Winter's coming. What can Louisiana expect from COVID-19?

Since its arrival in March, COVID-19 has been a viral disaster like none seen here in a century.

In Caddo Parish, more than 10,000 people have contracted COVID-19. More than 400 people have died because of the virus.

There was a surge of cases in the spring and another in the summer. Now with winter approaching, the conditions are set for another wave of COVID-19 cases and even more deaths. Louisiana is bracing for what could happen this winter with the virus.

Rising cases

Colder weather hasn't come to Louisiana yet. But around the country, one can see winter weather's effect on the spread of COVID-19.

"I clearly think we are entering the third surge,'' Dr. Chris Kevil, LSU Health Shreveport vice chancellor for research said. "That's happening in the Midwest and Mountain West, especially where it is colder.''

Indeed some of the states in those areas -- Illinois, Iowa, Kansas, Minnesota, Nebraska and  Wisconsin in the Midwest and Idaho, Montana, North Dakota, South Dakota, Utah and Wyoming in the Mountain West -- have the highest cases per capita in the nation.

Louisiana, for now, has been able to hold off a third surge. The state probably won't be so lucky in the winter.

"I think the spread of the virus is going to go up,'' Kevil said. "I think here in Louisiana, we've done a commendable job and I think the governor (John Bel Edwards) deserves credit for that and the relationship we've had with his office and LDH and the testing in the nursing homes.''

The state will eventually be challenged by cold weather. Unlike the summer when authorities were concerned about large gatherings, the winter concern is about indoor gatherings.

Edwards said he plans to have a smaller-than-usual Thanksgiving celebration as a model for Louisiana residents to follow.

More:LSU Health Shreveport is offering free COVID-19 testing. Here's where you can be tested

"I think what some of this is showing us is that as people are being driven indoors that is where the spread is happening,'' Kevil said. "It's going to be community spread, familial spread and that's really going to make it challenging.''

Kevil expects the state's number of COVID-19 cases to rise in winter. However, he doesn't see the number of COVID-19 deaths doing likewise.

He said LSUHS' testing in the nursing homes helped bring down the percent positivity of COVID-19 there to less than 1% in late October. Fewer cases in the nursing homes means fewer COVID-19 deaths there.

"We have a real strong grip on the people who are most vulnerable here, the challenge is the people who are younger,'' he said. "They spread the virus. They don't get as sick. But they are certainly vectors for it.''

In this scenario, many of the winter cases would be younger people. And the younger people would be less likely to die due to COVID-19.

"I think the winter is going to be tricky,'' Kevil said. "If we can keep it to the people who are going to spread it, they are going to get it, but they are not the most vulnerable. Say for example, people in nursing homes or the elderly, hopefully death rates will stay low.''

Hospital systems

When COVID-19 first struck the United States in March, the concern was stopping the spread of the virus to prevent hospitals from not having enough bed space for all patients.

While local hospital systems were indeed taxed last spring, they did not run out of bed space or ventilators.

They could be taxed again this winter.

"As far as the health systems, they have historically run at full capacity in the winter secondary to traditional flu and other respiratory illnesses( other pneumonias) before there was even a COVID virus,'' Dr. Phillip Rozeman, a practicing cardiologist and past Chief of Staff of the Willis-Knighton Health System, said in an email. "This is less a bed problem but a problem having enough personnel to open up all the nursing units in the hospital.''

Another concern, Rozeman pointed out, is the mental and physical well being of health professionals. He expressed concern about possible burnout because health professionals have "been going on all cylinders now with the COVID epidemic for the last eight months.''

More:Dr. Phillip Rozeman: Light at the end of the COVID-19 tunnel

Rozeman expects this winter to be a challenging one as well.

"Throughout the COVID epidemic, the health systems in our community have not been overwhelmed, but this winter may be even a greater test -- depending on the issues surrounding the vaccine and any more therapeutic breakthroughs,'' he said.

Vaccines

Everyone's hope since the start of the pandemic has been the development of vaccines for the virus.

"Some of the answer (on what to expect in winter fromCOVID-19) will depend on how fast we will have the vaccine, how many people get vaccinated and the effectiveness of the vaccines,'' Rozeman said. "It will be most important to do high-risk people ASAP-- elderly and comorbid conditions. If we do those by end of year or January, there will be a reduction in deaths and hospitalizations in the winter since those groups are responsible for most of the complications.''

The fastest development of a vaccine on record has been one for the mumps which took four years to complete in 1967.

There has been hope for the development of a COVID-19 vaccine by the end of 2020 or early 2021.

More:LSUHS Chancellor Dr. G.E. Ghali lauds President Trump's COVID-19 response at RNC

Pfizer reported an interim analysis showing its vaccine was more than 90% effective earlier in the week, higher than expectations. Moderna also said trial results for its own vaccine candidate may be available by the end of November.

With such progress, the hope is for vaccines to be available for primary health care workers and older patients by December. The hope is vaccines will be available for all Americans in spring.

Rozeman credits President Trump and the government for efforts to develop a vaccine. The Trump administration formed Operation Warp Speed -- a public–private partnership to facilitate and accelerate the development, manufacturing, and distribution of COVID-19 vaccines, therapeutics, and diagnostics.

"It has been so important the president has pushed pharmaceutical R and D and invested lots of money in the development of vaccines and therapeutics,'' he said. "It is also why it has been so important that the pharma companies are working together. Efforts to slow down the process will only cost people’s lives. Project Warp Speed is important and an example of government working with private enterprise to get something important done. This is much more important than wearing masks, though that is also the right thing to do.''

And like anything in 2020, citizens have to be on guard for misinformation when it comes to the vaccine.

Rozeman said vaccine disinformation has become an issue on social media. 

"It is incumbent on us in healthcare and media to get the facts out when the vaccines are ready,'' he said.

What's ahead

The first day of winter is Dec. 21, but winter weather could hit Louisiana before the calendar says winter.

Although no one knows exactly what is ahead with COVID-19, enough is known for the state's leaders to be concerned.

"We have to be very, very careful between now and the end of the year,'' Edwards said at a recent press conference.''

Louisiana has been one of the nation's better spots for slowing the spread in recent weeks.

But there is no guarantee things stay that way.

"All of the success that we have had is highly tenuous,'' Region 1 Director Dr. Joe Kanter said.