Charts show the US on the brink of a 4th coronavirus surge as variants spread and states relax restrictions

2021 florida spring break
Revelers flock to the beach to celebrate spring break in Fort Lauderdale, Florida, on March 5, 2021.

  • US coronavirus cases have increased 12% in the last week. About 30 states are reporting upticks.
  • Experts think the spread of a more infectious, deadlier variant is partially to blame.
  • Charts show how cases are spiking in the six states seeing some of the most dramatic increases.
  • See more stories on Insider’s business page.

Although 23% of the US population is now vaccinated against the coronavirus, the director of the Centers for Disease Control and Prevention has warned of “impending doom.”

In a press briefing on Wednesday, Rochelle Walensky said the US is in “a critical moment in our fight against the pandemic.”

In the last seven days, average daily case numbers have trended up in more than 30 US states. The country’s daily number of new cases has risen 12% during that time, according to Walensky. Hospitalizations nationally increased 5%, on average, over the last two weeks.

“For the health of our country, we must work together now to prevent a fourth surge,” Walensky said earlier this week.

US deaths are still trending down overall, but spikes in mortality typically appear at least three weeks after cases go up. And 900 Americans dying of COVID-19 per day is still far too many, Walensky said.

Not all states are seeing equal surges – the rise in new COVID-19 cases is more pronounced in the Northeast, Michigan, and Florida.

Anthony Fauci, President Joe Biden’s chief medical advisor, said states with new case spikes share commonalities: They are either loosening restrictions on indoor activities and gatherings too quickly, or they’re being disproportionately affected by infectious coronavirus variants, like the B.1.1.7 variant first found in the UK. Or both.

“This tension between the desire to start opening up and the risk associated with B.1.1.7 is placing us in a precarious position,” Yonatan Grad, an infectious-disease researcher at Harvard’s T.H. Chan School of Public Health, told STAT. “It would be great if people could wait a little bit longer until we get higher levels of vaccine coverage.”

States with more variant cases are seeing surges

Florida’s cases have increased 8% in the last two weeks, as hordes of college students and spring breakers flocked to beaches near Miami for vacation.

CDC data shows Florida has both the highest total number of B.1.1.7 cases – 2,351 – and a higher proportion of total cases linked to the variant than any other state: 13.2%. Studies have found that this mutated strain is 50% to 70% more contagious than its predecessors.

“More infections will result because of B.1.1.7,” Walensky said Wednesday. B.1.1.7 is responsible for about 26% of US cases to date.

Michigan is also struggling with B.1.1.7’s spread. It has 15% of the US’s total cases linked to that variant: more than 1,230. Studies suggest people who get infected with B.1.1.7 are up to 64% more likely to die than those who get other coronavirus strains.

Michigan’s weekly average of new daily cases have increased almost fourfold in the last five weeks, despite a statewide mask mandate. Jackson and Flint have some of the highest case rates in the US.

Daily hospitalizations in Michigan have more than doubled in the last month.

New York, too, is seeing a new spike that could be due to infectious variants – both B.1.1.7 and another variant called B.1.526, which was first detected in New York City in the fall.

Epidemiologist Dr. Jay Varma, New York City’s senior advisor for public health, told Gothamist that together, B.1.1.7 and B.1.526 accounted for more than half of New York City’s coronavirus cases in mid-March.

The state’s weekly average of new daily cases rose 42% over two weeks. Together with New Jersey, it has one of the highest per-capita case rates in the US.

Large gatherings and a lack of masks lead to more transmission

Many states experiencing surges have also loosened coronavirus-related restrictions on masks and gathering sizes in the last month, contrary to recommendations from the CDC.

“Consistently, three times a week for 10 weeks, Dr. Walensky has said, ‘Wear a mask, avoid crowds, socially distance, and don’t travel unless it’s absolutely essential,'” Andy Slavitt, an administrator on Biden’s COVID-19 advisory team, said during the Wednesday briefing. “We repeat that in all our conversations with governors. We repeat that in all our conversations with local officials.”

However, Florida, along with 17 other states, no longer have mask mandates. Texas Gov. Greg Abbott lifted the state’s mask mandate on March 10, and also eliminated capacity restrictions for all Texas businesses, including restaurants and bars.

Texas’s weekly average of new daily cases has remained above 3,200 for the last six months.

New Jersey, another new hot spot, has seen its average number of new daily cases increase by more than 50% since March 1.

New Jersey Gov. Phil Murphy allowed restaurants and businesses, including gyms and salons, to increase their capacity to 50% starting March 19. Murphy also said earlier this month that indoor events can include up to 150 people.

New York Gov. Andrew Cuomo, meanwhile, recently announced that arts and entertainment venues can reopen starting April 2, holding up to 100 people indoors and 200 people outdoors. He eased restrictions on weddings, sporting events, and concerts earlier this month.

Pennsylvania, too, is seeing a surge that coincides with its recent reopening.

The state will allow restaurants to increase indoor seating capacity to 75% starting this Sunday. Since March 1, Pennsylvania guidelines have allowed indoor concert venues and arenas to operate at 15% capacity.

The state recorded roughly 28,300 new cases in the week ending March 30: a 33% increase from the week prior.

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After Elon Musk opened Tesla’s Bay Area factory against local rules, around 450 workers got COVID-19

tesla fremont factory plant workers FREMONT, CA - JULY 26: Damien Boozer and Paul Jacob work on the general assembly of the Tesla Model 3 at the Tesla factory in Fremont, California, on Thursday, July 26, 2018. (Photo by Mason Trinca for The Washington Post via Getty Images)
Tesla has attempted to reopen its Fremont factory multiple times despite local lockdown orders.

  • Elon Musk reopened Tesla’s Fremont, California, factory in May in defiance of public health orders.
  • From May to December, it recorded around 450 COVID-19 cases, The Washington Post reported Friday.
  • Alameda County, where the factory is located, previously refused to release the data.
  • See more stories on Insider’s business page.

Around 450 of the roughly 10,000 workers at Tesla’s Fremont, California, factory tested positive for COVID-19 from May to December, The Washington Post reported Friday.

Tesla and Alameda County Public Health Department did not respond to a request for comment on this story.

Last May, after public health orders required non-essential businesses to shut down in Alameda County, Elon Musk reopened the factory in defiance of those orders. The county eventually reversed course and let the factory restart operations after Tesla sued.

But a month later, several Tesla employees tested positive for COVID-19 despite claims from the company’s safety chief that there had been “zero COVID-19 workplace transmissions” since the plant reopened.

That outbreak appears to be much larger than previously known, according to The Post, which reported that Alameda County data obtained by legal transparency advocate PlainSite showed cases at Tesla’s factory rising to as high as 125 active cases in December.

In exchange for being allowed to reopen, Tesla agreed to share COVID-19 case data with the county. The county argued for almost a year that it couldn’t release the data publicly because of the Health Insurance Portability and Accountability Act, which protects the privacy of Americans’ health information.

Plainsite was able to obtain the data following a court ruling earlier this year, according to The Post.

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US coronavirus cases have dropped 70% in the last six weeks. Experts chalk it up to more immunity and better behavior.

Arizona covid-19 testing coronavirus
Physician John Jones, tests administrative assistant Morgan Bassin for COVID-19 at One Medical in Scottsdale, Arizona, June 17, 2020.

  • Average daily coronavirus cases in the US have fallen roughly 70% in the last six weeks.
  • Experts attribute this to two main factors: a buildup of immunity and fewer social interactions after the holidays.
  • Other factors, including state lockdowns and increased mask wearing, could have also played a role.
  • Visit the Business section of Insider for more stories.

Many public-health experts got a surprise this month: US coronavirus cases have fallen roughly 70%, on average, in the last six weeks.

The US has recorded an average of around 68,000 daily cases over the last week. The last time the country saw weekly averages that low was in October. Yet with just 47 million Americans vaccinated so far, many experts assumed it would take longer for infections to plummet. 

So scientists have posited a few theories as to why cases fell: Among the most likely is that many people who are at high risk of exposure or illness have acquired some form of immunity, either through vaccination or natural infection. Cases were also bound to drop after the holidays, once people stopped traveling and congregating indoors as much.

“I think the major reason is that we were just on such a high before, with the surge from Thanksgiving and Christmas, that we’re finally dropping off from that,” Leana Wen, the former health commissioner of Baltimore, told Insider.

A few other factors may have contributed: California was responsible for nearly 14% of US cases from November through January, and the state’s lockdown helped slow transmission there. Increased mask compliance could also have some influence, and a decline in US testing could mean fewer cases are getting recorded. 

Still, experts say there was no magic change that brought cases down.

“I’m not sure that we have learned any lessons other than what we’ve known all along, which is when people congregate, the virus replicates and spreads and we have higher levels of infections,” Wen said.

She also cautioned that the US isn’t out of the woods.

Indeed, daily cases have risen in the last few days, from a recent low of 52,500 on Monday to around 75,500 on Thursday. (Some of that might be delayed test results from the recent winter storms.) Over time, pandemic fatigue and the spread of more contagious variants could still reverse the US’s positive trend.

“We’ll see a substantial decline in infection numbers by May,” Wen said, “but my worry would be: Will people become complacent and then will we see a substantial rebound come the fall?”

Social interactions declined after the holidays

Case counts typically reflect infections contracted about two weeks prior. That means the effects of transmission that occurred over Thanksgiving were likely recorded around the second week in December. Sure enough, average weekly cases in the US rose 25% from November 26 to December 10.

A similar pattern followed Christmas: Average weekly US cases rose 30% from December 25 to January 8. That’s when the nation recorded its highest daily case count ever: more than 312,000.

Then cases began to go down.

“If I were ranking explanations for the decline in COVID-19, behavior would be number one,” Ali Mokdad, a global-health professor at the University of Washington, told The Atlantic. “If you look at mobility data the week after Thanksgiving and Christmas, activity went down.”

News of high case numbers and overstressed hospitals may also have encouraged people to social distance, avoid crowds, or wear masks more.

“People adhere more to public-health mitigations when they see the cases going off the ceiling, so that’s what probably happened,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told Pod Save America’s Jon Favreau on Monday.

Fauci added that “we haven’t vaccinated enough people to have an impact on the kinetics of the outbreak.”

LOS ANGELES, CA - NOVEMBER 25: Holiday travelers pass through Los Angeles international Airport on Thanksgiving eve as the COVID-19 spike worsens and stay-at-home restrictions are increased on November 25, 2020 in West Hollywood, California. Starting today, travelers arriving to Los Angeles by airplane or train are required to sign a form acknowledging California's recommendation of a 14-day self-quarantine. Los Angeles mayor Eric Garcetti has warned that the virus is "threatening to spiral out of control" in the region, and that at the current rate of new COVID-19 cases and hospitalizations, there will not be enough hospital beds by Christmastime. Despite pleas from health officials to not gather with people outside of ones household, more than 2 million Americans are projected to fly for Thanksgiving. (Photo by David McNew/Getty Images)
Holiday travelers pass through Los Angeles International Airport on November 25, 2020.

Could immunity be more prevalent than scientists thought?

Most scientists don’t believe the US has reached herd immunity – the threshold beyond which the virus can no longer spread easily from person to person. But a few experts think we could be closer than previously realized.

Andrew Noymer, an associate professor of public health at the University of California, Irvine, recently told Insider that the US may be underestimating the prevalence of asymptomatic infections. Indeed, a recent model suggests that just 13% to 18% of COVID-19 cases are symptomatic. Given that asymptomatic people are less likely to seek a test, this could indicate that official case counts are missing a lot of infections.

What’s more, many people who have the highest chance of exposure – including essential workers and residents of homeless shelters and nursing homes – have likely been exposed already, gotten vaccinated, or both.

“It’s probably a combination of things – a combination of there being enough people who are already infected and people getting vaccinated, so there’s some level of protection,” Wen said.

New York waiter
A waiter wears a face mask at a restaurant in New York City on November 10, 2020.

A buildup of immunity – even if not to a herd-immunity threshold – could help slow transmission.

“It’s very likely that acquired immunity is playing a huge role in the falling cases in California and elsewhere,” Marm Kilpatrick, a professor of evolutionary biology at the University of California, Santa Cruz, told Insider.

But experts cautioned that this is still a fragile balance.

“While we might be seeing some effects of immunity now, it’s because a substantial fraction of the population is continuing to distance and isolate,” Dr. Kate Langwig, an infectious disease ecologist at Virginia Tech, told Insider.

She added: “If those people suddenly decided that because cases are going down, they felt more comfortable eating inside at a restaurant or socializing outside their pods, we could potentially erase the reductions that have been made over the past few weeks.”

California’s lockdown, and others, may have slowed transmission

At the peak of its outbreak, California accounted for around 40,000 of the US’s daily coronavirus cases, on average. But the state’s cases declined considerably in late January, after seven weeks of stay-at-home orders.

Similar restrictions across other states may have slowed transmission as well. New Mexico, for instance, implemented an 18-day stay-at-home order starting November 13.

In December, North Carolina also imposed a nighttime curfew that required residents to stay home from 10 p.m. to 5 a.m. The restriction lifted on Wednesday.

Los Angeles Coronavirus
A Covid-19 warning sign in Los Angeles, California.

We’ve gotten better at wearing masks

Langwig said consistent advice on mask wearing and more high-quality masks available could also be helping. 

The Centers for Disease Control and Prevention recently outlined several tips to make face coverings more protective, and even suggested that people double mask

Around 73% of US adults now say they wear a mask every time they leave the house, according to a recent poll from the Kaiser Family Foundation. That’s a considerable increase since May, when only 52% of US adults said they wore a mask every time.

We’re not testing as much

Average daily coronavirus tests have declined 27% in the last six weeks. That could indicate that the US isn’t confirming some new coronavirus cases – which might mean infections haven’t dropped as dramatically as it seems.

“I worry that it’s at least partly an artifact of resources being moved from testing to vaccination,” Eleanor Murray, a professor of epidemiology at Boston University School of Public Health, wrote earlier this month.

But the number of daily positive tests has declined since early January. At the peak of the outbreak, the percentage of coronavirus tests coming back positive was nearly 14%. Now that number is less than 5% – an acceptable level to start loosening restrictions, according to most scientists.

Plus, if cases were still high, experts would expect hospitalizations and deaths to remain high, too. In the last six weeks, however, average daily hospitalizations have fallen 57%, while average daily deaths have fallen 39%.

Andrew Dunn contributed reporting.

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There’s a clear, scientific path to safely reopening schools. The real barrier now is politics.

texas school reopening
Elementary school students walk to classes in Godley, Texas, on August 5, 2020.

By now, research clearly supports the idea that schools can safely resume in-person learning in the US. 

A January study of 11 school districts in North Carolina identified just 32 coronavirus infections in schools over nine weeks. Similarly, a report from the Centers for Disease Control and Prevention detected minimal transmission among K-12 schools in Wood County, Wisconsin. 

In an opinion article last month, CDC researchers even called for schools to reopen, with a few ground rules: Masks should be worn at all times. Social distancing should be upheld. And indoor sports practices and competitions should be limited. 

But a few political obstacles stand in the way.

For one, many US school districts lack the funding to improve their buildings’ ventilation systems, routinely test teachers and staff, or reduce classroom sizes so students remain six feet apart – measures that would make parents and teachers more comfortable with in-person learning.

The CDC’s threshold for resuming full in-person instruction is also tough for most counties to meet right now, since it requires low levels of community transmission. That means that in some states, reopenings have been delayed even though they might be relatively safe for students and teachers. 

Then there’s the lingering issue of mask resistance. In states like Georgia or Iowa, classrooms are already open, but many school districts haven’t enforced strict mask policies. That leaves students and teachers at higher risk of infection, which could potentially force schools to close again.

“We’ve had a lot of issues with reopening based on science,” Kavita Patel, a nonresident fellow at the Brookings Institution, told Insider. “I’d love to see a world where there is a little bit more of a practical engagement of the states and mayors with the scientists.”

coronavirus school district California
Students return to in-person learning in Orange, California, on August 24, 2020.

Polarization around school mask policies

Stances on school reopenings have increasingly fallen into two polarized camps, according to Daniel Benjamin, a pediatric infectious-disease specialist at Duke University: There’s either a general neglect for safety measures, or too much risk aversion.

At one end of the spectrum, Benjamin told Insider, “you have schools that are paralyzed by fear. They just don’t have the political will to open, despite the fact that if you do mitigation strategies, it’s safer for kids and adults to be in school than to be in the community.”

Then there’s the group at the other end.

“They don’t believe in masking,” Benjamin said. “They don’t have the backup of the [school] board. They don’t have the backup of the superintendent. The parents tell the kids don’t wear a mask in school. Masking is not enforced in the schools. And that’s dangerous. That’s not a good plan.”

face mask kid school covid 19
Kindergartner Grace Truax, 5, removes her mask before posing for a portrait during “picture day” at Rogers International School in Stamford, Connecticut, on September 23, 2020.

A November ProPublica analysis found that 11 states were not requiring students to wear masks, even when gathered indoors or at sporting events. 

Benjamin suggested that instead, schools should use face coverings as an incentive for in-person learning.

“It’s super simple: If you don’t want to mask, we have an alternative for you. You can learn remotely,” he said. “Schools that are closed right now can really leverage that as a part of reopening.”

A lack of funding for safety measures 

President Joe Biden has set a goal of reopening the majority of K-8 public schools in his first 100 days in office – roughly by the end of April.

His proposed coronavirus relief plan would allocate $130 billion to help primary schools reopen with the appropriate safety precautions. Congress will likely vote on the final legislation in mid-March. If the funding is approved, schools could use it to improve ventilation, reduce class sizes, hire more janitors, distribute personal protective equipment, or modify classroom layouts for social distancing.

Many schools are waiting on this funding before reopening to avoid putting teachers or other staff at risk. Teachers’ unions across the country are also pushing for safety assurances before in-person learning resumes – that  classrooms are well-ventilated, community transmission is low, or vaccines are more widely available to school staff.

schools reopening protest
Teachers, parents, and children march in Brooklyn to protest the reopening of city public schools amid the threat of a teachers strike in New York, September 1, 2020.

Earlier this month, Philadelphia teachers held virtual classes outdoors in frigid weather to protest the city’s school reopening plan, which included using windows and fans, rather than mechanical ventilation, to circulate air.

Chicago teachers also refused to report to classrooms unless the city met their safety demands – such as more frequent cleaning of classrooms and permission for teachers with high-risk family members to continue working remotely. And in Montclair, New Jersey, the local teachers union called for all educators to be vaccinated before resuming in-person learning.

The longer schools wait to establish and implement their safety plans, the higher the costs to students.

A lack of access to school meals has put millions of households at increased risk of food insecurity, according to an October report. An analysis from McKinsey & Company suggests that American students, on average, are likely to lose five to nine months’ worth of learning by June due to the pandemic. Already this fall, a report found that student achievement in math in grades 3-8 was 5 to 10 percentile points lower than before the pandemic. 

“This is all expected and known when you have kids out of school for an entire year – millions of kids – that there would be devastating consequences,” Joseph Allen, director of Harvard’s Healthy Buildings Program, told NPR last week. “Our country has not treated it like the emergency it is.”

The CDC’s strict reopening guidelines

The CDC’s guidelines about when it’s safe for kids to return to school pose an added challenge for districts looking to reopen.

The agency recommends that counties either see fewer than 50 weekly COVID-19 cases per 100,000 people or have test-positivity rates below 8% before fully reopening K-12 schools – thresholds that are often hard to meet. Even though cases are declining across the US, around 14 states still have test positivity rates above 8%, and 35 states are seeing at least 105 weekly cases per 100,000 people, on average, according to data from the New York Times.

“Wake up call to parents – if schools start following this new guidance strictly, kids are not getting back to full-time school,” Allen told NPR.

Many states have not prioritized restrictions that could lower cases, thereby giving schools a better chance of meeting the CDC guidelines. Restaurants and bars, venues known to easily facilitate coronavirus transmission, are open in most of the country while many schools remain closed. Infectious-disease experts say that doesn’t make sense.

“As we look at the school setting itself, it’s somewhere that you can have some control over whether kids are wearing masks and whether kids are physically distanced,” Dr. Cindy Prins, an epidemiologist at University of Florida, told Insider. “It’s probably more of those outside [of school] activities that could contribute to transmission.”

school reopen coronavirus Texas
Elementary school students wear masks and use hand sanitizer before entering school for classes in Godley, Texas, August 5, 2020.

The CDC’s own instructions say that “K-12 schools should be the last settings to close after all other mitigation measures in the community have been employed, and the first to reopen when they can do so safely.”

Some states, however, have reopened schools without following that guidance or meeting the CDC case thresholds. Effective last week, Iowa’s K-12 schools are required to offer in-person learning for all students who want to return to the classroom, even though the state has a test-positivity rate of around 13%. Arkansas, Florida, and Texas have also ordered schools to allow students back inside.

Andrew Dunn contributed reporting.

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A Johns Hopkins professor predicts the US will reach herd immunity by April, but many experts aren’t so optimistic

COVID Vaccine Line
People wait in line in a Disneyland parking lot to receive COVID-19 vaccines.

  • In an op-ed in the Wall Street Journal, Johns Hopkins professor Martin Makary wrote that COVID-19 would be “mostly gone” in the US by April.
  • The US’s drop in coronavirus cases suggests it’s close to reaching herd immunity, Makary said.
  • But many doctors and scientists say herd immunity is still a long way off in the US.
  • Visit the Business section of Insider for more stories.

The US’s daily coronavirus cases have declined 65% in the last month – a record drop in the course of the nation’s outbreak. New cases reached an all-time high of 312,000 on January 8. Since then, they’ve fallen to a weekly average of around 73,000 per day.

Dr. Martin Makary, a professor of surgery at the Johns Hopkins School of Medicine, suggested in The Wall Street Journal that the most likely explanation for the decline is that the US could be close to reaching herd immunity.

In a Thursday op-ed, Makary predicted that COVID-19 would be “mostly gone” by April.

He wrote that infections have likely been far more widespread than data suggests – so much so, in fact, that the US will soon hit a threshold beyond which the virus won’t be able to pass easily from person to person. 

“The consistent and rapid decline in daily cases since January 8 can be explained only by natural immunity,” Makary wrote. “Behavior didn’t suddenly improve over the holidays; Americans traveled more over Christmas than they had since March.”

He added that vaccines “don’t explain the steep decline” since early January, because “vaccination rates were low and they take weeks to kick in.” 

But many other doctors and public-health experts continue to caution that herd immunity is still a long way off in the US – particularly as more contagious variants spread.

“We’re nowhere near community immunity or population immunity or whatever people want to call it at this point,” Dr. Cindy Prins, an epidemiologist at University of Florida, told Insider. “We’re nowhere near that yet.”

Could 55% of Americans have natural immunity already?

mask coronavirus herd immunity

Researchers generally estimate the coronavirus’ reproductive value – that of the original strain, at least – to be between 2 and 3 in the absence of vaccines or public-health measures. That means that to achieve herd immunity, around 50% to 67% of a population would need to have some immunity to the virus – whether through vaccination or natural infection. 

“In theory, the numbers are around 70% – some say 65%, some say 75%, 80% – but it’s generally around those numbers. So it takes a while before you can get there,” Dr. Eyal Zimlichman, deputy director general at Sheba Medical Center, Israel’s largest hospital, told Insider in January. 

But Makary’s op-ed suggested that “observational data” indicates the US is close to the herd immunity threshold.

Assuming testing only captures 10% to 25% of infections, he said, about 55% of Americans would have natural immunity already, based on the number of tests reported. Add to that 15% of Americans who have been vaccinated so far, he wrote, “and the figure is rising fast.”

Makary didn’t respond to Insider’s request for comment on this story.

Other factors could explain the drop in US cases

mask shield airport
A couple wearing face shields and masks at Newark International Airport on November 25, 2020.

Experts say herd immunity isn’t the only possible explanation for the US’s falling case count. 

California’s second lockdown, which started in December, may have partially contributed to the decline. At the peak of its outbreak, California accounted for around 40,000 of the US’s daily coronavirus cases, on average.

Other factors like mask wearing, social distancing, and decreased travel after the holidays likely played a role as well.

“If I were ranking explanations for the decline in COVID-19, behavior would be number one,” Ali Mokdad, a global-health professor at the University of Washington, told The Atlantic. “If you look at mobility data the week after Thanksgiving and Christmas, activity went down.”

Thompson has also pointed out that certain communities may have greater shares of immunity than others. 

“Immunity is probably concentrated among people who had little opportunity to avoid the disease, such as homeless people, frontline and essential workers, and people living in crowded multigenerational homes,” he wrote. “It might also include people who were more likely to encounter the virus because of their lifestyle and values, such as risk-tolerant Americans who have been going to eat at indoor restaurants.”

Even if the US is nowhere near herd immunity, then, it’s possible that high levels of immunity among those with frequent social interactions could help slow transmission.

But there’s no concrete data yet to suggest that the majority of Americans are immune to the coronavirus.

The Centers for Disease Control and Prevention estimates that one-quarter of the US population has been infected with the coronavirus so far. Even in New York City, where the virus spread widely in the beginning of 2020, studies found that 22% of the city’s population had been infected by April. A more recent study found that by mid-November, around 14% of the US population had coronavirus antibodies.

“Even after adjusting for underreporting, a substantial gap remains between the estimated proportion of the population infected and the proportion infected required to reach herd immunity,” the authors wrote.

Variants make herd immunity a moving target

covid abbott rapid test swab
A medical worker conducts a rapid COVID-19 test in Brooklyn, New York, on August 27, 2020.

Zimlichman said the very idea that a nation can reach herd immunity with the coronavirus has “never been put to the test.” That’s because the required threshold is often a moving target – and it can rise as new, more contagious variants spread.

Studies have shown that the more contagious coronavirus variant discovered in the UK, called B.1.1.7, may increase the virus’ reproductive value by 0.4 to 0.9. In that case, up to 75% of the US population would likely need to develop some form of immunity.

“When you have a new variant of COVID, if the reproductive number is higher, that means that the virus is going to be able to spread even if fewer people are susceptible,” Rahul Subramanian, a data scientist at the University of Chicago, recently told Insider.

With that in mind, he said, “I would hesitate to say that we’ve reached herd immunity.”

Reaching herd immunity could be even more difficult if vaccines prove less effective against new variants or if people refuse to get shots.

Some research suggests that vaccines may not work as well against the more infectious variant discovered in South Africa. And 13% of adults in the US say they won’t get a coronavirus shot, according to a recent survey from the Kaiser Family Foundation. 

“Obviously you’ll have issues with people that refuse to get vaccinated for whatever reason,” Zimlichman said, “so getting herd immunity by vaccination is a hard one to achieve.”

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India’s sudden drop in coronavirus cases has puzzled disease experts. Strict public-health measures and difficulty recording rural cases may have factored in.

india school coronavirus
A student gets her body temperature taken in Hyderabad, India on February 1, 2021.

  • India’s daily coronavirus cases have plummeted since September.
  • The nation is now reporting just 8 daily cases per one million people, among the lowest per-capita rates in the world.
  • Experts say the decline is puzzling. The difficulty of recording rural cases, combined with strict public-health measures, may offer some explanation.
  • Visit Business Insider’s homepage for more stories.

At the start of the pandemic, few countries were more ripe for a major coronavirus outbreak than India.

Not only is India the world’s second most populous country, it’s also one of the densest, with around 1,200 people per square mile. Cases there climbed steadily from April through September, reaching a peak of nearly 100,000 daily cases on September 16.

Then something unexpected happened: India’s daily cases plummeted from mid-September until February, with average weekly cases dropping by roughly a third each month. The nation is now reporting fewer than 11,300 daily cases, on average – around 8 per 1 million people, among the lowest per-capita rates in the world.

India’s health ministry has attributed this success to a few factors, including a robust testing and contact-tracing effort. But infectious-disease experts say the quick turnaround is puzzling.

India only began administering coronavirus vaccines in mid-January, so it’s probably too soon for vaccinations to affect transmission. Some public-health experts say India’s strict mask mandates may have helped lower cases, but masks have been required there since April, so that don’t fully explain why cases dwindled so dramatically in the fall.

“There are a lot of questions and lessons to be learned, and I think that we need to do a deeper dive into what they’ve done well,” Dr. Krutika Kuppalli, an assistant professor at the Medical University of South Carolina, told Insider.

Kuppalli’s previous research focused on barriers to medical care among women with HIV in southern India.

“I know from having worked and lived in India that they have a lot of challenges in terms of dealing with large populations that are in close quarters, infection control issues, hygiene issues, ventilation issues – all the things that we are concerned about in terms of how this disease spreads,” she said.

Kuppalli added that it’s worth studying whether India’s population may have unique genetic or demographic characteristics that make people less susceptible to symptomatic COVID-19 infection. It’s also possible, she added, that coronavirus cases are simply hard to record in rural areas.

Penalties for not wearing masks 

india mask school
Students wearing face masks attend class in Hyderabad, India on February 1, 2021.

Widespread adherence to public-health measures may partly explain why India has gotten its outbreak under control. Several large cities and states there began requiring masks in public places in April, two months before the World Health Organization recommended face coverings for the general public.

Since then, the nation’s largest city, Mumbai, has levied fines against those who violate the rule. By October, Mumbai had collected a total of more than $70,000 in fines from more than 14,000 people who’d failed to wear masks in public. By early December, Delhi had also issued around 500,000 mask fines, The Wall Street Journal reported

For the most part, Indians have been supportive of mask requirements: In an October survey from social media platform LocalCircles (which included more than 15,000 responses across roughly 200 districts in India), nearly 90% of respondents said they were in favor of a mask mandate. About 40% said they would support increased penalties for those who didn’t comply.

The US, by contrast, has struggled to convince large segments of the public that masks are an effective tool. 

“The United States very much failed from a lack of national leadership, miscommunication, and a lack of community engagement. I think we can really boil it down to those three things,” Kuppalli said, adding, “we still have people who don’t believe the pandemic is real in this country.”

A focus on ‘test, trace, isolate’

india contact tracing
A member of the internal medical team at the Ahmedabad One Mall checks a staffer’s Aarogya Setu app, India’s virus contact-tracing app, on June 7, 2020.

Epidemiologists typically rely on a three-step strategy to contain a virus: test, trace, isolate.

Though India’s testing got off to a slow start, it has ramped up considerably since the summer. By August, the nation had nearly 1,600 testing labs, up from just 14 in February 2020. India is administering nearly 486,000 daily tests. Only two other countries, the UK and the US, are testing more.

India’s large population also worked to its advantage when it came to enlisting contact tracers.

From March through April, tens of thousands of health workers traced the contacts of more than 435,000 infected people across two southern states, Andhra Pradesh and Tamil Nadu. The workers reached more than 3 million contacts, around 575,000 of whom had available COVID-19 test results.

These efforts were made easier by a longstanding disease surveillance network that began monitoring COVID-19 cases in late January 2020.

As of April, Indian residents could download the nation’s contact tracing app, Aarogya Setu, to find out if they had been been within 6 feet of an infected person. Indian residents are asked to download the app if isolating due to a positive COVID-19 test and report any symptoms to a local surveillance officer.

Possible immunity to new pathogens

India covid
A healthcare worker collects a swab sample from a resident during a coronavirus screening at a civic clinic in Mumbai on October 12, 2020.

India has indeed seen fewer COVID-19 deaths per million than many developed nations. As of Wednesday, 113 out of every million people in India had died of COVID-19, compared to nearly 1,500 out of every million in the US and 1,755 per million in the UK.

India is now recording fewer than one daily death per million people.

Kuppalli said India’s rapidly falling cases raises another important question: “Are there things about this particular population, this ethnicity, that puts them at decreased risk?” 

An August study suggested that populations with a higher exposure to diverse types of bacteria – predominantly due to poor sanitation – might see fewer COVID-19 deaths per million, perhaps because of an acquired or innate immunity to new pathogens. This line of thinking isn’t new: A 2006 study found that developing countries may have a different “immunological experience” with tuberculosis than the US and Europe.

“Look at the average Indian: He or she has probably had malaria at some point in his life or typhoid or dengue,” Sayli Udas-Mankikar, an urban policy expert at the Observer Research Foundation in Mumbai, recently told NPR. “You end up with basic immunity toward grave diseases.”

The idea remains a theory for now, however.

Rural populations are harder to surveil 

rural india coronavirus
Chhayarani Sahu, an Indian farmer, plucks vegetables at in Bhadrak on September 14, 2020.

The coronavirus spreads best in dense, crowded environments. That means countries like the US, where more than 80% of residents live in urban areas, face an uphill battle to contain the virus’ spread.

India, on the other hand, is less urbanized: Around 65% of Indian residents live in rural areas. 

Though the virus has undoubtedly reached India’s rural population, the nation’s cities have been particularly hard-hit. By May, nearly 80% of India’s total COVID-19 cases hailed from just 30 cities. A January survey found that 56% out 28,000 people sampled in Delhi tested positive for coronavirus antibodies.

But Kuppalli said health trends among India’s rural population are difficult to track.

For one thing, rural areas are larger and more spread out. Many Indians living in these communities also lack internet access, which prevents them from plugging into the nation’s surveillance network.

Kuppalli also noted that it’s difficult for patients who are sick in rural places to get to large urban hospitals because of transportation or financial issues. A 2018 report found that only one state-run hospital is available for every 90,000 people in India’s rural communities. That could mean that India simply isn’t recording as many rural cases.

That too, is just a possibility, though. For now, Kuppalli said, “it’s great that they’ve had this turnaround.”

“It’s an opportunity for us to study this population,” she added. “There are lots of things to think about and try to understand.”

This article was originally published on February 3. It has been updated to reflect the latest data on India’s coronavirus cases.

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California is now the 4th state to report cases of the more infectious coronavirus variant found in South Africa

San francisco vaccine line
Alameda County workers line up to receive coronavirus vaccines outside St. Rose Hospital in Hayward, California on January 8, 2021.

  • California is the latest state to report cases of the more transmissible coronavirus variant found in South Africa
  • The variant, first identified in in October, has been found in at least four US states.
  • The variant seems to partially evade immunity gained in response to vaccines or infection with the original virus.
  • Visit the Business section of Insider for more stories.

Once South African scientists detected a more infectious coronavirus variant in early October, scientists knew it was only a matter of time before the strain reached the US.

At the end of January, the US reported its first two cases of the new variant, called B.1.351, in South Carolina. 

California became the latest state to report its own B.1.351 cases on Wednesday. At a press conference, Gov. Gavin Newsom said Stanford University had detected two cases in the San Francisco Bay Area: one in Alameda County and another Santa Clara County. He did not provide further details.

The Centers for Disease Control and Prevention has also identified six cases of B.1.351 in Maryland and one in Virginia.

The variant isn’t spreading as widely as B.1.1.7, another more infectious strain first identified in the UK in September. The CDC has reported more than 930 cases of B.1.1.7 across 34 states so far.

Coronavirus vaccines still appear to be highly effective against B.1.1.7, but scientists are more concerned about B.1.351 because preliminary research found it can partially evade the protection offered by current vaccines.

Moderna, for instance, exposed blood samples from people who’d received the company’s vaccine to B.1.351. They found those samples developed six times fewer virus-neutralizing antibodies than samples exposed to other variants. The company is now exploring the possibility of a booster shot that’s tailor-made to neutralize B.1.351.

Scientists also worry that people who already had COVID-19 could get reinfected with this more transmissible strain.

A race to keep B.1.351 from spreading

COVID-19, South Africa
Health worker Vuyiseka Mathambo takes a nasal swab from a patient to test for COVID-19 at a Masiphumelele community center in Cape Town, South Africa on July 23, 2020.

The US genetically sequences just 0.01% of its coronavirus cases – around three out of every 1,000 cases. That puts the country 33rd in the world for genetic sequencing, according to the latest data from GISAID, a global database that collects coronavirus genomes.

This sequencing deficit means new variants can easily spread undetected in the population. In all likelihood, B.1.351 entered the US long before South Carolina reported its first cases. Neither of those people had recently traveled, nor was there any personal connection between them.

Even people who previously got COVID-19 could be susceptible, evidence suggests. A recent study of Novavax’s vaccine candidate found that B.1.351 cases were just as common among people who’d previously recovered from infections with other strains as those who had not. 

“If it becomes dominant, the experience of our colleagues in South Africa indicates that even if you’ve been infected with the original virus, that there is a very high rate of re-infection,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN last week.

That possibility, combined with B.1.351’s increased transmissibility, could lead to another rise in coronavirus cases, scientists warn. The variant doesn’t appear to be deadlier than the original strain, though.

“When you have more contagious variants circulating and people now feeling free to do things that they weren’t able to do for a while, we do risk having another surge happen in the near future,” Anne Rimoin, an epidemiology professor at UCLA’s Fielding School of Public Health, recently told Insider. “So we need to be watching it carefully.”

For now, scientists hope that vaccinations and other public-health measures will be enough to keep B.1.351 from becoming the dominant strain in the US. More genetic sequencing, they add, could prevent future variants from spreading.

“We’ve got to find ways to get in front of this as opposed to constantly chasing behind it without good surveillance,” Rimoin said. Otherwise, she added, “we’re destined to make the same mistakes.”

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Israel is freezing flights in and out of the country to slow the spread of COVID-19 strains

FILE PHOTO: Israeli Prime Minister Benjamin Netanyahu, wearing a protective face mask, attends the weekly cabinet meeting at the Ministry of Foreign Affairs in Jerusalem, June 14, 2020. Sebastian Scheiner/Pool via REUTERS
FILE PHOTO: Israeli Prime Minister Benjamin Netanyahu attends the weekly cabinet meeting

  • Israel will ban inbound and outbound flights by foreign airlines to slow the spread of COVID-19 strains.
  • Haaretz reported the freeze will take effect early Tuesday morning and last until January 31. 
  • Emergency medical flights, firefighting planes, and legal travel will be permitted, according to the report.
  • Visit Business Insider’s homepage for more stories.

Israel will ban foreign airlines from flying in and out of the country until January 31 to curtail the spread of new COVID-19 strains.

The country’s cabinet on Sunday approved plans to freeze flights starting at midnight between Monday and Tuesday, Haaretz reported Sunday. Flights leaving the country will only be approved in rare instances. Firefighting planes, emergency medical flights, and cargo aircraft won’t be affected by the policy. Domestic airlines will also face some new restrictions.

Prime Minister Benjamin Netanyahu praised the new travel policy, saying in a government meeting “no nation has done what we are about to do,” according to Haaretz.

“We are hermetically sealing the country,” he added.

Read more: More than 200 coronavirus vaccines are still in development as the initial vaccine rollout ramps up. Here’s how experts anticipate 2021 playing out.

While several countries have reinstated travel restrictions to slow the virus’s spread, Israel’s latest motion is among the strictest actions yet. Many countries are now requiring passengers to show proof of a negative COVID-19 test before flying internationally.

Flights leaving Israel for legal or medical reasons will be permitted, as will those for family funerals or relocations. Travel for personal or humanitarian needs will require approval by the government’s directors-general of health and transportation, Haaretz reported.

The flight halt also marks the first time that Jewish people won’t be able to immigrate to Israel unless it’s “a matter of life or death,” transportation minister Miri Regev reportedly said in the meeting.

The harsher travel restrictions come as new variants of COVID-19 rapidly spread around the world. A new, more contagious strain that originated in the United Kingdom has already affected several in Israel and could fuel a new wave of cases. The country’s Health Ministry said Saturday that six out of seven hospitalized pregnant women were found to have been infected with the UK strain.

Separately, one of Israel’s biggest health insurers recently warned of the variant’s spread. Leumit Health Maintenance Office CEO Haim Fernandes said last week that up to half of its tested members had caught the UK strain, Haaretz reported.

Israel reported 4,933 new COVID-19 cases on Saturday, according to Johns Hopkins University data. Since the pandemic’s onset last year, the country has seen more than 4,300 virus-related deaths.

Read more: From abortion care to LGBTQ rights, here’s how Joe Biden is prepared to tear up Donald Trump’s restrictive gender policies

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76% of COVID-19 patients who get hospitalized still have at least one symptom 6 months later, a study found

coronavirus long hauler
A recovered coronavirus patient is monitored by medical staff at the Department of Rehabilitative Cardiology in Genoa, Italy on July 23, 2020.

  • Three-quarters of hospitalized COVID-19 patients in Wuhan, China had at least one lingering symptom six months after getting sick, a new study found.
  • Around 63% of patients reported fatigue or muscle weakness — the most common long-term symptom.
  • Doctors say long-term COVID-19 cases resemble chronic fatigue syndrome, an illness that can last several years or more.  
  • Visit Business Insider’s homepage for more stories.

Tens of millions of people have covered from the coronavirus so far worldwide. But questions linger about what recovery really means. A new study offers a peak at the alarming fates patients who were hospitalized face six months after their illness.

A study published Friday in the journal The Lancet found that 76% of COVID-19 patients who were hospitalized in Wuhan, China, still had at least one symptom six months after getting sick. The study tracked 1,733 adult patients diagnosed with COVID-19 between January and May 2020. 

Researchers followed up with the patients from June to September, conducting lab tests, physical exams, lung-function tests, and in-person interviews.

Around 63% of the patients in the study reported fatigue or muscle weakness after six months – the most common long-term symptom observed. Another 26% of patients said they had difficulty sleeping, while 23% said they had experienced anxiety or depression since getting sick.

The researchers said that to their knowledge, this study is the largest so far to assess long-term symptoms of formerly hospitalized COVID-19 patients. It also has the longest follow-up duration of any research on the topic to date.

“Because COVID-19 is such a new disease, we are only beginning to understand some of its long-term effects on patients’ health,” Bin Cao, one of the study’s authors, said in a statement. “Our analysis indicates that most patients continue to live with at least some of the effects of the virus after leaving hospital, and highlights a need for post-discharge care, particularly for those who experience severe infections.”

‘A forgotten group’ 

coronavirus recovery patient leaving hospital
A COVID-19 patient leaves the Juarez Hospital to go to his house in Mexico City, Mexico, on July 27, 2020.

Of the 390 patients in the study who took a lung-function test roughly six months after their diagnosis, those who’d received supplemental oxygen or been put on a ventilator – people with the most severe infections – were more likely to have lingering reduced lung function. They also had more difficulty walking than patients who’d had milder cases. 

Around 822 patients in the study had normal kidney function while in the hospital, but 13% of them were found to have reduced kidney function six months later. 

Read more: What’s coming next for COVID-19 vaccines? Here’s the latest on 11 leading programs.

Because the new study only examined hospitalized patients, its findings may not be generalizable to everyone experiencing long-term symptoms. 

Until recently, such individuals have been “a forgotten group,” Dr. Steven Deeks, a professor of medicine at the University of California, San Francisco, told Business Insider. 

“Everything has been about the management of acute illness, which is understandable,” he said. “But now there’s widespread acceptance that there are these long-term complications, that they can be disabling.”

Doctors still haven’t come up with a unified term for the set of long-lasting COVID-19 symptoms, but some researchers refer to it as “long-COVID.” Many patients, meanwhile, have defined themselves as “long-haulers.” Deeks said he prefers the term “post-acute COVID syndrome.” 

How many people have this affliction in total isn’t yet known. An August study from UK researchers estimated that one in 10 coronavirus patients experienced prolonged illness. A study from King’s College London that’s still awaiting peer review, found that nearly 100 out of 4,000 coronavirus patients hadn’t recovered after 12 weeks of illness.

Long-lasting symptoms may resemble chronic fatigue syndrome

The new study adds to a growing body of research suggesting that fatigue is a common symptom of long-haul cases. In the King’s College study, nearly 98% of patients who were still sick after four weeks said they suffered from fatigue.

Some patients also report feeling weak or foggy after too much physical activity – a hallmark of chronic fatigue syndrome, which is an illness that can last several years or more.  

chronic fatigue coronavirus
Sandra Cabreras, 57, rides an exercise bike to strengthen muscle tone while suffering from post-COVID fatigue.

Many patients who got SARS dealt with similar long-term symptoms, a useful clue since SARS and the new coronavirus share about 80% of their genetic codes.A follow-up study of SARS patients in Hong Kong found that 27% met the clinical criteria for chronic fatigue syndrome four years after their illness began. And a study of 109 SARS patients in Toronto found that more than half hadn’t returned to work due to persistent fatigue and weakness a year after they were discharged from the ICU.

This ultimately affected the SARS patients’ mental health. More than 40% of those in the Hong Kong study had active psychiatric illnesses, including post-traumatic stress disorder and depression. Only 3% of them had a history of these illnesses prior to their SARS diagnosis.

Mental-health issues, Deeks said, are a “big part of the package” when it comes to post-acute COVID syndrome.

He suspects the new condition is different from chronic fatigue syndrome, though there is likely some overlap. It may take years of research for scientists to understand why certain coronavirus symptoms linger, he added.

“There’s going to be a whole series of studies that are purely observational: Here’s what we saw in our clinic. Here’s what we saw in this hospital group,” Deeks said. “That’ll be helpful, but there will be no control arms.”

An ideal study, Deeks said, would enroll large groups of healthy people, then track them over time. Among the group that winds up getting COVID-19, researchers could then analyze the differences between patients whose symptoms lingered and those whose did not.

“That can take years,” Deeks added. “And in COVID time, that’s decades.”

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US daily COVID-19 hospitalizations have hovered above 100,000 for a month – but experts say the post-holiday surge is yet to come

coronavirus hospital christmas
Respiratory therapist Andrew Hoyt cares for a COVID-19 patient in the intensive care unit at Sharp Chula Vista Medical Center in Chula Vista, California on December 21, 2020.

  • Saturday marked one month of more than 100,000 consecutive, daily coronavirus hospitalizations in the US.
  • Those numbers likely reflect people who were infected before the Christmas holiday.
  • Experts anticipate that hospitalizations will continue to climb, meaning the pandemic’s worst days may still be ahead.
  • Visit Business Insider’s homepage for more stories.

The US coronavirus outbreak has continuously shattered records this winter, but Saturday marked a particularly gruesome milestone: one month of more than 100,000 consecutive, daily coronavirus hospitalizations.

Average daily cases also reached an all-time high of more than 275,000 on Saturday, according to data from the COVID Tracking Project. The US death toll has surpassed 350,000. 

The US’s average daily hospitalizations have more than tripled over the last three months, fueled by holiday travel, pandemic fatigue, and many state officials’ resistance to impose new lockdown restrictions. 

As of December 28, at least 280 of the nation’s hospitals had reached or exceeded maximum ICU capacity out of 4,824 hospitals for which data was available, according to data from the Department of Health and Human Services. In the week leading up to Christmas, nearly one-fifth of US hospitals with intensive care units reported that at least 95% of their ICU beds were full.

But hospitalizations are a lagging indicator: They usually reflect cases that were diagnosed a week ago.

“It takes somewhere between five and 10 days after an exposure to actually get sick from COVID and then it takes another week or so after that to be sick enough to need hospitalization,” Megan Ranney, an emergency-medicine physician at Brown University, told Business Insider.

That means people who were hospitalized around Christmas could have been infected around Thanksgiving. Experts don’t expect infections that occurred over the Christmas holiday to factor into hospitalization data for at least another week – perhaps more. 

“We’re all stealing ourselves for a really difficult next couple of months,” Ranney said in December.

The approval of coronavirus vaccines, she added, represents “a light at the end of the tunnel” – but the pandemic’s worst days may still be ahead.

The US could see another 210,000 coronavirus deaths from now until April, bringing the total death count to more than 560,000, the University of Washington’s Institute for Health Metrics and Evaluation (IHME) predicts.

coronavirus hospital full
Hospital staff sanitize their hands in the COVID-19 intensive care unit at Renown Regional Medical Center in Reno, Nevada on December 16, 2020.

Overflowing hospitals make it harder to treat patients

With the holidays over, US hospitals say they’ve never been more strained. 

Many hospitals are running low on ventilators and personal protective equipment (PPE) like masks, face shields, or gowns, forcing them to reuse these materials as many times as possible. In a December survey from the Association for Professionals in Infection Control and Epidemiology, 73% of infection prevention experts said they had sacrificed their normal standards of care due to respirator shortages.

Without enough beds to treat patients, hospitals are also having to make tough calls about who to admit or prioritize for treatment.

“This is by far one of the most difficult things for me and my colleagues, sending a patient home when we would normally admit them,” Dr. Frank LoVecchio, an emergency room physician at Arizona’s Valleywise Health, told Fox 10 Phoenix. “But you reach that point when the needs exceed what is available.”

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A hospital worker rests against the wall while working at UMass Memorial Hospital in Worcester, Massachusetts on November 11, 2020.

Some hospitals have had to transfer patients to alternate care sites, while others are forced to examine patients in outdoor tents or waiting rooms. Dr. Elaine Batchlor, CEO of Martin Luther King Jr. Community Hospital in Los Angeles, California, told CNN her hospital has started treating patients in the gift shop and chapel.

A tsunami of coronavirus patients also poses an increased risk of hospital staff getting sick themselves. When that happens, hospitals can become even more stretched. 

Josh Mugele, an emergency-room doctor at Northeast Georgia Medical Center in Gainesville, Georgia, told Business Insider he was “really nervous” about getting the virus in December. His hospital had reached maximum ICU capacity, having seen more coronavirus patients than at any other time during the pandemic. 

Mugele was diagnosed with COVID-19 last week. He suspects he got infected while working the night shift on Christmas.

“It’s frustrating now that somebody has to cover my shift,” he said. “The shifts these days are really, really hard. They’re just stressful. There’s a lot of sick people.”

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