Hospitalizations for COVID-19 have reached the highest point of the pandemic, forcing leaders from Alaska to Massachusetts to propose stringent mask rules and limits on gatherings while avoiding, at least for now, the sweeping lockdowns that ruined the economy in the spring.
With 60,000-plus patients, the hospital crush exceeds the worst of the Sun Belt surge and springtime disaster in the Northeast.
North Dakota Gov. Doug Burgum, a Republican, is allowing asymptomatic hospital workers to keep rendering care to reduce strain on the health care system. El Paso, Texas, is bringing in mobile morgues — a sign of the rising death toll despite improvements in survival rates.
Governors are trying to maintain health care capacity by stamping out the spread of the virus on the front end.
Iowa Gov. Kim Reynolds, a Republican who has resisted a statewide mask mandate, ordered people this week to cover their faces in large public gatherings. Massachusetts Gov. Charlie Baker, a Republican, imposed a curfew from 10 p.m. to 5 a.m. and told people to wear masks anywhere in public, even outdoors.
Minnesota Gov. Tim Walz, a Democrat, announced a “surgical” approach to restrictions this week. He said bars and dine-in service must close at 10 p.m. and be capped at 50% capacity to limit where young people congregate. He capped funerals and weddings at 50 people as of Nov. 27.
New York Gov. Andrew Cuomo, a Democrat, said Wednesday that all restaurants must close at 10 p.m. and private gatherings must be limited to 10 people as of Friday.
The U.S. used blunt lockdowns to curb the spread of the novel coronavirus in the spring because of fears that hospitals would be overwhelmed. But experts say contact-tracing data gathered throughout the pandemic has given a better sense of where the virus is likely to spread, including bars, restaurants and gyms.
“That allows targeted public health interventions to be put into place. This could include capacity restrictions on certain venues, limits on the number of people at a gathering, in modifications of other points of interest such as gyms,” said Amesh Adalja, senior health scholar at the Johns Hopkins Center for Health Security.
He said there is some evidence that approach can work. States in the South and West used a mix of business closures, mask rules and other moves to reel in their midsummer spikes.
“The goal should be to target those activities leading to spread while leaving others intact, but we need to be able to test enough to be well-informed about the epidemiology of spread,” Dr. Adalja said.
Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine, said preventing surges in intensive care units will be key to keeping mortality rates low. Some communities may be able to get by with limited, targeted measures while others may need to be more aggressive.
“This is where we need depoliticized advice from the [Centers for Disease Control and Prevention],” he said.
State leaders have been the public faces of mitigation efforts as the Trump administration focuses on progress in approving a vaccine and getting groundbreaking therapeutics to hospitals.
Progress in treating the disease has driven the case fatality rate to 2.4%, down from 6% early in the year, though more than an average of 900 people are dying from COVID-19 every day.
The world also is cheering signs that the Pfizer vaccine is highly effective and could be approved within weeks, though the rollout campaign will take months and will face a series of challenges. The vaccine must be stored at minus-94 degrees Fahrenheit, and those who take the vaccine must return for a second dose.
While the world waits for a vaccine, cases are surging well beyond 100,000 per day in the U.S. and deaths are topping 240,000.
President Trump has spent the week since Election Day contesting the results and highlighting claims of voter fraud instead of hosting the types of COVID-19 briefings that dominated the federal response earlier in the year.
Photos of a “Save Our Majority” rally for Republicans in Cobb County, Georgia, on Wednesday raised new questions about adherence to safety protocols. The crowd stood shoulder to shoulder indoors, many without masks. A CNN crew left because of the risk of transmission.
Presumptive President-elect Joseph R. Biden is trying to emphasize mask-wearing as he forms a COVID-19 advisory board during the transition process.
Thirty-four states and the District of Columbia mandate face coverings in public in some form, according to AARP. The CDC recently updated its guidance to say masks provide a protective benefit to the wearer by blocking infectious droplets. Officials previously focused on the benefits of masking people so they don’t spread the virus, particularly if they are asymptomatic and don’t know they are infected.
Utah Gov. Gary Herbert, a Republican, recently issued an emergency order requiring residents to wear masks in public and limit “casual social gatherings” to members of their household until Nov. 23.
“Laws are put in places to protect all of us. That’s why we have traffic lights, speed limits and seat belts, and that’s why we now have a mask mandate,” he said.
Other Republican leaders have resisted mask mandates. That includes North Dakota and South Dakota, which over the past seven days have ranked first and second, respectively, in the nation in COVID-19 cases and deaths per capita.
Mr. Burgum, who is allowing asymptomatic health care workers to treat patients who have the virus, hasn’t issued a statewide mask mandate in North Dakota. Instead, he emphasizes personal responsibility, but he is allowing local officials to issue mandates.
Sioux Falls Mayor Paul TenHaken recently declined a mask mandate in his South Dakota city. “The small uptick we’ll see in compliance is not worth the community division that this will create,” he said.