June 17, 2020

We seem to be living in the midst of a recurring nightmare.  We’re told one minute that the states are opening back up and that restrictions are easing and that elective surgeries are once again being allowed.  The next minute we’re told some states are experiencing the highest incidence of COVID on record and that some states are considering putting the brakes back on.  Just this weekend, I was at a restaurant that had recently opened back up for business.  The woman seating us then informed us that they may have to close once more due to a spike in COVID cases.

What’s going on?  Are we living in some sort of real-world Groundhog Day (the Bill Murray movie) where we are forced to relive the same event over and over?  One is reminded of the Pink Floyd lyric, “you are only coming through in waves.”  How many waves of the coronavirus are we expected to endure?  That’s the question we want to explore in this article.  We’ve been told for some time now that a second wave of COVID can be expected, and some say that’s what we’re experiencing now; but is that really what’s happening?

Morgan Haefner, editor for Becker’s Hospital Review, recently provided an argument against the current rise in COVID cases as constituting a “second wave,” but rather a continuation of the initial wave.  Here are her reasons:

1. Questions around whether the U.S. is in a second wave of the COVID-19 pandemic are being sparked after several states, including Arizona, Utah, Texas and Florida, have seen an uptick in daily cases.
2. Nationwide, average new daily cases of COVID-19 peaked April 10 at about 31,000. That number dropped to around 22,000 on average by mid-May, but has stayed near steady during the past four weeks, according to NPR. More than 800 Americans are dying each day nationwide from the disease.
3. Social distancing and stay-at-home orders helped push COVID-19’s reproduction number—or how many people an infected person could infect—just below one. Anything above one will spread exponentially. Still, because the reproduction number is still close to one, cases are more in a plateau than a downward spiral, and the reproduction number is even creeping above one as states reopen.
4. This plateau has led some experts to believe the U.S. never made it out of its first wave of COVID-19. Ashish Jha, MD, a professor of global health at Harvard University in Cambridge, Mass., told NPR, “We really never quite finished the first wave. And it doesn’t look like we are going to anytime soon.”
5. A “true” second wave may come later in the year, as more evidence is indicating that seasonality may be a big driver of a COVID-19 resurgence. Chris Murray, MD, the head of the University of Washington’s Institute for Health Metrics and Evaluation, told NPR: “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. So, seasonality will be a very big driver of the second wave.”

Of course, there are some clinicians and researchers who have disagreed with the numbers currently being reported, and there are those who take issue with any published prognostication of the timing and impact of a second wave.  Nevertheless, it does seem reasonable to conclude that we have yet to fully emerge from the effects of the first wave of the pandemic.  If that’s true, let’s consider the following: this is mid-June, with no sign of an end to the pandemic over the coming weeks.  Those predicting a second wave starting in early September are effectively saying that there will be little to no respite between the two waves.  If true, what does that say about the nature of this malady, and what does that mean for our nation’s hospitals?

For now, hospital administrators must remain circumspect, retaining all their options, realizing that past assumptions and recent projections may not be reliable.  Should elective surgeries continue on their ramp-up schedule?  Should the supply of personal protective equipment (PPE) and ventilators be beefed up or reordered?  What about workforce numbers?  It’s not quite the same as spinning the roulette wheel, but there is an element to playing the odds when it comes hospital planning during these next few weeks; and then there will be a new reality beginning this fall.

In the midst of uncertainty brought on by this most unpredictable disease, we at MiraMed Global Services remain steadfast in our commitment to the success of our hospitals and caregivers.  Please contact us to see the resources we can bring to bear on your behalf.  You can reach us at info@miramedgs.com.