The U.S. registered more covid-19 deaths in a single day than ever before -- nearly 3,900 -- on the same day the mob attack on the Capitol laid bare some of the same, deep political divisions that have hampered the battle against the pandemic.
The virus is surging in several states, with California hit particularly hard, reporting on Thursday a record two-day total of 1,042 coronavirus deaths. Skyrocketing caseloads there are threatening to force hospitals to ration care and essentially decide who lives and who dies.
"Folks are gasping for breath. Folks look like they're drowning when they are in bed right in front of us," said Dr. Jeffrey Chien, an emergency room physician at Santa Clara Valley Regional Medical Center, urging people to do their part to help slow the spread. "I'm begging everyone to help us out because we aren't the front line. We're the last line."
Meanwhile, the number of Americans who have gotten their first shot of the covid-19 vaccine climbed to at least 5.9 million Thursday, a one-day gain of about 600,000, according to the Centers for Disease Control and Prevention. Hundreds of millions will need to be vaccinated to stop the coronavirus.
[CORONAVIRUS: Click here for our complete coverage » arkansasonline.com/coronavirus]
National Institutes of Health Director Francis Collins acknowledged in an interview that U.S. vaccine distribution got off to a "rocky beginning," but he said he was "not totally surprised by that."
"The next couple of weeks are going to be really critical to see how we can get this distribution system up and going more smoothly," Collins said, adding: "We had this remarkable plan that [Operation] Warp Speed had put in place to have doses ready to go the very next day after the FDA approval, but that's a lot of logistics... so maybe we shouldn't be too shocked that it didn't go like clockwork."
About 1.9 million people around the world have died of the virus, more than 360,000 in the U.S. alone. December was by far the nation's deadliest month yet, and health experts are warning that January could be worse still because of family gatherings and travel over the holidays.
A new, more contagious variant is spreading around the globe and in the U.S. Also, it remains to be seen what effect the thousands of supporters of President Donald Trump who converged this week in Washington, many of them without masks, will have on the spread of the scourge.
[Video not showing up above? Click here to watch » https://www.youtube.com/watch?v=sQb0bHBnhvM]
On Wednesday, the day a mob breached the U.S. Capitol, disrupting efforts to certify the election of Joe Biden, the U.S. recorded 3,865 virus deaths, according to Johns Hopkins University. The numbers can fluctuate after holidays and weekends, and the figure is subject to revision.
"The domestic terrorists overran the Capitol police, just as the virus has been allowed to overrun Americans," said Dr. Eric Topol, head of the Scripps Research Translational Institute. "The U.S. lost control of a Trump-incited mob and a Trump-played-down pandemic virus."
Craig Spencer, director of Global Health in Emergency Medicine at New York-Presbyterian/Columbia University Medical Center, had just walked away from receiving his second coronavirus vaccine dose when he saw news of the mob descending on the Capitol.
He said that if not for the siege on the Capitol -- in addition to fatigue with news related to the pandemic -- the story of the day late Wednesday might have been the record death count.
"We're a year into this and we set a record death toll yesterday, and it's going to be higher sometime in the next week and higher again in the coming weeks," he said, adding: "Unlike this massive acute onslaught of insurrection ... people have just gotten used to the fact that thousands of people will die."
Health and Human Services Secretary Alex Azar tweeted that the agency was "committed to a peaceful and orderly transition of power over the next 13 days," and he said more than 300 meetings have been held with Biden's transition team as the incoming administration readies to take over the response to the pandemic.
CALIFORNIA, FLORIDA
In California, health authorities Thursday reported 583 new deaths, a day after 459 people died. The overall death toll there stands at more than 28,000. The state also registered more than a quarter-million new weekly cases, and only Arizona tops California in cases per resident. Florida broke its record for the highest single-day number of cases with over 19,800, while its death toll reached 22,400.
A travel advisory issued Wednesday "strongly discouraged" people from out of state from entering California. It also said Californians should avoid traveling more than 120 miles from home except for essential purposes.
The state's previous advisory, issued in November, encouraged people to stay home or within their region without giving a specific range in miles. It outlined quarantine guidelines for out-of-state travelers but did not explicitly discourage travel.
California this week ordered hospitals in the hardest-hit areas to delay many elective surgeries in order to free up space.
Los Angeles County, the nation's most populous with 10 million residents, and nearly two dozen other counties have essentially run out of intensive care unit beds for covid-19 patients.
"This is a health crisis of epic proportions," said Barbara Ferrer, public health director for Los Angeles County.
Guidelines posted on the website for Methodist Hospital of Southern California warned: "If a patient becomes extremely ill and very unlikely to survive their illness (even with life-saving treatment), then certain resources ... may be allocated to another patient who is more likely to survive."
Health officials warned Wednesday that hospitalizations will continue for at least the next three weeks as people who ignored social distancing rules to gather for Christmas and New Year's Eve fall ill.
Hospitals statewide with room have been told to accept patients from others that have exhausted their ICU beds but in fact most of the state is reporting struggling to provide ICU beds, with non-covid-19 patients spilling into corridors, tents and cafeterias.
Meanwhile, Florida again broke its record for the highest single-day number of covid-19 cases Thursday, adding 19,816 new cases as the state's death toll surpassed 22,400.
The previous single-day record since the pandemic began was 17,783 cases on Wednesday.
[Gallery not loading above? Click here for more photos » arkansasonline.com/18covid/]
Thursday's report by the Florida Department of Health of nearly 20,000 cases brought the state's known total of covid-19 cases to 1,429,722, the third-highest in the country, according to The New York Times database of U.S. cases.
Also, 164 new resident deaths were announced, bringing the state's resident death toll to 22,481. Six new nonresident deaths were also announced, bringing the nonresident toll to 336.
ASYMPTOMATIC TRANSMISSION
Separately, a new model developed by researchers at the Centers for Disease Control and Prevention found that people with no symptoms transmit more than half of all cases of the coronavirus.
Their findings reinforce the importance of following the agency's guidelines: Regardless of whether people feel ill, they should wear a mask, wash their hands, stay socially distant and get a coronavirus test. That advice has been a constant refrain in a pandemic responsible for more than 350,000 deaths in the United States.
Fifty-nine percent of transmission came from people without symptoms in the model's baseline scenario. That includes 35% of new cases from people who infect others before they show symptoms and 24% that come from people who never developed symptoms.
"The bottom line is controlling the covid-19 pandemic really is going to require controlling the silent pandemic of transmission from persons without symptoms," said Jay Butler, the CDC deputy director for infectious diseases and a co-author of the study. "The community mitigation tools that we have need to be utilized broadly to be able to slow the spread of SARS-CoV-2 from all infected persons, at least until we have those vaccines widely available."
The emergence of a more contagious variant, first detected in the United Kingdom and since found in several U.S. states, throws the significance of those guidelines into even starker relief. "Those findings are now in bold, italics and underlined," Butler said. "We've gone from 11-point font to 16-point font."
The model, published Thursday in the journal JAMA Network Open, comports with earlier estimates of the contribution of asymptomatic spread.
"It's certainly confirmatory, but it's nice to see confirmation," said epidemiologist Richard Menzies, who directs the McGill International TB Centre in Canada and was not affiliated with this research. "These are pretty believable, solid results."
Many factors influence how the coronavirus spreads. The researchers took an uncomplicated approach -- Butler called it "a fairly simple mathematical model" -- to assess several scenarios, varying the infectious period and the proportion of transmission from people who never develop symptoms.
The model consistently predicted that asymptomatic spread accounted for about half of viral transmission. "I was a bit surprised how well it held up under a broad range of base assumptions," Butler said, such as shifting the timing of peak contagiousness from four days after infection to five or six.
But Muge Cevik, an infectious-disease expert at Scotland's University of St Andrews, argued some of the model's assumptions are flawed. Cevik said the best estimate for the relative contagiousness of people who do not have symptoms, versus those who do, was 35%, drawing from a review of the scientific literature published in September.
The study authors instead estimated, at baseline, that people without symptoms were 75% as contagious. That figure, Butler said, came from their analysis that included peer-reviewed and preprint research. "I have no doubt that we'll still have people say, 'Well, what if you did X, Y or Z?' But hopefully being able to adjust the variables will help address some of those concerns, such as what we did," Butler said.
Cevik also noted that the study does not account for the environment where the spread occurs. "Maybe asymptomatic transmission is important, but it may be much more important in long-term care facilities and households," she said. "That might mean that we need to do much more targeted testing for high-risk populations," as opposed to mass screening.
Whether vaccines stop coronavirus transmission is not certain, and that was not a scenario addressed in this model. "The data on the impact of the vaccines on asymptomatic infection are very limited," Butler said, though he anticipates more information in the coming months.
The clinical trials for the mRNA vaccines, authorized in December, concluded that the vaccinations are highly capable of preventing symptomatic illness. But those trials did not determine whether vaccinated people are able to spread the pathogen.
"If they were asymptomatic but equally contagious, then that's going to have quite an impact on the epidemic," Menzies warned. That is why it is so important to keep testing people, he said, especially those who were vaccinated and then exposed to the virus.
Information for this article was contributed by Carla K. Johnson, Lisa Marie Pane, Olga Rodriguez, Tamara Lush, Jim Salter, Christopher Weber, Don Thompson, Bob Jablon and Elliot Spagat of The Associated Press; by Ben Guarino and Paulina Firozi of The Washington Post; and by Devoun Cetoute of the Miami Herald.
