What’s happening with the COVID-19 pandemic going into the fall? The truth is no one knows.

As we look towards the weekend after Labor Day, I wanted to take a brief overview of the numbers concerning the COVID-19 pandemic in the United States. There were a number of interesting findings that came out of today’s CDC’s numbers and Johns Hopkins School of public health. 

First, infections continue to occur throughout the United States although at a lower level than the peak seen in early July. 

Deaths continued to trail as a percentage of infections and appear to indicate a case fatality rate (not the infection fatality rate which is still unknown) of approximately 0.1%. 

Testing remains consistent, although new testing modalities that could provide more rapid results have yet to impact public health activities. 

While states continue to raise concerns of infection increases, the overall RT values have not changed over the past four weeks. This suggests that overall, while the COVID-19 pandemic is not contracting, it is also not expanding. As a result, the dynamics of the pandemic have not fundamentally changed during the summer although there are significant reductions in many of the hot spots in southern states.

One of the most interesting states is West Virginia. It has remained as the highest R₀ (infection rate) in the nation over the past six weeks suggesting increases in expansion of the infection. Despite this, the number of deaths has not substantially increased, and it may be that the increases in infections reflect infections in younger people less likely to die from COVID-19 disease.

Statements today from Dr. Fauci and Dr. Birx suggested that the fall may be problematic because of increased indoor activity. Quite honestly, I don’t think anyone knows exactly what’s going to happen this fall. The situation may be similar to when we were going into the summer and people expected infections to decrease (which obviously did not happen). 

This disease is not acting like influenza, and the transmission of infection, despite being respiratory, appears to be unique. While being mindful and doing everything we can (masks!!!) to minimize spread, I think we should withhold judgment about what will happen in the fall and winter. Plan for the worst and hope for the best, while trying to maintain a semblance of normal activity.

Time will tell.