Can the U.S. avoid a ‘twindemic’ of coronavirus and flu?

“The 360” shows you diverse perspectives on the day’s top stories and debates.

What’s happening

Public health experts have feared for months that the United States would see a “second wave” of coronavirus cases in the fall as temperatures drop across the country. Now that autumn has officially begun, warnings that the U.S. could be heading for a catastrophic health crisis have become more urgent.

“We are entering into a risk period,” Dr. Anthony Fauci, the nation’s leading infectious diseases expert, told CNN on Tuesday. The U.S. has seen two distinct surges in coronavirus cases so far: the initial outbreak that reached its peak in April and another over the summer after lockdown measures were lifted. The United States recently passed 200,000 total coronavirus-related deaths.

Cases of respiratory viruses like the one that causes COVID-19 tend to rise in the fall and winter months as temperatures drop and people spend more time indoors. Most pandemic models predict a surge starting in the fall and worsening into the winter that could rival or even surpass the worst days of the spring. One well-regarded forecast sees a “most likely” scenario of more than 3,000 deaths a day in December and nearly 400,000 cumulative coronavirus-related deaths by the end of the year.

That timeline coincides with the typical course of flu season, which on its own causes about 37,000 deaths a year in the U.S. The combined risk of the coronavirus and flu virus has led some experts to warn of a “twindemic” that could overwhelm the country’s health care capacity.

Why there’s debate

Health experts see many reasons to predict that the next several months could bring what CDC Director Robert Redfield called “the worst fall, from a public health perspective, that we’ve ever had.” Many experts say the U.S. hasn’t done enough to suppress the virus during the months of favorable weather and is still lagging behind in terms of testing, contact tracing and mask-wearing to prevent a major outbreak. The flu and coronavirus present very similar symptoms, which can be a problem for doctors trying to determine the best course of treatment, particularly in areas where coronavirus tests are in short supply.

Despite warnings about the risks of the coming months, many parts of the country are lifting lockdown restrictions on businesses and welcoming children back to schools. At the same time, the odds that the federal government might take significant steps to curb infections — like a nationwide mask mandate or another round of economic stimulus — seem slim.

As the weather starts to turn, many outdoor activities that have allowed people to socialize safely will become impractical in parts of the country. This may force people to choose between isolating or meeting up with people indoors, where the virus spreads more effectively. Experts worry that a combination of science skepticism and “quarantine fatigue” will lead many to abandon safe practices, especially during the holiday season.

While these circumstances point to a dire scenario over the coming months, there are some reasons for optimism. Doctors have learned a lot about how to treat COVID-19 since the start of the pandemic, which could mean that death rates won’t increase much even if more people become infected. Though a vaccine is unlikely to make much of an impact in 2020, other scientific innovations like rapid-results tests and better treatments could be widely available in the next few months.

The public has also learned what needs to be done at an individual level to limit the spread of the virus. Experts hope that, outside of a vocal group of dissenters, most people will step up their safety measures when another spike appears to be occurring. There are also hopeful signs that this year’s flu season may not be as bad as in previous years. Precautions put in place to contain the coronavirus have led to record-low flu seasons in several countries in the southern hemisphere. Concern about a “twindemic” may drive more people to get flu shots than in a typical year.

What’s next

After declining steadily for the past two months, coronavirus cases in the U.S. are rising again. While it’s too early to say whether this uptick in cases is the start of a predicted fall surge, it’s a troubling sign for experts who are hoping to get the country’s baseline level of infections down.

Perspectives

Pessimists

We haven’t done what’s needed to prevent a worst-case scenario in the fall and winter

“It’s hard for me to think of a positive scenario where things are going to get better in October and November. I don’t see behavior changing adequately. I don’t see testing ramping up. I see political winds continue to be oppressive to doing the right things.’’ — Dr. John Swartzberg, infectious diseases expert, to USA Today

The U.S. missed its opportunity to get the virus in check over the summer

“Human coronaviruses, the distant cold-causing cousins of the virus that causes COVID-19, circulate year-round. Now is typically the low season for transmission. But in this summer of America’s failed COVID-19 response, the SARS-CoV-2 virus is widespread across the country, and pandemic-weary Americans seem more interested in resuming pre-COVID lifestyles than in suppressing the virus.” — Helen Branswell, Stat