• Experts say the United States is still in the first wave of the COVID-19 pandemic, with new cases and hospitalizations rising.
• They warn that a second wave could hit this fall when schools reopen and people begin spending more time indoors.
• They say people need to learn to live with the virus and should continue to wear masks, keep their physical distance, and avoid large indoor events.

There may have been some initial optimism concerning the COVID-19 pandemic as businesses reopened and the number of new cases flattened out.

However, reports from the past week of a surging number of new cases in more than 20 states suggests something of a reality check: This is far from over.

The New York Times’ reports indicate that 20 percent of newly diagnosed cases of COVID-19 around the globe are in the United States — despite the fact that the country is 4 percent of the world’s population.

Hospitalizations due to COVID-19 are rising in 14 states, especially Arizona and Texas. That’s a key measure scientists use to gauge the severity of the outbreak.

The head of Harvard’s Global Health Institute says that without drastic action, the U.S. death rate from the coronavirus could reach 200,000 in September.

This isn’t a second wave

Experts tell Healthline the current surge is still part of the ebb and flow of the first wave.

“There is no second wave. That’s kind of a misnomer,” said Dr. Jeffrey D. Klausner, professor of medicine and public health at the UCLA David Geffen School of Medicine and the Fielding School of Public Health in California.

“These are expected continuations of infection into susceptible populations,” he told Healthline. “This is not a big one-size-fits-all where everyone gets infected at the same time.”

In part, the experts say, this is the virus pushing into smaller communities after the initial outbreaks in large urban areas such as New York City.

“New York City has population density,” said Helen E. Jenkins, PhD, an assistant professor of biostatistics at the Boston University School of Public Health in Massachusetts. “People there rely on a public transport system, which is a great way to spread the virus.”

“I think what we’re seeing is the fact that the virus spreads a little bit more slowly in places where people are spread out more and are more reliant on cars,” Jenkins told Healthline.

What’s behind the spikes?

It has been widely suspected that the protests for racial equity around the country could be a vehicle to transmit the virus to thousands.

There have been reports of people who attended rallies being diagnosed with COVID-19, but experts say being outdoors probably worked to the advantage of the demonstrators.

“I definitely think the outdoors will make transmission less likely in those settings,” Jenkins said. “I don’t think we’re seeing the impact of those at this point.”

What part does reopening play?

“Reopening, depending on how you do it, is likely to increase the spread,” she said.

Florida and Texas were among the first states to reopen and loosen restrictions. Both states are now seeing record numbers of new daily COVID-19 cases.

In Texas, the numbers have seen a dramatic jump over just the past few days. The number of new cases has averaged more than 3,500 per day. The number of hospitalizations are at more than 3,200 a day.

Texas Governor Greg Abbott said his state will step up patrols of places not complying with physical distancing and will shut down overcrowded bars. But the governor said “Closing down Texas again will always be the last option.”

But a “slowdown” is underway in some states as their COVID-19 numbers sharply increase.

Officials in Oregon, Utah, and Tennessee are pumping the brakes on reopening plans, at least temporarily.

The virus decides the timeline

“Since the very first day of this pandemic, I don’t think [we’ve been] in a more confused position about what’s happening. We just aren’t quite sure what [the novel coronavirus is] going to do next,” Michael T. Osterholm, PhD, MPH, said in an interview with National Public Radio last week.

Osterholm is an infectious disease epidemiologist and director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

“I think the one factor that we must keep in mind at all times is that, to date, about 5 to 7 percent of the U.S. population has been infected with the virus. That’s it,” he said.

“All the pain, suffering, death, and economic disruption have occurred with 5 to 7 percent. But this virus is not going to slow down transmission overall. It may come and go, but it will keep transmitting until we get at least 60 or 70 percent of the population infected and hopefully develop immunity. Or, if we get a vaccine, that can get us there, too,” he added.

Potential second wave this fall

The Trump administration now says it’s preparing for the possibility of a second wave of COVID-19 that could hit this fall.

“We are filling the stockpile in anticipation of a possible problem in the fall,” Peter Navarro, the White House’s trade advisor, told CNN on Sunday. “You prepare for what can possibly happen. I’m not saying it’s going to happen, but of course you prepare.”

Experts tell Healthline a second wave this fall is indeed a possibility.

“I think it’s pretty likely there will be a second wave in the fall. People will be spending more time indoors as the weather gets colder. Schools and universities come back. The states will reopen more and more,” Jenkins said. “All those things combined could cause a second wave in the fall.”

That second wave could launch right around the time we start fighting flu season.

“Because we can anticipate an increase in the fall, we need to make sure people get the influenza vaccine,” Klausner said.

“We have to protect the population and reduce the burden on hospitals,” he added. “Every year the flu results in hundreds of thousands of medical visits, and they sometimes end up in the ICU.”

What living with COVID-19 looks like

Experts say you should continue wearing your mask, keeping your distance, and washing your hands because those strategies work.

“Some of the most effective interventions have been some of the personal behavior changes,” Klausner said.

Experts add that there will have to be more testing, surveillance, and contact tracing.

They note we probably won’t see a vaccine anytime soon. But there are treatments in the pipeline that could help.

“I think we’ll be very lucky to see a vaccine next year. It’s possible it could take longer than that,” Jenkins said. “Don’t forget, it’s not just having a viable vaccine. It’s also producing it in large numbers, getting it to people.”

“But in the meantime, there are lots of trials going on of different treatments to help people,” she added. “If we find some treatments that happen to save lives, then we can at least lower the death rate if large numbers of people end up getting infected.”

Jonathan Van-Tam, Britain’s deputy chief medical officer, is already warning the United Kingdom it may have to learn to live with COVID-19 “certainly for many months to come, if not several years.”

And if you’ve ever wondered how public health experts personally see the future, this recent New York Times survey of more than 500 epidemiologists gives us some insight.

Many said that without a vaccine or effective treatment, it would be more than a year before they’d be willing to go back to concerts, sporting events, or to church.

And some said they may never greet people with hugs or handshakes again.

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