The US has suffered its worst week for new infections of the entire Covid-19 pandemic just days ahead of the election, underscoring what some epidemiologists described as “life and death” stakes as Americans head to the polls.

Scientists have sounded alarms about unabated Covid-19 spread across the midwest, a spread that has the potential to create even more devastation this winter if nothing is done to control the virus. And political divisions are fueling the surge.

“There were so many red flags early on that made us vulnerable from day one,” said Natalia Linos, a social epidemiologist who ran in a Democratic primary in Massachusetts this fall and is executive director of the Harvard FXB Center for Health and Human Rights. “We were worried, and it showed from day one this has been a political failure.”

As key swing states such as Wisconsin are experiencing “crisis levels” of Covid-19 infections people have been “driven people further into their camps”, said Katherine J Cramer, a professor of political science at the University of Wisconsin-Madison, and author of The Politics of Resentment: Rural Consciousness in Wisconsin and the Rise of Scott Walker.

“There’s still very strong support for President Trump here, and I think among his supporters they think he’s done a great job handling the pandemic,” said Cramer. “Then, the opposite is the case for people who are leaning toward Joe Biden,” she said about the Democratic presidential candidate.

This week marked the worst week in terms of new infections of the entirety of the pandemic in the US, breaking 500,000 new cases for the first time, according to the Covid Tracking Project.

More tests are coming back positive in 47 states, and hospitalizations are climbing in 39 states. More than 1,000 people are dying a day on average, but deaths have not risen as fast as new cases, because they are considered a “lagging indicator”. It often takes weeks between a positive test, hospitalization, death and reporting for victims of Covid-19.

A number of coalescing forces could cause dramatic increases in deaths in the coming months, although they are far from inevitable. Scientists believe deaths have not risen in direct correlation with new cases for a few reasons.

First, more young people, who are more resilient to the disease, are getting infected. Second, clinicians have found ways to modestly reduce mortality through treatment. Last, and most importantly, hospitals are not yet as overwhelmed as they were at the start of the pandemic.

However, if politicians resist enacting containment measures or people refuse to follow them, the virus will spread, and could overwhelm hospitals. Key industries such as nursing homes are again warning of shortages of personal protective equipment, especially nitrile gloves. Further, government watchdogs said the Trump administration is “woefully behind” in stocking gloves necessary to mitigate spread.

“When scientists say this is life or death – this election – it really is. And it’s not life and death equally for everyone,” said Linos. “One in 10 white Americans know someone who has died of Covid, and one in three black Americans do. That is unfair, unjust and my biggest worry.”

Even as cases have increased to record numbers, politicians have shown little political will for more lockdowns. In El Paso, Texas, a local judge declared a two-week lockdown, which was then declared unlawful by the state’s attorney general.

In Wisconsin the Democratic governor, Tony Evers, has framed Covid-19 as an “urgent crisis” but described containment measures as a “self-imposed lockdown”, according to local news station WMTV.

Meanwhile, Trump has held multiple in-person rallies, playing up the threat of lockdowns while also helping spread the virus.

“Biden’s cruel and senseless lockdowns would cause countless deaths from suicide and from all of the problems we have,” Trump told supporters in West Salem, Wisconsin last week. “People lose their jobs. They lose their jobs.”

That is a potent message for supporters, many of whom blame lockdowns (rather than the virus) for devastating local economies.

“People perceive that President Trump has been something of a hero in saying, ‘this has to come to an end,’ and ‘we have to get people back to work,’” said Cramer. “With respect to freedom and employment, people think he’s done the right thing.”

What is certain is the race will turn on Covid-19. Six in 10 voters consider it a “very big problem”, facing the country. An overwhelming majority of Democrats feel lockdowns were lifted too soon, while a majority of Republicans feel lockdowns were not lifted soon enough, according to a recent analysis of polls in the New England Journal of Medicine.

“We’re all so focused on the election but the biggest challenges are in front of us,” said Cramer. The challenge will be “how we actually come together as a state and as a country to deal with this pandemic”.

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