The grim milestone of 200,000 reported COVID-19 deaths is a reminder of how quickly the coronavirus can spread and a warning of what could happen as the nation enters autumn.
Indeed, the fall could see a new “wave” of the virus and not a “surge.” A surge is merely a spike in COVID-19 cases within a particular wave. There isn’t exactly a formal definition of a wave, but new COVID-19 cases in the United States had been declining or “receding” much like a wave since mid-August. A new wave may be on its way, as cases have increased over the last seven days.
Numerous models forecast another wave of COVID-19 arriving in the next few weeks. For example, the Institute for Health Metrics and Evaluation predicts a second wave that begins in late September and doesn’t reach its peak until Thanksgiving.
“My feeling is that there is a wave coming, and it’s not so much whether it’s coming but how big is it going to be,” Eili Klein, an epidemiologist at Johns Hopkins University School of Medicine, told the Washington Post recently.
Others are not so certain.
“We really don’t know yet,” said Dr. Georges Benjamin, executive director at the American Public Health Association. “What we do know for sure is that we are going to have these peaks and episodic outbreaks.”
Benjamin pointed to children returning to school and people trying to return their lives to normal as likely main causes of episodic outbreaks going forward.
The fall, though, also brings Halloween and Thanksgiving, two holidays during which people tend to congregate and travel via airline.
“In our communities here in Memphis, we saw an increase after the Labor Day weekend. We saw an increase in cases and the positivity rate,” said Dr. Manoj Jain, an infectious disease physician in Tennessee and an adjunct professor at the Rollins School of Public Health at Emory University. “There is a very fragile equilibrium that we are at, and the slightest disruption can lead to an increased number of cases. And that can lead to community transmission, which can be very hard to control.”
“I suspect travel will increase for Thanksgiving,” said Susan Hassig, an epidemiology professor at Tulane University School of Public Health and Tropical Medicine. “Air travel has been slowly creeping up. … But it may be that people do more driving trips for Thanksgiving.”
Benjamin noted that one positive about Halloween is that children do wear masks, but he added, “The people who are handing them candy may or may not be wearing a mask, and there is the risk of being exposed if you get too close. And if you are out, you will still need to use hand sanitizer or wash your hands frequently.”
Also increasing the risk of a wave is the fall election campaign, which involves not only large rallies but people canvassing door to door to get out the vote.
“The biggest risks are the campaign rallies, where people are close to one another, sometimes without masks. Even with masks, it is a risk,” said Benjamin. “In terms of the door-to-door campaigning, you have to be careful, you have to wear a mask and step back from the door.”
In addition to the holidays and election, there will be the risk of students being back in school.
“Schools are bringing lots of people who haven’t seen each other for 6 months into contact with each other,” said Hassig. “The whole ecosystem of education is dependent on the behavior of everyone. If you’ve got just a few people who are not wearing masks, not social distancing … that can be a problem.”
Another final problem is the looming flu season.
“What’s concerning is we are entering flu season, and you could get the flu that weakens your immune system, making you more vulnerable to COVID, or vice versa,” said Angela Clendenin, instructional assistant professor at Texas A&M School of Public Health. “We’re looking at the potential of some people’s immune systems getting hit twice. That could lead to more serious illness for some people. But you can do something about the flu and get a vaccine.”
Some models suggest that the pandemic will continue to wane during the fall.
Data scientist Youyang Gu, whose pandemic models have proven quite accurate, predicts an additional 24,000 deaths due to COVID-19 by Nov. 1, which would be less than 500 per day. Deaths have averaged 830 per day during September.
“I don’t think individual dates and events have as big of an impact as people think,” Gu said. “For example, many people expected cases to spike up after Memorial Day or after protests, but that never materialized. The bigger drivers for a potential fall wave include: virus seasonality, more time spent indoors, increased mobility as schools reopen and people return to work, and the potential loss of acquired immunity.”
