- Coronavirus Second Wave? Why Cases Increase
- Are the spikes in coronavirus cases due to more coronavirus testing?
- Tracking Coronavirus Surges
- What is herd immunity from the coronavirus?
- Why us again? Italy suffers disproportionate toll in second COVID wave
- DEATHS PER CAPITA
- HEALTH CUTS
- COVID-19’s third wave is hammering the Midwest
- Rising caseloads are concentrating in Midwestern metro areas
- Economic activity contracted fastest in the Midwest
- Metro areas need economic help, stat
- The US isn’t in a second wave of coronavirus – the first wave never ended
- To have a second wave, the first wave needs to end
- Different states, different trends
- What could a second wave look ?
Coronavirus Second Wave? Why Cases Increase
- Lisa Lockerd Maragakis, M.D., M.P.H.
When the coronavirus pandemic began early in 2020, experts wondered if there would be waves of cases, a pattern seen in other virus pandemics.
The overall pattern so far has been one of increasing cases of COVID-19, with a surge in the summer and a larger one in the fall.
Some locations that saw a high number of coronavirus infections early on, followed by a decline, are having a “second wave” of increased cases.
What will the future hold? Lisa Maragakis, M.D., M.P.H., an infectious disease specialist at Johns Hopkins Medicine, sheds light on what we know now about COVID-19 in communities and why the numbers of infections increase during certain times.
Human behavior is the major factor. State and local governments, as well as individual people, differ in their response to the pandemic. Some follow COVID-19 precautions, such as physical distancing, hand-washing and mask-wearing. Others are not as prescriptive in requiring these measures or in restricting certain high risk activities.
In some cities, towns and communities, public places are closed or practicing limitations (such as how many people are allowed inside at one time); others are operating normally. Some government and community leaders encourage or even mandate mask wearing and physical distancing in public areas. Others say it is a matter of personal choice.
However, the relationship between those precautions and cases of COVID-19 is clear: In areas where fewer people are wearing masks and more are gathering indoors to eat, drink, observe religious practices, celebrate and socialize, even with family, cases are on the rise.
Also, places where people live or work closely together (multigenerational households, long term care facilities, prisons and some types of businesses) have also tended to see more spread of the coronavirus. Coronavirus outbreaks at nursing homes and “superspreader” events — gatherings of people where one infected person or more transmits the virus to many others — continue to occur.
Are the spikes in coronavirus cases due to more coronavirus testing?
No. During a surge, the actual number of people getting sick with the coronavirus is increasing. We know this because in addition to positive COVID-19 tests, the number of symptomatic people, hospitalizations and later, deaths, follows the same pattern.
Infectious disease expert Lisa Maragakis explains why COVID-19 cases are surging across the United States and important preventative steps to halt coronavirus transmission.
As communities began to reopen bars, restaurants and stores during the spring and summer of 2020, people were understandably eager to be able to go out and resume some of their regular activities.
But the number of people infected with the coronavirus was still high in many areas, and transmission of the virus was easily rekindled once people increased their activities and contact with each other.
Medical experts urged reopening communities to continue diligent COVID-19 precautions, including physical distancing, hand-washing and mask-wearing, and monitoring for symptoms.
Unfortunately, the combination of reopening and lapses in these infection prevention efforts has caused the number of coronavirus infections to rise again.
Tracking Coronavirus Surges
There is a delay between a policy change such as reopening businesses or relaxing occupancy limits in a community and when the effects of this change show up in the COVID-19 data.
An increase in the number of COVID-19 cases or hospitalizations will not be seen a week or even two weeks later.
It seems to take much longer, perhaps as many as six to eight weeks, for effects of a policy or widespread behavior change to appear in the population-level data.
When a person is exposed to the coronavirus, it can take up to two weeks before they become sick enough to go to the doctor, get tested and have their case counted in the data.
It takes even more time for additional people to become ill after being exposed to that person, and so on.
Several cycles of infection must occur before a noticeable increase shows in the data that public health officials use to track the pandemic.
So when an area relaxes precautions, the effects of that change will take a month or more to be seen. Of course, surges also depend on the behaviors of people when they start moving around more.
If everyone continues to wear masks, wash their hands and practice social distancing, reopening will have a much lower impact on transmission of the virus than in communities where people do not continue these safety precautions on a widespread basis.
Learn why it takes several weeks of gathering data to determine if the COVID-19 infection rate is rising or falling.
In the beginning of the pandemic, some people wondered: Will the coronavirus go away in the summer? Unfortunately, a substantial spike during the hot summer months in the U.S. made it clear that this was not the case.
Other respiratory illnesses, colds and influenza (flu), are more common in the colder months. Now that fall is here, we are seeing a dramatic increase in COVID-19 across the U.S.
In colder months, people gather indoors and this is a risk for further transmission of the virus.
When the coronavirus first appeared in the U.S. in early 2020, it started with a very small number of infected people, so it took longer to spread. Now that the disease is widely distributed, with many unknowing coronavirus carriers in many different areas of the country, the risk of transmission is widespread.
Fall and winter in the Northern Hemisphere means inclement weather in many areas, with more people spending time indoors. Several holidays take place around the end of the calendar year, and people who celebrate them want to gather, travel, and visit friends and family.
Also, after many months of canceled activities, economic challenges and stress, people are frustrated and tired of taking coronavirus precautions. All these are factors that are driving surges and spikes in COVID-19 cases.
What is herd immunity from the coronavirus?
Herd immunity is a public health term that refers to the fact that, when enough people in a community have immunity from a disease, the community is protected from outbreaks of that disease.
Infectious disease experts at The Johns Hopkins University explain that about 70% of the population needs to be immune to this coronavirus before herd immunity can work. People might be immune from the coronavirus, at least for a while, if they have already had it, but we don’t know this yet. A widely available, safe and effective vaccine may not be available for months.
Without a vaccine, most doctors and scientists agree that a herd immunity approach of letting the virus “take its course” is not acceptable. Letting the coronavirus circulate freely among the public would result in hundreds of thousands of deaths and millions more people left with lasting lung, heart, brain or kidney damage.
Researchers are currently trying to determine if, and for how long, people are immune from the coronavirus after recovering from COVID-19. If it turns out that immunity only lasts for a while, people could get COVID-19 again, resulting in even more death and disability.
Check symptoms. Get vaccine information. Protect yourself and others.
Doctors, clinics and hospitals recognize that more COVID-19 surges are ly to occur. They are working with manufacturers to stock up on equipment, and they are continuing their policies for protecting patients and staff members.
Here’s what you can do now:
- Continue to practice COVID-19 precautions, such as physical distancing, hand-washing and mask-wearing.
- Stay in touch with local health authorities, who can provide information if COVID-19 cases begin to increase in your city or town.
- Make sure your household maintains two weeks’ worth of food, prescription medicines and supplies.
- Work with your doctor to ensure that everyone in your household, especially children, is up to date on vaccines, including this year’s flu shot.
What you need to know from Johns Hopkins Medicine.
Why us again? Italy suffers disproportionate toll in second COVID wave
By Crispian Balmer, Angelo Amante
ROME (Reuters) -In late November doctor Maurizio Cappiello visited more than 130 patients in the emergency room of Cardarelli hospital, in the southern Italian city of Naples. More than two-thirds had COVID-19.
A man places a sticker outside a pharmacy reading “COVID-19 rapid test, result in 15 minutes” where medical staff carry out swab tests, as the government prepares to bring in further restrictions over the Christmas period amid the spread of the coronavirus disease (COVID-19) in Rome, Italy, December 14, 2020. REUTERS/Guglielmo Mangiapane
The virus which was limited mainly to Italy’s industrial north during the first wave in the spring was now also ravaging the poor south, overwhelming its fragile public health system.
“Despite our efforts it was impossible to help them as we would have wanted and to transmit a sense of humanity, we tried to be fast and concentrate on the most critical,” Cappiello, a top official at Italy’s national ANAAO-ASSOMED doctors’ union, told Reuters.
Campania, the populous region around Naples, numbered just 430 coronavirus deaths by June 15. The total has now risen to more than 2,300 as Italy’s overall death toll has overtaken Britain’s to become the highest in Europe.
The first Western country to be hit by the virus in March, Italy won plaudits for seemingly getting its outbreak under control by the summer. Now questions are once more being asked about why more people apparently die of COVID-19 in Italy than in other wealthy nations.
Among explanations often put forward are its elderly population; a social structure in which the young often live with the old, exposing them to the virus; an underfunded health system; and a lack of preparedness and organisation.
“During the summer, when daily cases were low, we failed to recruit more staff and made no plan to reorganise,” the Naples doctor Cappiello said.
DEATHS PER CAPITA
According to Worldometers data, Italy has registered 65,011 COVID-19 fatalities since February, against 64,170 in Britain, 57,911 in France and 47,624 in Spain – three other European nations badly battered by the disease.
On a per capita basis, Italy lies 37th in the world for number of cases, but 4th when it comes to deaths, with 1,076 COVID fatalities per million people. This compares with 943 in Britain, 886 in France and 924 in the United States.
The only European Union state with a higher per capita death ratio is Belgium on 1,546 – the worst in the world.
Countries count COVID deaths in slightly different ways and medical experts cautioned against drawing hasty conclusions, saying a clearer picture would only emerge when excessive death figures for the whole year became available.
But officials acknowledge Italy has suffered more than most, and pin the blame largely on the fact that it has many elderly citizens who have proved especially vulnerable.
According to Eurostat data for 2019, Italy had the oldest population in Europe, with 22.8% of its people aged over 65. It also ranks as one of the countries with the highest life expectancies worldwide – 83 years.
But doctors say that while Italians live a long time, they are not especially healthy. A 2017 report by the Osservatorio Nazionale health association said 71% of over-65s had at least two underlying health conditions. Almost half of this age-group took at least five different medicines a day.
“There is a very dangerous nexus between the high number of elderly people here and (the high number of) health conditions. We are paying a very, very high price for this,” Health Minister Roberto Speranza told La7 television channel.
The first wave of the pandemic, which accounted for roughly 35,000 lives, was concentrated in the north, where some emergency wards were swiftly overwhelmed – a problem that pushed up the death toll as doctors were forced to decide who they could treat, and who they had to push away.
Doctors hoped that knowledge gained from the initial contagion would help them sharply reduce fatalities in any new outbreaks. However, as the second wave sweeps over the whole country, Stefano Centani, professor of respiratory illnesses at Milan University, said the death rate remained elevated.
“Sadly we don’t seem to have made much progress. Perhaps we have even done worse. This will have to be analysed,” he said.
Prolonged underfunding of the public health service was probably partly to blame, he said.
“We are paying for 20 years, maybe more, of constant cuts to health resources…When this pandemic exploded all our problems were exposed.”
Speranza also bemoaned spending cuts introduced more than a decade ago to try to help contain a ballooning national debt.
“The biggest problem is a lack of doctors. You can buy masks, respirators and protective clothing on the international market but you cannot buy doctors, and you cannot buy nurses, you cannot buy personnel,” he said.
“In Italy, for 15 years, we have had a rule that blocked spending on personnel at 2004 levels minus 1.4%. This is incredible.”
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COVID-19’s third wave is hammering the Midwest
America is now firmly in the grips of what many are calling the “third wave” of the COVID-19 pandemic. Each day, new COVID-19 cases nationwide routinely approach or exceed 200,000, and associated deaths hover around 2,000.
In reality, however, each wave of the pandemic within the United States has been a regional one.
The first wave, in March and April, was centered largely in Greater New York and New England, among the locations where the virus first hit U.S. shores.
The second wave, which peaked in July, most affected metro areas in the South and West, after many relaxed their social distancing measures just as the virus began to take root in their communities.
My colleague William H. Frey documents that nearly all metro areas (and rural areas, too) are now experiencing increasing COVID-19 cases. That noted, the third wave thus far has hammered the Midwest most of all.
And the region’s metro areas are suffering an associated economic toll, as indicated in the latest data from our Metro Recovery Index, which tracks the real-time economic conditions in 192 metro areas across the United States.
Rising caseloads are concentrating in Midwestern metro areas
Until the fall, the pandemic’s impact in the Midwest had been lower than in other regions. But between September and November, the combined average daily new case rate (per 100,000 population) across Midwestern metro areas rose fivefold, from 14.2 to 71.7.
The Midwest is home to the six metro areas that saw the largest COVID-19 case increases over that period, and 13 of the top 20. Midsized metro areas such as Cedar Rapids, Iowa, Fort Wayne, Ind., and Peoria, Ill.
, as well as very large metro areas such as Grand Rapids, Mich., Milwaukee, and Minneapolis-St. Paul, registered especially large spikes.
Despite accounting for only 18% of the combined population across the 192 metro areas, Midwestern metro areas accounted for 33% of their new COVID-19 cases in November.
Case rates spiked in the three other regions as well, though not nearly to the degree they did in the Midwest. By November, average case rates in Northeast, South, and West metro areas were less than half those of Midwestern metro areas. Nonetheless, rates in each of those regions were higher than at any other point so far during the COVID-19 pandemic.
Economic activity contracted fastest in the Midwest
As COVID-19 cases spiked in the Midwest in November, consumers and businesses in the region pulled back. While we don’t yet have official metropolitan data on jobs and unemployment for November, other indicators point to a significant slowdown.
For instance, many of the metro areas in which November’s average case rates rose the most saw the steepest drops in workplace visits, according to data from Google’s Community Mobility Reports.
Visits were down in nearly every metro area, but fell by the largest margins in metro areas in Michigan, Iowa, and Minnesota.
Midwestern metro areas accounted for many of those registering significant declines in workplace-related travel.
Small businesses in Midwestern metro areas also faced negative impacts from rising caseloads. None of the nation’s 50 largest metro areas (for which data are available) saw an increase in the percentage of its small businesses that were open in November.
Closure rates were highest, however, in Indianapolis, Chicago, Milwaukee, and several other Midwestern metro areas.
By November, one-third of Detroit’s small businesses were shuttered compared to January, a decline matched by only the Boston and San Francisco metro areas.
Metro areas need economic help, stat
With COVID-19 cases reaching unprecedented levels in November—and many more cold months to come in the Midwest—a robust economic recovery is not in the near-term forecast. Vaccines will take months to sustainably lower virus levels, and even after that, Americans will be understandably cautious in their travel and spending.
The pandemic’s toll on metropolitan health and economic activity—in blue states (Michigan, Minnesota) and red states (Indiana, Iowa), as well as in large cities (Chicago, Milwaukee) and midsized regions (Cedar Rapids, Sioux Falls, S.D.)—provides a stark reminder that places of all sizes and political persuasions need immediate, significant federal assistance to avoid disastrous economic damage, and to safely navigate COVID-19’s latest deadly wave.
The US isn’t in a second wave of coronavirus – the first wave never ended
After sustained declines in the number of COVID-19 cases over recent months, restrictions are starting to ease across the United States.
Numbers of new cases are falling or stable at low numbers in some states, but they are surging in many others. Overall, the U.S.
is experiencing a sharp increase in the number of new cases a day, and by late June, had surpassed the peak rate of spread in early April.
When seeing these increasing case numbers, it is reasonable to wonder if this is the dreaded second wave of the coronavirus – a resurgence of rising infections after a reduction in cases.
The U.S. as a whole is not in a second wave because the first wave never really stopped. The virus is simply spreading into new populations or resurging in places that let down their guard too soon.
To have a second wave, the first wave needs to end
A wave of an infection describes a large rise and fall in the number of cases. There isn’t a precise epidemiological definition of when a wave begins or ends.
But with talk of a second wave in the news, as an epidemiologist and public health researcher, I think there are two necessary factors that must be met before we can colloquially declare a second wave.
First, the virus would have to be controlled and transmission brought down to a very low level. That would be the end of the first wave. Then, the virus would need to reappear and result in a large increase in cases and hospitalizations.
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Many countries in Europe and Asia have successfully ended the first wave. New Zealand and Iceland have also made it through their first waves and are now essentially coronavirus-free, with very low levels of community transmission and only a handful of active cases currently.
In the U.S., cases spiked in March and April and then trended downward due to social distancing guidance and implementation. However, the U.S. never reduced spread to low numbers that were sustained over time. Through May and early June, numbers plateaued at approximately 25,000 new cases daily.
We have left that plateau. Since mid-June, cases have been surging upwards. Additionally, the percentage of COVID-19 tests that are returning positive is climbing steeply, indicating that the increase in new cases is not simply a result of more testing, but the result of an increase in spread.
As of writing this, new deaths per day have not begun to climb, but some hospitals’ intensive care units have recently reached full capacity. In the beginning of the outbreak, deaths often lagged behind confirmed infections. It is ly, as Anthony Fauci, the nation’s top infectious-disease specialist said on June 22, that deaths will soon follow the surge in new cases.
After months of strict social distancing rules, New York has reduced its new cases to a fraction of what they were in April and is still being cautious. John Nacion/STAR MAX/IPx 2020/AP Images
Different states, different trends
Looking at U.S. numbers as a whole hides what is really going on. Different states are in vastly different situations right now and when you look at states individually, four major categories emerge.
Places where the first wave is ending: States in the Northeast and a few scattered elsewhere experienced large initial spikes but were able to mostly contain the virus and substantially brought down new infections. New York is a good example of this.
Places still in the first wave: Several states in the South and West – see Texas and California – had some cases early on, but are now seeing massive surges with no sign of slowing down.
Places in between: Many states were hit early in the first wave, managed to slow it down, but are either at a plateau – North Dakota – or are now seeing steep increases – Oklahoma.
Places experiencing local second waves: Looking only at a state level, Hawaii, Montana and Alaska could be said to be experiencing second waves. Each state experienced relatively small initial outbreaks and was able to reduce spread to single digits of daily new confirmed cases, but are now all seeing spikes again.
The trends aren’t surprising how states have been dealing with reopening. The virus will go wherever there are susceptible people and until the U.S. stops community spread across the entire country, the first wave isn’t over.
The 1918 flu came back with a vengeance after a mutation and lack of preparedness set the stage for tens of millions of deaths during the second wave. Universal History Archive/Universal Images Group via Getty Images
What could a second wave look ?
It is possible – though at this point it seems unly – that the U.S. could control the virus before a vaccine is developed. If that happens, it would be time to start thinking about a second wave. The question of what it might look depends in large part on everyone’s actions.
The 1918 flu pandemic was characterized by a mild first wave in the winter of 1917-1918 that went away in summer. After restrictions were lifted, people very quickly went back to pre-pandemic life.
But a second, deadlier strain came back in fall of 1918 and third in spring of 1919.
In total, more than 500 million people were infected worldwide and upwards of 50 million died over the course of three waves.
It was the combination of a quick return to normal life and a mutation in the flu’s genome that made it more deadly that led to the horrific second and third waves.
Thankfully, the coronavirus appears to be much more genetically stable than the influenza virus, and thus less ly to mutate into a more deadly variant. That leaves human behavior as the main risk factor.
Until a vaccine or effective treatment is developed, the tried-and-true public health measures of the last months – social distancing, universal mask wearing, frequent hand-washing and avoiding crowded indoor spaces – are the ways to stop the first wave and thwart a second one. And when there are surges what is happening now in the U.S., further reopening plans need to be put on hold.