Fauci warns seven Midwest states to be on alert over Labor Day

Dr. Anthony Fauci discusses the latest in the fight against coronavirus on Aug. 15, 2020, meeting and medical symposium organized by the American Association of Physicians of Indian Origin and the Florida Association of Physicians of Indian Origin. Photo: courtesy AAPI

Anthony Fauci, the U.S.’s top infectious disease expert, said that seven states that have seen upticks in covid-19 cases should be particularly vigilant over the Labor Day holiday, and warned that if Americans are “careless” there could be another jump in cases this fall.

“There are several states that are at risk for surging, namely North Dakota, South Dakota, Iowa, Arkansas, Missouri, Indiana, Illinois,” Fauci, the director of the National Institute of Allergy and Infectious Diseases, said in an interview this week. “Those states are starting to see an increase in the percent positive of their testing; that is generally predictive that there’s going to be a problem.”

Memorial Day marked a turning point for many newly reopened states, which saw previously moderate covid-19 outbreaks start to spread. July Fourth came just a few weeks before the worst of the U.S. spike, with new cases regularly topping 60,000 later that month. While new infections are down significantly, the daily death toll is still hovering near 1,000, based on a seven-day average.


That has many worried about how the country will fare over the long Labor Day weekend, as the U.S. outbreak tops 6 million confirmed cases and 185,000 deaths.

Fauci joined Vice President Mike Pence on a call with governors this week to urge them to tell their residents to follow guidance on masks, social distancing and other measures to lower the risks of contagion to ensure there aren’t repeats of the surges following the Memorial Day and July Fourth weekends.

“If we’re careless about it, then we could wind up with a surge following Labor Day,” Fauci said. “It really depends on how we behave as a country.”

There’s particular concern since the holiday comes as more Americans are going back to schools, colleges and work, and commercial travel expands.

“There is a lot of potential to see a huge explosion of infections in September and October,” said Eleanor Murray, an assistant professor of epidemiology at Boston University School of Public Health who has called for more nuanced social-distancing guidelines. “We seem to go back and forth between people actually realizing that this is a thing that exists and taking precautions and then deciding it’s all over.”

While infections are tapering in recent hot spots including Arizona, Texas and Florida, a major challenge has been persuading people in areas that haven’t experienced major outbreaks that precautions like masks and social distancing are vital. In South Dakota, where several thousand gathered in August for a 10-day annual motorcycle rally in the town of Sturgis, at least 105 cases have been traced to the event, the state health department said.

The contrast in behaviors is clear for Ashish Jha, dean of Brown University’s School of Public Health. Large parts of the country will behave how one should during a pandemic, he said.

“What I worry about is there are other parts of the country where there is a lot of misinformation, a lot of ‘This is nothing but the flu,’ and a lot of people who haven’t learned the lesson,” he said.

If Americans stick with wearing masks, avoiding indoor crowds in favor of small outdoor gatherings over the Labor Day holiday, “we’re going to be in really good shape going into the fall,” Brett Giroir, the Trump administration’s testing coordinator, said Tuesday.

California’s cities were hit hard early in the pandemic. After relaxing a bit this summer after the spread slowed, the state saw surges in less densely populated regions. On Wednesday, Gov. Gavin Newsom, D, issued a stern warning about the long weekend, urging residents to avoid mixing with people from outside their households and wear masks.

“We saw this a few months back,” Newsom said. “We started to see progress over an extended period of time, and invariably people said, ‘Well, looks like we’re out of the woods.’

“That’s why it’s more important than ever to be vigilant,” he said.

That’s in part because of another concern: The looming influenza season brings the possibility of a “twindemic” if people don’t take precautions, according to Aaron Glatt, chairman of the department of medicine at Mount Sinai South Nassau in Oceanside, New York.

“If people do not do anything and flu just comes, that would make it disastrous,” said Glatt, whose hospital took care of 1,500 covid patients. “We had some patients who had both” the coronavirus and the flu.

The last flu season was particularly bad. The CDC’s preliminary estimates put deaths at 24,000 to 62,000, compared with about 34,000 and 61,000 in the two previous seasons. Final estimates are due this winter.

Fortunately, covid prevention measures also stop the flu.

“We have data now that shows in the southern hemisphere masking and social distancing has dramatically reduced in the incidence of flu there,” Glatt said. “It’s imperative that everybody do all three: Take the flu vaccine, mask and distance.”

More studies are needed to gauge the effect of a combined Covid-19 and flu infection, said Rajesh Gandhi, infectious diseases physician at Massachusetts General Hospital, which has treated more than 1,600 covid patients.

“To be really honest, we don’t want to find out,” said Gandhi, who’s also part of the National Institutes of Health Covid-19 Treatment Guidelines Panel.



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