Friday marked the United States' latest tragic pandemic milestone. It has now reached 700,000 deaths due to COVID-19. Meanwhile, the surge from the Delta variant is beginning to slow down, giving relief to overwhelmed hospitals. The variant's rapid spread through unvaccinated Americans meant that the U.S. suffered from 600,000 to 700,000. It took the country 3 1/2 months to reach this milestone. The death toll is greater than that of Boston. This is a frustrating milestone for public health officials and medical professionals at the frontlines. Vaccines have been readily available to all eligible Americans for six months, and they overwhelmingly protect against death and hospitalizations. There are still 70 million unvaccinated Americans, which is encouraging for the variant. Debi Delapaz, a UF Health Jacksonville nurse manager, said that the hospital lost eight patients per day to COVID-19 during its summer surge. "This is unacceptable." There are some signs of improvement despite the increasing death toll. The number of COVID-19-positive patients in hospitals across the country has dropped to 75,000, compared with 93,000 in September. The average number of new cases is about 112,000 per day, which represents a decline of around one-third in the last two weeks. Deaths are also on the decline, with an average of 1,900 per day, compared to more than 2,000 a week ago. The summer surge is now waning. This can be attributed to more people being vaccinated and wearing masks. A decrease in cases could also be due the virus burning through vulnerable people and running out fuel in some areas. Merck also announced Friday that its experimental drug for COVID-19 patients had reduced hospitalizations by half and prevented more deaths. It will become the first drug to treat COVID-19 if it is approved by regulators. This will make it an important and easy-to-use weapon in the arsenal against the pandemic. All coronavirus treatments in the United States are now approved by the FDA and require injections or IVs. On Friday, Dr. Anthony Fauci warned that some might see encouraging trends as an excuse to not get vaccinated. He said, "It's great news we're beginning to see the curves." "This is no excuse to ignore the need to get vaccinated." It's not clear how flu season will impact already strained hospital staffs or whether people who refuse to get vaccinated might change their mind. Mike Osterholm, the director of the University of Minnesota Center for Infectious Disease Research and Policy, warned that "if you don't have natural infection protection, this virus can find you." Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, noticed a rise in COVID-19 hospitalizations around mid-July. By the beginning of August, the facility was full. It stopped elective surgery and brought in military nurses and doctors to care for the patients. The military team will be leaving at the end October, with fewer cases. Dr. Catherine O'Neal (the hospital's chief physician) said that the hospital's hospitalization rate isn't declining as fast as the community. This is because the delta variant affects more young people, who are generally healthier and live longer in the ICU on ventilators. She said, "It causes a lot ICU patients that don’t move anywhere." Many of these patients don't go home at all. The hospital has seen several COVID-19-related deaths in the past few weeks. There were even 10 deaths on one day. O'Neal stated that O'Neal had just lost another father in his 40s a few days earlier. It's still happening. That's the tragedy of COVID." She said that she cannot predict where the epidemic will lead. She said that Ochsner Health's system medical director for hospital Quality at Ochsner Health, Louisiana, warned the hospital to prepare for the next surge in November. Flu season is also on the rise. However, Sandra Kemmerly, who is the system medical director for hospital safety and quality, stated that this fourth pandemic surge has been more difficult. She said, "It's frustrating for people to lose to vaccine-preventable diseases." Ochsner hospitals were home to 1,074 COVID-19-positive patients at the peak of this latest wave on Aug. 9. As of Thursday, it was 208. Other hospitals are also seeing declines. At its peak in mid-August, the University of Mississippi Medical Center saw 146 COVID-19 patients. This number was 39 as of Friday. Lexington Medical Center, West Columbia, South Carolina had more than 190 patients in September, but only 49 on Friday. Kemmerly does not expect this decrease to continue. She said that she fully expected to see COVID-related hospitalizations increase. Natalie Dean, Emory University professor of biostatistics, is cautious about winter. It is not clear if the coronavirus will follow the seasonal pattern of flu. There are predictable peak times in winter when people gather indoors for holidays. She said that there will be outbreaks and surges in many places due to the country's size and diversity. The uncertainty of human behavior further complicates the situation. People take precautions to reduce the risk of infection. People feel safer and are more likely to mix with others, resulting in a new wave. Dean stated that infectious disease models are not the same as weather models. "A hurricane doesn’t change its course due to what the model predicted," Dean said. A University of Washington model projects that new cases will increase this fall. However, vaccine protection and infection-induced immunity will stop the virus from claiming as many lives as last winter. The model still predicts that 90,000. more Americans will die before January 1, bringing the total death toll to 788,000. According to the model, half of these deaths could have been avoided if everyone wore masks when they went out in public. Ali Mokdad, a professor in health metrics sciences at the university, said that mask wearing is already moving in the wrong direction. "We must be ready for winter, because our hospitals are exhausted."