Here's Everything We Know About A Second Wave Of COVID-19
Experts anticipate a second wave happening in the fall and winter months, though it’s difficult to accurately predict with a new virus.
In-person schooling, holiday gatherings, and cold weather driving people indoors could lead to increases in cases around the country.
Experts remind to practice mask-wearing and social distancing as best you can as the months continue on.
The global health situation was pretty intense when COVID-19 first swept across the country—and the world. People were forced into lockdown, with little to no warning, and there was a constant fear of contracting the virus. Now, while life has gone to a new version of normal, the worry surrounding COVID-19 lingers, as does the question of whether or not we're going to be dealing with a second wave of COVID-19.
Public health experts have warned about a possible second wave of COVID-19, and it’s a term that keeps coming up. In a Q&A published in August by the Journal JAMA Network, White House health advisor Anthony Fauci, MD, noted that experts aren’t sure what will happen with COVID-19 once the weather continues to cool off. "I do not know...nor can anyone know what the fall is going to bring,” he said.
While Dr. Fauci has talked in the past about the possibility of a second wave of COVID-19 infections, he now urges people to focus on being prepared. “Rather than say, ‘A second wave,’ why don’t we say, ‘Are we prepared for the challenge of the fall and the winter?’” he told CNN.
He’s not the only expert who thinks that people need to be prepared and act responsibly: “The virus isn’t going anywhere any time soon,” says infectious disease expert Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security. And with many people assembling in groups and crowds again and taking their activities indoors, there is a risk of a new spike in cases.
Okay, but asking for a friend here: What does a second wave mean, exactly? And how worried about this should we be? Here’s everything you need to know.
How do you define a “second wave” of a virus?
FWIW, there’s no official definition of a second wave. “A lot of it is open to interpretation,” says William Schaffner, MD, an infectious disease specialist and professor at the Vanderbilt University School of Medicine. Basically, there’s no set number of cases that need to be reached in a particular period of time in order for an uptick to be considered a second wave, he explains.
Public health experts have generally agreed on a basic idea behind a second wave, though. “A second wave refers to a period of increasing disease transmission following an overall decline,” says Richard Watkins, MD, an infectious disease physician in Akron, Ohio, and a professor of internal medicine at the Northeast Ohio Medical University. “When the overall rate of COVID-19 transmission has declined across the country, and then begins to climb again, that will indicate a second wave.”
There could be smaller increases in cases of the virus here and there—and that’s happening right now in various parts of the country. But what will usually be considered a second wave, at least from a national perspective, is a big resurgence in cases, Dr. Schaffner says.
What causes a second wave of a virus?
Some viruses just work this way, Dr. Schaffner says. “The main reason you get a second wave is that plenty of people didn’t get the virus the first time around,” he says. That keeps the general population from building up herd immunity (a situation where a large proportion of a population is immune to an infectious disease) and leaves more people open to potential infection, he explains.
This has happened with viruses in the past. For example, the 1918 influenza pandemic actually happened in three waves (in the spring, fall, and winter), according to the Centers for Disease Control and Prevention (CDC). The World Health Organization (WHO) also warns that pandemic waves “can be separated by months and an immediate ‘at-ease’ signal may be premature.”
But there is some human error involved in second waves, too. “The second wave will likely occur as people become lax about social distancing and mask wearing,” Dr. Watkins notes. And, as it gets colder and we enter winter months in the U.S., people will be inside more—sharing the same air—which can also lead to more infections, he says. Dr. Schaffner adds that infections can be accelerated and lead to an even bigger wave if people don’t do the social distancing that was effective in the first wave.
It’s also worth pointing out that a virus can mutate, leading to a second wave. The flu does this every year, which is why it’s so important to get an annual flu shot, Dr. Schaffner says.
Sooo…are we in a second wave or not?
Honestly, it depends on who you talk to. Again, a viral wave is not a scientific term, so it’s open to interpretation. Some experts saw the initial onslaught of COVID-19 cases as the first wave, and all of the cases that have cropped up in different areas since, like the south, west, and midwest, as subsequent waves in those areas.
FWIW: Dr. Fauci does not seem to think we’ve seen a second wave yet. Back in July, when many people expected that we would see a break from COVID-19 cases—and didn’t—Dr. Fauci said during a National Institutes of Health (NIH) livestream, per The New York Times, that, “We are still knee-deep in the first wave of this. This would not be considered a wave. It was a resurgence of infections superimposed on a baseline that really never got down to where we wanted to go.”
It’s hard to tell, but Dr. Fauci may be talking from a national perspective. On a local level, “there are going to be plenty of waves as cases rise and fall,” Dr. Adalja notes.
At this point, concerns of a second wave are largely based on theory and historical data of other serious respiratory infections. "It is too early to say with any degree of certainty, although it is obviously concerning," Dr. Watkins says. There’s also no official info from the CDC or WHO that states that a second wave definitely is happening or will happen as of now, but experts from both organizations, along with other doctors, still warn that it's a possibility.
Dr. Adalja adds that COVID-19 isn’t just magically going to disappear without a vaccine, so cases are expected to go up again in the future. “Whether you call that a second wave or just persistence of this one is up to you,” he says. “Will we still be facing this virus in the fall? Yes.”
Could a second wave be worse than the first?
Yeah, it’s possible. “A second wave of COVID-19 could potentially be more severe because it has a longer time to run,” Dr. Schaffner says. Think of it this way: COVID-19 is thought to have originated in Wuhan, China, in late December. It started spreading in communities in the U.S. in February, which is halfway through the winter, a time when infectious diseases like this typically spread.
“COVID-19 was introduced midway through the influenza season this year,” Dr. Schaffner says. “If it surges in October or November, it has more winter months to spread and cause more people to become ill.” And while many people have been living on-edge worrying about COVID-19, “the vast majority of the population in the U.S. has not yet experienced it,” Dr. Schaffner points out; that raises the risk that more people could become infected with a second wave.
Could there be another lockdown?
Lockdowns are determined by local governments, and it’s hard to say for sure what different states and areas will do in the future. Still, Dr. Adalja doesn’t think we’ll see a shutdown like we experienced in the past. “Instead, there may be more precision-directed types of measures,” he says, including continuing to encourage social distancing and limiting mass gatherings and unnecessary travel. “It’s clear the fall of 2020 is not going to be the same as the fall of 2019,” Dr. Adalja says.
No state in the U.S. has gone back to the extreme lockdown measures we saw when the pandemic first began, but there have been both relaxed and increased restrictions happen in various locations, depending on rising case counts in certain areas. For instance, some schools across the country shut down or went to a remote learning model after facing an increase in COVID-19 cases, and many gyms and indoor fitness facilities are operating at a reduced capacity. Bars have been opened and closed, depending on local case counts. Ultimately, a lot of it depends on the state and local governments.
But Dr. Watkins says a more extreme lockdown “might be necessary.” It’s already happened in Singapore, Hong Kong, and parts of China after the countries experienced a new spike in cases, he says.
Can there be *more* waves?
While there’s been a big focus on the second wave, there’s no limit to the number of waves we can experience with COVID-19. “Unfortunately, waves will likely continue until either there is an effective vaccine or at least 70 percent of the population becomes infected,” Dr. Watkins says. “Some models suggest COVID-19 might be around for a few more years.” It’s honestly impossible to say for sure right now.
Technically, the flu keeps having new waves each fall and winter, Dr. Schaffner points out, and it’s possible things might get to the same point with COVID-19. "But, if we had to bet, that’s where we’d put our dollar," he says. "The hope is that we will get at least a partially effective vaccine that’s safe that we can employ widely."
The race for a vaccine has had starts and stops, with some major trials, like those run by Johnson & Johnson and Merck, halting due to an unexplained, serious illness in a trial participant. Currently, there are 11 vaccines in Phase Three (i.e., the final phase) of clinical trials, according to The New York Times’ vaccine tracker. It’s hard to say what will happen next with vaccine development for COVID-19, but many experts are working diligently to get a safe, reliable vaccine to the public ASAP.
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