Anticipating worst surge yet, is US better at handling COVID-19 now?

(CNN) — Dr. Joseph Varon hasn’t taken a day off in 214 days.

“It’s not that I don’t want to. But the patients keep on coming,” said Varon, a critical care doctor and chief of staff at United Memorial Medical Center in Houston.

It used to be worse. After COVID-19 crushed the hospital earlier this year, his team juggled as many as 88 patients at once with the disease. But in the last few weeks, as few as 10 coronavirus patients needed their care.

“Then the last five days have been hell. We’re getting a lot of patients. And the patients are coming in very, very ill.”

The fall COVID-19 surge is gripping the US, and doctors expect the next few months to be the worst period yet.

Seven months into the pandemic, doctors and scientists have made major strides in learning how to better treat patients of this still-new disease. And that knowledge is a huge advantage.

For example, ventilators — once widely used early in the pandemic — are now used less frequently, as doctors have learned how they may injure COVID-19 lungs.

But in some places, nurses still don’t have enough protective equipment. People keep flouting masks and social distancing. And rapid, at-home testing remains a pipe dream.

Here’s where experts say the US stands as it enters the next phase of the COVID-19 pandemic.

What doctors have learned about treatments

Many COVID-19 patients who entered hospitals earlier this year did not make it out alive.

Since then, “the death rate per case … has definitely dropped. And that’s a tribute to modern medicine,” epidemiologist Dr. Larry Brilliant said.

“We have tools in our arsenal now. We have … dexamethasone, which we know works. We have convalescent plasma, which we believe works,” he said.

But as more patients survive, many are also stuck at the hospital with long-term complications.

“Before, people would come in when they were just dying. Now, we keep them alive. But many of them have very bad lung disease, and they will require long-term care,” Varon said.

These days, Varon said he’s again seeing patients come in with more advanced COVID-19.

“Part of that is based on what I call Covid fatigue syndrome. People are tired … they are looking the other way. If they have symptoms, (they think) it’s no big deal. And then by the time they come to us, they are very sick.”

It’s critical to seek medical care immediately because “at the early start of the illness when you have COVID, the virus is multiplying like there is no tomorrow,” Varon said.

He said some treatments can work well, such as convalescent plasma therapy or remdesivir.

Convalescent plasma is a blood product that is taken from volunteers who have recovered from an illness such as COVID-19. That plasma has antibodies that can help stimulate an immune response in someone who is currently sick.

“The evidence on convalescent plasma as a treatment for severe cases of COVID-19 is promising but incomplete,” Dr. Francis Collins, director of the National Institutes of Health, said in a written statement last month.

For now, the NIH treatment guidelines don’t recommend for or against using convalescent plasma to treat COVID-19.

Remdesivir was found to speed recovery in moderately ill patients with pneumonia from COVID-19, according to Phase 3 clinical trial results published in August in the medical journal JAMA.

But this month, the World Health Organization said remdesivir has “little or no effect on mortality” for patients hospitalized with COVID-19 and it doesn’t seem to help patients recover any faster, either.

Despite the ever-evolving research, “we have learned a lot,” Varon said. “What I do today is not what I was doing three, four months ago.”

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Why ventilators might be bad for COVID-19

While states were scrambling to find ventilators earlier this year, Varon and other doctors now only use ventilators as a last resort when treating COVID-19 patients.

With many patients, “we learned that putting somebody on a ventilator is basically signing their death sentence,” Varon said.

“We learned the hard way that putting pressure into your lungs in somebody that has damaged lungs, like COVID patients, was creating more injury than benefit.”

Brilliant said it’s “good news” that hospitals aren’t using ventilators as much on COVID-19 patients.

“Doctors are not shoving ventilators down people’s throats quite as quickly. That’s a wonderful thing,” he said.

Now, doctors like Varon sometimes allow a concept known as “permissive hypoxemia.” The NIH says hypoxemia, or a low level of oxygen in the blood, is common in COVID-19 patients.

“You know how everybody thinks that an oxygen (level) of more than 90% is good, and that’s where you need to stay? We learned that because we were causing so much damage (with ventilators), maybe we should tolerate a little lower oxygen. So if it came down to 85%, we probably would be OK.”

That’s different from his previous methods with non-coronavirus patients, in which those with “85% (oxygen) gets a (breathing) tube. 89% gets a tube. So we learned that we can actually allow lower oxygen concentrations.”

Doctors have also learned that laying patients facedown on their stomachs can help increase the amount of oxygen that’s getting to their lungs.

The technique is called proning. Critical care specialists say lying on the belly seems help because it allows oxygen to get into the lungs more easily.

“We’re saving lives with this,” Dr. Mangala Narasimhan, regional director for critical care at Northwell Health in New York, said in April.

“It’s such a simple thing to do, and we’ve seen remarkable improvement. We can see it for every single patient.”

When patients lie on their backs, the weight of the body effectively squishes some parts of the lungs.

But “by putting them on their stomachs, we’re opening up parts of the lung that weren’t open before,” said Dr. Kathryn Hibbert, director of the medical ICU at Massachusetts General Hospital.

While it’s great that doctors can save more lives, “we’re seeing the long-term effects of COVID,” Varon said.

“We are now recognizing that they end up having some chronic lung issues. Their lung capacity is not what it used to be,” he said. “The heart may or may not have issues. There’s so many things, it’s not even funny.”

How hospital capacity has improved — or not

Varon’s hospital in Houston has turned into a gigantic intensive care unit as it braces for an onslaught of COVID-19 patients this fall and winter.

Across the country, many hospitals are already starting to max out due to soaring COVID-19 cases, said emergency medicine physician Dr. Megan Ranney, who directs the Brown-Lifespan Center for Digital Health in Rhode Island.

“My colleagues across the country are sharing stories of their ERs getting overwhelmed, their ICUs being full, running out of nursing staff because their nurses are getting sick,” Ranney said.

“We are facing the same situation that we were in in April and May in the Northeast and in July in the South. And the trouble now is that we’re seeing it literally across the country,” she said.

“We’re hearing similar stories from my colleagues literally across the country, including here in the Northeast. We’re starting to see hospitalizations tick up. We are seeing people who are much sicker than they have been since that first wave in the Northeast in the spring.”

Infectious disease specialist Dr. Aileen Marty, a professor at Florida International University, said COVID-19 hospital admissions are going up in her state.

“We’re balancing those by being able to get people out of the hospital sooner than we were because we’ve learned a lot,” she said. “But it’s still happening.”

Some health care workers still don’t have enough PPE

In the spring, we heard horror stories about health care workers struggling to find enough personal protective equipment. Some had to make face shields out of plastic report covers. The Centers for Disease Control and Preventionpreviously advised medical workers to use bandanas or old face masks if needed.

Fast-forward to October, and PPE shortages are still a concern, according to National Nurses United, the largest union of registered nurses in the US.

“We must currently rely on firsthand accounts from our members because hospitals are only required to report PPE stock levels to the US Department of Health and Human Services, which does not publicly release the data,” the union said in a written statement.

“The lack of transparency on PPE stock and supply is outrageous.”

Without sufficient PPE, health care workers treating coronavirus patients are at high risk because “the viral load — the amount of virus — does determine the severity of your illness,” said emergency medicine physician Dr. Leana Wen, a former Baltimore health commissioner.

“So that could happen in the case of health care workers who are exposed to a lot more COVID-19 as a result of their work — that they get more severely ill.”

More than 1,700 health care workers in the US have died from Covid-19, according to National Nurses United. It’s a mass tragedy not just for their loved ones and colleagues, but also for patients who relied on their care.

“Let’s be clear that this pandemic is not over. Cases are rising again in many areas of the country,” the union said this week.

“We are still demanding that President Trump activate the Defense Production Act to mass produce PPE, and that federal OSHA promulgate an emergency temporary standard on infectious diseases to mandate that our employers give nurses optimal PPE.”

Insufficient testing is holding the US back

“Unfortunately, the US is not better at controlling Covid-19 than it has been since the beginning of the year,” said Dr. William Haseltine, a former professor at Harvard Medical School and the author of “COVID Commentaries: A Chronicle of a Plague.”

“We have more people infected. We have more states, we have our rural areas affected. Once again, we have hospitals filling up — this time, not just in our major metropolitan areas, but in more rural areas. The death rates are going up,” he said.

Americans should have quick, easy access to testing, Haseltine said. But that’s still not the case in many places.

“One of my grandchildren had a cold. And we had to get tested. It was murderous. In New York City, there were two places that could do the rapid tests,” he said. “Two places in Manhattan. That is unbelievable. And we had to wait hours — six hours just to get tested.”

Health experts agree that testing is key to finding those infected with coronavirus — especially nonsymptomatic carriers — so they can isolate for 14 days and break the chain of infection.

Since the beginning of the pandemic, “we are a little bit better at testing, (but) not much,” Haseltine said.

By this point in the pandemic, he said, Americans should have access to cheap, rapid 15-minute tests similar to the ones used by the NBA.

Haseltine said tests have gotten more accurate in recent months, and some are more affordable — as cheap as 50 cents.

But even if all families had access to rapid tests, not everyone can afford to miss 14 days of work to isolate — especially since many Americans don’t have sick leave from work.

“My recommendation is make (tests) universally available to every household, and if somebody in the household is positive … we make it economically possible by paying them to stay home — the whole family — for 14 days,” Haseltine said.

“That could end this epidemic within three to four months.”

Haseltine said he has calculated the estimated costs for “a program to get everybody three or four months’ worth of free tests — they can test everybody in their family — and pay everybody $500 to stay home for two weeks, for their entire family” if someone tests positive.

“It would cost less than $200 billion. And we are already $16 trillion in the hole on this pandemic (projected through fall 2021). It’s a fraction of what it would cost.”

This plan is “comparatively inexpensive, compared to what we are putting up with,” Haseltine said. “If we decided to push the button now, go full-speed ahead, we could probably have this epidemic over and done with by March.”

So why don’t we all have COVID-19 tests in our medicine cabinets yet?

“From the President on down, most of the official leadership has been deeply misguided,” Haseltine said. “They have focused first on treatment and not on prevention.”

In June, President Donald Trump famously said “slow the testing down, please.” He has said increased testing can lead to higher numbers of reported Covid-19 cases.

Adm. Brett Giroir, the White House testing czar, said COVID-19 testing has improved dramatically in the US.

But Giroir has repeatedly said, “We can’t test our way out of this” pandemic.

“He’s right in a limited way,” Haseltine said. “He’s right that testing isn’t enough. Testing plus isolation is the way to drive this down to zero … voluntary testing followed by paid isolation.”

As for the theory that COVID-19 cases are surging just because of increased testing, “that is absolutely not the case,” Haseltine said.

“That is not why hospitalizations are going up. That’s not why deaths are going up.”

‘A war against stupidity’

While many Americans are getting lax due to pandemic fatigue, some have taken virtually no precautions at all. Either way, cases are surging again, and we’re headed right back to where we started — further delaying a mask-free return to normal life.

Doctors are “better prepared. We’re better studied. But patients are coming in. And people are being stupid,” said Varon, the critical care doctor who’s worked every day for seven months.

“I am fighting two wars. I am fighting a war against Covid, and I’m fighting a war against stupidity. It is unbelievable.”

After spending 16 to 20 hours a day at work, Varon said he’s disgusted by images of people socializing without face masks.

“I just had one of the worst weekends (at work) I’ve had for a very long period of time,” he said. “This is not a hoax. This is real. And anybody who doesn’t believe me, they can come and spend a day with me.”

As for young people, “if you think nothing bad is going to happen to you, you are wrong,” he said. “And I would hate to see you on long-term oxygen or being crippled, having to be on a wheelchair or a walker for the rest of your life.”

That’s not hyperbole.

He vividly recalls a 32-year-old man with no pre-existing conditions and was “healthy as a horse” — until he came down with coronavirus.

“He ended up here with us in the hospital. He was a very sad story,” Varon said. “He spent with us close to 70 days and eventually went home on oxygen — probably for the rest of his life.”

But there are ways to get out of this pandemic, Haseltine said.

“The first thing that we have to do right away is for everybody to take what you hear every public health official say, which is wear a mask and socially distance,” he said.

“The second thing is we have to have a federal policy that we are going to do everything we can to get rapid tests in everybody’s hands immediately. And we are going to pay people to stay home so they don’t infect other people when they are potentially infectious.”

If we take those steps, he said, “we could put this close to zero in four months.”

Coronavirus links

Indiana coronavirus timeline

With information from the Indiana Department of Health through March 4, 2021, this timeline reflects updated tallies of deaths and positive tests prior to that date.

March 6, 2020: Indiana State Department of Health (ISDH) confirms the first case in Indiana. Officials say the Marion County resident had recently traveled to Boston to attend a BioGen conference as a contractor.
March 8: ISDH confirms a second case. A Hendricks County adult who had also traveled to the BioGen conference was placed in isolation. Noblesville Schools says a parent and that parent’s children will self-quarantine after attending an out-of-state event where someone tested positive.
March 9: Avon Community School Corp. says a student on March 8 tested positive.
March 10: ISDH launches an online tracker. Ball State University basketball fans learn the Mid-American Conference tourney will have no fans in the stands. Three businesses operating nursing homes in Indiana announce they will no longer allow visitors.
March 11: The Indianapolis-based NCAA announces the Final Four basketball tournaments will happen with essential staff and limited family attendance. The Big Ten announces all sports events, including the men’s basketball tournament at Bankers Life Fieldhouse, will have no fans starting March 12. Ball State University suspends in-person classes the rest of the spring semester. NBA suspends all games, including the Indiana Pacers, until further notice. Butler University and the University of Indianapolis extend spring break, after which they will have virtual classes.
March 12: Gov. Eric Holcomb announces new protections that led to extended public school closings and the cancellation of large events across the state. The NCAA cancels its basketball tournaments. The Big Ten suspends all sporting events through the winter and spring seasons. The league including the Indy Fuel hockey team suspends its season. Indy Eleven says it will reschedule four matches. Indianapolis’ annual St. Patrick’s Day Parade is canceled.
March 13: The Indiana High School Athletic Association postpones the boys basketball tournament. Wayzata Home Products, a Connersville cabinet maker, shuts down and lays off its entire workforce due to market uncertainty. Holcomb announces actions including the elimination of Medicaid co-pays for COVID-19 testing and the lifting of limits on the number of work hours per day for drivers of commercial vehicles. Franklin College says it will begin online classes March 18 and empty residence halls of students in two days. The Children’s Museum of Indianapolis closes indefinitely. The Indianapolis Public Library joins other libraries across Indiana and closes all facilities indefinitely.
March 14: The Indiana Gaming Commission says all licensed gaming and racing operations will close in two days for an indefinite period.
March 15: Indiana had its first death. St. Vincent Hospital in Indianapolis announces it will suspend all elective, non-urgent surgeries.
March 16: Indiana had its second death. Gov. Holcomb announced the first Hoosier death. He closes bars, restaurants and nightclubs to in-person patrons, but maintains carryout and delivery services.
March 17: Indiana had its third and fourth deaths. ISDH announces Indiana’s second death. Gov. Holcomb activates the National Guard. Purdue, Butler and Indiana State universities cancel May commencement ceremonies.
March 18: Indiana had its fifth death. Eli Lilly and Co. says it will use its labs to speed up testing in Indiana. The 500 Festival suspends all events. Simon Property Group closes all malls and retail properties.
March 19: Holcomb extends Indiana’s state of emergency into May. Holcomb says he’ll close all K-12 public and nonpublic schools; standardized testing was canceled. The state’s income-tax and corporate-tax payment deadline was extended to July 15. Holcomb says the state will waive job search requirements for people applying for Temporary Assistance to Needy Families. Indiana’s high school boys basketball tournament was canceled.
March 20: Indiana’s death toll rose to 9. ISDH announces Indiana’s third death. Holcomb moves the state’s primary election to June 2. Indiana University says it is postponing May commencement ceremonies on all campuses.
March 21: Indiana’s death toll rises to 14. ISDH announces Indiana’s fourth death. Indiana National Guard says it and the state Department of Transportation are distributing medical supplies to hospitals.
March 22: Indiana’s death toll rises to 18. ISDH announces seven deaths.
March 23: Indiana’s death toll rises to 23. Holcomb orders nonessential Hoosiers to “stay at home” from March 24-April 7. Eli Lilly & Co. begins drive-thru testing for the coronavirus for health care workers with a doctor’s order. Ball State University cancels the May commencement.
March 24: Indiana’s death toll rises to 28. Fred Payne of Indiana Workforce Development says any Hoosiers out of work, including temporary layoffs, are eligible to apply for unemployment benefits.
March 25: Indiana’s death toll rises to 33. Indianapolis Motor Speedway announces the Indianapolis 500 is moved to Aug. 23.
March 26: Indiana’s death toll rises to 42.
March 27: Indiana’s death toll rises to 45.
March 28: Indiana’s death toll rises to 58.
March 29: Indiana’s death toll rises to 77.
March 30: Indiana’s death toll rises to 91.
March 31: Indiana’s death toll rises above 100, to 113. Holcomb extends the limits of bars and restaurants to offer only “to go” and “carryout” through April 6.
April 1: Officials extend Marion County’s “stay at home” order through May 1. Marion County health officials say they will start COVID-19 testing services for front-line employees.
April 2: The state announces K-12 schools will be closed for the rest of the school year. Indiana High School Athletic Association cancels spring sports seasons.
April 3: Holcomb extends the “stay at home” order through April 20. The Indiana National Guard says it, the Army Corps of Engineers and state health officials will begin to assess sites for alternate health care facilities.
April 6: The state reports a Madison County nursing home has had 11 deaths. Holcomb extends the “stay at home” order through April 20. He also limits additional businesses to carry-out only.
April 7: Indiana health commissioner Box says four long-term care facilities have 22 deaths that appear to be related to COVID-19.
April 10: ISDH said 24 residents of a long-term care facility in Madison County have died from COVID-related illness.
April 14: Indiana’s death toll rises above 500.
April 16: Indiana records more than 10,000 positive coronavirus tests. The governor says he expects Indiana to experience a reopening in early May.
April 20: Holcomb extends the “stay at home” order to May 1. The governor also says if the medical supply chain is in good shape, other elective medical procedures can resume April 27.
April 22: The Tyson facility in Logansport voluntarily closes so 2,200 employees can be tested for COVID-19.
April 24: The Indianapolis City-County Council approves $25 million to help small businesses. Fishers City Council creates a city health department.
April 25: ISDH says it will launch an antibody testing study for Hoosiers; thousands of residents were randomly selected to participate in the study.
April 27: Indiana’s death toll rises above 1,000.
April 28: Indiana officials say they will open COVID-19 testing to more Hoosiers, with expanded criteria and new testing services at 20 sites around the state.
April 29: The state says it will spent $43 million on contact tracing.
April 30: Indianapolis extends its stay-at-home order through May 15.
May 1: Gov. Holcomb announces a phased reopening plan for the state of Indiana. He also extends the “stay at home” order to May 4.
May 3: Indiana records more than 20,000 positive coronavirus tests.
May 4: Indiana enters Stage 2 of its Back on Track plan, which excludes Cass County until May 18, and Lake and Marion counties until May 11.
May 6:The state begins testing for all Hoosiers at 20 sites, with plans to expand the number of sites to 50 in a week. Ivy Tech Community College says it will continue virtual classes when summer courses begin in June.
May 8: Cris Johnston, director of the Office of Budget and Management, says the state missed out on nearly $1 billion in anticipated April revenues; all state agencies will be given budget-cutting goals. Purdue University OKs plans to reopen for the fall semester with social distancing and other safety measures.
May 13: The first phase of a state-sponsored study of the coronavirus estimated about 186,000 Hoosiers had COVID-19 or the antibodies for the novel virus by May 1. Indianapolis Mayor Joe Hogsett announced plans for limited reopenings of worship services, retail establishments, libraries and restaurants.
May 15: Simon Property Group reopens Castleton Square Mall, Circle Centre Mall, and Fashion Mall at Keystone
May 18: Indiana reports its first case of multisystem inflammatory syndrome in a child. The Farbest Foods turkey-processing plant in Huntingburg is closed for three days; 91 people had tested positive there.
May 21: Indiana records more than 30,000 positive coronavirus tests.
May 22: Indiana advances to Stage 3 of the Back on Track reopening plan. Indianapolis closes portions of five streets to allow restaurants to reopen with outdoor dining only.
May 26: Indiana’s death toll rises above 2,000.
May 27: Indiana University says the fall semester will have in-person and online courses, plus an adjusted calendar through May 2021. Ball State University says the fall semester will be 13 straight weeks of in-person classes with no day off on Labor Day and no fall break.
May 29: Places of worship in Marion County can begin holding indoor services at 50% capacity with proper social distancing. Jim Schellinger, Indiana secretary of commerce, said the federal Paycheck Protection Program has made 73,430 loans in Indiana totaling $9,379,164,461, the federal Economic Injury Disaster Loan program has made 5,070 loans in Indiana totaling $445,428,500, and the federal Economic Injury Disaster Loans Advance program has made 38,365 grants in Indiana totaling $136,554,000.
June 1: Marion County restaurants begins serving customers indoors and outdoors with 50% capacity. Marion County salons, tattoo parlors reopen by appointment only. Marion County gyms, fitness centers and pools reopen with 50% capacity and no contact sports. However, a Marion County curfew that began the night of May 31 and continued into the morning of June 3 after rioting impacted the reopening of some businesses.
June 3: Phase 2 of statewide testing of random Hoosiers by the Indiana University Richard M. Fairbanks School of Public Health at IUPUI and the Indiana State Department of Health begins.
June 5: Indiana reports May tax revenues were 20% short of projections made before the coronavirus closings started.
June 8: Indianapolis leaders agree to spend $79 million in coronavirus relief funding on contact tracing, rent relief, personal protective equipment and support for small businesses.
June 12: Indiana, excluding Marion County, advances to Stage 4 of reopening plan.
June 15: Casinos and parimutuel racing reopen in the state. Marion County’s public libraries begin a phased reopening. Indiana records more than 40,000 positive coronavirus tests.
June 19: Marion County advances to Stage 4 of state’s reopening plan.
June 24: Holcomb says the state’s moratorium on the eviction on renters will be extended through July. Indiana announces it will create a rental assistance program July 13. Indiana Pacers guard Malcolm Brogdon says he has tested positive for COVID-19.
June 27: Indiana hospitalizations for COVID-19 begin to increase, with about 33 new patients a day through July 1.
July 1: The governor pauses Stage 5 final reopening plan, announces Stage 4.5 from July 4-17.
July 4: Indiana’s Stage 4.5 reopening plan begins.
July 9: Indiana records more than 50,000 positive coronavirus tests. Marion County mandates mask-wearing.
July 10: Indianapolis Public Schools announces its reopening plans.
July 11: Indy Eleven resumes 2020 season with victory at Lucas Oil Stadium. The Children’s Museum of Indianapolis reopens.
July 13: Indiana begins rental assistance program for all counties but Marion County. Marion County begins its own rental assistance program.
July 15: Indiana announces the Stage 4.5 reopening plan will continue another two weeks. The WNBA season begins.
July 16: Indianapolis suspends applications for its rental assistance program due to overwhelming demand.
July 24: Bars, taverns and nightclubs in Indianapolis are shut down again. City officials also return to other previous restrictions.
July 25: Indiana Fever begins WNBA season after delays.
July 27: Indiana governor’s order to wear face coverings begins. Great Lakes Valley Conference, which including University of Indianapolis, postpones most fall sports, including football, men’s and women’s soccer, and volleyball, until spring.
July 30: NBA season resumes.
Aug. 4: Indianapolis Motor Speedway announces the Aug. 23 Indianapolis 500 will be run without fans.
Aug. 9: Indiana records more than 75,000 positive coronavirus tests.
Aug. 11: Indiana’s death toll rises above 3,000.
Aug. 17: Indianapolis Public Schools restarts with online-only classes. News 8 learns the 2021 NBA All-Star Game will not happen on Presidents Day weekend in 2021.
Aug. 20: Purdue University suspends 36 students after a party at a cooperative house.
Aug. 21: Indiana high school football season begins with some teams not playing due to COVID-19 concerns.
Aug. 23: Butler University tells undergraduates that instruction will occur remotely for the first two weeks of the semester, starting Aug. 24, instead of in classrooms.
Aug. 24: Purdue, Indiana, IUPUI and Ball State universities resume in-person classes.
Aug. 25: Reports say a fraternity, a sorority and a cooperative house at Purdue University are under quarantines.
Aug. 26: Gov. Holcomb extends the mask mandate through Sept. 25. Indiana’s rental assistance program will take applications for one last day.
Aug. 27: Indiana University says eight Greek houses are under 14-day quarantines.
Sept. 2: Indiana University tells 30 Greek houses in Bloomington to quarantine.
Sept. 6: Indiana records more than 100,000 positive coronavirus tests.
Sept. 8: Marion County allows bars and nightclubs to reopen with 25% capacity indoors and 50% capacity outdoors.
Sept. 12: The Indianapolis Colts open their season with a loss in a Jacksonville stadium with a limited number of fans.
Sept. 21: The Indianapolis Colts home opener is limited to 2,500 fans.
Sept. 23: Gov. Eric Holcomb extends the mask mandate through Oct. 17.
Sept. 24: The state’s mask mandate is extended through Oct. 17.
Sept. 25: The Mid-American Conference announces it will start a six-game football season Nov. 4, with the championship game Dec. 18 or 19.
Sept. 26: Indiana advances to a revised Stage 5 of Indiana Back on Track plan with relaxed limits on gatherings, restaurants, bars, nightclubs and more. Marion, Monroe and Tippecanoe counties decided to have more restrictive limits, however.
Sept. 27: The Indianapolis Colts second home game is limited to 7,500 fans.
Sept. 28: Purdue University says it’s suspended 14 students, including 13 student-athletes, for violations of a pledge designed to curb the coronavirus pandemic on campus.
Sept. 30: The Indiana State Department of Health’s online coronavirus dashboard began showing data on positive coronavirus cases in Indiana schools.
Oct. 1: IU’s website shows two additional fraternities and a sorority at the Bloomington campus have been issued “cease and desist” orders.
Oct. 2: Franklin College suspends classes and moves to virtual education and activities through Oct. 9 after a “concerning and unusual” increase in the positivity rate for COVID-19.
Oct. 12: Franklin College returns to in-person classes.
Oct. 13: Indianapolis-based drugmaker Lilly pauses its trial of a combination antibody treatment for coronavirus for safety reasons.
Oct. 14: Indiana health commissioner Dr. Kristina Box announces she has tested positive for COVID-19.
Oct. 15: Gov. Holcomb issues executive order to extend mask mandate and Stage 5 reopening plan.
Oct. 16: Indiana’s death toll rises above 4,000.
Oct. 18: The Indianapolis Colts third home game was limited to 12,500 fans.
Oct. 23: The Big Ten begins its football season.
Oct. 30: Gov. Holcomb extends the public health emergency through Dec. 1.
Nov. 1: Indiana National Guard to begin deploying to long-term care facilities to provide coronavirus assistance. The Mid-American Conference football teams begins its six-game regular season.
Nov. 5: Indiana records more than 200,000 positive coronavirus tests.
Nov. 8: The Indianapolis Colts fourth home game was limited to 12,500 fans. .
Nov. 10: Indiana’s death toll rises to 5,000.
Nov. 12: Indianapolis calls for schools to go to virtual learning by Nov. 30.
Nov. 15: Indiana adds coronavirus-control restrictions for all businesses and gatherings in counties with the highest number of new cases as part of an update to the statewide COVID-19 pandemic response.
Nov. 16: Indianapolis limits capacity inside bars, private clubs, fraternal organizations and gyms to 25%; inside restaurants, libraries, funeral homes, swimming pools and shopping malls’ food courts to 50%; and inside religious services to 75%. Marion County Health Department requires preregistration for COVID-19 testing after increased demand at three drive-thru locations.
Nov. 22: Indiana records more than 300,000 positive coronavirus tests.
Nov. 23: Indianapolis Public Schools returns to virtual learning through Jan. 18.
Nov. 24: The NCAA men’s and women’s basketball seasons begin; some games had no fans in the stands.
Nov. 25: Indiana’s death toll rises above 6,000.
Nov. 26: Butler University men’s basketball cancels Nov. 29 game against Eastern Illinois after a positive COVID-19 test.
Nov. 28: Butler University men’s basketball team postponed two more games because of a positive COVID-19 test.
Dec. 1: Bankers Life Fieldhouse hosts its first NCAA men’s basketball game, Kansas vs. Kentucky, since the start of the pandemic.
Dec. 2: Indianapolis ends its rental assistance program.
Dec. 5: The men’s basketball game of No. 1 Gonzaga and No. 2, Baylor at Bankers Life Fieldhouse is postponed 90 minutes before tipoff after two Bulldogs test positive.
Dec. 6: Indiana’s death toll rises above 7,000.
Dec. 9: Indiana records more than 404,000 positive coronavirus tests. Holcomb says virus restrictions will now by county based on ratings that show the local virus spread. Indiana and Purdue universities cancel the Old Oaken Bucket football game set for Dec. 12.
Dec. 10: Indiana House Speaker Todd Huston says he tested positive for COVID-19.
Dec. 11: The Pacers lose to the Cavaliers as the NBA preseason begins. The Carmel Walmart in Westfield closes for nearly two days to sanitize the store.
Dec. 12: Ball State University President Geoffrey Mearns tests positive for the coronavirus.
Dec. 14: Health care workers receive the first coronavirus vaccinations in Indiana.
Dec. 15: Vice President Mike Pence holds a roundtable in Bloomington at pharmaceutical maker Catalent on the distribution of COVID-19 vaccines. Indiana and Purdue again cancel the Old Oaken Bucket football game that’d been reset for Dec. 18.
Dec. 16: Indiana’s death toll rises above 8,000.
Dec. 20: The Indianapolis Colts allows up to 10,000 attendees at Lucas Oil Stadium for the team’s game against the Houston Texans.
Dec. 22: NBA starts league’s 75th season, delayed and shortened to a 72-game schedule because of the pandemic.
Dec. 23: In response to the high volume of unemployment claims, Holcomb extends the suspension of certain requirements to expedite the hiring and training of temporary workers to more quickly resolve unemployment issues. Indiana Pacers to host first home game against New York Knicks with no fans present.
Dec. 27: Indiana’s death toll rises above 9,000.
Dec. 29: Indiana records more than 500,000 positive coronavirus tests.
Dec. 31: Indiana’s death toll for 2020 is 9,459 (as recorded through March 4, 2021).
Jan. 1, 2021: Indiana’s death toll rises above 9,500.
Jan. 3: The Indianapolis Colts allow 10,000 attendees at Lucas Oil Stadium for the team’s game against the Jacksonville Jaguars.
Jan. 4: Grades 1-12 schools in Marion County are allowed reopen to in-person learning. Perry Township Schools is the only district to reopen to in-person learning.
Jan. 5: Purdue and Nebraska postpone a men’s basketball game over health and safety concerns.
Jan. 7: Indiana’s death toll rises above 10,000.
Jan. 8: Hoosiers 80 and older start receiving the coronavirus vaccine.
Jan. 13: Hoosiers 70 and older can get the coronavirus vaccine.
Jan. 18: NFL announces the scouting combine will not happen in Indianapolis in February.
Jan. 20: Indiana records more than 601,000 positive coronavirus tests. Indiana Pacers host up to 1,000 at a game at Bankers Life Fieldhouse, the first fans since the pandemic began.
Jan. 21: Indiana’s death toll rises above 11,000.
Feb. 1: Hoosiers 65 and older can get the coronavirus vaccine. The Indianapolis St. Patrick’s Day parade is canceled for the second year in a row.
Feb. 4: More than 1,500 coronavirus deaths were added to the Indiana State Department of Health’s dashboard after an audit found they were not recorded. News 8 learns all games for the Big Ten men’s basketball tourney will move from Chicago to Indianapolis’ Lucas Oil Stadium.
Feb. 7: Indiana to change school protocols for classroom quarantine and contact tracing.
Feb. 14: Indiana’s death toll rises above 12,000. Indiana records more than 650,000 positive coronavirus tests.
Feb. 17: Indiana officials announced plans for a $448 million program to give housing assistance to Hoosiers.
Feb. 19: The NCAA says up to 25% capacity will be allowed for all rounds of the men’s basketball tourney including the Final Four. The Indianapolis Motor Speedway announces the May 30 Indianapolis 500 will have fans.
Feb. 19: Indiana’s death toll rises above 12,100.
Feb. 23: Hoosiers 60 and older can get the coronavirus vaccine.
Feb. 25: Indiana records more than 660,000 positive coronavirus tests. Capacity limits at bars, restaurants, gyms, and music venues in Marion County were adjusted after a consistent trend in the community’s COVID-19 positivity rate.
Feb. 25: Indiana’s death toll rises to 12,200.
Feb. 28: Indiana National Guardsmen to end assistance to long-term care facilities.
March 1: The 500 Festival Mini-Marathon says it will be virtual for the second year in a row.
March 2: Hoosiers 55 and older start receiving the coronavirus vaccine.
March 3: Hoosiers 50 and older start receiving the coronavirus vaccine.
March 4: News 8 learns up 8,000 fans will be allowed in Lucas Oil Stadium for Big Ten men’s basketball tournament games. Indiana records more than 665,000 positive coronavirus tests.
March 5: A three-day, drive-thru, mass-vaccination clinic opens at Indianapolis Motor Speedway for 16,800 Hoosiers.
March 12: A two-day, drive-thru, mass-vaccination clinic was set for Ivy Tech Community College in Sellersburg.
March 18: NCAA men’s March Madness games, all of them at venues in Indiana, to start with First Four games in Bloomington and West Lafayette.
March 26: A two-day, drive-thru, mass-vaccination clinic was set for Compton Family Ice Arena at the University of Notre Dame.
March 31: Holcomb’s emergency declaration with county-based restrictions and a mask mandate set to end at 11:59 p.m.
May 4: Indianapolis Indians set to begin delayed season with away game against Iowa Cubs.

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