Coronavirus: We’re still in the first wave. So what happens during flu season?

For a while, at least, it looked like the US was flattening the curve of coronavirus infections. New cases were trending down, albeit slowly, as states began reopening their economies. But then, in mid-June that trend reversed course, and the days and weeks since have resulted in record numbers of new infections, well outpacing the virus’s spread at the beginning of the pandemic. That’s led many to wonder: Is this the second wave we were warned about?

Experts, like Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, say we’re still in the first wave because we didn’t flatten the curve enough in our initial response to bring about an effective end to the initial outbreak.

Another complication: The uncertainty of the approaching fall and winter — in other words, flu season. Speaking to Time Magazine, the director of the Centers for Disease Control and Prevention, Dr. Robert Redfield, warned, “The real risk is that we’re going to have two circulating respiratory pathogens at the same time.”

We take a look at what doctors and scientists have to say about a second wave of the coronavirus, including how it might relate to the current spike in new cases as well as what experts predict for the fall and winter. Please note: This story provides an overview of the current discussion, and updates frequently in light of new and changing information provided by health officials, global leaders and the scientific community. It is not intended as a medical reference.

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Coronavirus cases are spiking worldwide: The latest news

• New coronavirus cases are growing in 40 US states, with 12 states hitting record high seven-day averages for daily new cases as of July 8.
• About 50% of new cases are confined to just four states: Arizona, California, Florida and Texas.
• Over 43,000 people are currently hospitalized with coronavirus, with 1,000 to 2,000 new patients being admitted daily.
• The overall death rate, however, appears to be declining.
• Total US coronavirus cases are now at over 3.1 million, with over 135,000 deaths so far.
• Black people account for 23% of all COVID-19 deaths where race is known, meaning they are 2.5 more likely to die from the disease than white people. Other communities of color, particularly Latino groups, have also been found to be disproportionately affected (CDC report) largely as a result of socioeconomic factors.
• Nearly half of all US states have either paused or rolled back their reopening plans.
• In Brazil, where new coronavirus cases and the overall death toll are climbing at rates similar to the US, the Brazilian president has tested positive.

If we’re still in the first wave, when will a second wave happen?

“We are still knee-deep in the first wave of this [pandemic],” Fauci said during a July 6 interview on Facebook Live. “And I would say, this [recent uptick in cases] would not be considered a wave. It was a surge, or a resurgence of infections.”

The first wave will end when the rate of positive coronavirus tests drops to “the low single digits,” Fauci said in June. Instead, new cases declined modestly, then plateaued through most of May before starting to spike again in late June, never quite getting low enough. Basically, you can’t have a second wave until cases and deaths from the first wave drop close to zero for a sustained period of time. If cases spike again after that point, that’s a bona fide second wave. 

South Korean officials, for example, have declared the country is experiencing a second wave as case numbers have begun to surge again after about two months of single-digit infection rates. However, while the World Health Organization has acknowledged the seriousness of these new clusters of cases, the WHO has stopped short of calling it a “second wave.”

Why are experts worried about coronavirus in the fall?

Most public health experts — including Fauci and Redfield — have said they anticipate a big uptick to happen this fall and winter. The White House has admitted it’s preparing for the possibility. However, part of that prediction was based on the assumption that the virus would slow down over the summer, which appears not to be happening.

Much of the attention aimed at fall has now shifted to concern over the possibility of two potentially lethal viruses circulating at the same time — COVID-19 and the seasonal flu, the latter of which kills around 40,000 people in the US per year. Because of certain overlapping symptoms such as fever and a cough, it may be harder for individuals and doctors to immediately determine which infection you have.

If severe COVID-19 infections continue to push hospitals to the brink of their capacity and abilities, it may also be harder to care for potentially virulent flu patients.

The CDC is nudging drug manufacturers to produce millions more doses of flu vaccine this year than usual in anticipation of greater demand. Typically, fewer than half of all US adults take the flu vaccine in any given year, but that rate increases to about two out of three for adults over 65, a population the CDC has identified as being at a higher risk for more severe COVID-19 infections.

Why did coronavirus cases start going back up again?

At one point, about 90% of everyone in the US was under some sort of lockdown order and the curve was starting to flatten. But that all began to change in the second half of April, when a few states — notably Georgia and South Carolina, which are both now seeing about a five-fold increase in new daily cases compared to mid-April — started loosening lockdown restrictions.

For a while, some government officials, including US President Donald Trump, claimed the rising rates of infections were due to increased testing capabilities. However, that view has since been challenged by a ProPublica analysis of the data in June and a World Health Organization press briefing in July, both of which concluded that the pandemic is accelerating faster than testing expansion alone can account for.

An analysis by the New York Times demonstrates how the current surge in new coronavirus cases is being driven, for the most part, by states that were among the first to ease lockdown restrictions. Many doctors, including Fauci, had warned this could happen.

Are we headed for another lockdown?

By mid-July, about half of all US states were either reopening or had reopened. Meanwhile the other half had either paused or begun rolling back reopening plans. 

Health experts, including Fauci and Dr. Ali Khan, the former director of the CDC’s public health preparedness office, have said that if states are able to effectively test for coronavirus — and follow that testing up with contact tracing — while people in those states practice social distancing and wear masks in public, it would be possible to once again flatten the curve without having to revert back to a full-blown lockdown. If that strategy isn’t followed and new cases continue to skyrocket, “your only option is to shut down,” Khan said.

In early July, NBC reported that the White House had begun formulating a new coronavirus messaging strategy summed up as, “We need to live with it.” 

Not long after that revelation,President Donald Trump began publicly pressuring the CDC to loosen its guidance for safely reopening schools and threatening to cut federal funding for districts that don’t go back to in-person classes this fall. 

Some critics claim such pressure is an attempt to boost the flailing US economy in advance of the November presidential election. Trump has trailed in the polls for months against presumptive Democratic candidate Joe Biden, which most analysts attribute to Trump’s handling of the coronavirus pandemic.