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Between the cold weather, lax behaviors and the holidays, December and January will be the worst months the United States has seen so far in the COVID-19 pandemic, public health experts said this week. 
The outbreak is bad now, with all 50 states reporting more COVID-19 cases and 33 setting records  in the last week compared to the week before. But based on the virus’ pattern of exponential growth, it’s going to get worse soon, public health experts said. 
Assistant Secretary for Health Adm. Brett Giroir warned Americans on Monday to remain vigilant in the coming weeks. “Our nation is in a critical phase of the pandemic,” Giroir said.
The virus is spreading more quickly throughout the country, with more than 100,000 cases every day. Hospitalizations and deaths are rising. That means people must physically distance, avoid crowds and wear masks, he said. 
“You have a much better chance at surviving COVID than you did even a few months ago,” Giroir said. “Nonetheless, because of the number of cases, hospitalizations and deaths will continue to rise until we rigorously adhere to public health prevention measures.”
Other public health experts have tried to get the nation’s attention in recent days.
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“This is a time when we absolutely have to maximize the power of prevention while we wait for a vaccine,” Dr. Howard Koh, a professor at the Harvard T. H. Chan School of Public Health and the Harvard Kennedy School, told reporters Tuesday.
Katelyn Evans, 16, gets the first of two shots as part of a trial testing Pfizer’s COVID-19 vaccine in minors.
 (Photo: Cincinnati Children’s Hospital)
Dr. Michael Mina, a Harvard epidemiologist, said distancing, masks and frequent testing are becoming even more critical as cases spread. He has long said rapid, inexpensive coronavirus tests are the best hope for slowing the virus until vaccines can be widely deployed.
Abbott is making tests that can be administered under the supervision of a health care worker and deliver results in 15 minutes. The Department of Health and Human Services purchased 150 million kits and is deploying them to states and nursing homes. However, no rapid tests have been approved for home use.
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“Our options dwindle and dwindle and dwindle every day,” Mina said. “This is why Im saddened by this every day because we have had tools at our disposal for months now and we just never have used them.”
‘We’re in for a rough few months’
In many areas of the country, the cooler, drier air of late fall and winter allows respiratory viruses of all types to spread more easily, especially with people spending more time indoors, said Dr. Paul Offit, director of the Vaccine Education Center at Childrens Hospital of Philadelphia and a professor of vaccinology at the Perelman School of Medicine at the University of Pennsylvania.
“I think we’re in for a rough few months,” Offit said.
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The current surge is already more dramatic than earlier this year.
In the worst week of the spring surge, New York had 356 cases of COVID-19 per 100,000 residents, according to a USA TODAY analysis of data from Johns Hopkins University. In the summer surge, Florida suffered the most, with 387 cases per 100,000 people.
Now, North Dakota has 1,239 cases per 100,000 residents.
Projections for the next few months are not uplifting. 
Monday, there were 119,944 new COVID-19 cases in the United States, according to Johns Hopkins data. By Jan. 1, there are likely to be between 300,000 and 350,000 new cases every day, according to one estimate, depending on whether people wear masks and how restrictive public health restrictions are.
‘Pandemic fatigue’ will cause more deaths
Death rates have come down since the spring because of better medical care and because young people, who are less likely to succumb, now make up the majority of those infected.
But Dr. Daniel Griffin, who has been treating patients in New York since early in America’s outbreak, said he thinks death rates will start to climb again, likely reaching a total of 400,000 by February. The death count was about 239,000 on Tuesday.
“Older individuals are getting to the point where they’re willing to take certain chances because they’re really desperate to see their kids and grandkids.”
Dr. Daniel Griffin, head of infectious disease at ProHEALTH
“Pandemic fatigue” over the holidays will drive up those figures by making it harder for people to stay away from family and friends, said Griffin, head of infectious disease at ProHEALTH, an independent, physician-led health care organization. Young people could bring the virus home to parents and grandparents, who are more likely to fall quite ill.
“Older individuals are getting to the point where they’re willing to take certain chances because they’re really desperate to see their kids and grandkids,” Griffin said.
Just as in the spring, an increase in COVID-19 patients could make it hard for hospitals to meet patients’ needs, putting them in even more danger. 
Coronavirus survivor Luisa Antonio, 92, is released from the Brockton Health Center nursing home in Boston on July 9, 2020.
 (Photo: Alyssa Stone/The Enterprise)
In the spring, Griffin pointed out, it was mainly New York-area hospitals that were overwhelmed, so nurses and doctors came to the rescue from other parts of the country. But if hospital demand is increasing everywhere this winter, that won’t be possible.
“If you overwhelm the hospitals and you overwhelm the staff, we don’t have the time and can’t get to everyone in time  and that’s really the tipping point we’re worried about,” he said. “A lot of parts of the country are getting really close to that tipping point.”
A ‘brilliant spring and summer’
As dark as the next two months will be, Griffin and others believe the light will return in the spring.
On Monday, Pfizer and BioNTech revealed that their candidate COVID-19 vaccine was 90% effective in early results. That means a vaccine will likely start rolling out to millions of Americans early in the year.
There will be more treatments and prevention tools, like the monoclonal antibody from Lilly that the Food and Drug Administration authorized for use Monday.
“I think this is potentially going to be a very positive, brilliant spring and summer,” Griffin said. “The world is going to change in a really positive way as we get into the middle of 2021.”
Contributing: Mike Stucka
Contact Karen Weintraub at kweintraub@usatoday.com and Elizabeth Weise at eweise@usatoday.com
Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.
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