At the same time that America’s health systems are preparing for another surge, the country is abandoning almost all of its funding and structures for dealing with Covid. Testing is inaccessible and more expensive than ever, now that public funding for PCR tests and the three-month price reduction for rapid tests expired. That means it’s impossible even to know how many cases we have—which in turn means we may not know we have a new surge until it’s already upon us. Researchers at the University of Washington, for instance, estimate that currently we are only detecting 4 to 5 percent of cases. Booster campaigns are flagging. The U.S. Centers for Disease Control and Prevention changed its recommendations so that staff and visitors in hospitals and nursing homes don’t need to wear masks unless cases are high, a move that will only make it more difficult for vulnerable people—older people; organ transplant recipients; cancer patients; those with kidney, heart, lung, or liver disease; people with disabilities; those with diabetes or obesity or immunodeficiencies; pregnant people—to receive the care they need. We are pushing to the edges of society those who need protection the most, and we are sickening and disabling those who don’t realize how serious this is until it’s too late or who realize it but are helpless to make the changes needed on a system-wide level.

“I am unfortunately going into winter thinking, OK, well, I’m going to see some people dying, and I’m somewhat helpless to prevent that from happening.”

Health workers too are overstretched, sick, scared of the winter surge, and contemplating leaving the field entirely. “Health care as a whole is so inaccessible right now,” Choo said. “We’re just begging people that we know to be very careful, to not get sick, to not need emergency care—which is something that we’ve said from time to time throughout the pandemic, but it’s now broken beyond recognition.”

Health workers say they have never known so many colleagues who are trying to leave medicine or take a break from clinical work. They are getting sick constantly and scrambling to cover shifts. “Every season we say it can’t get much worse in health care, and then we feel like it’s so much worse than the last season,” Choo said. “And I can’t imagine how bad another surge would be.”