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COVID-19 cases rise above 1,000 in SC, with 5.1 % positive

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Nova Scotia is imposing new restrictions in the Halifax area following a steady rise in the number of active COVID-19 infections in the region. Chief medical officer Dr. Robert Strang says starting Saturday, restaurants and bars will be forced to stop serving food and beverages at 9 p.m. and close by 10 p.m. - one hour earlier than under the previous health order.

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N.S. officials up health restrictions amid rise in COVID-19 cases

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Nova Scotia is imposing new restrictions in the Halifax area following a steady rise in the number of active COVID-19 infections in the region. Chief medical officer Dr. Robert Strang says starting Saturday, restaurants and bars will be forced to stop serving food and beverages at 9 p.m.

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The Covid-19 coronavirus pandemic has already resulted in over 265,000 deaths in America, a number ... [+]
Corbis via Getty Images

Records are made to be broken. But this has become a broken record.

Seemingly every day there is a new record number of reported Covid-19 coronavirus cases in the U.S. And Friday, which also happened to be National Absurdity Day, was no different. According to the New York Times, November 20 had over 194,000 new reported cases and over 82,000 people hospitalized due to Covid-19. Both incidentally were records.

All of this has been about as surprising as the movie Mars Needs Moms being a box-office flop. After all, when you see something coming yet don't do a whole lot to change what's coming, what's coming will come. Back on October 10, I listed for Forbes eight reasons why the Covid-19 coronavirus pandemic could get worse in the U.S. in the late Fall and Winter. Let's check back at these and see how we are doing with each:
1. Lower humidity and lower temperatures.
Assuming that you don't have a gigantic space heater and humidifier, there's not much you can do about the change in seasons. As I mentioned before, transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) seems to increase with lower humidity and lower temperatures. That may be because lower relative humidity and less water vapor in the air may lead to smaller and lighter respiratory droplets that have higher concentrations of virus and can hang in the air longer. The virus may be able to survive longer in lower temperatures as well.

Additionally, you may not quite be the same when the temperature and humidity drop. Your body's defense systems may get weaker. For example, those tiny hairs, the mucus, and the cells that line your respiratory tract and are supposed to remove junk from your respiratory tract may not work as effectively.
2. Businesses re-opening and 3. Schools re-opening.

In early September, indoor dining resumed in Newport Beach, CA. (Photo by Jeff Gritchen/MediaNews ... [+]
MediaNews Group via Getty Images

Given that Covid-19 coronavirus transmission was expected to pick up in the late Fall and Winter, organizations needed to be more proactive about ratcheting up prevention and control measures from what was being done in the warmer months. The theme in the early Fall should have been "I Know What You Did Last Summer, But This Isn't The Bleeping Summer Anymore."

This isn't to say that lockdowns were the answer. Instead, Swiss cheese should have been in place everywhere. That may sound delicious. However, in this case, the Swiss cheese is metaphorical. It's something that Ian M. Mackay, PhD, a scientist and an adjunct Associate Professor at the University of Queensland illustrated in the following tweet:

As you can see, all organizations such as businesses and schools needed to have multiple layers of protection in place because any single intervention alone like the plot of the movie The Dark Knight Rises would have lots of holes.Think about it. Would you try to cover yourself up in freezing weather wearing only fishnet stockings or a shirt made out of fishnet material? No, instead the solution is to layer clothes on top of each other to give yourself enough protection. Similarly, businesses and schools need to have much more than just physical distancing or hand washing in place, not just within their confines but in the surrounding community as well. However, this has not been happening across the country. Re-opening with too many holes can can leave you with a whole lot of trouble, which in turn can make you say hole-y bleep.
4. Shifting from outdoor to indoor gatherings.
Doing the Swiss cheese thing is especially important as the activities move from outdoors to the indoors with the changing weather. The outdoors can automatically provide at least two layers of cheese: ventilation and the opportunity for more physical distancing. When these aren't automatically present anymore, you've got to add more cheese please.
5. The flu and other respiratory illnesses.
OK, the flu and other respiratory viruses may not have arrived in full force yet. But stay tuned. And get your flu shot.
6. People getting lax on precautions.

A student receives a mask from a member of staff at the entrance to the Erasmus of Rotterdam high ... [+]
Getty Images

Yes, behavior change is tough. Getting people to do even simple things differently for just a minute can be difficult, let alone for months. Plus, the virus is microscopic that can't be readily seen every day. Things might be different if the virus were ten feet tall and holding a scimitar in one hand (or one spike) while singing the song "You're Beautiful" by James Blunt. This would be a lot more threatening and keep people more on the alert. But this virus is more subtle and as a result more devious. It can kill and cause suffering but allows enough people to escape with mild or no symptoms so that it can continue to spread more unfettered. After all, the Centers for Disease Control and Prevention estimates that over 50% of the Covid-19 coronavirus transmissions occur from people who don't even realize that they are infected. Pandemic fatigue is playing a role as well. People are getting tired of hearing about the pandemic and maintaining precautions.
7. Misinformation campaigns.
What kind of questionable information is still being spread about the pandemic? Well, you could say that there is an atlas of them. For example, in a tweet that he has since deleted, Scott Atlas, MD, who is a neuroradiologist and not an infectious disease or pandemic expert, suggested that people should "rise up" against Covid-19 coronavirus prevention measures, measures that real public health experts have been promoting:

Atlas has certainly not been the only person (or bot) urging people to not cooperate with Covid-19 coronavirus control measures. In fact, as I have covered previously for Forbes, some have even advocated for the "let the virus spread" strategy, otherwise known as the "do nothing" strategy. Some aspects of infectious disease epidemiology are pretty straightforward. If you do nothing about a contagious virus, the virus will continue to spread. And spread. And spread.
8. Lack of a coordinated national plan.
This continues to be a big problem. Letting each state decide what to do can be like a football coach telling a team during the game, "yeah, we don't really have any plays or cleats or uniforms for that matter. So, just do whatever you want to do. By the way, the opposing team is going to magically go away. Make sure you give the coach the credit if something good happens to happen." The virus doesn't recognize national, state, or municipal boundaries. It's going to keep going until it hits a barrier like a face mask, is swiped away with a disinfectant (that's on a surface and not in a person's body), is cleaned away with soap and water, or is too far from another human being to infect. Again Swiss cheese has to be everywhere that the virus is actively spreading, across the country. And the federal government needs to further increase testing and put an active national surveillance system in place to track where the virus is spreading.

As long as these seven things remain not fully addressed, new records in the numbers of new reported Covid-19 coronavirus cases, hospitalizations, and potentially eventually deaths per day will continue to occur. In fact, another factor, Holiday travel if it occurs, could further push up the spread of the virus. This may sound like a broken record, but the U.S. response to the pandemic has been, in the words of Lovelytheband, broken.
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Why Are Covid-19 Cases Increasing? Here Are 7 Reasons

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Records are made to be broken. But this has become a broken record. Seemingly every day there is a new record number of reported Covid-19 coronavirus cases in the U.S. And Friday, which also happened to be National Absurdity Day, was no different.

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Featured Experts:

In many parts of the world, cases of COVID-19 are declining, while other areas are seeing spikes. But the pandemic is still evolving. Doctors, public health experts and researchers are trying to answer tough questions: When will this first wave be over, and will there be a second wave of COVID-19 in the fall?

Because so little is known about the SARS-CoV-2, the coronavirus that causes COVID-19, these are not easy questions to answer, but Lisa Maragakis, M.D., M.P.H., a specialist in infectious disease at Johns Hopkins Medicine, sheds light on what we know now.

Is the first wave of coronavirus over?

No, we're still in the first wave. In some sense, the spread of the coronavirus so far has been more like a patchwork quilt than a wave. The COVID-19 pandemic in the U.S. is affecting different areas throughout the country in different ways at different times.

Some cities and towns experienced severe outbreaks and appear to be recovering, other places have not had many cases, and some states are only now experiencing a rise in COVID-19. It's also clear that places where people live or work closely together (nursing homes, multigenerational households, prisons and businesses such as meat packing plants) have tended to see more spread of the coronavirus.

Although some areas are reporting declining numbers of infections and deaths, localized outbreaks at nursing homes and "superspreader" events - in which one infected person transmits the virus to many others at a gathering - continue to occur.

COVID-19: Why are surges occurring across the U.S.?

Why are there coronavirus spikes?

As communities begin to reopen, people are understandably eager to be able to go out and resume some of their regular activities. But we don't yet have an effective therapy or vaccine, so the reopenings are intended to take place safely while maintaining social distancing, and masking and hand-washing as we've done over the last few months. Some people relax these infection prevention efforts as soon as places begin to reopen, and this can cause the number of coronavirus infections to rise.

There seems to be a long delay between a policy change in a community and when its effects show up in the COVID-19 data. As locations reopen businesses, they might not see any effects, such as an increase in the number of COVID-19 cases or hospitalizations, a week or even two weeks later. It seems to take much longer, perhaps as many as eight weeks, for effects to appear in the population-level data.

When a person is exposed to the coronavirus, it can take up to two weeks before they become sick enough to go to the doctor, get tested and have their case counted in the data. It takes even more time for additional people to become ill after being exposed to that person, and so on. Several cycles of infection are likely to occur before a noticeable increase shows in the data that public health officials use to track the pandemic.

So when an area relaxes social distancing guidelines and "reopens," the effects of that change might take a month or more to be seen. Of course, surges after reopening also depend on the behaviors of people when they start moving around more. If everyone continues to wear masks, wash their hands and practice social distancing, reopening will have a much lower impact on transmission of the virus than in communities where people do not continue these safety precautions on a widespread basis.

Understanding Data Spikes

Learn why it takes several weeks of gathering data to determine if the COVID-19 infection rate is rising or falling.

Is warm weather helping to lessen COVID-19's impact?

In the beginning of the pandemic, some experts wondered if warmer weather would slow down the spread of the coronavirus. Some respiratory illnesses, like colds and influenza (flu), are more common in the colder months, so researchers are trying to find out if this is true of COVID-19.

In one study, warm weather reduced coronavirus spread by 20%. Even if that trend is accurate across the country, the pandemic might slow down but it would be unlikely to end. So far, we have not seen evidence that SARS-CoV-2 transmission is slowed by warm weather.

Why are experts concerned about a second wave of coronavirus?

A second surge could happen before fall, with human behavior playing a major part. People are frustrated. Cellphone data are showing decreased social distancing. It takes weeks for the number of COVID-19 cases to change after a major behavior shift, so in June, we're seeing a reflection now of what was going on in early April. Since then, we've had better weather, Passover, Easter, Mother's Day and Memorial Day. By the end of this summer, we're going to see the results of behavior changes that took place over those events and that period of time.

When predicting the future of the COVID-19 pandemic, experts look to other pandemics and the behavior of other viruses. Examples include the 1918 flu pandemic and the 2009 H1N1 flu epidemic. Both of these events began with a mild wave of infections in the spring, followed by another surge of cases in the fall.

Around the world, according to the World Health Organization, a resurgence of COVID-19 is a threat. Areas that were hit hard by the coronavirus in the winter, such as China, Italy and Iran, are still on guard for outbreaks. Some countries have already relaxed closures and distancing measures, even though new infections are still occurring. Even countries with strict lock-down policies over the winter, such as China, are seeing new cases.

Will a second wave of coronavirus be worse in the fall?

It could be, because people infected with the coronavirus are capable of transmitting it to others even before they develop any symptoms themselves, and we are worried about what will happen when the virus circulates along with other respiratory viruses like influenza.

When the coronavirus first appeared in the U.S. in early 2020, it started with a very small number of infected people, so it took longer to spread. A second wave could start with many unknowing coronavirus carriers in many different areas, and the risk of transmission increases when people spend more time together indoors, which is more common in the fall and winter months.

It's a challenge because now there are so many different chains of infection to follow. At the beginning, we had the opportunity to do contact tracing and quarantine, but now that the disease is widespread, it makes it harder to detect and control transmission.

Can I get coronavirus twice?

Researchers are eager to answer this question. Right now, it's not known. If SARS-CoV-2 behaves like other coronaviruses, such as those that cause mild colds, some experts say you might be immune for a while and then lose that immunity within a few months. Studies are ongoing, but we don't yet know whether an antibody response to SARS-CoV-2 protects someone from getting the infection again at a later time.

Coronavirus (COVID-19) Self-Checker

Check symptoms. Protect yourself. Get information.

COVID-19 in the Fall: Other diseases could complicate the picture

An increase in COVID-19 cases in the fall could be troublesome, because seasonal flu is likely to be accelerating at the same time. If the coronavirus surges in the fall and the flu season is bad, the combination could put hospitals and patients at risk. In the U.S. during the 2019-2020 flu season, the Centers for Disease Control and Prevention reported 39 million cases and 24,000 deaths.

Another concern is that since the COVID-19 pandemic began, far fewer children have been getting their regular vaccinations. An outbreak of pertussis (whooping cough), measles, flu or other preventable disease in children could also complicate the picture, making it harder for doctors and hospitals to care for all patients.

When will we have herd immunity from coronavirus?

Herd immunity is a public health term. When enough people in a community have immunity from a disease, it protects the community from outbreaks of that disease.

Infectious disease experts at The Johns Hopkins University explain that about 70% of the population needs to be immune to this coronavirus before herd immunity can work. People might be immune from the coronavirus if they have already had it, but we don't know this yet. A widely available, safe and effective vaccine may not be available for many months.

Preparing for a Second Wave of Coronavirus

Doctors, clinics and hospitals recognize the chance that COVID-19 cases could start increasing in the fall. They are working with manufacturers to stock up on equipment, and they are continuing their policies for protecting patients and staff members.

Here's what you can do now:

Continue to practice COVID-19 precautions, such as physical distancing, hand-washing and mask-wearing.

Stay in touch with local health authorities, who can provide information if COVID-19 cases begin to increase in your city or town.

Make sure your household maintains two weeks' worth of food, prescription medicines and supplies.

Work with your doctor to ensure that everyone in your household, especially children, is up to date on vaccines, including this year's flu shot when it is available.

Coronavirus (COVID-19)

What you need to know from Johns Hopkins Medicine.

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Infectious Diseases Featured Experts: In many parts of the world, cases of COVID-19 are declining, while other areas are seeing spikes. But the pandemic is still evolving. Doctors, public health experts and researchers are trying to answer tough questions: When will this first wave be over, and will there be a second wave of COVID-19 in the fall?

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Where COVID-19 Cases, Hospitalizations Are Rising

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COVID-19 hospitalizations dropped significantly this past week in the United States while the number of new cases declined sharply again.