Lines for COVID-19 testing in Los Angeles. Getty Images
  • Many Americans wonder what the coming months of the pandemic will look like in states where case rates are currently high, as well as states where the curve has been flattened.
  • Earlier in the year experts didn’t know if the coronavirus would follow a seasonal pattern similar to the cold and flu viruses.
  • Those viruses tend to be very active in late fall and winter, but cause few infections in warm months.

When COVID-19 first arrived in the United States, it hit New York and New Jersey particularly hard.

With the implementation of lockdown measures, mandated face masks, and other mitigation strategies there, cases in those states have substantially declined.

Meanwhile, COVID-19 cases have surged in many states in the south and west of the country throughout June and July — including Florida, Texas, Arizona, California and others.

Many Americans wonder what the coming months of the pandemic will look like in states where case rates are currently high, as well as states where the curve has been flattened.

What happens in the months ahead will largely depend on the actions of officials and other community members, health experts advise.

“To stop the epidemic dead in its tracks, we need to wear masks universally, physically distance, wash our hands,” Dr. Eric Cioe-Pena, an emergency physician and director of Global Health at Northwell Health in New Hyde Park, New York, told Healthline

“Quick reactions of health departments, contact tracers, and focused testing to break the chain of transmission” are also essential for limiting outbreaks, he said.

No break this summer

While COVID-19 cases in northeastern states were falling this spring, experts there warned that a second wave of infections might hit in the fall.

At that point, experts didn’t know if the novel coronavirus would follow a seasonal pattern similar to common cold and flu viruses. Those viruses tend to be very active in late fall and winter, but cause few infections in warm months.

The recent spike in cases in many southern and western states shows that the virus that causes COVID-19 does fine in hot conditions.

For example, sweltering temperatures in Arizona haven’t kept infection rates down.

Whether the surge in cases there represents a “second wave” of infections or the continued cresting of the “first wave” doesn’t matter much, according to Will Humble, MPH, executive director of the Arizona Public Health Association and former director of the Arizona Department of Health Services.

“I don’t think it’s so important to label it as a ‘first wave’ or ‘second wave,’” Humble said. “What’s important to recognize is this happened for a reason.”

Arizona’s warning sign

Humble attributes the surge in COVID-19 cases in Arizona to poor policy decisions by government officials who rushed to reopen in May.

“We had a really good stay-home order that went through the end of March, all the way through April — and then everything was open by May 15,” Humble said.

“Nightclubs were open till 2:00 in the morning, bars were totally packed — people had been pent up for six weeks, and the governor had just told him everything was OK,” he continued.

Soon after Arizona’s s stay-home order was lifted, COVID-19 case rates in the state began to climb. From the end of May to the beginning of July, Arizona’s rolling average of new daily cases increased more than 10 fold.

Even as the case rate soared, state officials allowed businesses to operate much as usual.

It wasn’t until June 17 that Arizona Gov. Doug Ducey (R) permitted county and municipal officials to implement local face mask requirements.

On June 29, the governor ordered bars, nightclubs, movie theaters, and water parks across the state to close again.

Finally, Arizona’s case rate has started to drop in the last few weeks.

Planning for the future

Looking ahead, will states like Arizona be able to flatten their infection curves? Will a second wave of infections hit areas like New York?

The answers to those questions depend on the steps that officials and community members take in the weeks and months ahead, Humble said.

Researchers around the world have been working to develop a vaccine against SARS-CoV-2, but it will be months at least before a vaccine becomes available.

In the meantime, public health experts are calling for continued physical distancing, mask wearing, and other mitigation strategies to flatten the curve where it’s high and keep case rates down where they’re low.

“The key is to not let your guard down as the pandemic continues,” Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City, New York, said.

“This means practicing physical distancing, wearing a facial covering when in public, and washing your hands with soap and water or using hand sanitizer after touching shared or common surfaces,” he advised.

Reopening schools

One of the pressing questions about the future of the pandemic is when will schools reopen? And when they do, will they be safe?

“Having in-person classes clearly elevates risk to everyone,” Glatter told Healthline, “and we must balance this with the need for social contact and the benefits of socialization that in-person classes provide.”

Compared with other members of the population, young children appear to be less likely to contract and spread the novel coronavirus.

However, a study released last week by the Korea Centers for Disease Control and Prevention found that children over 10 years old can transmit the virus to others at least as well as adults can.

This has important implications for the risk of transmission in schools, including the chance of children passing the virus to medically vulnerable teachers and other adults, Glatter said.

Targets to move towards

Rather than set an arbitrary date for school reopenings, Humble would like officials to establish criteria to be met before in-person classes resume.

“If you just set a date, you’re not mobilizing the population to achieve anything together,” he said.

“So put some metrics in, allow each county to work towards achieving that goal, and when they meet that goal, the schools can open,” he continued.

In a recent blog post, he proposed the following criteria as potential targets:

  • A consistent 30-day reduction in the number of new COVID-19 cases in the community;
  • A community percent positive rate of less than 5 percent;
  • Eighty percent of case and contact tracing investigations completed within 96 hours of sample collection; and
  • Community hospitals at 80 percent or less of capacity and open for elective procedures.

When schools do reopen, risk mitigation plans will need to be in place.

“We need quick testing, good contact tracing, the ability to have schooling outside or socially distant inside with open windows and lots of air changes in classrooms,” Cioe-Pena said.

“Kids need to be wearing masks but be allowed to take safe mask breaks,” he continued, “and there should be a remote learning option for families who have high-risk individuals at home or aren’t comfortable with in-person schooling.”

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