Experts Say We Are Still “Knee Deep” in the First Wave of COVID-19. How Bad Will the Second Be?
Since the novel coronavirus first emerged in late December 2019, our world and day-to-day reality have drastically changed. After months of hunkering down for shelter-in-place orders from March 2020 on, all 50 states began to reopen in the spring and summer with varying timelines, guidelines, and regulations. With suddenly crowded parks, pools, restaurants, and bars across the nation, it may have been tempting for some of us to believe (or at least hope) that we were returning to some semblance of normalcy. But despite widespread quarantine fatigue, SARS-CoV-2, the virus that causes COVID-19, never went away.
Unfortunately, new cases of COVID-19 have begun to surge across the country. On July 17, the U.S. reported more than 70,000 new coronavirus cases, breaking its record for the 11th time in the past month, according to a New York Times database. As of press time, case numbers are increasing in 44 U.S. states and territories, and the West and Southeast are covered in hot spots from California and Nevada to Louisiana, Mississippi, Alabama, Georgia, Florida, South Carolina, and Tennessee. While new cases have gone flat in a few areas like hard-hit New York and New Jersey, we’re only seeing a downtick in cases in three states: Arizona, Delaware, and Maine, per reporting by The New York Times.
This uptick in cases—which is even greater than the initial peak of cases in April before nationwide shutdowns were enacted—can’t just be explained away by increased testing, as the number of people hospitalized for complications of COVID-19 is also rising. As a result, nine states, many of which were among the first to loosen restrictions, have had to reverse reopening. California, Nevada, Arizona, New Mexico, Colorado, Michigan, Texas, Louisiana, and Florida have all been forced to backtrack due to outbreaks, reimposing certain restrictions and business closures. Another 13 states have paused their reopening efforts, The New York Times reports.
While public health and infectious disease experts initially warned of a potential “second wave” of COVID-19 this upcoming winter, it may seem as if we’ve already entered a new wave in the battle against this invisible enemy. So, is this the second wave? Or are we still in the first? Regardless, what can you do to prepare for future waves of COVID-19? Read on for the answers, with insight from infectious disease experts.
What does a “second wave” mean, exactly?
“A second wave refers to the resurgence of COVID-19 cases in our population,” says Robert Amler, M.D., dean of the School of Health Sciences and Practice at New York Medical College and former chief medical officer for the CDC.
In late spring, the first wave of novel coronavirus cases in the United States seemed to be “breaking” after its “peak” around the end of March when upwards of 20,000 new cases of COVID-19 and approximately 2,000 deaths from the virus were announced every day, says Jay Varkey, M.D., an infectious disease specialist and director of the Antimicrobial Management Program at Emory University Hospital. In some states, case numbers had begun to stabilize or go down. However, public health and infectious disease experts warned that we weren’t in the clear. A second wave of outbreaks—and perhaps multiple waves—could follow for many months to come.
Why? While social distancing measures have helped slow the spread of the virus, to stop additional waves, we still need to develop a broad immunity to the novel coronavirus or produce an effective vaccine, which might not be available for another year or so, says Dr. Varkey. Since both are a long way off, that leaves many of us at risk of catching the virus, especially since you can spread it without any symptoms.
An uptick in COVID-19 cases could come about if we relax social distancing measures too quickly and too much (allowing the virus to spread more rapidly again) or if the virus ends up following a seasonal up-and-down pattern like other types of coronaviruses and the influenza virus, which tend to arrive in fall and peak in winter months, says Nasia Safdar, M.D., Ph.D., an infectious disease specialist and medical director of infection control at UW Hospital and Clinics.
“That’s been the predictable behavior for so many of these viruses over the years, so we think this virus will behave similarly,” Dr. Safdar says. Past pandemics can give us an idea of what we might expect from COVID-19, too: The H1N1 influenza pandemic, for example, hit the U.S. in the spring of 2009 and returned for a second wave in the fall and winter.
But new cases of COVID-19 never completely leveled out in the U.S., and in many places, they’re still going up. So, are we still in the first wave?
“Yes, we are still “knee deep” in the first wave of the novel coronavirus pandemic in certain regions of the country,” says Bojana Berić-Stojšić, M.D., Ph.D., an ambassador for the United Nations Society for Public Health Education and director of the master of public health program at Fairleigh Dickinson University.
There are multiple outbreaks catching fire with different levels of intensity and being put out at different rates across the country. But generally, experts agree that we never left the first wave of COVID-19 in the United States.
You can blame our national response. Certain states reopened too early, flouting guidelines provided by the CDC and state and local public health officials that would have ideally allowed for the virus to die down to more manageable levels. Because of this, SARS-CoV-2 was able to continuously spread, explains Dr. Berić-Stojšić.
When is a second wave of COVID-19 expected to hit?
Because the United States is a patchwork of differing rates of cases and a second wave can only hit after a first wave has tapered down significantly, it’s hard to say when the next wave might hit and the timing could vary vastly from place to place.
For example, New York—once the epicenter of the pandemic—has gotten cases down to a very low level, which now puts it at risk of a second wave, says Davidson Hamer, M.D., a board-certified infectious disease specialist and professor of global health and medicine at the Boston University School of Public Health and Medicine.
All in all, though, “it’s highly likely we will experience a second wave and possibly more waves starting this fall and winter, with a potential peak around October or November,” says Dr. Varkey. Just remember: We’re dealing with an entirely new (and therefore unpredictable) virus, so it’s probably too early to say whether COVID-19 will follow a seasonal pattern, he says.
Will a second wave be just as bad as the initial coronavirus outbreak?
How bad the second wave could be remains unknown. “We couldn’t really predict the current behavior of the pandemic until it was actually among us, so it’s hard to make sweeping statements about what a second wave might look like,” says Dr. Safdar.
A few possibilities: We might experience a series of waves similar in intensity to the first, a second wave that’s far more severe than the first (which is what happened during the 1918 influenza pandemic), or a “slow burn” of ups and downs in various “hot spots” depending on differing responses to the virus around the world, per a report released by the Center for Infectious Disease Research and Policy (CIDRAP) in late April 2020.
If the virus does strike again in the fall, one complicating factor is our already taxing flu season, says Dr. Safdar. “Our health systems already deal with thousands of people coming in with flu-related illness, and when you have COVID-19 on top of that, it can get overwhelming quite quickly,” she says.
To put this into perspective, during the 2019-2020 flu season, there were at least 39 million cases of the flu and upwards of 24,000 deaths in the U.S., according to estimates by the CDC. As of July 21st, there are more than 3.8 million confirmed cases of COVID-19 and more than 141,426 Americans have died from the illness, according to data from the Johns Hopkins University Coronavirus Resource Center.
Whether we face a tsunami, ripple, or something in between depends on how we respond worldwide, as a nation, and as individuals, says Dr. Varkey. If we’re well-prepared, the wave could be smaller, he says.
How are experts preparing for a second wave?
For starters, public health officials and infectious disease experts are working hard to communicate that social distancing practices must continue, even as new cases of COVID-19 fall in certain places, says Dr. Varkey. Doctors and healthcare workers are also coming together to demand action from elected officials. Organizations like the American Hospital Association and National Nurses United have sounded the alarm on severe and widespread shortages of personal protective equipment (PPE), ventilators, medication, medical supplies, testing kits, and hospital staff desperately needed to continue fighting COVID-19.
Many infectious disease experts are working hard to try to better determine who has been infected with the virus by expanding testing of people with symptoms of COVID-19 as well as testing for antibodies, or proteins your body makes in response to the virus. Although having antibodies for COVID-19 doesn’t necessarily mean that someone is immune to becoming reinfected with the virus, it can give us an idea of who was infected in the first wave in order to figure out just how big or small the second wave will be, says Dr. Varkey.
Contact tracing (or identifying who has been infected with COVID-19, tracking who they’ve been in contact with, and enforcing quarantine to stop the spread of the virus) will also be important as we prepare for a second wave, says Dr. Varkey. The U.S. will need some 300,000 specially-trained contact tracers to do the job, according to an estimation by Tom Frieden, M.D., a former head of the CDC, and there are an estimated 28,000 contact tracers at work so far, per The Hill. The most recent coronavirus relief bill dedicated $75 billion to contact tracing, coronavirus testing, and treatment.
How to prepare for a second wave of coronavirus
Thinking about a second wave of COVID-19 can be really stressful, but you can empower yourself by focusing on what’s within your control right now, says Dr. Safdar. Thankfully, there are many things you can do to prepare yourself and your loved ones for a potential second wave. Here, your quick guide:
✔️Shift your perspective.
COVID-19 is exhausting, but it is far from over, says Dr. Varkey. Rather than wishing you could just “get back to normal,” understand that this is our “new normal” for the foreseeable future—and that could mean periods of social distancing as needed, per the World Health Organization. Off and on, restaurants won’t be able to serve at full capacity, parks will still enforce six-foot distancing, and working from home could extend longer than you’d prefer.
✔️Get your flu shot.
Since the second wave might hit this fall or winter, getting your yearly flu vaccine is a must (yet only about 45% of American adults do it!), says Dr. Varkey. While a flu shot won’t protect you from catching the novel coronavirus, it can reduce your risk of being hospitalized for a gnarly case of the flu—which could leave an ICU bed open for someone who needs it in order to recover from COVID-19, he says.
✔️Find a new way to say “hello.”
It might sound silly, but we need to figure out a new way to greet other people without touching, says Dr. Varkey. No judgment if you’re having a hard time not automatically shaking hands or hugging someone when you see them (after all, you’ve been doing this your whole life!). But now’s the time to pick a new go-to greeting, whether that’s a friendly wave, an air high-five, or “namaste,” he says.
✔️Keep doing what you’re probably already doing.
Chances are, you’ve mastered washing your hands properly, not touching your face, following social distancing guidelines, and self-isolating if you have symptoms of COVID-19. If you have not jumped on board yet, it’s time: Find a face mask you like and wear it out in public when you cannot maintain a distance from others outside of your household. As we brace for the second wave, keep it up and make sure to stay informed by checking in with the CDC and your state health department for the latest updates.
Bottom line: We’re all in this crisis together.
The steps you take to protect yourself aren’t just for you—ultimately, you’re doing your part to keep your family, friends, and neighbors safe. Getting through a pandemic is like running a marathon (or a few), so check in with yourself and the people you care about and reach out for help when you need it, says Dr. Varkey.
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