Public Health

If Carelessness Gave Us the Current COVID-19 Surge, Individual Precautions Can Abate That Trend

Recent upward trends in cases and deaths seem to reflect virus transmission tied to holiday gatherings.

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Newly identified COVID-19 cases in the United States, after falling between December 18 and December 29, have risen to record levels since then, a trend that may reflect infections tied to Christmas and New Year's gatherings. Daily deaths also have climbed to record highs since late December, with no sign of letting up.

According to Worldometer's tallies, the seven-day average of daily new cases was more than 250,000 yesterday, down slightly from the high recorded on Monday but still seven times the average in mid-September. The seven-day average of daily deaths yesterday was more than 3,400, the highest toll recorded so far. The dip in deaths recorded between December 22 and December 27 probably was mostly a function of holiday-related reporting delays, which would have shifted the recording of some deaths that happened during the Christmas weekend to the following week.

COVID-19 symptoms that might prompt someone to seek testing appear two to 14 days after infection, which makes it plausible that holiday gatherings toward the end of 2020 contributed to the recent surge in daily new cases. The falloff in recent days could be a sign that the impact of those celebrations is abating.

Researchers at Harvard University's T.H. Chan School of Public Health found that "deaths often occur 2–8 weeks after the onset of COVID-19 symptoms." That suggests a lag as long as a month between laboratory confirmation and death, which means the daily death toll is apt to continue climbing for the rest of the month, reflecting the increase in newly identified infections since the end of last year.

The U.S. death toll—currently about 395,000, per Worldometer—has more than doubled since the beginning of September. The United States has seen more COVID-19 deaths per capita than all but a handful of countries.

If there is anything hopeful in this dark news, it is the impact that individual decisions have on trends in cases and deaths. The factors that drive new infections—such as gathering indoors for extended periods of time in close proximity with people from other households—are hardly ineluctable. If new cases continue to fall after the post-holiday surge, that will be further evidence that the course of the epidemic is largely determined by how Americans choose to behave in the months until vaccines are widely available.

It seems likely that dramatic increases in case and death numbers encourage people to exercise more care, which in turn helps counter those trends. The danger is that the success of basic COVID-19 precautions, reflected in fewer daily cases and deaths, may lead people to be less careful. If that's true, we could be caught in a self-perpetuating cycle of ups and downs.

It is one thing to resent arbitrary, scientifically dubious, and sometimes unconstitutional COVID-19 control measures imposed by frequently hypocritical politicians. It is quite another to eschew even sensible precautions, thereby endangering people around you, as if it were some sort of political statement.

At least half a dozen members of Congress tested positive for COVID-19 after they were sequestered in close quarters with Republican legislators who refused to wear face masks during last week's riot at the Capitol. The fact that such discourtesy and carelessness has become a badge of honor among many Trump supporters is understandable in the sense that they are taking their cues from a president who has repeatedly denigrated the value of face coverings, even after he described wearing them as "patriotic." But as a matter of basic decency, it is baffling.

San Mateo County, California, Health Officer Scott Morrow, an early advocate of lockdowns last spring, has criticized recent legal restrictions supposedly aimed at curtailing the pandemic, noting that they are often illogical and empirically questionable. But that hardly means he thinks Americans should throw caution to the winds and let the pandemic proceed unimpeded.

"I think people should stay at home, avoid all non-essential activities, wear masks, and not gather with anyone outside their households," Morrow says in a statement he posted on his department's website last month. "I've been saying this for about 10 months now. If you didn't listen to my (and many others') entreaties before, I don't think you'll likely change your behavior based on a new order. I appreciate that some of you think I (or the government) have magical abilities to change everyone's behavior, but I assure you, I (we) do not."

You may quibble with Morrow's advice, which on its face does not allow for "non-essential" but low-risk activities such as outdoor dining and recreation. But his basic point is valid: When it comes to reducing virus transmission, individual choices matter more than government policy. "What I believed back in May, and what I believe now," Morrow says, is that "the power and authority to control this pandemic lies primarily in your hands, not mine."