Americans Are in for a Dangerous and Lonely Winter
Editor’s Note: The Atlantic is making vital coverage of the coronavirus available to all readers. Find the collection here. Throughout the pandemic, one lodestar of public-health advice has come down to three words: Do things outside. For nearly five months now, the outdoors has served as a vital social release valve—a space where people can still eat, drink, relax, exercise, and worship together in relative safety.Later this year, that precious space will become far less welcoming in much of the U.S. “What do you do when nobody wants to go to the beach on some cold November day?” Andrew Noymer, a public-health professor at UC Irvine, said to me. “People are going to want to go to bowling alleys and whatnot, and that’s a recipe for disaster, honestly—particularly if they don't want to wear masks.”[Read: How the pandemic defeated America]In recent interviews with Noymer and other experts, I caught glimpses of the winter to come, and what I saw was bleak, even compared with what Americans have already experienced. The winter will be worse—for the quality of daily life in America and, possibly, for the course of the pandemic itself.“There really is no easy way to socialize during late fall [and] winter in large parts of the country if you're not doing it outside,” Ashish Jha, the director of the Harvard Global Health Institute, told me. “Could I have people over in my house for two hours on a Sunday morning in December? Barring really good testing, probably not.”That’s because the risk of spreading the coronavirus is heightened in enclosed spaces. Outdoors, there is enough air for the virus to be “rapidly diluted,” as well as the helpful “virus-killing action of sunlight,” explains Linsey Marr, an engineering professor at Virginia Tech. Indoors, she told me, “the virus can build up” and be more easily inhaled, and “if the space is heated, it can lead to dry air,” which is more hospitable to the virus.The experts I consulted were very concerned about the risks of indoor gatherings, but mentioned several measures that could make them safer if people decide to have them anyway: stay at least six feet apart, wear a mask, wipe down frequently touched surfaces, meet in a building with sufficient filters in its ventilation system, use a portable air purifier and a humidifier, and stay clear of crowded rooms. (If all of that sounds onerous, it’s because spending time indoors with people you don’t live with is really risky—and better avoided if you can help it.)[Read: We need to talk about ventilation]In places with chilly winter weather, the usual reprieves from the cold—cozy indoor gatherings and vacations to warmer climes—will come with significant risks, but going outside and meeting others will still be okay if people keep proper distance and wear a mask. “It may not be spreading a blanket in Central Park and having a picnic, but certainly there are outdoor activities that one can [do],” says David Vlahov, an epidemiologist at the Yale School of Nursing. Going on a walk with a friend or having a snowball fight seemed relatively safe to him. (He was not as keen on sledding with multiple passengers.)Perhaps the safest way to gather in someone’s home, as unpleasant as it might sound, is to make the indoors more like the outdoors. Marr told me that her family doesn’t plan to have any guests inside their house during the pandemic, but may convene winter gatherings in their garage, with the “door open and a heat lamp, with hats and gloves and maybe bundled in sleeping bags.” She also suggested getting together with people outdoors around a bonfire or under heat lamps.Similarly, Jha told me that for close friends, he could imagine opening up the windows in his house and letting in fresh winter air in order to have them over. “It'll be painful for a couple of hours, but we'll sit and at least get a chance to chat,” he said. “Then [they’ll] leave and we'll close everything up and turn the heat back on.”He did, however, bring up a possibility that could spare him, and the rest of us, this discomfort: the widespread use of cheap, quick coronavirus tests. “Imagine those tests get better and they become ubiquitous—could you go and hang out with a friend if you both tested negative that morning, in a community that doesn't have large transmission? I would feel comfortable” doing that, he said. But “I probably wouldn't give them a hug and sit right next to them.”This winter, moving outdoor gatherings indoors could contribute to further increases in COVID-19 cases and deaths. “The winter could get a lot worse than even now,” Noymer said. “There’s plenty of room [in the population] for this thing to expand.”“We know that the biggest risk of spread for this virus is when meaningful numbers of people gather indoors for any extended period of time,” Jha said. “Also, people are already feeling pandemic fatigue, and I think that'll only get worse.” Due to the combination of indoor transmission risk and that increased desire to gather, he thinks “there almost surely will be a spike in cases” this winter.[Read: The coronavirus is never going away]Though data on the coronavirus’s circulation during winter are scant, other respiratory viruses, such as influenza, tend to spread more readily in the winter than the summer. Noymer mentioned some possible explanations for this—that people spend more time indoors together, that the lower level of humidity suits the viruses better, that our mucous membranes get drier and more vulnerable to infection—and said he would be surprised if the coronavirus weren’t aided in colder months by these or other forces.Making matters worse, the pandemic will, if it isn’t somehow neutralized, coincide with flu season, which usually starts in October and is at its worst December through February. Even though researchers don’t yet know how severe this year’s flu season will be, this overlap is worrying for three main reasons.First, even in the absence of a pandemic, flu season can tax hospitals’ beds and resources, Noymer said; having both the flu and COVID-19 spreading at once could further strain an already strained health-care system. Second, “COVID compromises the respiratory system and so does flu, so each of them makes the other one worse,” Vlahov told me. (He says that everyone who’s able should get the flu vaccine this year.) And third, because the two diseases have some symptoms in common, telling them apart can be difficult. That in turn can hinder efforts in hospitals to identify suspected COVID-19 cases, Vlahov said. It also could prompt worry and fear in people who don’t know which disease they’ve come down with, notes Steven Taylor, the author of The Psychology of Pandemics.Winter will be different from now in important, distressing ways, but in other ways it will be familiar. Looking ahead to the colder months, Vlahov thinks that they could resemble the homebound early stages of the pandemic, when many people who were able to “just stayed home and once a week went out for 20 minutes to get some grocery shopping done.”And many Americans are currently living in places where being outdoors for long periods of time already isn't feasible, because of the summer heat. A seasonal shift toward cooler indoor gatherings, Jha thought, might have contributed to rising case counts in some states that have had large outbreaks recently, such as Arizona and Texas. “It’s not [primarily] about summer or winter,” he explained. “It’s about outdoors versus indoors … Arizona in June is like Boston in December.”Also, Noymer noted that many Americans have no choice but to spend time in risky indoor conditions, no matter the season. “It’s always winter inside a meatpacking plant,” he said.The U.S. may still be able to avert the most dismal predictions for winter. “I am more optimistic that November, December, January, February are not going to be some kind of apocalypse that looks like what life felt like in March or April,” Jha said. “I think we can do better than that. But it will require policy intervention.” Namely: widespread, affordable, and quick testing; strongly enforced masking mandates; and improved ventilation in classrooms and other indoor spaces.But Jha can also envision a “nightmare scenario” playing out, with people cooped up indoors, schools closed, a still-weak testing regime, and a bad flu season. Americans could be living like that for months. “I think it is wholly avoidable, but 150,000 deaths later, a lot of this was avoidable,” Jha said. “So I don’t put it past our nation to botch the next phases of the response.”Jha is hoping that useful data from vaccine trials will be available by December. Learning then that a vaccine will arrive in the spring could fortify Americans for the winter, but if a vaccine turns out to still be a ways off, the season will be tougher to bear.The shape of early 2021 could be apparent by the time the weather turns cold. Until then, savor the outdoors.