Some health experts first postulated that a second wave of coronavirus cases would rock the United States when winter arrived later this year, alongside the seasonal flu — but many are now wondering if a second outbreak is already here. After spending the better half of two months sheltering in place, Americans are eager to get back to work and into their normal routines, with governors in virtually every state rolling back stay-at-home orders while following new Centers for Disease Control guidelines on reopening non-essential businesses (some as early as the end of April). But in the wake of reopenings taking place across the country, more than 20 states are reporting steady increases in new COVID-19 cases on a daily basis, according to data collected by Johns Hopkins University. On June 30, U.S. officials broke another record by reporting more than 48,000 new COVID-19 cases across the country, the highest single-day increase thus far. Dr. Anthony Fauci reportedly told U.S. Congress officials that he believes that trend could double later this summer, The New York Times reports.
Twelve of the states showing new upward trends — Florida, California, Texas, Utah, South Carolina, Nevada, Georgia, Missouri, Montana, Tennessee, and Oklahoma — saw record numbers of new COVID-19 cases over Father's Day weekend alone, and many have since gone on to break these records (in some cases, as in Texas, consecutively). Florida's upward trend in cases is particularly concerning as it's posed to become the next epicenter of the outbreak; the state reported over 9,000 new cases on June 27.
Does all of this mean that a second wave has already arrived in the United States? "I don't think that it would be appropriate to use the term 'second wave' for the uptick in COVID-19 cases at this time," says Bojana Berić-Stojšić, MD, PhD, CHES, an ambassador for the United Nations' Society for Public Health Education and director of the master of public health program at Fairleigh Dickinson University. "It is still the first wave of the pandemic, and this uptick could be directly attributed to the Phase II of the states' 'reopening' plan."
The upward trend in new cases could get a lot worse for states across regions during the summer, as more people are likely to leave their homes (trending upward, per this CDC-sponsored mobility tracker) to head back to work, go shopping, eat in restaurants, or even head out on vacation. "Coupled with people not complying with CDC guidelines for preventing community spread of SARS-CoV-2, this is most likely the cause of the uptick," Dr. Berić-Stojšić explains.
What is a wave? Will we see another one during the summer?
Jonathan Fielding, MD, MPH, a professor of health policy and management at UCLA and the former public health director of Los Angeles County, tells Good Housekeeping that certain cities, states, and regions show variability in new cases that makes it hard to understand what a "wave" is. The idea of a wave comes from the curve on a graph that illustrates how many cases there are during an outbreak; the curve looks like a wave if more and more people become sick (this all relates back to "flattening the curve").
A second wave would indicate that there was a lull in activity for all 50 states, but states that are experiencing an upward swing in new cases may be just "lagging behind" the states that are now reporting downtrends, Dr. Berić-Stojšić says. There hasn't been enough of a drop off in new cases (despite social distancing efforts in April) to allow for a second wave to start; it seems that states are going through a delayed chain of spikes in new cases. These new cases could be these states' first wave compared to places like New York and California. "You should expect continued increase in some, but not all, states," Dr. Fielding adds. "There are some disturbing examples of increases associated with loosening requirements for protective behavior, but the public desire for the 'old normal' is swamping common sense in some individuals."
Texas COVID-19 hospitalizations rose by 421 in past day, an 8.2% increase
(Graph from state website) pic.twitter.com/tLFnTy9q1x
— Steve Lookner (@lookner) June 28, 2020
As states continue to move into Phase II of their reopening plans, it's crucial for them to continue to follow current CDC guidelines to reduce the spread of SARS-CoV-2, the virus that causes a COVID-19 diagnosis. It'll be a while before all states can maintain or lessen the number of new COVID-19 cases they're reporting, which will be then be threshold for a second wave of coronavirus.
When will there be a second wave of COVID-19?
While it's likely that we'll continue to see spikes in new cases over the summer, understanding when the next outbreak across all states will occur is a bit more complicated. Top experts at the World Health Organization have previously shared that a proper second wave could impact European nations as early as September or October, and Dr. Hans Kluge doubled down on his warnings in a recent WHO briefing held by Russian officials in mid-June, per the Daily Mail.
In the United States, Dr. Berić-Stojšić believes that the first wave won't be over in June or July: "It's not over yet, although the incidence of new confirmed positive cases, number of hospitalizations, and the death rates due to COVID-19 are tapering off." Depending on the region, some states will continue to spike as they experience their first wave of cases, until they peak, and eventually show a downward trend. "The second wave should be expected only later, after the number of new cases is stabilized at lower levels and before the safe and effective vaccine becomes available."
Will states close again?
Another unclear question that will largely depend on the actions of leadership, Dr. Fielding says. "For me, the distinction between waves isn't really helpful — the tough question is when, if ever, those in authority should reinstate some behavioral constraints?" he asks. "It may make sense, but it's hard for political leaders to backtrack." According to information curated by the New York Times, four states have already rolled back reopening measures — and 10 others have paused plans to reopen all non-essential businesses with varying restrictions. You can see local reports for how governors are handling reopening issues in your state using the Times' interactive map here.
Despite Florida's Governor Ron DeSantis maintaining that his administration isn't considering reinstating stay-at-home orders, the state has since closed indoor bars again in the last week of June due to unchecked new COVID-19 cases in places like the metropolitan Orlando area. The same is true for restaurants and bars in Iowa, according to reports from the Des Moines Register, and in Texas, where significant spikes in new cases in metropolitan areas like Dallas in particular are too significant to ignore, per the Texas Tribune. "At this time, it is clear that the rise in cases is largely driven by certain types of activities, including Texans congregating in bars," Governor Greg Abbott told the Tribune. "The actions in this executive order are essential to our mission to swiftly contain this virus and protect public health."
Arizona's Governor Doug Ducey closed more than just bars — an executive order also mandated that gyms, movie theaters, and water parks once again shut their doors to the public, according to the Arizona Republic. Arizona's reversal might be the nation's most sweeping so far, but what's more compelling is that many other states have halted their reopening procedures. Maine recently extended closures for indoor bar service, and many other states are currently considering future implications, according to the Washington Post.
State health departments are continuing to pass recommendations onto businesses that are reopening, but experts say it's crucial for people to exercise best practices while out in public. If you do choose to visit non-essential businesses, Dr. Fielding and Dr. Berić-Stojšić stress the following:
Physical distancing: Maintain a 6-foot distance between yourself and all those who do not live with you currently.
Face masks: You should be wearing them when you are outside the home in public spaces, per current CDC guidelines.
"The most important is the risk reduction. Reducing the number and length of exposure to people in closed spaces and keeping safe distance is very important," Dr. Berić-Stojšić explains. "In addition, knowing the data... and deaths from COVID-19 in where one lives is very important, and helps guide our decisions and behavior."
Which states are experiencing new cases?
Remember, you can always learn more about new cases in your own vicinity by visiting the COVID-19 resources provided by your state health department. If you're looking for a quick way to see how the spread of COVID-19 is affecting your community, a new data initiative from the Harvard Global Health Institute illustrates up-to-date case information by county in each state across the United States. You can view this interactive local map here.
Explore our interactive Testing Target Dashboard, built in collaboration w/Microsoft AI for Health @MSFTIssues, to see testing targets for the US and many other nations around the world, and track progress towards them in real time👇https://t.co/fEyo3IC8vI pic.twitter.com/pWhnYs515r
— HarvardGlobalHealthInstitute (@HarvardGH) June 30, 2020
Here's how states are currently trending in new case counts, according to trend reports from Johns Hopkins University, as of June 26:
Upward trends: Alabama, Alaska, Arizona, California, Colorado, Delaware, Florida, Georgia, Idaho, Iowa, Illinois, Kansas, Ohio, Oregon, Oklahoma, Louisiana, Montana, Mississippi, Michigan, Minnesota, Nevada, North Carolina, North Dakota, New Mexico, Pennsylvania, South Carolina, Tennessee.Texas, Washington, Utah, Wisconsin and Wyoming.
No growth in average new cases: Connecticut, Maine, Nebraska, Hawaii, South Dakota, Virginia and West Virginia.
Downward trends: Arkansas, Indiana, Kentucky, Maryland, Massachusetts, Missouri, New Hampshire, New Jersey, New York, Rhode Island and Vermont.
There are more than 2.5 million cases of COVID-19 in the United States; 117,000 and counting have died from the virus. Internationally, there are more than 10 million cases, with 500,000 plus deaths recorded thus far.
As more information about the coronavirus pandemic develops, some of the information in this story may have changed since it was last updated. For the most up-to-date information on COVID-19, please visit the online resources provided by the CDC, WHO, and your local public health department. You can work to better protect yourself from COVID-19 by washing your hands, avoiding contact with sick individuals, and sanitizing your home, among other actions.
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