Questions About a Second – or Even a Third – Wave

There has been a lot of media attention on a “second wave” of COVID-19 hitting New York City in the coming days and a “third surge” rising across the country. Right now, the United Kingdom, France, Spain, Czech Republic, and The Netherlands are experiencing a second wave of COVID-19 infection and are beginning to implement new restrictions. So what is actually happening here in our city, and are we heading towards a second and perhaps even harsher wave of disease?

What is a “Second Wave”?

The term “second wave” is not used by scientists. Instead it is used by local health, governmental officials and the media in an effort to monitor substantial increases in cases after reducing the rate of infection in certain areas.

For New Yorkers, specifically, our local and state leaders have designed a set of metrics to help determine and/or trigger nonessential business and school openings or closings. For us, it is a rolling average of more than 3% of COVID-19 tests being positive - otherwise known as the positivity rate - for seven days. This means that for us to be concerned, for every 100 COVID-19 tests, three or more would have to be positive.

Unlike the spring, when testing was not widespread and hard to come by, the city now has multiple testing sites and even rapid testing sites so we are testing more New Yorkers than we were in the spring. This is a great thing which might make the total number of positive tests go up, but should not affect the positivity rate which should be unchanged by the total number of tests performed. Yet even without the widespread testing information this spring, it is estimated that there were more than 250,000 COVID-19 cases and more than 23,000 deaths in New York City alone.

Right now, citywide, our infection rate is below 2%, which is definitely higher than we were in early September when we were below 1%, but not what it was just six months ago. However, the problem with a positivity rate that slowly creeps upward is that it means more hospitalizations, which, unfortunately, is also inching up at the moment. At Mount Sinai Hospital, we now have more than 100 COVID-19 cases up from about 25 cases in early September. So while it is true that our inpatient cases are definitely increasing, keep in mind this spring we had over 2,000 inpatient cases.

So Are We Heading to a Second Wave?

Some scientists believe nationwide that we are still in a first wave as we never got the infection rate under control across the country. COVID-19 is still in its first surge some parts of the USA. For us in New York City, our first surge was in the spring and thanks to the efforts of the department of health, local government, and New Yorkers working together, we recovered. For the Midwest, they are getting hit hard now.

Schools and offices have begun to reopen, there is some limited indoor dining, gyms have reopened, and people who left New York City have returned from their summer homes so the city is definitely getting more crowded than it was this summer. However, a second wave implies that we are going to get hit hard again the way we were six months ago and that is unlikely. The uptick that we are seeing seems to have occurred as a result of loosening restrictions, social gatherings around Labor Day, the religious holidays this September and likely COVID-19 fatigue. It is not a mystery. Surges are a direct results of human behavior such as not wearing masks, not practicing social distancing, and not taking safety precautions seriously. Keeping these practices up is tough but they’re still really important as they are our most effective way of keeping COVID-19 under control as we wait for breakthroughs in treatment and prevention.

A second wave for New York City assumes that we will all stop wearing masks and go back to life as we knew it before the pandemic hit. But we all know that social distancing, wearing masks and limiting our social gathering to smaller outside groups have all helped to stem the tide. With testing more available we have more information and the ability to act and react in real-time. This is great as it will give us the opportunity to nip new outbreaks in the bud before many people become ill. New restrictions, such as closing schools and nonessential businesses, in 20 hot spots in Brooklyn and Queens with rising positivity rates - as high as 8% in some spots - and substantial fines for not following the rules are part of how we can try to make sure outbreaks do not spread throughout the city. However, our best tactic for controlling COVID-19 continues to be the day-to-day mask wearing, hand washing and the social practices of readers like you.

So What Can We Do?

So let’s keep doing what we have been, simply because it works, despite the looser restrictions and recent school and business re-openings. The basics are social distancing when possible – and not to host parties or large family gatherings this holiday season (especially not indoors). Wash your hands and wear that mask.

I recommend that you keep an eye on infection rates in your neighborhood. If you see it tick up, it is time to make sure you have enough food, pet food and medications to last for two weeks at least just in case we need to intensify restrictions to help keep everyone healthy. Also, make sure everyone in your family has their vaccines up to date. The last thing we would want you to have to worry about now is something we have a vaccine to prevent, like influenza or bacterial pneumonia. Do this for your health, your family’s health, your community, and your health care providers.

The Bottom Line:

When an area has a high infection rate, it is not easy to contain. Controlling the rate of transmission is in all of our power. COVID-19 restrictions can be exhausting and we all have a bit of pandemic fatigue, but surges are the result of all of our behavior and we cannot give up. We do not know what kind of immunity having had Covid-19 gives us or how long it may last so we cannot depend on being immune after infection until we learn more. We know for sure that asymptomatic cases exist and are highly contagious. While not everyone who catches COVID-19 will become very sick, there are people in our communities who are very likely to become very ill or die if they contract this virus. We all need to work together to keep these people safe. The city is a fantastic place to live when the infection rate is low and it is up to all of us to keep it there.

Richard Silvera, MD, MPH is an Instructor of Medicine in Infectious Diseases at The Mount Sinai Hospital and an HIV primary care provider at the Jack Martin Clinic.