The US is close to having ‘exponential spread’ in some areas, and the hardest part may still be ahead, former FDA official says

The country is facing another cycle of the Covid-19 pandemic, and it may be the hardest yet, former Food and Drug Administration Commissioner Dr. Scott Gottlieb said Monday.

“I think we’re right now at the cusp of what’s going to be exponential spread in parts of the country,” Gottlieb said on CNBC’s “Squawk Box.”

“If we took aggressive steps right now, we could potentially forestall the worst of it, but we’re not going to do that,” because there’s a lot of fatigue and “policy resistance to taking strong action,” he said.

“We really have two or three months of the acute phase of this pandemic to get through,” he said. “This is going to be the hardest phase, probably.”

Worst number of cases yet

That’s as the country continues to report the most number of cases we’ve seen to date. The seven-day average of daily new cases reached an all-time high of 68,767 on Sunday, according to data from Johns Hopkins University. The previous record of 67,293 was set July 22.

“Unfortunately, I think the statement about ‘new record’ is going to be repeated over and over again in the days and weeks to come,” said Dr. Ashish Jha, dean of the Brown University School of Public Health.

“I expect that those numbers will continue to climb. Hospitalizations are going to continue to climb.”

Medics transfer a patient on a stretcher from an ambulance outside of Emergency at Coral Gables Hospital where Coronavirus patients are treated in Coral Gables near Miami, on July 30, 2020. (Photo by Chandan Khanna/AFP/Getty Images)

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The abysmal week was marked by the two worst days of daily new cases reported since the pandemic began. More than 83,000 new cases were reported both Friday and Saturday, according to Johns Hopkins.

To be clear: This surge reflects an onslaught of new infections – not just increased testing, contrary to what skeptics claim.

“You know why we have cases? Because we test so much,” President Donald Trump claimed at a rally Saturday in North Carolina. “And in many ways, it’s good. And in many ways, it’s foolish.”

But the seven-day average of new Covid-19 cases has soared 23% in the past week, according to Johns Hopkins data. The seven-day average of new tests performed has risen only 2.87% over the past week, according to the Covid Tracking Project.

And we are long past the point of just urban, heavily populated areas being the only places hit hard. South Dakota’s test positivity rate is 23%, the state’s health department said Monday. That means of every 100 people tested, 23 have been infected. The World Health Organization in May advised governments not to reopen until test positivity rates were 5% or lower for at least 14 days.

States to receive 36.7 million rapid tests

The federal government is shipping 36.7 million rapid Covid-19 tests, and states should be receiving them by the end of the week, the US Department of Health and Human Services told CNN Monday.

The tests are intended to help states with reopening, according to an HHS news release.

“To protect seniors and to facilitate the continued re-opening of schools, businesses and the economy, the Trump Administration prioritized scaling-up our state and national point of care testing capacity,” Adm. Dr. Brett Giroir, the department’s assistant secretary for health, said in a news release Sunday.

President Donald Trump last month announced a plan to send 150 million BinaxNOW Covid-19 tests nationally. HHS on Monday confirmed that this week’s shipments are part of that total.

“Combining personal responsibility with smart, targeted testing is a proven formula to prevent outbreaks – but we cannot ‘test our way’ out of this pandemic,” Giroir said. “Public vigilance in adhering to precautionary measures is required – especially as we clearly see the onset of mitigation fatigue.”

What happens when hospitals get overwhelmed

Some hospitals are starting to max out because of the new surge. And that’s bad news for everyone – not just those with coronavirus.

“We’ve seen what happened earlier in this pandemic, when hospitals become overwhelmed and patients end up not receiving care – not only patients with coronavirus, but also patients with heart attacks and strokes and were in car accidents,” emergency medicine physician Dr. Leana Wen said.

Salt Lake County Health Department public health nurses look on during coronavirus testing outside the Salt Lake County Health Department Friday, Oct. 23, 2020, in Salt Lake City, Utah. (Rick Bowmer/AP)

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In Utah, for example, hospitals could be days away from using a patient’s age, health and other factors to decide who can stay in crowded intensive care units, and who can’t.

“That potentially could be occurring all over the country as our hospitals become overwhelmed,” Wen said. “And unlike last time, where it was only certain parts of the country that were experiencing this, now we have virus hotspots that are occurring everywhere.”

As of Monday, at least 37 states had growing numbers of new Covid-19 cases this past week compared with the previous week, according to Johns Hopkins data. Thirteen states were holding roughly steady, and no state had Covid-19 decreases of at least 10%.

More than 8.6 million people have been infected with coronavirus in the US, and more than 225,000 have died.

Track the virus in your state and across the US

We have ‘a narrow window of opportunity right now’

Yes, the dreaded fall surge is spreading across the country. But if we act quickly, we can prevent it from turning into a catastrophic winter surge, doctors say.

UNITED STATES - OCTOBER 12: Mark Meadows, White House chief of staff, tells the media he wont speak through his mask after being asked to put it on, during a break in the Senate Judiciary Committee confirmation hearing for Supreme Court justice nominee Amy Coney Barrett on Monday, October 12, 2020. The hearing was being held in Hart Senate Office Building. (Photo By Tom Williams/CQ-Roll Call, Inc via Getty Images)

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“This is not inevitable. We actually have a narrow window of opportunity right now to stop the explosive spread that is coming,” Wen said Monday.

“But we have this window to take action now. That includes things like national mask mandates, that includes other targeted policies. This is not an all-or-nothing,” she said.

“President Trump tends to frame this as either we shut down completely, or we literally do nothing. Actually, there’s a lot that we can do that will both save lives and also keep our economy going. We should implement those policies now.”

In Illinois, “there seems to be a Covid storm on the rise, and we have to get prepared,” Gov. J.B. Pritzker warned Monday, announcing some restrictions starting for some regions in the state starting Wednesday.

In Idaho, Gov. Brad Little announced Monday he is moving the state back to a more restrictive phase.

And in Kentucky, a health official expressed concern about a third escalation of the virus that is starting at a higher level of infections than the first two.

“We’re running a lot hotter now. It’s like the popcorn is popping in the microwave at full intensity, and if we launch from here, this is where we get in trouble real fast,” Dr. Steven Stack, commissioner of the Kentucky Department for Public Health, said at a news conference Monday.

A national mask mandate could help keep businesses open

A growing number of officials from across party lines are calling for a nationwide mask mandate.

Gottlieb, a former FDA head appointed by Trump, wrote an op-ed for The Wall Street Journal titled “Winter Is Coming: Time for a Mask Mandate.”

“A mandate can be expressly limited to the next two months,” Gottlieb wrote, adding that it’s easier to wear a mask in the winter than the summer.

An RN hands off a coronavirus sample to medical assistant Bettie Cleveland at a COVID-19 testing site set up by Harvard Street Neighborhood Health Center at Prince Hall Grand Lodge in Grove Hall in Boston's Dorchester on Oct. 22, 2020. (Photo by Jessica Rinaldi/The Boston Globe via Getty Images)

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“The inconvenience would allow the country to preserve health-care capacity and keep more schools and businesses open.”

Andy Slavitt, former acting chief of the Centers for Medicare and Medicaid Services, agreed with Gottlieb on a mask mandate.

“Scott Gottlieb was a Republican. This is not a partisan issue,” said Slavitt, who served in the Obama administration.

“This is an issue for everyone’s public health, and will slow down the spread of the disease.”

If 95% of Americans wore masks in public, more than 100,000 lives could be saved in the United States through February, according to data released Friday by the Institute for Health Metrics and Evaluation at the University of Washington.

“If people are not wearing masks, then maybe we should be mandating it,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Gottlieb wrote that mask mandates have become divisive only because of the way some politicians and political commentators have framed the issue.

“States should be able to choose how to enforce a mandate,” he wrote, “but the goal should be to make masks a social and cultural norm, not a political statement.”

CNN’s Amanda Watts, Jacqueline Howard, Artemis Moshtaghian, Ganesh Setty, Alec Snyder, Naomi Thomas and Kay Jones contributed to this report.