Surging coronavirus figures across the world are providing what one senior health official has called "a wake-up call" with the impact of an imminent second wave of the coronavirus beginning to be felt.
So, will the United States follow suit?
That remains to be seen, experts say. While one forecast model is predicting that death from covid-19 could almost double in the United States, reaching almost 380,000 by the end of year, most health officials are still being cautious.
Throughout the course of the pandemic, public health experts have feared it could follow the pattern set in the famous ‘Spanish Flu’ of 1918-19, which killed an estimated 50 million people worldwide. In that case, a massive second wave of an influenza virus in the fall caused far more deaths and illness than the first, spring wave.
“We haven’t really gotten out of our first wave,” said Joshua Michaud, Associate Director for Global Health Policy at the Kaiser Family Foundation an independent, national healthcare charity in Washington DC.
“It’s a little bit of a misnomer to talk of second wave because we are still at very high levels of transmission,” he added. “What would be more apt is to say that there is a possibility for a surge of cases beyond this high level of cases we have now.”
While case numbers had fallen significantly in the United States from the peak in July, the number of daily cases remains high, around 45,000. Deaths, though still well below their peak spring levels, averaged around 850 per day in mid-September, far more than were reported in early July.
With more than 200,000 deaths, the US has the world's highest death toll.
As has been the case since the start of the pandemic, the situation varies from state to state. Reported cases in New York, which was the worst affected state early on, have stayed low for months. Some places that suffered the most in early summer, including Arizona, Florida, Texas and California, have since seen steep declines, while other states in the Midwest and the Great Planes - North Dakota, South Dakota, Missouri and Iowa - that had been faring better have now seen their numbers rise.
The global scene
Globally, the situation is worse. A new record for daily coronavirus infections was set on Friday, with 315,000 reported over 24 hours. That’s well up from the average of 250,000 cases that were witnessed in July and August.
The number of confirmed infections worldwide has passed the 31 million mark, while more than 942,000 people have died since the coronavirus emerged in China late last year.
As air travel resumes between some countries - for business and vacations - international transmission could pick up as well. That is certainly the worry in Europe, where the UK announced Friday that it was adding new regional restrictions on social gatherings after the number of new daily cases has reached the highest level since mid-May.
Cases have also risen alarmingly in France, which recorded 10,593 cases on Thursday - the highest daily number since the pandemic began. Spain on Wednesday recorded 239 new coronavirus deaths, the highest number since June.
Coronavirus cases also remain high in Latin America and Asian where Brazil and India are the driving forces behind the numbers. Peru, Colombia, and Argentina have all reported more than half a million cases each.
Signs of a surge?
Florida health officials reported Friday that the number of covid-19 positive patients that are currently hospitalized was down more than 70 percent since July. The state has also had 36 straight days below 10 percent positivity of new cases.
But there are worrying indicators that cases in Florida could be about to surge again. Thermometer data shows Florida has double the number of than would be expected in a normal flu season based, according to Kinsa Health, a California company which relies on 1.5 million internet-connected thermometers across the country to try to detect outbreaks before people can get tested or go to the doctor.
“Our data is showing increasing rates of illness transmission, that’s of concern,” said Nita Nehru, spokeswoman for Kinsa, who identified the Tampa Bay area as the focus of the illness spike.
The company’s data does not indicate if the infection is flu, covid or some other coronavirus type illness. “ Something is happening. It may be an indication of covid cases increasing, but we can’t make that assertion,” she said.
Since the covid-19 pandemic began, the company’s data has detected regional spikes two or three weeks before there is a jump in confirmed cases.
Experts are also concerned that the imperfect covid-19 testing system in the United States, could be hiding the true impact of the disease. For every case being detected there are likely a couple of others that are not detected, they say.
Worst case scenario
A projection from the University of Washington in Seattle suggests there could be 415,000 deaths in the United States by the end of the year, though it says this could be reduced to 260,000 if 95% of Americans wear masks in public.
The Washington university model is an extreme projection that assumes a nationwide acceleration of state’s reopening their economies and the public disregard of social distancing guidelines.
Hospitals are now better equipped to deal with the virus, and doctors have also learned much about the best drug therapies to treat patients.
On a positive note, hospital admissions and deaths have not yet seen a similar rise. That is partly thanks to better understanding of the disease and the ways to contain – and treat - the virus.
Though critics say, most states still don’t have satisfactory contact tracing systems in place to be able to respond quickly to outbreaks. And questions remains over the availability of testing, and the accuracy of results and collection of data by state authorities.
There is also another big unknown: the seasonal effect of cooler dryer weather with has historically shown to favor viral transmission, in part due to people staying indoors more in the winter.
In fact, f ears of a dual epidemic from covid-19 merging with the annual influenza season, are receding after indications this summer that use of face masks and social distancing have helped reduce the transmission of flu.
Countries in the southern hemisphere – Argentina, Chile, Australia and South Africa – have all seen very low rates in transmission. The Centers for Disease Control and Prevention (CDC) this week also reported “historical lows” in the U.S. transmission of flu this summer.
That said, the relaxing of lockdown measures in some states, such as bars and restaurants resuming indoor service, as well as the reopening of universities and schools, is already resulting in regional spikes of covid cases.
“The truth is, transmission of this virus depends entirely on our behavior and what we do now changes the way that the epidemic will look a month from now,” said Michaud.
While younger people, who are less likely to be severely impacted if they are infected, currently make up the largest proportion of new cases, there are still fears of many more cases of serious illness if the virus spreads to older and more vulnerable groups.
“If people take social distancing seriously, if they wear masks, and the high-risk locations like bars and restaurants are taken into consideration, then you have a substantial effect on the transmission. It’s not like something that happens to us. It happens because of us. So. everything depends on behavior and adhering to the public health guidelines that we know work. If we ignore those, sure, we could see a massive rise in cases,” he added.