By Erika Edwards and Denise Chow - NBC News
In the pre-dawn hours of March 30, Dr. Deborah Birx stood in front of the camera on the White House lawn and made an alarming prediction about the coronavirus, which by then had killed fewer than 3,000 people in the United States.
"If we do things together, well, almost perfectly, we can get
between 100,000 and 200,000 deaths
," Birx, coordinator of the White House coronavirus task force, told Savannah Guthrie of NBC News' Today show.
"We don't even want to see that," she added, before Guthrie cut her off.
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"I know, but it takes my breath away with that prediction," Guthrie said.
"Because what I hear you say is that this is the best case," he added.
"The best scenario," Birx replied, "would be for 100% of Americans to do precisely what is required."
On Saturday, Birx's prediction came true as the number of lives lost to the pandemic in the United States surpassed 200,000.
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Experts such as Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention (CDC, for its acronym in English), recalled that this should not have been the case.
"Tens of thousands of people would not have died if America's response had been more effective," said Frieden, now president of Resolve to Save Lives, a global public health initiative.
Michael Osterholm, director of the Center for Infectious Diseases Policy and Research at the University of Minnesota, said Birx's prediction in late March was
"very sobering
.
"
That was the time, he said, to develop and implement a plan to stop or at least slow the spread of the virus.
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That didn't happen then and it hasn't happened since.
"Where is our national plan?" Osterholm wondered.
"How are we so far from having one and why don't we?" He added.
"We have a long way to go," he concluded.
In fact, the country still faces many challenges in overcoming the pandemic, including elementary awareness.
Americans are still arguing over whether they should wear masks, whether the virus is serious, and how safe it is to reopen certain businesses and resume certain activities.
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In short, 100% of Americans, including government officials, are still not doing exactly what is required.
Another ominous prediction
Now many experts are making another dire prediction: A surge in infections in the fall and winter, combined with a growing fatigue from respecting social distancing and other public health measures,
could result in more than 415,000 deaths in the US for the month. January
, according to the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.
The prediction comes even as doctors' treatments have improved substantially and clinical trials are revealing that treatments like remdesivir and dexamethasone can help.
As the pandemic has spread in a second wave, the youngest and healthiest populations that are least likely to die from coronavirus have become the most infected.
A woman walks past Green-Wood Cemetery in Brooklyn, New York, adorned with tributes to victims of the pandemic, on May 28, 2020.AP Photo / Mark Lennihan
The IHME projections are not set in stone.
Changes in human behavior, such as an increased habit of wearing masks, can significantly lower the predicted figure, said IHME director Dr. Christopher Murray, professor of health metrics sciences at the University of Washington.
But experiences in other countries have shown that as the pandemic progresses, public relaxation is a real concern.
"We are seeing it in a very big way in parts of Europe, for example, where the lack of surveillance is already causing a big rebound," Murray said.
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The IHME model is one of several the CDC uses to track the evolution of the pandemic, but it has suffered from some skepticism.
The model often includes high degrees of uncertainty and was criticized from the start for underestimating the number of deaths across the country.
In April, for example, the IHME model projected that the death toll in the US through August could be 60,415, although the prediction included a wide range to account for uncertainties at the beginning of the pandemic.
Murray explained that the model is constantly being improved to provide more accurate scenarios, but that
most community researchers had been warning for months that the pandemic could have a large death toll.
It's the kind of knowledge, Murray noted, that makes the 200,000 death milestone even more frustrating.
"Obviously, there is something quite depressing about this whole drama as it unfolds," he recalled.
"It's like a train wreck that we know is unfolding and people are still clinging to the idea that it's not that bad," he exemplified.
200,000 who did not expect to die
For those whose loved ones have died, such complacency is "like a daily kick in the teeth."
Nicole Hutcherson of Goodlettsville, Tennessee, lost her father, Frank M. Carter, 82, to the coronavirus in April.
Hutcherson said that since then, people around her have questioned whether the pandemic is real (it is) or have suggested that her father was already frail or ill before becoming infected with the virus (he was not).
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"My dad could work more than anyone in his 30s," Hutcherson said.
"People are just not realizing that this is a big problem," he added.
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Dr. E. Wesley Ely, a professor of medicine and critical care at Vanderbilt University Medical Center in Nashville, Tennessee, called the 200,000 deaths a "sad benchmark."
"That's 200,000 people who didn't think they were going to die this year," Ely explained.
The pandemic has killed people of all ages, all races, and all political affiliations.
Including a veteran New York Fire Department emergency medical technician, a pastor in Texas, a nurse in South Carolina, or children who have succumbed to a rare inflammatory complication of the disease called MIS-C.
The states that currently have the highest number of daily deaths from coronavirus are California, Florida and Texas.
By far the state with the most deaths is New York, with just over 33,900 as of Saturday.
A Coronavirus "Tsunami"
Dr. Hugh Cassiere felt he was facing a "tsunami" of seriously ill coronavirus patients when New York was at its peak in March and April.
He ran an intensive care unit at North Shore University Hospital, part of Northwell Health, on Long Island.
The coronavirus presented
new challenges
even for veteran ICU doctors.
"There were a lot of deaths every day, no matter how best we could do it. It was professionally and emotionally overwhelming," Cassiere recalled.
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But not all the patients made it to the ICU.
Joyce Brown Wigfall, a nurse in Forest Hills, New York, began feeling ill on March 30, the day Birx made the prediction of 200,000 deaths.
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Wigfall, 67, felt weak and had trouble catching her breath when climbing stairs - unusual symptoms for a woman who raised five children, loved Zumba classes, and had just completed a master's degree in nursing while already applying for a doctorate.
"I was so proud of her,"
said Wigfall's son, Erik Brown, 33.
A week after falling ill, Wigfall was diagnosed with coronavirus, but felt well enough to recover at home.
Brown said her mother was still engaged to her co-workers from afar, and on April 12 claimed she was ready to go back to work.
On April 13, Wigfall's health rapidly deteriorated.
He died within a few hours.
His death left an immeasurable void.
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"She was the center of the family. She was the rock," Brown said.
"I'm angry that we still don't have any kind of concrete plan to get the country back to 'normal', whatever that is," Brown lamented.
"There is still no way we can get back to the life I had before March 30," he added.
Parishioners prepare a memorial for José Agustín Iraheta, who died of coronavirus, before funeral blessings at Santa Rosa de Lima Catholic Church in Chelsea, Massachusetts on May 12.Brian Snyder / Reuters file
An unpredictable path
Much is still unknown about how the virus might progress in fall and winter, particularly regarding whether seasonal changes will affect how it spreads within communities, as cold weather draws people to the interiors.
But
experts stressed that maintaining vigilance will be one of the most effective ways to contain it
and prevent out-of-control outbreaks.
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A team from Northeastern University in Boston created a model that provides state and national projections up to four weeks into the future, similar to a weather forecast.
Beyond four weeks, the accuracy of the model can be diluted by many unknown factors, explained Alessandro Vespignani, director of the Northeastern Institute for Network Sciences.
Numbers aside, Vespignani insisted that certain proven strategies, when followed, would reduce the number of future cases and deaths.
Mexican Consul General Jorge Islas López leads a group of people carrying cremated remains after a prayer service at St. Patrick's Cathedral in New York on July 11.
The service was held to bless the ashes of Mexicans who died during the coronavirus pandemic but were unable to have funeral Masses or burials.Andrew Kelly / Reuters file
"A storm will do what it is supposed to do. You can't do anything about it," Vespignani said.
"With an epidemic, we can change the trajectory," he said.
Many of the ways to do this are not new, such as wearing masks, practicing good hygiene by washing your hands frequently and getting a flu shot, she said.
Managing the factors that can be controlled will be crucial in the coming months, especially as most scientists anticipate a new wave of infections during the fall and winter, coinciding with the flu season.
"Winter is coming and there could be another wave of transmission ahead
, so we still need to have a plan to deal with that," said Sen Pei, an associate research scientist at Columbia University, who has done extensive modeling work. of the pandemic.
"Otherwise, we will continue to see people die," he warned.
The IHME model's prediction that the United States will double its number of coronavirus deaths by January, to 415,000, is not unrealistic, according to experts.
Cassiere of Northwell Health sees it achievable: "I think we'll easily hit 400,000."