Exactly one year later, as Joe Biden takes the presidential oath of office, he will inherit a pandemic that has sickened and killed more people — and caused anguish and hardship across the nation — at a scale not seen since the influenza pandemic of 1918.
More than 400,000 people have died — a quarter of them in the past month. Nearly 123,000 are currently hospitalized. The rollout of vaccines has been slow and chaotic. And the virus itself has proved to be a slippery foe, capable of mutating in ways that could make it all the more contagious.
“He’s inheriting a disaster,” Jeffrey Shaman, an epidemiologist at Columbia University, said of Biden.
Despite the bleak picture, infectious-disease experts say there is reason for hope. Vaccines have proven to be safe and effective and, offer optimism for an end to the pandemic.
Even before vaccines have made much of a difference, the grim trends in infections and hospitalizations have shown signs of moderating in recent days. Washington Post data showed a peak in hospitalizations nationally at 132,311 on Jan. 6, with modest declines since. All but a few states are now reporting declines in new cases and hospitalizations.
But scientists are worried about the appearance of mutated, more-transmissible variants of the virus that could reverse those trends. They include a highly contagious one, first seen in the United Kingdom, that the Centers for Disease Control and Prevention forecasts could become dominant in the United States by March.
The virus is not a static target, and the world is witnessing a vivid and unnerving demonstration of Darwinian natural selection. It potentially could evolve its way around natural human immunity or escape the immune response elicited by vaccines. That has the CDC and the scientific community on high alert. New variants of potential concern are being identified on almost a daily basis as scientists conduct genomic sequencing on virus samples.
Biden also is inheriting a delayed and disjointed vaccine rollout, the result of poor coordination between the federal government and the 50 states and other jurisdictions that are trying to conduct one of the most ambitious immunization campaigns in history.
The Trump administration’s announcement last week about changes to the vaccine rollout have added to confusion on the ground. The changes raised unrealistic expectations among millions of Americans who are waiting for shots and intensified demand on already stressed sign-up systems, state and local officials said.
“The central unfortunate issue is that the vaccine is too late. It’s too late for most people. A third of the country has already had the virus,” said Shaman, whose research suggests that five times as many people have been infected as have tested positive for the virus.
One of the most immediate issues Biden’s team will need to address is the way vaccine doses will be allocated to the states. Health and Human Services Secretary Alex Azar announced that, starting next week, the federal government will give greater weight to the 65-and-older population and “redistribute” vaccine from states moving too slowly to get people vaccinated and reward those that move faster.
Any forecast for the future of the pandemic depends to a great degree on human behavior, which has been unpredictable and subject to political winds, misinformation and psychological exhaustion. Even though the virus has already claimed more than 2 million globally, many people still view the pandemic as a hoax, or simply as overblown.
Sticking to what works to limit viral spread, such as wearing masks, remains important even when the pandemic numbers trend downward and people start to move about more freely once the restrictions imposed by governors and mayors begin to be lifted, said David Rubin, director of PolicyLab at Children’s Hospital of Philadelphia. At that point, he said, “You’re basically shifting more and more responsibility to individuals, because public restrictions are coming to an end.”
State and local leaders have been announcing few new restrictions, and in some cases have loosened them, as they shift their focus to vaccinations.
Colorado Gov. Jared Polis (D) on Monday asked vaccine providers to use their supplies immediately rather than reserving vaccines for second doses. Washington Gov. Jay Inslee (D) announced Monday a new public-private partnership to vaccinate as many as 45,000 residents daily, drawing on a wide range of groups — from labor unions to Starbucks to the National Guard — to set up mass vaccination sites.
New York Gov. Andrew M. Cuomo (D) on Monday asked Pfizer whether the state could directly purchase vaccines from the drugmaker, mirroring a similar request by Michigan Gov. Gretchen Whitmer (D). It’s unclear whether Pfizer would sell vaccines to states directly, but the requests show a lack of confidence in the Trump administration’s handling of vaccine distribution.
Many states reimposed restrictions as cases started to rise after Thanksgiving, leaving few other measures to implement. In Illinois, Gov. J.B. Pritzker (D) allowed some parts of the state to reopen activities starting Monday, including partial indoor dining in central and northwest Illinois, and museums, casinos and small indoor fitness classes in Chicago.
California Gov. Gavin Newsom (D) sent a letter to Biden on Tuesday praising his plans for a coronavirus stimulus package, including an additional $1,400 check for Americans, and called on him to release “all available vaccines as possible.”
Los Angeles County, which surpassed 1 million cases this weekend, is starting to see a stabilization of high levels of hospitalizations that required conserving oxygen and ambulance trips. Deaths remain alarmingly high, with more than 200 people a day succumbing to the virus and environmental regulators lifting limits on cremations to ease a backlog in corpses held at the coroner’s office.
Officials also caution that progress could be wiped out as a result of new variants of virus that have been detected in Los Angeles County, including the highly contagious mutated version first detected in the United Kingdom. Right now that variant remains scarce in the United States, accounting for fewer than 0.5 percent of cases.
“The wild card here, unfortunately, is that U.K. variant, and whether it comes in and takes over the way it did in southeast England,” Shaman said. “If something like that were to happen here, we’re going to have another surge potentially.”
Researchers at the Cedars-Sinai health system announced Monday that they found a new strain in a third of samples recently reviewed, which could be contributing to the spike in new cases.
Arizona, which saw hospitalizations spike last month after turning the corner from a summer surge, has started to plateau despite fears of another wave of residents falling ill after contracting the virus at holiday gatherings. But it still has the highest hospitalization rate in the country with 69 of every 100,000 residents admitted — the same as the start of the year.
Biden is taking power as the national numbers are at, or very close to, the peak of their winter surge. The only reason the numbers are likely to decline in coming weeks is that the virus has been so efficient in spreading that it is starting to run out of new victims. The virus that for most of last year operated with a wide-open landscape of “susceptibles” now finds itself in a different biological situation, having infected so many people that it often collides with human immunity.
George Diaz, head of infectious diseases at Providence Regional Medical Center, treated Patient One and was surprised by his range of symptoms, including a stomach condition that prevented him from eating. The patient — whose coronavirus infection was announced by the CDC on Jan. 21 — recovered fully, but Diaz in coming weeks and months would discover that the coronavirus was quirky and unpredictable.
The experience of Patient One was “a harbinger of what was to come,” Diaz said. “Now we realize this virus causes very severe inflammation and can attack any part of the body: brain, heart, lungs kidney, liver, and your arteries and veins.”
Since Jan. 20, 2020, the United States has endured several distinct waves of the pandemic, each blending into the next. The spring wave was marked by the associated terror of the unfamiliar pathogen, and the country essentially closed down — a move that drove down infection numbers but crashed the economy. The waves that followed hit the Sun Belt, the Upper Midwest and Southern California especially hard, but few places escaped the virus.
The fall and winter surge has been statistically worse than what happened in the spring, although some of that may be because of testing shortages early in the pandemic. What’s certain is that the virus managed to infect a large chunk of the American population. No one knows the exact number, but the CDC’s modeling assumes up to 30 percent. That’s about 100 million people.
Most have recovered at home, but about 20 percent of confirmed infections have resulted in treatment at hospitals. The infection fatality rate is below 1 percent, but that has translated into the staggering death toll that has been projected to reach 500,000 before the end of February.
Experts warn against fatalism and continue to urge people to focus on what they can do to crush the pandemic. That includes getting vaccinated. The experts agree that one of Biden’s challenges, and that of the scientific community more broadly, is to persuade skeptics that the vaccines are not only safe for individuals but critical to the common good.
Biden promised a million doses a day. That appears to be in reach: Between Jan. 7 and Jan. 14 the vaccination rate — doses actually in arms, not merely distributed to states — nearly doubled, and as of Sunday the health departments collectively were reporting 851,000 doses administered daily on average, according to Washington Post data. More than 15 million vaccinations have taken place nationally as of Tuesday.
“This pandemic has plunged us to the bottom of a very deep well,” Angela Rasmussen, a virologist at the Georgetown Center for Global Health Science and Security, wrote on Twitter on Monday. “After recovering from the shock of a long, abrupt fall into cold, fetid water, we looked up and saw only darkness. But we did find a ladder leading upward.”
Jacqueline Dupree contributed to this report.
