When it comes to the spread of novel coronavirus (COVID-19) across the US, Lisa Lockerd Maragakis, MD, MPH, wrote for Johns Hopkins Medicine that she wants us to visualize a patchwork quilt. "The COVID-19 pandemic in the US is affecting different areas throughout the country in different ways at different times," she explained. So, as for the prediction that cases would decline in the summer and a "second wave" would come in the fall, that's not what is happening. We're seeing a decline in some US states, while other areas, many of which were among the first to reopen, are currently seeing surges in cases — and two experts POPSUGAR spoke with clarify that, therefore, we're still in the first wave of this virus.
Why Experts Say We're Still in the First Wave of COVID-19
"We are not at the bottom of a curve where we have gotten our cases down to really low levels."
Anne Liu, MD, immunologist and infectious disease doctor with Stanford Health Care, told POPSUGAR that the concept of a second wave assumes that there was a "clean first wave," and she cannot say that we're clear of that first wave. Janet Baseman, PhD, MPH, associate dean of the school of public health and professor of epidemiology at the University of Washington, agreed. We haven't gotten the virus under control yet, and the increase of cases in states such as Florida means the first wave isn't over, she said.
Simply put, "we are really worried about places like Texas and Florida where we see numbers going up, the hospitalizations going up, ICUs filling up, and that is not their second wave," Dr. Liu explained. Aside from the fact that respiratory viruses tend to drop-off in the summer — which isn't happening with COVID-19 — originally, the discussions of a second wave come fall were charged by the fact that people spend more time indoors and schools pick back up, Dr. Baseman said. A spike in cases because of that could still happen, she told POPSUGAR, but "our first wave has not been contained. We are not at the bottom of a curve where we have gotten our cases down to really low levels."
Both doctors pointed to the fact that we don't have universal strict measures across the country as a whole. "If you look at the new cases graphs for other countries where measures have been applied more uniformly, there is more of an up and a down," Dr. Liu said. Here's a graphic of the downward curves in France and Italy, according to data collected by The New York Times. Here, in comparison, is a chart of US cases, where the curve continues to go up.
And, Dr. Liu further explained in a previous interview with POPSUGAR that in places where public health messageing has been more clear about physical distancing and wearing masks — mask mandates, for example — there tends to be less spikes in cases. Other factors such as having more people per household in your community and also having a higher concentration of essential workers, come into play as well, she said.
Despite government recommendations on opening up America in phases, "what our phases of opening and closing look like are actually completely different across the country," Dr. Baseman said. "What the policies are, are completely different. What the mandates are, are completely different. It's really kind of a patchwork approach because there's not a national approach." She further said that she believes places like Florida reopening as far back as May has a direct correlation with the increase in COVID-19 cases.
Is It Guaranteed That Cases Will Surge When Places Open Up?
Depending on where you are, there may or may not be an increase in cases with reopening in the near future, or if your area were to go back into a "lockdown" mode and then reopen later on, Dr. Baseman said. Parts of our country that have not seen a high level of cases tend to be more remote areas, and therefore it's possible that those areas might not see any cases with reopening, she explained. Furthermore, spikes in cases after reopening is not inevitable in every single community, but in general, there will be outbreaks as people come together again until we achieve herd immunity, where a high percentage of the population is immune, she said. (Note: the duration of human immunity to COVID-19 is still unknown.)
That being said, what we've learned from states that were the first to open up and are now seeing an increase in cases is that "you can't just flip a switch and have everything go back to normal," Dr. Baseman said. "Imagine a situation where community-level mixing comes almost to a halt," she continued (like the lockdowns that many places had at the start of the epidemic in the US). "The case numbers come down, and what that helps us to do in addition to keeping people from getting sick and saving lives, is we get a handle on reopening so that our infrastructure can hopefully help to prevent the transmissions that will inevitably happen here and there."
Doing testing, case investigations, and contact tracing to interrupt future chains of transmission is much easier to execute when there are lower numbers of cases than in places where cases are high, Dr. Baseman explained. "It's really hard to do all of those things that you need to be doing when you are just completely overwhelmed with cases." The key is slow reopening: "a tap, not a switch," she stated.
As you slowly reopen, you are able to keep up with the cases that you've identified, "either in a household or in a community or associated with an event. You test those people. You do case investigation and contact tracing in order to get people to do the self and community protective behaviours that could then help us all prevent the next generation of transmissions," Dr. Baseman explained. "You've got to open the tap slowly so that you can make sure that that all of your systems can handle what's coming out of the tap, rather than flipping a switch."
What Can We Do?
Keep taking a "layered" approached, Dr. Baseman said. "None of these biggest public health measures alone solves our problem. Not the six-foot rule, not the wear-a-mask rule, not the do-outdoors-more-and-indoors-less rule, hand-washing . . . none of those things by themselves is going to keep people from getting sick." So, practice all of them. Wash your hands, physically distance from people, and wear a mask when in public, especially in crowded indoor settings with poor ventilation.
Dr. Baseman applauded the CDC director's comments in mid July that urged universal masking across the US, given the fact that masks are proven to help mitigate the spread of the virus. Masking, though, has become politicized, she said, so she doesn't know if universal masking all around the country can be achieved. Regardless, "I think it's still worth doing, because it's really important that we get a handle on this using any strategy that we can that is evidence based," she noted, adding that she's very practically-minded about COVID-19. Bottom line? "We've got to get it under control, and it's not under control."
POPSUGAR aims to give you the most accurate and up-to-date information about the coronavirus, but details and recommendations about this pandemic may have changed since publication. For the latest information on COVID-19, please check out resources from the WHO, CDC, and local public health departments.