically in all kinds of weather. Despite millions of infections and more than 188,000 deaths, most people in the United States remain susceptible.
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"A pandemic virus is different, because most of us do not have prior immunity to this virus," Foxman said. "That means it's a lot more contagious than a typical virus that we get every year."
There is a small body of evidence that a person who gets the virus acquires a limited amount of immunity. And there also are indications that some people can become infected a second time.
It's possible that some people suffer minimal or no effects from the coronavirus because of exposure to other viruses, which prime the body's immune system against pathogens generally. This is seen as one plausible explanation for the unusual percentage of people -- the Centers for Disease Control and Prevention estimates 40% -- who become infected with the novel coronavirus but are asymptomatic.
There still is no approved vaccine. Most experts do not expect one to be distributed, at least in any significant numbers, before the end of the year, and broad distribution could take many months.
INFECTION NUMBERS
Meanwhile, the country's health departments are reporting roughly 40,000 positive test results every day -- more than double the number in May when many states began reopening after the first wave of infections.
Epidemiologist Jeffrey Shaman of Columbia University said a good target for the entire country would be to drive transmission down to 500 infections a day. At that level, contact tracing and testing could keep outbreaks under control.
"The question is, is it going to spread out of control broadly?" Shaman said. "Are we going to get us down to 10,000 cases, then under 1,000, and then to my magical number of 500? The thing about this disease, it really spins out of control."
Klein, the John Hopkins epidemiologist, warns that the fall wave is likely to be more intense than the peak in the spring. Maryland had 2,000 covid-19 patients in hospitals at its peak in April, he said, and his midrange scenario envisions twice that many hospitalized patients at the next peak.
At John Hopkins, doctors are discussing what they call "Surge 2.0." They are envisioning outbreaks that could overwhelm hospitals with covid-19 patients. Even less-catastrophic surges could hamper other kinds of non-covid-19 medical care, said Lisa Lockerd Maragakis, an associate professor of medicine and infectious diseases.
Information for this article was contributed by Joel Achenbach and Rachel Weiner of The Washington Post; and by Sophia Eppolito and Wilson Ring of The Associated Press. Eppolito is a corps member for The Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.
