Forget the Idea of a Second Wave of Covid-19

The coronavirus will go where it hasn’t been yet and back to where it has

Forget the idea of a second wave of Covid-19 in America. Think instead of a wave that went into a pool and now it’s sloshing around, suggests Roger Shapiro, MD, an associate professor of immunology and infectious diseases at Harvard T.H. Chan School of Public Health. SARS-CoV-2 is likely to slosh into every untouched corner of the country and flow back into places it’s already been, pushing the number of daily new infections back up near the highs seen during summer, possibly higher.

“The places where it hasn’t been, it will go,” Shapiro told a group of reporters on October 7. “The places where it has already been, it can go back.”

Nobody can predict exactly where the coronavirus will go next or what communities will be hardest hit, but no state, city, or community is immune, Shapiro says. What happens will depend largely on prevention efforts at the state and local level.

“Places that don’t have mask orders are going to be hit worse,” Shapiro says. “Places that are opening up bars and restaurants are going to be hit worse.”

Already there are “disturbing trends throughout the country,” Shapiro says, with the upper Midwest being hit hard and new infections ticking back up even in New York City.

“These surges are stubbornly radiating across America, spurred on by a troublesome connection between our own behavior and the virus’s biology.”

Shapiro expects the number of daily new Covid-19 infections to reach 50,000 to 60,000 by mid-November “if we take no measures to stop this trend or reverse it.” The numbers are impossible to predict with accuracy, especially given all the political and behavioral factors at play. But it could get even worse.

“We must prepare for a surge this fall that will almost certainly surpass the April peak we experienced under stay-at-home orders and that may equal or eclipse our summer surge when we let go of the reins,” says Mark Cameron, PhD, an immunologist and medical researcher in the School of Medicine at Case Western Reserve University in Ohio.

The number of daily new cases is already rising or high and staying high in 23 states as of October 7, from Montana and Utah to the Dakotas and Wisconsin. In more than a dozen additional states, cases are lower but rising, including much of the Northeast that had been hit hard early on. “These surges are stubbornly radiating across America, spurred on by a troublesome connection between our own behavior and the virus’s biology,” Cameron tells Elemental.

Such resurgences are not unexpected: Since the spring, Cameron and other infectious disease experts have been warning of the exact scenario we’re in right now, with a vast reservoir of infected people heading into the viral high season, when colder weather helps viruses thrive and when people tend to crowd together.

“If there is an opportunity available for a new series of infections, Covid-19 will take it,” Cameron says. “This pattern will continue until enough people are vaccinated, and a vaccine is months away.”

A successful vaccine, should one be developed, could change the picture dramatically if the vast majority of people get the shot, experts say, but widespread distribution is not expected until sometime next year at the earliest. Meantime, any natural “herd immunity,” by which enough people will be infected to slow or halt the spread of the virus, remains a distant possibility, Shapiro and other experts say, and one with horrific consequences: a million or more U.S. deaths along the way.

“If there is an opportunity available for a new series of infections, Covid-19 will take it. This pattern will continue until enough people are vaccinated, and a vaccine is months away.”

If there is one bright spot in the pandemic, it’s the declining number of deaths as a percentage of Covid-19 infections. “We’re seeing lower death rates in this country, which is really fantastic,” Shapiro says, citing two reasons: A higher percentage of infections are among younger people instead of the deadly waves that washed through nursing homes; and treatments have improved, from how patients are physically positioned in the hospital to the administering of steroids to reduce mortality, and other drugs, such as remdesivir, that reduce symptom severity.

“Put all that together and we may be 40% to 50% better at keeping people alive than we were in the spring,” Shapiro says.

Yet infectious disease experts, psychologists, and health officials alike worry that “Covid fatigue” is already causing people to let their guard down in places that have been hit hard.

“Complacency is our worst enemy right now,” says Saskia Popescu, PhD, an adjunct professor of public health at the University of Arizona. “Loosening things up in a rapid or rushed way, unfortunately, leads to spikes, and that’s something we want to try to avoid as we go into respiratory virus season, when people are more likely to be inside and congregating.”

Shapiro is also concerned about complacency in rural areas and other spots where people may not yet have experienced Covid-19 directly and therefore underestimate their own risk. His warning: “It will come.”

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