Category: Corona Virus

Dr. Ethan Weiss making his way to New York in late April to treat Covid-19 patients.

Source: Dr. Ethan Weiss

When Dr. Ethan Weiss arrived in New Yorkin late April,he started his first shift almost immediately.

Weiss is a cardiologist based in San Francisco, which has had relatively few hospitalizations related to Covid-19. He decided to help out with New York's massive Covid-19 outbreak because he felt helpless sitting at home.

Weiss was just one of the doctors and nurses from University of California San Francisco's hospital system who risked their lives by flying out to Manhattan. New York City has now reported more than 20,000 deaths. Another group headed to the Navajo Nation, another hotspot, which has reported more than 6,000 cases of coronavirus.

In total, about 40 doctors and nurses from UCSF across a variety of specialties flew out to Covid-19 hotspots, according to the chairman of medicine, Dr. Bob Wachter.

It's now been about a month since Weiss got back to San Francisco. He's glad that he went, but calls it one of the most challenging experiences of his life. And he's vexed that so many people still aren't taking the public health guidelines seriously.

"I'm in a dark place right now," he told me by phone in late May. "Everyone is impatient. A lot of people are feeling done with this pandemic. They don't understand this is how it is going to be for a while."

Covid-19 is still a major part of the national conversation, but researchers have found growing evidence of a "pandemic fatigue."Many people are itching for life to resume as normal after months of sheltering in place. Moreover, many states are re-opening shuttered businesses, and President Trump has stated that he's planning tohold rallies, all which is sending a signal that the pandemic is under control.

But as of June, Covid-19 is still spreading in the United States. Arizona, Texas and Utah, among other states, are reporting an increase in diagnosed cases and hospitalizations. Epidemiologists and public health experts remain worried.

Now, these doctors are urging anybody who will listen to take the pandemic seriously and keep observing precautions.

"There's no way to describe how awful this disease is until you see it," said Dr. Michelle Yu, a pulmonary and critical care doctor from UCSF, who worked at a hospital in the outer boroughs of New York City. "The nurses kept showing up every day, and they will keep showing up, but you could see the fatigue on their faces."

"It was just horrible," added Weiss.

Dr. Michelle Yu, in red in the front row, at the New York Presbyterian Hospital in New York on one of her last days treating Covid-19 patients.

Source: Dr. Michelle Yu

The San Francisco team noticed that the New York providers, who had been dealing with the situation for weeks, were seriously burnt out by the time they arrived. Some weren't trained to care for patients with severe viral illnesses, but were asked to step in nonetheless.

Dr. Maya Kotas, a pulmonary and critical care doctor from UCSF, found herself working with nurses and physician assistants who were trained in specialties like neurology or neurosurgery. Many of these providers were learning on the fly. Dr. Yu said she gave lectures to the residents and nurses as frequently as she could.

One of the most challenging aspects was the lack of clear clinical guidelines for treatments. Scientists still don't know a lot about the disease.

"I've worked in a lot of settings," saidDr. Michael Peters, a pulmonary critical care doctor, was assigned to a hospital in Queens overwhelmed with Covid-19 cases. "These patients were very sick, and they had a disease that we didn't know how to take care of yet."

All of the UCSF doctors said they saw patients in their forties and fifties, who didn't meet the "typical" profile for Covid-19because they were otherwise healthy. In the Queens hospital, where Peters worked, many of the patients were Black or Hispanic. Data shows that the virus has hit racial and ethnic minorities worse, and studies are underway to better understand why.

Kotas said she was thrown outside of her comfort zone almost immediately once she arrived to New York. She was stationed at New York Presbyterian/Weill Cornell Medical Center alongside several colleagues, including Yu.

"We are used to dedicated ICUs (intensive care units) with space and equipment," said Kotas. "And sliding glass doors to get patients in and out." But she and her team were constantly facing a shortage of necessary medications, supplies and personnel in their converted ICU, and the patients were extremely isolated to preserve resources.

"They were alone in their sickness...they didn't have families see them, and our contact was limited to preserve personal protective equipment," she explained. "Sometimes we would call to say that a patient had died, and they hadn't even seen them in three weeks."

Dr. Maya Kotas volunteering at the New York Presbyterian Hospital during the height of the Covid-19 pandemic.

Source: Beth Higgins

Weiss said sometimes he would just sit in patients' rooms for a while just to keep them company, even though they weren't responsive. Dr. Yu recalled having to Facetime family members to provide updates via the one functional iPad that was being passed around across three ICUs (that's one iPad for every 36 critically ill patients). She sometimes had to inform them that the patient had died.

Many of the Covid-19 patients who were on ventilator but survived seemed very frail to the doctors. "People were so weak that they came off a ventilator and three weeks later, they still couldn't wiggle their toes," said Kotas.

All of the doctors were aware of the risks to their own health, but took their chances.Yu insisted on doing procedures on her own, such as removing breathing tubes from patients, to reduce the risk that anyone else would be exposed to the virus if it aerosolized.

Fortunately, she and the other doctors tested negative after they returned to California and were able to resume treating patients at home.

One of the most devastating aspects of the virus is that it's known to sweep through families.

Kotas recalls working with a nurse whose own parents were in the ICU a few floors up at Cornell, and one of them died.

Weiss immediately observed that many of his patients were related. He doesn't typically see that in cardiology, where it's extremely uncommon to see two members of the same family dying of heart disease at the same time.

None of the doctors are public health experts, so they didn't feel qualified to advise people about how to stay healthy and safe. But on their return to San Francisco, they all implored their network of friends and family-members to take Covid-19 seriously and listen to the advice of public health officials. They know what happens when health systems get overwhelmed.

"I hope we have the stamina and spirit and sense of collectivism (to avoid outbreaks like New York)," said Dr. Weiss. "If there's one thing I'd recommend, it's to keep wearing masks."

"I know everyone is getting tired," added Kotas, who said she's willing to fly out again to the next potential hotspot if she's needed. "But please take it seriously. People really suffer when we don't take care of each other and contagion gets out of control."

Correction: The Navajo Nation has reported more than 6,000 coronavirus infections and about 300 deaths. A previous of this story misstated the number of fatalities.

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These San Francisco doctors flew to New York to fight the coronavirus and they have a warning for us - CNBC

Arlingtons coronavirus data continues to look good, even while a resurgence of cases in the U.S. and China weighs on the stock market.

The second wave has begun, one medical school professor told CNBC today. But even while 22 states mostly in the west and the Sun Belt report an acceleration of new cases, Arlington and Virginia are looking to be in good shape, for now.

No new COVID-19 deaths were reported in Arlington over the weekend. In fact, no new COVID-19 deaths were reported in all of Northern Virginia on Sunday, the first time that has happened since April 6.

As of Monday morning, Arlington has reported a cumulative total of 2,346 cases, 405 hospitalizations and 125 deaths. The seven-day trailing total of new cases and hospitalizations now stands at 90 and 13 respectively.

Arlington and Northern Virginia entered Phase 2 of the reopening on Friday, allowing restaurants and gyms to open indoor spaces for the first time since March.

Arlingtons seven-day trailing average daily testing and positivity rates, meanwhile, currently stand at 220 tests per day and 6.6% respectively. The latter represents a new low in the countys test positivity rate.

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No New Coronavirus Deaths Reported Over the Weekend - ARLnow

Emmanuel Macron has announced that France is open and back in business.

In his fourth televised address to the nation since the beginning of the coronavirus pandemic, the French president said the country was turning the page on the first act of the crisis that we have gone through.

The fight against the epidemic is not over, but I am happy that we have won this first battle against the virus, he said.

Macron opened by saying the whole of France, except for the overseas departments of Mayotte and French Guiana, were turning green, meaning restaurants, bars and cafes in the Paris area can now fully open, and that all schoolchildren except for those in lyces (upper high schools) will be expected to return to class from next Monday.

With the academic year due to end for the two-month summer holiday at the beginning of July, the announcement that the return to class is obligatory has come as a surprise to many parents and headteachers in areas where secondary school classes are currently closed.

Macron also announced Frances Schengen borders would be open as from Monday and its non-EU borders from 1 July. UK and Spanish visitors to France will be however asked to self-quarantine.

We can be proud of what we have done in our country. Of course this challenge has also revealed weaknesses, fragilities, our dependence on other continents to procure certain products, our cumbersome organisation, our social and territorial inequalities I would like us to learn all the lessons from what we have been through, Macron said during the 20-minute address.

He said the country was facing an economic crisis, but stated while coronavirus easing measures had cost the country 500bn, there would be no tax rises. He suggested plans for Frances economic reconstruction would include encouraging firms to relocate back to France and plans for economic independence that he would announce next month.

At EU level, the president called for the consolidation of an economically independent Europe to take on the US and China.

Macron made no direct reference to the widespread but largely peaceful anti-racism and anti-police violence protests in France at the weekend, sparked by the police killing of George Floyd in America, but said racism, anti-semitism and discrimination are unacceptable.

We are a nation where everyone, whatever their origins or religion, has their place our battle [against discrimination] must continue and intensify, he said.

However, he warned there would be no rewriting of French history.

I will be very clear tonight, compatriots. The republic will not erase any name, any trace of its history. It will forget none of its artworks. It will tear down no statues, Macron said.

He also issued a clear message of support for the police forces, saying they take daily risks and deserve the support of those in power and the gratitude of the nation.

The address received a mixed response in the French media. Librations front page headline read: Macron congratulates Macron, while Le Monde similarly accused Macron of giving himself a certificate of satisfaction over his handling of the crisis. The centre-right paper Le Figaro chose to lead on Macron calling the French to return fully to work.

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France 'turning page' on coronavirus as schools, borders and workplaces reopen - The Guardian

ANAHEIM (CBSLA) An Anaheim firefighter has been put on a ventilator after facing complications from the coronavirus.

Six other Anaheim Fire and Rescue members have also tested positive. The first case among the firefighters is believed to have originated on May 27, but the source of their infections is still unclear.

Officials did not reveal the names of the two stations that were impacted to protect the privacy of those impacted.

Four firefighters have recovered and are expected to return to work in a few days, one is isolating at home and doing well and two are hospitalized.

We believe the first original case was related to exposure on a call serving our community, said Anaheim City Spokesperson Mike Lyster.That is just the nature of coronavirus and risk of exposure that we might all encounter in our daily lives.

The department has more than 200 firefighters and paramedics.

Our stations are regularly disinfected. We go through health screening checks for our firefighters and paramedics up to three times a day, Lystersaid.

The Anaheim Fire and Rescue department strongly encourages the community to continue to wear masks and practice physical distancing.

To date, Orange County has reported a total of 8,269 cumulative coronavirus cases and 217 deaths.

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A Total Of Seven Anaheim Firefighters Have Tested Positive For Coronavirus - CBS Los Angeles

The coronavirus lockdown has virtually halted international travel and tourism, hitting airlines and other travel companies, aerospace and auto manufacturers and oil companies hard.

As these businesses adjust to dramatically reduced revenue projections, job losses are starting to mount alarmingly. More than 40,000 redundancies have already been announced across these sectors, with more than 10,000 likely to be in the UK.

Rolls-RoyceThe jet-engine manufacturer has confirmed that3,000 job cuts, of a planned 9,000 worldwide, will be made in the UK. Rolls-Royce will make the first round of redundancies through a voluntary programme, with about 1,500 posts being lost at its headquarters in Derby, as well as 700 redundancies in Inchinnan, nearGlasgow, another 200 at its Barnoldswick site in Lancashire and 175 in Solihull, Warwickshire.

BentleyThe luxury carmaker intends toshrink its workforce by almost a quarter, slashing 1,000 roles through a voluntary redundancy scheme. The majority of Bentleys 4,200 workers are based in Crewe, Cheshire.

Aston Martin LagondaThe Warwickshire-based luxury car manufacturer has alsoannounced 500 redundancies.

BPThe oil company plans to make10,000 people redundant worldwide, including an estimated 2,000 in the UK, by the end of the year. The BP chief executive, Bernard Looney, said the majority of people affected would be those in office-based jobs, including at the most senior levels. BP said it would reduce the number of group leaders by a third, and protect the frontline of the company, in its operations.

British AirwaysThe UK flag carrier is holding consultations tomake up to 12,000 of its staff redundant, a reduction of one in four jobs at the airline. BA intends to cut roles among its cabin crew, pilots and ground staff, while significantly reducing its operations at Gatwick airport.

Virgin Atlantic Richard Bransons airline is tocutmore than 3,000 jobs, more than a third of its workforce, and will shut its operations at Gatwick.

EasyJetThe airline has announced plans to cut 4,500 employees, or 30% of its workforce.

RyanairThe Irish airline intends to slash 3,000 roles and reduce staff pay by up to a fifth.

P&O FerriesThe shipping firm intends to cut more than a quarter of its workforce,a loss of 1,100 jobs. The company, which operates passenger ferries between Dover and Calais, and across the Irish Sea, as well as Hull to Rotterdam and Zeebrugge, will initially offer employees voluntary redundancy.

CentricaThe owner of British Gas is to slash 5,000 jobs, saying it was looking to cut costs by simplifying its business structure. The company is removing three layers of management, with more than half of the job losses falling on leadership roles, including half its 40-strong senior team.

Johnson MattheyA major supplier of material for catalytic converters in cars, Johnson Matthey announced plans to make 2,500 redundancies worldwide, or 17% of its total workforce. The group said it was the result of the pandemic and the uncertain outlook for the car industry.

Heathrow AirportVoluntary redundancy has been offered to all of its 7,000 direct employees after coronavirus wiped out its passenger traffic.

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BP expects to take $17.5bn hit due to coronavirus writedown - The Guardian

The S&P 500 was volatileMonday as investors grappled with signs of a spike in coronavirus cases.

Here's what five experts say investors should watch.

Darrell Cronk, CIO for wealth and investment management at Wells Fargo, is keeping an eye on key levels for the S&P 500.

"I think we did get a little bit overextended. We were probably almost 75% into a retracement from the March 23 lows which is extremely high on a retracement. We did break the short-term 20-day moving average at the end of last week. We will probably go through the 200-day moving average, which is the support level. And if we get down to around 2,910, that's the 50-day moving average. So, you would have kind of the trifecta of breaking the 20-day, the 200-day and the 50-day simultaneously, which would put some more downside probably to the equity markets in the near term."

Kevin Giddis, chief fixed income strategist at Raymond James, said the Treasury market could be sending a signal to equity investors.

"Two distinct events last week that we've talked about a lot one was the dovish Fed and their call for not even thinking about raising rates until 2023, and the rise in Covid-19 cases as the U.S. economy reopened. One thing I will point out, while the equity volatility was quite high, bond volatility went down last week, and I think that is the Treasury market in particular saying, 'Hey, this recovery is going to take longer than people think.' It also is a credit to the Fed and the Treasury for what they did back in March, which settled the credit markets down."

Sarat Sethi, managing partner at Douglas C. Lane & Associates, is picking out some beaten-down stocks.

"I do like some of the companies out there Chevron, General Motors are companies that we're adding to, they're down over 20% for the year. This is going to be more about the duration. These companies are going to be solvent, they're going to be fine and I would add to them. I would add to some of the large-cap banks JPMorgan, Bank of America, Morgan Stanley. And then on sell-offs like we get, the high-quality companies that we kind of added to in the early part of the sell-off, you can go to the Lowe's of the world, the Disneys of the world the companies that have the balance sheets and that are going to get through these fits and starts."

David Gerstenhaber, CIO of Acorn Advisory Capital, is concerned over how expensive stocks have become.

"I think valuations are unsustainable at current levels. I think the economy will disappoint in the fall particularly as the government stimulus programs begin to wind down. I think valuations are excessive and, in particular, I think that we will see a little surge in actual activity now as cabin fever gets people out. But, I think that's short term in nature and over the next couple of months, I think you'll see more disappointing data that the market will have to come to terms with."

Mohamed El-Erian, chief economic advisor at Allianz, sees the influx of retail investors as a positive.

"It is a good thing to have more retail participation in this market. It's a good thing that it be based on transparency and information. And what the retail sector got absolutely right is your rotation rate. They were ahead of everybody else, they understood that you would have a rotation from stay-at-home to reopening stocks, from leaders to laggards, and they did very well up to last week."

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Another volatile day on Wall Street here's what to watch - CNBC

Since the pandemic began, sales of vitamin D and other supplements promoted for immune health have soared. But preliminary studies of vitamin D and Covid-19 have yielded mixed results.

At the University of Chicago Medicine, which serves a largely black and Hispanic population on the South Side of Chicago, researchers reviewed the medical records of more than 4,300 patients, many of them health care workers, who were tested for Covid-19 in March and early April.

After controlling for factors that can influence vitamin D levels, like age, race and chronic medical conditions, they found that people who were vitamin D deficient before the pandemic began were 77 percent more likely to test positive for Covid-19 compared to people who had normal levels.

Dr. David Meltzer, a professor of medicine at the University of Chicago and the lead author of the study, which has not yet been peer reviewed, cautioned that the findings were correlational and did not prove causation. He said he and his colleagues were recruiting local paramedics, police officers and other emergency workers for a randomized trial that will test whether taking low to moderate doses of vitamin D daily has an impact on their risk of developing Covid-19 or the severity of their symptoms. Dr. Meltzer suspects that people taking vitamin D who contract the virus will have fewer symptoms of Covid-19 because the immune system will be less likely to have an exaggerated inflammatory response.

I think you can learn a lot from observational studies, said Dr. Meltzer, who is chief of the Section of Hospital Medicine at the University of Chicago Medicine. But in the end we desperately need randomized trials to determine as rapidly as we can if theres a real effect here.

In Britain people from minority ethnic groups, such as those with African or South Asian ancestry, make up a third of all confirmed cases of Covid-19 in critical care, even though they account for just 14 percent of the population. They also experience higher levels of poverty, chronic diseases and vitamin D deficiencies. At least one medical group, the British Association of Physicians of Indian Origin, has urged all British health care workers from minority backgrounds to consider taking vitamin D supplements as a precaution.

But two recent studies using data from the U.K. Biobank, a long running project that has tracked the health of a half million people aged 40 to 69, cast doubt on the links between vitamin D and Covid-19. One group of researchers found that participants who recently tested positive for coronavirus were more likely to have had very low or deficient levels of vitamin D compared to other participants. But the association disappeared after the results were adjusted for factors like age, race, obesity and socioeconomic status.

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Exploring the Links Between Coronavirus and Vitamin D - The New York Times

Robert F. Bukaty | AP

Robert F. Bukaty | AP

Tourists walk by newly reopened shops, Tuesday, June 9, 2020, in Boothbay Harbor, Maine. Many Maine tourists towns have seen a sharp drop in the number of visitors due to the coronavirus pandemic.

The BDN is making the most crucial coverage of the coronavirus pandemic and its economic impact in Maine free for all readers. Click here for all coronavirus stories. You can join others committed to safeguarding this vital public service by purchasing a subscription or donating directly to the newsroom.

36 more cases of the new coronavirus have been detected in Maine, health officials said Saturday.

There have now been 2,757 cases across all of Maines counties since the outbreak began here in March, according to the Maine Center for Disease Control and Prevention. Thats up from 2,721 on Friday.

Of those, 2,452 have been confirmed positive, while 305 are likely positive, according to the Maine CDC.

[Our COVID-19 tracker contains the most recent information on Maine cases by county]

No new deaths were announced. The statewide death toll still stands at 100..

So far, 313 Mainers have been hospitalized at some point with COVID-19, the illness caused by the coronavirus. Of those, 29 people are currently hospitalized, with 10 in critical care and four on ventilators, according to the Maine CDC.

Meanwhile, 2,152 people have fully recovered from the virus, meaning there are 505 active and likely cases in the state, according to the Maine CDC.

Heres the latest on the coronavirus and its impact on Maine.

Several indicators of the spread of the coronavirus suggest that the deadly virus has declined in Maine over the past few weeks, although it is still too early to say whether recent large public gatherings might lead to an uptick in cases. Jessica Piper, BDN

Robert Fleury knew he wanted to serve his country when he was a teenager, so he signed up for one of the most remote assignments in World War II tracking the weather for the U.S. Navy in the frigid Aleutian Islands off Alaska. He would later parlay the skills he learned in Quonset huts along the Bering Sea into a decades-long career with the National Weather Service. Like thousands of other veterans and elderly people in nursing homes around the country, Fleury was isolated from his family and friends when he died at 94 in Scarborough from the coronavirus. Patrick Whittle, The Associated Press

With just over a month to go until the July 14 primary election, Maine voters have requested absentee ballots at a higher rate than they did for past primaries, but they still represent only a fraction of the total number of voters expected to participate in the states first election during the coronavirus pandemic. Jessica Piper, BDN

State employees are pushing for more input in how the Maine government gradually returns them to their offices as the states phased reopening continues. Caitlin Andrews, BDN

The life-sized sculptures started out as a quarantine pastime activity for Katie Quirks family. It was something theyd always wanted to do and during the COVID-19 pandemic, theyd finally found time to do it. Cobbling together scrap pieces of wood found in their garage, they built their first sculpture a 7-foot-tall stick-figure parent with a red and yellow striped shirt standing next to a child in a matching outfit, which they proudly displayed along the trails near their Orono home. That idea has inspired a group of friends to start a series of community-wide projects in celebration of Pride Month that may end up becoming a yearly tradition for the town. Nina Mahaleris, The Penobscot Times

As of Saturday evening, the coronavirus has sickened 2,066,993 people in all 50 states, the District of Columbia, Puerto Rico, Guam, the Northern Mariana Islands and the U.S. Virgin Islands, as well as caused 115,206 deaths, according to Johns Hopkins University of Medicine.

Elsewhere in New England, there have been 7,576 coronavirus deaths in Massachusetts, 4,186 in Connecticut, 833 in Rhode Island, 318 in New Hampshire and 55 in Vermont.

Watch: The 102-year-old who survived the Spanish flu and died from COVID-19

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June 13 evening update: The latest on the coronavirus and Maine - Bangor Daily News

Read: All the presidents lies about the coronavirus

Those lessons, however, were long delayedin part because predicting the next pandemic is hard business, and support for infectious-disease preparedness was leaning elsewhere. Both SARS and its far deadlier coronavirus cousin, Middle East respiratory syndrome (MERS), were understood to be threats. But other coronaviruses cause the common cold, and the SARS and MERS outbreaks each burned out in less than a year. When cases of those diseases fell off, public-health responders shifted to other viral emergencies such as Ebola and Zika, and coronavirus research funding dropped sharply.

That left many investigators who had been working on therapies for SARS holding the bageven as laboratories around the world were reporting ominous findings. A number of SARS-like coronaviruses in bats, they had discovered, were only a few simple mutations away from being able to infect human cells.

Whether the world should have heeded the warnings of coronavirus specialists is, of course, a matter of hindsight. But to some experts whose business it is to hunt potential pathogens before they spill over into human populations, the many years spent not girding for a serious coronavirus outbreak were tragicallyand unnecessarilywasted.

We were out there on the ground after SARS, working on coronaviruses with Chinese colleagues in collaboration, said Peter Daszak, president of the EcoHealth Alliance, a New Yorkbased nonprofit group that took part in a large federally funded effort, called Predict, to hunt for new pandemic viruses in wildlife in 31 countries, including China. That program was famously defunded last fall, just before the SARS-CoV-2 outbreak began.

But we were the only group of western scientists, Daszak added. How can we be the only people looking for these viruses when there was such a clear and present danger?

The coronavirus research community has always been small, friendly, and interactive. A cul-de-sac at the end of the road of virology, said Buchmeier, whos been studying coronaviruses since 1980. Scientists were drawn to the field by a shared fascination: Coronaviruses had evolved strategies unlike any other in the microbial world to protect themselves from genetic errors during replication.

Coronaviruses may induce lethal infections in certain animal species, particularly cats and pigs. But their reputation in human medicine had long been one of being wimpy viruses that cause only mild disease, said Albert Osterhaus, founding director of the Research Center for Emerging Infections and Zoonoses in Hanover, Germany. So when SARS emerged in late 2002, there was initially general disbelief among medical people that a coronavirus could be the basis of such a huge outbreak.

As that epidemic spread, an influx of new researchers crowded the field. More grants were awarded, and funding started to climb. Everyone wanted to know where the virus had come from, said Ralph Baric, a microbiologist at the University of North Carolinas Gillings School of Global Public Health. Initial findings pointed to wild civets and raccoon dogs sold for meat and pelts, respectively, in Chinese markets. Later evidence began to implicate horseshoe bats as the original source of the infections. Some researchers whose pre-SARS careers had been grounded in basic coronavirus biology began working on therapies and vaccinesand they made steady progress for several years.

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Coronavirus Researchers Tried to Warn Us - The Atlantic

People rest inside social distancing markers at Domino Park in the Brooklyn borough of New York in late May. Stay-at-home orders in New York helped to lower the state's "reproduction number," which estimates how many people one sick person could infect with the coronavirus. Michael Nagle/Xinhua News Agency/Getty Images hide caption

People rest inside social distancing markers at Domino Park in the Brooklyn borough of New York in late May. Stay-at-home orders in New York helped to lower the state's "reproduction number," which estimates how many people one sick person could infect with the coronavirus.

Just weeks after parts of the U.S. began reopening, coronavirus infections are on the upswing in several states, including Arizona, Utah, Texas and Florida. Dramatic increases in daily case counts have given rise to some unsettling questions: Is the U.S. at the start of a second wave? Have states reopened too soon? And have the recent widespread demonstrations against racial injustice inadvertently added fuel to the fire?

The short, unpleasant answer to the first question is that the U.S. has not even gotten through the current first wave of infections. Since peaking at around 31,000 average new daily cases on April 10, new daily cases dropped to around 22,000 on average by mid-May and have stayed almost steady over the last four weeks. Nationwide more than 800 people continue to die day after day.

Prominent forecasters are predicting a slow but steady accumulation of additional deaths between now and Oct. 1 more than 56,000 by one estimate, around 90,000 by one another.

"We really never quite finished the first wave," says Dr. Ashish Jha, a professor of global health at Harvard University. "And it doesn't look like we are going to anytime soon."

That said, forecasters say, we could still be due for a true second wave later in the year, citing growing evidence that colder weather could lead to a surge in coronavirus cases.

Why we're stuck

So why is the U.S. stuck in a coronavirus plateau despite months of widespread social distancing? To explain, it helps to get a bit technical. The key indicator at issue is what's called the "reproduction number" of the coronavirus or the R for short essentially a proxy for how powerfully infection is spreading in your community. It tells you, for each individual who is infected, how many other people this person will go on to infect. When the reproduction number is above 1, case counts will spiral upward exponentially. When it gets to well below 1 and stays there, outbreaks subside.

For example, if the reproduction number is 2, then one person goes on to infect two others. Those two people go on to infect four others. Those four go on to infect eight, then 16 and so on. If you assume, say, a six-day interval between each new round of infections in just over a month, that one initial person will have launched a chain that has infected 127 people.

Most estimates are that early this year, when no measures were being taken to keep the coronavirus in check, the reproduction number in the U.S. was above 2.

The stay-at-home measures and other social distancing efforts that states undertook this spring served to push the reproduction number to slightly below 1 to 0.91, according to an estimate by Youyang Gu, an independent modeler whose work is highly regarded by prominent epidemiologists.

This halted the upward spiral of cases. But because the reproduction number was still so close to 1, the curve of new infections never really bent sharply downward. Essentially most of the U.S. reached a kind of steady state with each infected person passing the virus on to one new person in a regular drip-drip of new infections and new deaths.

Now that states have opened up, the reproduction number has started to creep back up above 1. According to Gu's analysis, that is now the case in more than two-thirds of the states.

So far, at least, the reproduction number has been hovering at just above 1. Assuming that remains the case, the U.S. won't see the kind of runaway run-up in cases that was so alarming in New York. But it does mean cases and deaths will continue to accrue steadily.

"If things stay basically status quo and we continue doing what we're doing, we're going to continue seeing 25,000 to 30,000 additional deaths a month for the foreseeable future," Jha says.

Parkland Memorial Hospital employees give instructions to a man and a woman on how to self-administer a test for the coronavirus at a Dallas walk-up facility. Texas saw a surge in cases within the past week. Tony Gutierrez/AP hide caption

Parkland Memorial Hospital employees give instructions to a man and a woman on how to self-administer a test for the coronavirus at a Dallas walk-up facility. Texas saw a surge in cases within the past week.

Grim as it is, even this picture may be overly rosy, Jha adds. "I'm worried that the idea that we're going to stay flat all summer is a very optimistic view of what is going to happen over the next three months," he says.

To maintain a reproduction number that's just over 1, or better yet, push it back to just under 1, even in the midst of further re-opening "would take a lot of work," Jha says. "You'd have to have really substantially ramped-up testing and isolation [of new cases]." There's also evidence emerging that widespread use of masks by people when they are out in public could help, Jha notes. Unfortunately, he says, it is hard to envision the U.S. adopting any of these practices to a sufficient degree "based on where we are today."

The seasonal effect

It gets worse. On Thursday, Chris Murray, the head of the University of Washington's Institute for Health Metrics and Evaluation forecasting team, pointed to growing evidence that the coronavirus will spread more easily as the weather turns cold.

Murray's team analyzed the pattern of the spread of the coronavirus in the U.S. to date. They found that the drop in the reproduction number since early spring can't be entirely explained by obvious contributing factors such as people's reduced mobility or mask wearing or better testing. And when the team looked for additional variables that could explain the change, it found a strong correlation with warming weather.

This finding doesn't shed light on why transmission may be reduced in the warmer months. (For example, could it be that coronavirus droplets don't hang in warmer air for as long? Is it simply that people spend less time mingling with each other indoors?) But Murray says that "as time goes by, the evidence is accumulating that it is a very strong predictor of transmission."

The effect is not strong enough to make the virus completely disappear over the summer. But it does mean, Murray says, that come autumn transmission will likely pick up.

"We start to see a powerful increase that will be driven by seasonality starting in early September and these numbers will intensify through till February," Murray says. "So seasonality will be a very big driver of the second wave."

Restaurants have opened up in cities across the country. As more people intermingle, coronavirus modelers say that any steps to mitigate risk such as social distancing or mask wearing can have an impact on the spread of the virus. Alex Edelman/AFP via Getty Images hide caption

Restaurants have opened up in cities across the country. As more people intermingle, coronavirus modelers say that any steps to mitigate risk such as social distancing or mask wearing can have an impact on the spread of the virus.

He adds though, that this does not take into account actions that could mitigate the impact. "Clearly what individuals choose to do can moderate the forecast," he says, noting that widespread mask use and avoidance of social contact with people outside one's household could help.

Parsing the effects of protests

Even as many public health experts cheered the anti-racism protests and the possibility that lives could ultimately be saved if demonstrations result in policy changes that reduce racial inequities some wondered at the extent to which these would come at a cost of increased deaths from COVID-19.

But calculating just how many additional deaths the demonstrations might lead to is difficult. There is no accurate count available of the number of participants, let alone their ages which appear to skew young, suggesting the vast majority of those infected would not experience bad outcomes.

Also with little prior research on this particular form of intermingling, it's hard to say how much infection results from it. Though many people have been standing and marching in close quarters, being outdoors mitigates the effect of crowding, as does mask use.

But the biggest determinant of how many deaths ultimately result is what happens in the aftermath of the demonstrations, says Marc Lipsitch, an epidemiologist at Harvard.

"Some transmissions will almost certainly happen at the protests and the question is whether those lead to a lot of cases down the line or a relatively small number of cases down the line," he explains. Do those who are infected at marches go back into an environment where there's a high level of ongoing transmission or a low level?

"How much transmission happens later on," Lipsitch adds, "is far more dependent on our actions as a society and whether we can suppress transmission around the country than on how many people go to the protests."

In other words, perhaps the better question is not, will the demonstrators cause a spike in COVID-19 infections? But rather will all of us the public and our leaders behave in a way that keeps the reproduction number low and ensures that these marches and any improvements to racial equality they achieve don't come at a price of many more COVID-19 deaths.

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Coronavirus 2nd Wave? Nope, The U.S. Is Still Stuck In The 1st One - NPR