Coronavirus infections are rising as states reopen, potentially signaling a second wave

On Sunday, President Trump, ever the optimist, tweeted that coronavirus “Cases, numbers and deaths are going down all over the Country!”

Two days later, both Reuters and the New York Times reported that new daily cases of COVID-19 — which have been falling for weeks, both nationally and in the hardest-hit metropolitan areas — suddenly and simultaneously started to rise in more than a dozen states.

The Times counted 14 states where the rolling seven-day average of new infections has climbed over the last two weeks.

Narrowing the timeframe and focusing on the total weekly case count, Reuters found that 20 states reported an increase in new infections during the week ending May 24, up from 13 states the week before.

Most of the affected states were among the first to reopen in late April or early May: Alabama, Colorado, Florida, Georgia, Minnesota, Mississippi, Missouri, Nevada, South Carolina, Tennessee and West Virginia. In others — Arkansas, North Dakota, Oklahoma — statewide stay-at-home orders were never issued, but businesses that had been closed began reopening around the same time.

A guidelines sign at a public beach includes "maintain proper social distance" and "avoid groups of 10 or more people"
A sign indicates new social distancing rules at a public beach in Dauphin Island, Ala., on May 1. (Maranie Staab/Bloomberg via Getty Images)

So while Trump touts the good news from 30,000 feet, is a second wave beginning to build just below the surface?

For months, epidemiologists have been warning of the risks of reopening too soon. In April, the Trump White House issued its “Guidelines for Opening Up America Again,” which listed “the data-driven conditions each region or state should satisfy before proceeding to a phased reopening.” One of these conditions was a “downward trajectory of documented cases within a 14-day period.” Few if any of the early-to-open states met this benchmark. Then they reopened anyway. The fear among experts was that these states would soon see a rise in coronavirus infections as a result.

To get a sharper sense of where things stand — and where they may be heading — it’s helpful to zoom in on a single state. According to Reuters, South Carolina had the biggest week-over-week increase in new COVID-19 cases: 42.4 percent. The next closest state, Alabama, lagged far behind at 28.2 percent.

The question is how to interpret those numbers.

Skeptics of the second-wave hypothesis note that states such as South Carolina have been conducting more tests in recent weeks. Technically, they’re not wrong. Over the last seven days, the Palmetto State has averaged 5,381 tests per day; three weeks ago (from April 29 through May 5) it averaged 2,232 per day. The more people you test, the thinking goes, the more infections you’ll find.

But in reality the math isn’t so simple. For one thing, the people who seek out tests first are the most likely to be sick; scale up capacity and you’ll start to test more and more people with less and less chance of infection.

So while there’s at least some relationship between increased testing and increased case counts, the returns are diminishing. Case in point: Between May 12 and May 19, South Carolina tested an average of 7,000 people per day and found 1,129 new infections. The following week (May 19 to May 26) the average number of daily tests went down by about 1,600 but the number of new infections went up (to 1,360).

That’s why testing can’t be the only factor.

The relaxation of voluntary social distancing practices is probably starting to play a part as well. The coronavirus doesn’t magically retreat when a governor decides it’s time to relax lockdown measures. The deadly pathogen will continue to spread wherever and whenever people interact at a distance of less than 6 feet, without a mask, and especially indoors.

In South Carolina and elsewhere, people are doing more of that kind of interacting now than they were just a few weeks ago. This is quantifiable. Over Memorial Day weekend, Twitter and cable news were filled with outrage-inducing images of the most egregious offenders: shirtless, maskless, spring-break-style revelers packed into a pool at Missouri’s Lake of the Ozarks; similarly attired and unprotected hordes chugging beers at a pro-Trump "MAGA Boat Parade" in South Carolina’s Charleston Harbor.

But these brazen spectacles of social-nondistancing distract from a more commonplace shift: All 50 states have reopened to some degree, and pretty much everyone is moving around more.

According to Apple’s daily mobility trend reports, which are based on requests for directions in Apple Maps, driving, walking and transit riding fell sharply across the U.S. in mid-March, stayed down through mid-April and have been steadily rising since then.

Over the holiday weekend, however, driving shot up by nearly 50 percent, surpassing its immediate pre-COVID-19 peak for the first time since Americans started staying home.

A security guard takes the temperature of a customer outside an Apple store
A security guard takes the temperature of a customer outside an Apple store in Charleston, S.C., on May 13. (Sean Rayford/Getty Images)

In South Carolina, the effect was even more pronounced. The weekend before last, driving there had already returned to its immediate pre-COVID-19 peak. Over Memorial Day, it spiked roughly 20 percent higher than at any previous point this year.

Mobility will increase as reopening proceeds. That is inevitable, even if it is riskier than sheltering in place. Infections will likely tick up as a result. But there are simple ways to limit the risks of leaving home, and thus to help limit infections as well. The more government rolls back its restrictions, the more personal restraint and responsibility Americans are expected to exercise.

Are South Carolinians exercising that responsibility? It’s hard to say. According to Unacast, which uses cellphone data to score states on their social-distancing efforts, mobility is still down about 20 percent nationwide, with trips to nonessential businesses (anything other than grocery stores, pharmacies, pet stores, etc.) down about 30 percent and encounter density (basically how many people are in the same place at the same time) down about 50 percent.

In South Carolina, however, mobility is currently down by only about 10 percent. Nonessential trips have already reverted to their baseline level. And encounter density is more than 150 percent higher than it was before COVID-19 struck. People there are proudly “socializing for the 1st time since life began to reopen,” spending their holiday weekend celebrating birthdays at restaurants, chilling and grilling on the beach with out-of-state relatives and fishing with friends for hours on small boats — all without masks or 6 feet of distance.

South Carolinians aren’t alone in this. Remember: Infections are on the rise in as many as 20 states. In neighboring Georgia, the first state to reopen, the numbers were looking good for weeks, but now infections may be increasing. And while the latest Yahoo News/YouGov poll shows conservatives are more likely than liberals to favor a speedy end to government lockdown measures, six of the states with growing case counts (according to Reuters) lean blue: California, Colorado, Maryland, Minnesota, Nevada and North Carolina.

To some degree, a second wave of COVID-19 is probably “inevitable,” most likely in the fall, as Dr. Anthony Fauci, the nation’s top infectious disease expert, has predicted. Nationwide, average new daily coronavirus hospitalizations increased last week, from 1,709 to 2,330, after declining for three straight weeks — an important but lagging indicator, since it typically takes several weeks for an infection to send someone to the hospital.

“We now see … an uptick in hospitalizations,” former Food and Drug Administration Commissioner Scott Gottlieb said Tuesday on CNBC. “It’s unmistakable and it is probably a result of reopening. We are going to have to watch it.”

Meanwhile, in South Carolina, Rt —an epidemiological statistic that represents transmissibility, or the number of people a sick person infects at a particular point in an epidemic — is now estimated to be 1.09. An Rt below 1.0 indicates that each person infects, on average, less than one other person; an Rt above 1.0 indicates that an outbreak is growing.

But degree matters. The reason the first wave has been so devastating is that the virus was spreading undetected and uncontained for months in dense metropolitan areas such as Seattle, New York, Detroit, New Orleans and Los Angeles.

South Carolina isn’t New York, and May isn’t February. We’ve learned a lot. The scale of South Carolina’s outbreak is still relatively modest, with just 4.4 positive tests per 100,000 people. In May, health officials there aimed to test 2 percent of the population, and they have already met their goal, completing more than 110,000 tests so far this month. Likewise, they have increased their staff of contact tracers from 20 to 380 and contracted with private companies to hire 1,400 more. The state is also meeting federal guidelines on tests per 100,000 people per day and ICU bed availability.

Inevitably, infections will rise when restrictions relax, businesses reopen and social distancing declines. That’s part of what’s happening now. The questions that will determine the size and scope of any second wave are how prepared health officials are to contain it — and how willing residents are to cooperate.

In the coming weeks, South Carolina and other states may have to confront those questions.


Click here for the latest coronavirus news and updates. According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please refer to the CDC’s and WHO’s resource guides.

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