Illustration: Kieran Blakey

The Nuance

This is What Could Make or Break the U.S. This Fall

If the United States doesn’t get its act together, it’s going to be a tough autumn

As May gave way to June, rates of Covid-19 cases and deaths were falling across much of the United States, especially in New York, New Jersey, Michigan, and many of the virus’s springtime hot spots. Some epidemiological models even predicted that warm and sunny weather, coupled with more open windows and outdoor-centric lifestyles, would push infection rates so low that much of America could return to a state of relative normalcy.

Of course, things haven’t played out that way. Falling case and death counts helped lull many parts of the country into a false sense of security. In many states, imprudent reopenings, coupled with poor adherence to commonsense safety measures, gave a dwindling virus a big boost. “We declared victory at a plateau a couple months ago, and now we have a brand-new peak that has broken the previous record by twice the magnitude,” says Mark Cameron, PhD, an associate professor in the Department of Population and Quantitative Health Sciences at Case Western Reserve University School of Medicine in Cleveland.

Cameron and other experts say that if the United States makes the right moves now — starting today — there may still be time to right the ship before the fall. But if we don’t, prognostications for the coming months are almost uniformly dire.

“Whether you’re looking at individual states or the whole country, the outlook right now is grim,” he says.

Creating fresh reservoirs

Over and over again, virus experts highlight two foreseeable events as likely to cause major trouble this fall. Those events are school reopenings and the advent of the cold and flu season.

“I understand the need for parents to send their kids back to school, but I think school reopenings are going to create huge reservoirs of infected people,” says Lee Riley, MD, a professor and division head of infectious diseases and vaccinology at UC-Berkeley.

Riley says that if students and teachers rigorously adhere to mask guidelines and other virus-blocking protocols, and if people who develop symptoms or who are exposed to an infected individual immediately self-quarantine, it’s possible that schools could safely reopen. But he says that the politicization of these measures — and masks in particular — will make this level of adherence unlikely. “Kids will bring the infection home, and many people will develop severe infections, especially parents and grandparents who have preexisting conditions,” he says. “I don’t think there’s any question that will happen.”

“We are roughly seven months into this pandemic in the U.S., which is the most technically sophisticated country on the planet, and we’re still struggling to get aggressive and widespread testing in every community.”

Experts say the arrival of the cold and flu season will worsen this already difficult situation — and in more ways than one. For starters, Riley says that people who catch one of the seasonal bugs may be more likely to develop a serious infection if also exposed to SARS-CoV-2. “I think it will be very important for people to get the flu vaccine, and I think demand for that vaccine will create shortages,” he says.

Clinics overwhelmed by non-Covid-19 patients

Common cold and flu cases could also put a strain on the country’s still-feeble Covid-19 testing capabilities. “When we start seeing the normal circulation of influenza and this whole huge family of viruses that cause respiratory illness at this time every year, we’re going to have a lot of people developing symptoms that are consistent with Covid-19,” says Julie Fischer, PhD, a microbiologist at the Georgetown University Center for Global Health Science and Security.

Fischer says that easy access to quick and accurate Covid-19 testing will be absolutely vital when it comes to identifying the true coronavirus cases and ensuring that those people receive prompt and appropriate treatment. Testing will also ensure that hospitals and clinics aren’t overwhelmed with non-Covid-19 patients. Unfortunately, it seems unlikely that these testing capabilities will be in place by fall. “We are roughly seven months into this pandemic in the U.S., which is the most technically sophisticated country on the planet, and we’re still struggling to get aggressive and widespread testing in every community,” Fischer says. “We’re still rationing.”

She says that America’s testing deficiencies do not stem from a lack of technical know-how or capability. “The problem is that [testing] requires a lot of planning and communication and supporting policies, all of which are leadership issues,” Fischer says. In states or cities that have strong leaders who have “been guided by science,” she says that testing capabilities are good and getting better. “But in places where leadership or communication or coordination have broken down, we’re still struggling with testing,” she says. “The fact that we’re still dealing with these basic testing questions is incredibly frustrating.”

If everyone got on board with those measures, and if the country’s leaders ensured that testing access is appropriately ramped up, the fall could be a time of minor and controlled outbreaks.

Time is running out

There’s still time — roughly two months — to ramp up testing capabilities across the country. “But this will take real leadership, including at the national level,” Fischer says.

Other experts agree that the United States still has a chance to get its act together in time to prevent calamity this fall. “If we are diligent and do everything we can to break the chains of transmission, we could get down the other side of this current wave by October,” says Case Western Reserve’s Cameron. “But we can’t make the same mistakes we made after the spring.”

What needs to happen? The answers aren’t surprising. “Other countries have been able to lower their curves by having good mask compliance, by controlling the opening of risky businesses like bars, and by avoiding large groups of people getting together without adequate social distancing,” Cameron says.

If everyone got on board with those measures, and if the country’s leaders ensured that testing access is appropriately ramped up, the fall could be a time of minor and controlled outbreaks. Throw in the emergence of a new and highly effective form of Covid-19 treatment — and several are in the works — and there’s a slim chance that autumn could turn out to be a happier and safer time in the United States than summer has proven to be. But it’s not looking good.

“I wish I had a more hopeful view for the fall, but in the U.S. there are a lot of people who don’t like to follow rules,” says Efraín Rivera-Serrano, PhD, a molecular virologist at the University of North Carolina at Chapel Hill.

Rivera-Serrano says that all the models that predicted lower transmission rates this summer were based primarily on environmental variables — such as more UV light and greater humidity levels. Those optimistic models didn’t account for huge chunks of the country ignoring social distancing directives and other safety measures.

“I don’t have high hopes, because I don’t trust people’s behavior,” he adds.

I write about health and science. I live in Detroit with my wife and kids. I’m trying to learn German, but my progress so far is nicht gut.

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