There is currently profound despair in the public-health and medical communities. SARS-CoV-2 is spreading relentlessly in every state. Hospitals in the Great Plains and Mountain West will soon reach a disastrous tipping point. Staffing needs will not be met, and ICU beds will not be available for many patients. By Christmas, our country is on track for a daily mass casualty event. Tens of thousands of families may be robbed of quality years spent with loved ones.

Our window to avoid this unprecedented national trauma is closing. SARS-CoV-2 continues to exploit our societal structure — trickling like water into foundational cracks — infecting new sectors of the population at each pandemic stage. In the spring, large outbreaks in senior living facilities resulted in waves of profoundly ill patients, particularly in the New York metro region. Crowded work environments such as meat packing facilities and prisons were hot spots. During the summer, super-spreader events shifted toward socializing younger populations.

Now many transmissions are occurring in people’s homes, at small gatherings with families and friends. The virus is capitalizing on collective COVID fatigue and a misguided sense of trust. Americans falsely assume that friends and loved ones are without risk. Many people also now report that they are unaware of when or where they became infected, an ominous sign that SARS-CoV-2 is widely disseminated in the community.

The circuitous and unpredictable path that the virus has taken obscures that its rules of engagement remain simple. SARS-CoV-2 spreaders are usually unaware they’re sick. The virus spreads efficiently indoors, primarily via aerosols. It can infect many people gathered in the same room, often within a narrow window of time. These super-spreader events, in which a person infects at least five other people, are vital to the virus’ survival in a population.

Accordingly, the necessary steps to stop viral spread are obvious and no longer news: avoid indoor crowds and wear a mask.

However, given our current state of emergency, let me be very specific. If you are considering having friends or extended family over for a social event, then ask yourself if this is really worth putting other people’s lives at risk. If you plan on eating at a restaurant, why not lessen the risk to the staff by ordering takeout. If there are compelling reasons to be among family indoors such as a newborn child or a funeral, then insist that everyone wears a mask and limit the duration of exposure. If a family member returns home for the holidays, ensure that this person quarantines for a week.


These little choices will add up and either cause, or prevent, an exponential growth in cases and deaths. Until we develop a vaccine, making safe choices is our only weapon.

It has become tedious for people in my field to make these nagging recommendations which are at minimum unpleasant and, at worst, painful. We understand how terrible it feels to avoid close friends and family for more than a year.

However, please consider the infinitely worse alternative: tens of thousands of dead Americans. Remember the sacrifice of health-care workers who place your safety above their own, every single day. While we lament the temporary loss of experiences in our lives, hospital staff will suffer mental anguish for years to come as a result of caring for dozens of dying patients in overburdened wards. Understand that our children cannot realistically go back to school if our health care system is imploding. The economy will not recover until thousands of deaths are no longer occurring every day.

Hope is on the way. The incoming administration has organized a COVID-19 task force that will focus on critical issues such as protecting at-risk populations, increasing test availability, formalizing mask mandates and optimizing vaccine allocation. It is likely that effective vaccines are coming this spring. If enough people take them, we can slowly open our society.

Until then, it is on you and me. Unfortunately, the impending death of many thousands of Americans is inevitable. However, the scale of the calamity is yet to be determined. If we all make the necessary sacrifices, we can save more lives than will be lost. We can all be heroes.