There Will Be No Second Wave

There has been talk from the very beginning of the pandemic of a concern of a “second wave” of infections that could hit after the first surge dies down. The idea that the virus could come back again after going away is based on historical precedent. The spanish flu had such a pattern. There were 3 distinct waves of illness during that pandemic, starting in March 1918 and subsiding by summer of  1919. The pandemic peaked in the U.S. during the second wave, in the fall of 1918. This highly fatal second wave was responsible for most of the U.S. deaths attributed to the pandemic and was reason for concern with COVID-19. Considering how bad the first wave was it was quite scary to think that this first wave was the “small” bump on the graph. There will be no second wave.

There will be no second wave with COVID-19 but its not for the reason you might think. As the cases started to rise in June there were several media reports asking whether or not we are in a second wave. I was guilty of this myself with my post (Is this the second wave). I have come to realize that I was wrong so please forgive me (although the post is still worth reading in my highly biased opinion). To say there is going to be a second wave would imply that the first wave has come and gone. That’s how waves work. They come and go. Around memorial day, as numbers were dropping, many states eased or completely removed restrictions. This was around the time where the public messages from the public health officials were not what people wanted to hear. They were not grabbing the ratings they once did. With fewer hospitals in crisis mode and fewer attention grabbing images of the dead or dying, the pandemic became more abstract for the public and less salient for the media. Dr. Fauci was only on cable TV 4 times the entire month of April. Instead of reporting the viral carnage, there were more stories of people going back to the beaches, bars, and hair salons – a much more positive and happy message corresponding with the coming happiness of summer break. Many many people felt that this was an indication that the pandemic was done. Put away the masks and pack the station wagon, we’re going to the beach!

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With fewer hospitals in crisis mode and fewer attention grabbing images of the dead or dying, the pandemic became more abstract for the public and less salient for the media.

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The problem was that, even though numbers were down, the virus never went away as you can see from this report in late June. There were still several thousand new cases a day in the US. It was alive and well just waiting for people to let their guard down and let their guard down they did.

I myself am still seeing patients in the hospital with new diagnoses of COVID-19 in a state where cases are not exploding. Our cases have gone down and are staying down but have not gone to zero. As long as there is virus around it can come back. Remember, the explosion in New York happened just a few weeks after one person got off a plane from Italy. This means that the virus will continue to spike and fall more like a game of wack-a-mole than an oscillating ocean surf.

This is exactly what happened in the sun belt. No state that eased restrictions had a prolonged significant decline in new cases when the restrictions were eased and there was a dramatic (and predicted) rise in new cases (there were also spikes in percent positive tests and hospitalizations so the change cannot be explained by more testing).

The good news is that the numbers all fell after we took all the measures we did to halt the spread after the first surge. The better news is that a full lockdown is not necessary to keep things sufficiently under control. We can keep the numbers down enough to prevent widespread destruction and overwhelming the healthcare system without closing down businesses. We can keep the curve flat and down. We all know how. As I said in the last post, masks make a huge difference. Outdoor transmission does not seem to be significant (supported by evidence of the lack of a spike in cases triggered by the George Floyd protests) so the outdoors is open to everyone as long as we keep a safe physical distance as there is evidence for the benefit of that as well.

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We can keep the numbers down enough to prevent widespread destruction and overwhelming the healthcare system without closing down businesses.

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In other words, if we continue to do the things that we have been told from the beginning we will keep the virus under control and can keep our businesses open with minimal modifications. I know people are tired of hearing the same boring recommendations by the same boring doctors (no offense taken): wear masks, keep a safe distance, clean your hands, and stay home when you’re sick. It doesn’t make for good attention grabbing headlines or click worthy blog posts but it does work.

The reality is that the virus doesn’t really care if we’re tired of masks or want to go back to our normal lives. It will rear its ugly head with a vengeance if we ease up too much regardless of our desires or political sensibilities. If we don’t respect it, we will all suffer. So there will be no second wave because there will not be a complete end to the first wave. We have the power to prevent huge spikes – spikes that would lead to great loss of life, catastrophe for our hospitals, and probably a return to the draconian lockdowns such as we had in March. Hopefully we can all hang in there until the vaccine comes as difficult as it will be. In the interim, if people make handwashing a political thing I quit.