Coronavirus pandemic expected to get worse before it gets better, experts say - CNET

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For the most up-to-date news and information about the coronavirus pandemic, visit the WHO website.

With more than 24 million known infections worldwide and a death toll inching closer to 1 million every day, it may seem like the end of the coronavirus pandemic is nowhere in sight. Teams of scientists across the world are working on dozens of vaccine candidates, with at least one manufacturer -- Pfizer -- saying it expects its vaccine to be distributed in the US before the year's end. But even if one or more vaccines can gain FDA approval before 2021, it's going to be at least a year from now before the pandemic is under control, according to some experts.

That could be a problem, since the US never actually flattened the curve of new infections and experts say current signs point to the situation getting worse before it gets better. 

"We need to hunker down and get through this fall and winter, because it's not going to be easy," warned Dr. Anthony Fauci, the top US infectious disease expert. "Don't ever, ever underestimate the potential of the pandemic," he added. "And don't try and look at the rosy side of things." 

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With domestic travel up, mask use down and fall and winter pushing people indoors, "We look like we're going to have a very deadly December ahead of us in terms of the toll of coronavirus," Director of the Institute for Health Metrics and Evaluation Dr. Christopher Murray told CNN. The number of US deaths could double over the next four months, according to an IHME computer model.

Here's everything you need to know about the current state of the coronavirus pandemic leading into the fall. This story is updated often and is intended to provide background information only, not medical advice.

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Why do coronavirus cases go up and down so much?

"This is like a forest fire, full steam ahead," said renowned epidemiologist Michael Osterholm, who directs the Center for Infectious Disease Research and Policy at the University of Minnesota. "And wherever there's human wood to burn, it'll do it. What we see, though, are these spikes in cases where [lockdowns] ended, or they're not adhering to them."

At one point, about 90% of everyone in the US was under some sort of lockdown order and the curve was starting to flatten. But that all began to change in the second half of April, when a few states started loosening lockdown restrictions. By June, most of the country had almost fully reopened. Not long after, new cases began to surge once again.

Epidemiologists have identified a strong correlation between lockdown and case levels. Basically, wherever you look, cases drop when lockdown orders are issued -- and shoot back up right after restrictions start lifting. The only thing that seems to disrupt the trend is how well an area's population adheres to disease prevention measures like wearing face masks and limiting social gatherings.

"We are still in the first wave," Vanderbilt epidemiologist Loren Lipworth told the Washington Post. "As we ease up on restrictions, there is always going to be a resurgence in cases. It's not that it's a new wave of the virus."

Although some have blamed the rise in new cases on expanded testing, positivity rates are rising faster than testing alone can account for.

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Why are experts worried about coronavirus in the fall?

Most public health experts -- including Fauci and Robert Redfield, director of the CDC -- have said they anticipate a big uptick this fall and winter. The White House has admitted it's preparing for the possibility. However, part of that prediction was based on the assumption that the virus would slow down over the summer, which appears not to have happened.

Much of the attention aimed at fall has now shifted to concern over the possibility of two potentially lethal viruses circulating at the same time -- COVID-19 and the seasonal flu, the latter of which kills around 40,000 people in the US per year. Because of certain overlapping symptoms such as fever and a cough, it may be harder for individuals and doctors to immediately determine which infection you have.

As fall approaches, so does flu season, which experts warn could complicate the public health response to the coronavirus pandemic.

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"The real risk is that we're going to have two circulating respiratory pathogens at the same time," Redfield warned when he spoke to Time Magazine regarding the upcoming flu season. Also, if severe COVID-19 infections continue to push hospitals to the brink of their capacity and capabilities, it may also be harder to care for potentially virulent flu patients.

The CDC is nudging drug manufacturers to produce millions more doses of flu vaccine this year than usual in anticipation of greater demand. Typically, fewer than half of all US adults take the flu vaccine in any given year, but that rate increases to about two out of three for adults over 65, a population the CDC has identified as being at a higher risk for more severe COVID-19 infections. 

Are we headed for another lockdown?

Fauci and Dr. Ali Khan, the former director of the CDC's public health preparedness office, have said that it's possible to avoid a full lockdown, but there are conditions.

States must effectively test for the coronavirus and follow up that testing with contact tracing. And people must change their behavior to make social distancing and mask wearing part of daily life. Only then would it be possible to flatten the curve without having to revert to full-blown lockdowns. Otherwise, as new cases continue to skyrocket, "Your only option is to shut down," Khan said.

A yo-yo effect of reopening and closing is possible until a vaccine is distributed.

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More than likely, we will see various levels of lockdown come and go in different areas, depending on where the virus flares up and dies down, until a coronavirus vaccine is found and distributed. Even then, however, we might not be in the clear just yet. 

"We will be dealing with this virus forever. Effective and safe vaccines and hopefully ones with some durability will be very important, even critical tools, in fighting it," Osterholm said. "But the whole world is going to be experiencing COVID-19 till the end of time."

For more on the coronavirus, here's what's happening with coronavirus vaccine development, what to do if you or someone you live with gets COVID-19 and how to vacation while taking coronavirus precautions this summer.

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