Doctors Explain What To Expect From A Second COVID-19 Wave

There are reasons to be hopeful.

A woman wearing a jacket and mask opens a fridge door at a grocery store. Doctors explain how the second wave of COVID could be different from the first.
Luis Alvarez/DigitalVision/Getty Images

After a summer of stable, but still high coronavirus case counts, experts fear a second wave of COVID-19 infections as the weather gets colder and winter sets in. Eli Klein, an epidemiologist at Johns Hopkins University School of Medicine, told the Washington Post in September that the wave will likely gather pace during the fall, and peak around Election Day in early November. Cases have been steadily rising in European countries already, giving the U.S. some insight into what a second wave of infections might look like. But if you're thinking back to the early days of the pandemic, know that the second wave might differ quite a lot from the first.

One reason it'll be different is that scientists and individuals know a lot more about how to prevent the spread of COVID-19 — and that helps researchers understand what a second wave might look like.

"Colder weather drives people indoors, which we now know is riskier than outdoor settings," Dr. Seema Sarin M.D., director of lifestyle medicine at EHE Health, tells Bustle. Lower levels of air flow inside mean there's less chance of COVID-19 droplets dispersing harmlessly in the breeze, and more of a chance that you'll breathe them in and get infected.

It's worth remembering that we're now all old hands at dealing with the coronavirus, which might help make the second wave less intense. “If everyone is rigorous about mask use, physical distancing, appropriate hand hygiene, and avoids venues where masks are not used, especially indoor poorly ventilated spaces, the feared increase in new infections will hopefully be minimized," Dr. Thomas A. Russo M.D., a professor in the Division of Infectious Diseases at the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo, tells Bustle.

"Everything being equal, outcomes are improving."

But Dr. Sarin says that our months of preparation could backfire if people experience quarantine fatigue. "This is an adaptive reaction of the brain and emotions marked by low motivation to keep following safety guidelines." If people are thoroughly sick of masks, hand-washing, and social distancing, they might be less likely to keep acting safely, and that could send case numbers up again. It might also be harder for people to adapt if their communities have to re-introduce severe COVID-19 protections in fall and winter after gradually reopening over the summer. Paris is enforcing early bar and restaurant closing times and limiting gatherings to 10 people, while the three largest cities in The Netherlands will see new rules on face masks in shops and a ban on more than three visitors at home.

There's reason to be hopeful, though. “We have learned a lot on how to best treat serious coronavirus infections since the beginning of this pandemic, and as a result, everything being equal, outcomes are improving," Dr. Russo says. Treatments like proning, where seriously ill patients are put on their stomachs to improve oxygen flow, and the use of medications like remdesivir and dexamethasone, show a lot of promise, Dr. Sarin says. That means that while more people might end up getting hospitalized, their stays might be shorter and their treatment more effective.

And the people who are most likely to experience serious COVID-19, like the elderly and people with immune conditions, might be less likely to catch it in the second wave. “The vulnerable were most severely affected in the first wave of this pandemic," Dr. Russo says. "We have learned how to protect them from infection, and hopefully they have learned how to best protect themselves. This knowledge will go a long way towards decreasing bad outcomes.”

Still, winter is also flu season, and that means everyone, low and high risk, need to be careful. "It's possible that mixing a second wave of COVID-19 with the seasonal flu could overwhelm the healthcare system," Dr. Sarin says. All the more reason to get your flu shot this year.

The second wave is coming, and it's definitely something to take seriously. "Ultimately, COVID-19 remains a novel infection, and there is still a lot to learn," Dr. Sarin says. "But improved medical knowledge combined with public compliance with risk mitigation strategies can help to manage the likely second wave of outbreaks."


Dr. Thomas A. Russo M.D.

Dr. Seema Sarin M.D.