Coming to Grips With the Fall Surge

As predicted, the uptick in cases has begun

Image: Andriy Onufriyenko/Getty Images

Just as scientists predicted, the fall surge of Covid-19 has begun. Since the early days of the pandemic, researchers have warned that the return to school, cooler weather, and the end of outdoor activities could create the perfect conditions for an uptick in new cases. That’s exactly what the numbers are showing now.

In the U.S., the case count has risen steadily in the past two weeks, from 24,257 on September 7 to 39,330 on September 22, according to data collected by Johns Hopkins University (JHU). A graph of the seven-day moving average in the U.S., also from JHU, shows this trend:

After a huge summer spike, Covid-19 cases in the U.S. are again on the upswing. Credit: Johns Hopkins Coronavirus Resource Center

Other countries in the northern hemisphere, where the weather is cooling, are seeing the same pattern. Spain, France, Russia, and the United Kingdom, which are on JHU’s list of the top 10 most affected countries, have all seen a rise in cases in the past seven days.

Even though scientists had warned that this would happen, it’s understandable if this news feels alarming. But take comfort in knowing that scientists understood enough about the spread of the coronavirus that they could predict how it would behave in the fall. Understanding its spread means knowing how to prevent it. And unlike the start of the pandemic in March, we know much more about that now, too.

“Concerns for the winter are primarily related to the transmission dynamics of Covid-19,” Abraar Karan, MD, MPH, an internal medicine doctor at the Brigham and Women’s Hospital and Harvard Medical School, tells the Coronavirus Blog via email. “We know that the disease transmits best indoors, in crowds, and in poorly ventilated spaces.” As I wrote previously, both the droplets and aerosols (tinier particles that can travel farther than six feet) expelled through talking, coughing, and sneezing can spread the coronavirus indoors.

As the weather gets colder, people will naturally spend more time indoors, increasing their risk of spreading the virus. “While the summer gave us the benefit of moving our social activities outdoors, the winter will demand that we are smarter about how we operate and interact indoors,” Karan says. “Ensuring the use of masks while indoors, as well as better ventilation, will be exceptionally important.”

Doing your part to prevent the further spread of the coronavirus this fall will require a certain amount of discipline and sacrifice. Halloween, Thanksgiving, and the holidays — not to mention the NBA playoffs, followed shortly by baseball playoffs and football season — are around the corner, and it will be tempting to get together after spending so many months in isolation or, at best, socializing at a distance outdoors.

As the holidays arrive, says Karan, “the concern is that people may let up their guard and socialize further. We can’t let that happen, and it will take strong public health leadership, as well as better public communications, to ensure that we get this right.”

Strong leadership and messaging have been painfully absent from the Trump administration’s coronavirus response. Though Anthony Fauci, MD, head of the National Institute of Allergy and Infectious Diseases and the country’s leading infectious disease expert, has been critical in helping the American public understand Covid-19, public trust in him has waned as partisan politics increasingly tears the country apart. Further, the reputations of the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA), government organizations that once set global standards for health and safety, are now heavily tarnished after a frustrating string of botched decisions that derailed the country’s coronavirus response.

An effective response to the fall surge will partly “depend on the CDC,” says Karan. He points to the CDC’s recent blunder, in which it added, and then removed, guidance stating that the primary way the virus spreads is through air droplets from people’s mouths. This is “an example of what should not happen,” says Karan, “because anything that confuses the public threatens their trust, and ultimately, the actions they are willing to take.”

One ray of hope is the potential that a coronavirus vaccine may hit the market later this winter, but Karan cautions against banking on it to end Covid-19. “It remains to be seen how safe and effective they will be; and so I would say that hoping a vaccine on its own will stop the epidemic is not a good way of thinking.”

Instead, he says, we must do what we know works. “We must continue to think in terms of a layered strategy of risk mitigation; vaccines, masks, ventilation, avoiding super-spreading scenarios, utilizing rapid antigen testing more cleverly, figuring out ways to make contact tracing more efficient, such as digital options, and focusing on equity and protecting our most vulnerable — these are all parts of a sophisticated strategy,” he says. This guidance should not only shape the way governments, schools, airports, offices, and businesses operate but also individuals and families.

Much more is known about the coronavirus than six months ago when the pandemic started. Experts like Karan have identified ways to prevent its spread and curb outbreaks, and nations with a strong coronavirus response, like New Zealand, have proven that following these strategies actually work. Now, as flu season threatens to coincide with the fall spike, a renewed sense of vigilance and determination is crucial.

“I predict the winter to be tough globally,” says Karan, “but if we do this all right, we can reduce not only Covid19 spread but hopefully also influenza and other respiratory viruses.”

Editor, Medium Coronavirus Blog. Senior editor at Future Human by OneZero. Previously: science at Inverse, genetics at NYU.

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