Dr. Fauci Sees 'Terribly Painful Months' Ahead

November 21, 2020 

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A note to our readers:

The United States is heading into an intensely difficult period of the pandemic. We're also staring down a perilous holiday season, as many Americans struggle to celebrate and honor traditions without putting loved ones in danger.

To address this moment, we've asked some colleagues and experts -- including Dr. Anthony Fauci, the nation's top infectious disease expert -- about the next few months, and how we should think about the holidays.

The last major pandemic in the U.S., in 1918, initially hit in the spring and came roaring back to peak in the fall, when a majority of victims died. In many ways, the coronavirus pandemic of 2020 is following a similar trajectory.

"This will probably be the darkest period," said Julia Marcus, an epidemiologist at Harvard Medical School. "I think we can expect probably the most difficult moment in the pandemic to be these next few months, both in terms of challenges related to social isolation and economic devastation but also sickness and death."

When we spoke to Dr. Anthony Fauci, he told us that what makes this surge different from past waves is the steepness of the curve.

"It's almost an exponential curve," he said. "It's different because when you have an exponential curve up like that, by the time it peaks and then comes ultimately down, the duration of the surge is much longer."

"I think that December, January and early February are going to be terribly painful months," Dr. Fauci added.


Credit...The New York Times

Epidemiologists dread exponential growth because cases can quickly double, then double again. As the country edges closer to recording 200,000 newly detected infections a day, the numbers could become staggering. And even though a relatively small percentage of coronavirus patients actually die, that will be small comfort with cases in the millions.

"Earlier in the pandemic, it was possible for people to make reasonable plans based on risk levels," said Apoorva Mandavilli, who covers science for The Times. "But for the next two to three months, no activity is truly safe unless you're at home with your family."

If you're feeling weary about the prospect of a locked-down winter, there are signs -- for perhaps the first time in the pandemic -- of significantly better times ahead, provided we can get through the next few months.

Asked about what gives him hope, Dr. Fauci cited "the spectacular results of the vaccines." Now that shots from Pfizer and Moderna are on their way, with Pfizer applying for emergency F.D.A. approval today,"this should be a motivation to double down even more to get us through this until the vaccine comes to the rescue."

Don't take the vaccines as an invitation to throw caution to the wind, he said. "It's kind of like the last soldier to get killed in a war when the war is going to be over soon. You don't want to be that person."

The way most people become infected in the U.S. may be shifting. In the summer, a large driver of infections was young people socializing and bringing the virus home to their parents and relatives. Now, family and social gatherings are assuming a much more prominent role, Dr. Fauci said.

"Which is the reason why the Thanksgiving holiday makes me really nervous," he said.

Dr. Megan Ranney, an emergency physician in Rhode Island, put it this way to our colleague Charlie Warzel, an Opinion writer at large: "I hate to be apocalyptic, but it'll be the day that will determine our trajectory for the rest of the year."

We went to our experts for advice about how to make the holidays safer. They all agreed on one thing: This year, Thanksgiving should ideally be just for you and your immediate family. The Centers for Disease Control and Prevention has the same advice and some states have limited the size of gatherings, including in private residences.

But that doesn't mean it can't still be a celebration.

"Revel in the fact that you, the cook, have the day off and you can make exactly what you want to eat," said Melissa Clark, a columnist for the Times Food section. "Give yourself permission to make the food you want -- some of my friends are having Sichuan dumplings and pumpkin pie."

If you do gather, Tara Parker-Pope, the founding editor of Well, has some advice.

  • Consider the most vulnerable. "Is there somebody who is at high risk?" Tara said. "Maybe it's an older person, someone who is immune compromised, somebody getting cancer treatment, or somebody very obese or with diabetes." Consider their needs first.

  • Stay small. Keep your guest list as small as possible. You have to know where everyone has been, because one person who's been exposed can put everyone at risk. "Friendship does not make a bubble, behavior makes a bubble," Tara said.

  • Take it outdoors. If you live in a warmer climate, or even if you don't, move the meal to the backyard. If you are eating indoors, keep the windows open and turn on exhaust fans in the bathrooms and kitchen.

  • Mask up. Wear a mask as much as possible. Tara said she would model behavior. "When I saw the meal start to shift to the conversation afterward -- which is the best part of the meal -- I would take out my mask and put it on," she said.

  • Wash your hands. We often overlook it now, but it's still important.

Tara told us that she canceled her own Thanksgiving plans and is having dinner with just her daughter.

"I know these are hard choices for people," Tara said. "I'm telling people, 'A sacrifice this holiday will give you many, many more holidays with the people you love. Don't make this the last holiday with them.'"

A warning about tests. "If you start using testing to justify your 10 or 20 person gathering, you are making a big mistake," Tara warned. Testing can lower your risk, and it can be useful for college students coming home or for people caring for an older relative, she said, but a negative test isn't 100 percent reliable and is not a replacement for other precautions, like mask-wearing and social distancing.

A tool to understand your risk. How safe is a Thanksgiving dinner in Des Moines? Or Boise? Or Atlanta? Researchers at Georgia Tech created a risk assessment tool that can estimate the chance that someone infected with the virus will show up at dinner in your county. Gather with 25 people in New York City, for example, and there's a 21 percent chance at least one person is positive. In Stutsman County, N.D., there's a 99 percent chance.

We asked families to share how they're adapting their Thanksgiving traditions this year. Their words, edited for length and clarity, show that even in a year full of pain and difficulty, Americans are determined to find a way to give thanks.

(Dr. Fauci, for his part, told us he is most thankful for his wife, Christine Grady, chair of the Department of Bioethics at the National Institutes of Health: "She's sort of like a solid anchor in the sense of unflappable and extraordinarily good judgment ... whenever I feel I'm flailing around in the universe of people that want to kill me, want to fire me, want to behead me, it's always nice to come home to somebody who's really a very rational person.")

Our family is circulating a food sign-up list, and we'll deliver favorite dishes to those who request them. We ended up laughing at the almost complete disagreement about what the best foods were. It turns out that some have been pretending to love traditional foods that very few people actually enjoy, and those who enjoy the traditional are totally uninterested in all of the added recipes I've introduced over the years.

-- Kathryn L. Nelson, Minneapolis

Instead of gathering with family, we are planning to order different components of the meal from area restaurants. They need the support. Extra food will be packed up and shared with a few we know are struggling.

-- Mary Godlewski, Chicago

My parents, who are 78 and 81, live in Canada. I haven't seen them in a year. To keep everyone safe, I won't be going home for Thanksgiving or Christmas. Because I can't be there, I had a life-size cardboard cutout of me made and sent it to my parents. While it's ridiculous and slightly silly, I know it's bringing a smile to my mom's face.

-- Christine Campbell, Los Angeles

I'll be at work, in our I.C.U., where we'll be short staffed, again, because of the growing numbers. I'll be having Thanksgiving with my work family hoping we'll have a chance to eat.

-- Nicole Germano, South Portland, Maine

We are moving our Thanksgiving outdoors and earlier in the day with a group of less than 10. Building a bonfire and ditching the traditional meal in favor of soups and appetizers that can be hand held. No one is mad that we aren't having turkey -- maybe that part of the change will stick!

-- Annie Wanner, Minneapolis

For the past several years, my boyfriend and I have cooked a big Thanksgiving meal together. We live separately in our own apartments. We are healthy but older, 67 and 72, so we are being cautious and are practicing social distancing. For this Thanksgiving, we plan to take a nice walk and share a quick snack at my place (windows open) or in the park. We'll watch a movie together, but remotely, in our own homes. Our goal is to stay healthy and alive during these holidays, with the hope that we can have a real Thanksgiving together in 2021.

-- Karen Kawaguchi, the Bronx, N.Y.

I'm a college student living states away from the rest of my family. If I went home for Thanksgiving, I'd have to finish the rest of the semester from Chicago, instead of on campus in Boston, where I am now. So I'm going to be spending the break in my dorm, eating dining hall turkey by myself.

-- Tyler O'Brien, Boston

We took advantage of an unusually warm day in November for Connecticut and had Thanksgiving early outdoors! We invited our parents and siblings over and had a potluck-style Thanksgiving dinner al fresco. It was fantastic!

-- Teri Schatz, Woodbridge, Conn.

Skipping it. No risk, no harm, no one gets sick, no one dies, no one grieves. Better apart than under. I respect and love my family enough to remain apart so that we are able to enjoy many more years of celebrations.

-- Paul Marber, New York, N.Y.

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Ian Prasad Philbrick contributed to today's newsletter.

Email your thoughts to briefing@nytimes.com.

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