Why Covid-19 Is Spreading Again: Fatigue, Colder Weather, Eased Restrictions


Seven months into the pandemic, David Aronoff has found himself often thinking of Sisyphus, the Greek mythological figure known for his eternal plight.

“Every day since March, I come to work, and I push up against this boulder of Covid-19, and at the end of the day I feel like I may have accomplished something,” said the director of the Division of Infectious Diseases at Vanderbilt University Medical Center in Nashville,Tenn. “Then I come back in the morning, and I see the boulder at the bottom of the mountain again.”

The U.S. appears to be heading up another coronavirus slope. Tuesday marked the seventh day in October that newly confirmed cases nationally ticked above 50,000.

Daily reported Covid-19 cases in the U.S.

Note: For all 50 states and D.C., U.S. territories and cruises. Last updated

Source: Johns Hopkins Center for Systems Science and Engineering

Since Oct. 1, an average of about 48,000 cases has been reported each day, a marked increase from the previous six weeks, when the average hovered below 41,000.

The seven-day average of new cases was outpacing the 14-day average in 44 states and Washington, D.C., as of Tuesday, according to a Wall Street Journal analysis of Johns Hopkins University figures—marking the most states at that level since mid-July. When the seven-day average is higher than the 14-day average, it suggests cases are rising.

Some epidemiologists and public-health researchers said a number of factors are likely playing a role.


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The virus has spread to more rural counties and other communities, exposing vulnerable populations that hadn’t yet experienced it significantly and who are now reacting instead of taking steps to prevent the virus, public-health researchers said.

Some people have grown tired of restrictions on their movements and might be taking more risks than they did in the spring, they said. Mixed and inconsistent messaging over preventive measures has sowed confusion and complacency. Some local governments have eased restrictions on businesses and requirements to wear masks. Meanwhile, college students returned to campuses, leading to some spreading of the virus, and the onset of cooler weather has led many Americans indoors, where the virus is more transmittable, the public-health researchers said.

Students on the campus of Ball State University in Muncie, Ind., last month.


Michael Conroy/Associated Press

But the researchers also said it is difficult—and might be too early—to identify the exact causes of the recent increase in cases.

“I long for the day when each and every day we see fewer cases than the day before,” said Dr. Aronoff. “But if you were to ask me when that day would be, I don’t honestly know.”

Daily case-count tallies are likely to increase or remain at high levels without concerted use of such strategies as enhanced testing, widespread mask-wearing and clear, consistent messaging, epidemiologists and public-health researchers said.

“It doesn’t have to be this way,” said Jewel Mullen, the associate dean for health equity at the Dell Medical School at the University of Texas at Austin. “The longer it takes for us to adopt behaviors to lower collective risk, the longer it’s going to take for us to recover socially, economically from a pandemic standpoint.”

New case counts are high nationally, but it is far from uniform across the country; often one area surges when another improves. While cases have ebbed in Sunbelt states like Arizona, they have gone up throughout parts of the rest of the country, especially the upper Midwest. And community transmission has persisted in states like Florida and Texas where cases have dropped recently.

Monitoring the U.S. Outbreak

Confirmed cases by state, ranked by latest full-day count

Daily confirmed cases per 100,000 residents

Note: Trend indicates whether a state had an increase or decrease in total number of cases in the past seven days compared with previous seven days. Last updated

Sources: Johns Hopkins Center for Systems Science and Engineering; the Lancet; Associated Press; U.S. Census

“It’s almost like we never ended the first wave,” said Marissa Levine, a professor at the University of South Florida College of Public Health. “We may be going into the third hump of the first wave.”

On a national scale, the U.S. never saw the same substantial drops in cases experienced in European countries before infections rose there again.

The U.S. Centers for Disease Control and Prevention said in a recent report that divisiveness and mixed messages over mask-wearing might have contributed to a rise in coronavirus cases among younger people in a Wisconsin county. Another CDC report found increases in positivity rates among older age groups followed surges in younger populations. This week, a judge upheld Gov. Tony Evers’s mask mandate and public-health emergency after three residents challenged the actions.

Without a vaccine or a therapeutic breakthrough, prevention tools are the best approach for controlling the spread. Precautions like wearing masks and maintaining distance help lower risk of transmission but don’t entirely eliminate it, especially without full compliance, according to health officials.

“We have been saying it for months now that if everybody doesn’t do it, we’re not going to have this huge, overwhelming success,” said Jasmine Marcelin, an assistant professor at the University of Nebraska Medical Center and infectious-diseases physician. “It’ll be in fits and starts.” Communities might continue to slide back and forth between phases of the pandemic, Dr. Marcelin warned.

Compliance fatigue has been seen as a contributing factor to the second wave of infections that has spread across Europe in recent weeks. Across the Continent, restrictions are snapping back into place as cases rise and hospitals once again fill up.

In the U.S., swelling cases have already spurred record-high hospitalizations in states including Wisconsin, the Dakotas, Montana and Utah. The U.S. recorded the highest number of patients hospitalized with Covid-19 since the end of August on Wednesday, according to data from the Covid Tracking Project.

The Wisconsin National Guard administering drive-up Covid-19 tests this month in Milwaukee.


alex wroblewski/Reuters

More deaths and hospitalizations are likely to follow as cases edge higher and potentially shift from younger people to more vulnerable populations, a situation that is already playing out in Europe. The latest projections from the University of Washington’s Institute for Health Metrics and Evaluation indicate that nearly 180,000 additional deaths could occur in the U.S. by Feb. 1.

Health-care professionals are able to provide better care when not overwhelmed with patients or short on critical supplies, said Ryan Demmer, an epidemiologist and associate professor at the University of Minnesota.

“If we get back to 70,000 a day and we get beyond that, then the system probably is not really prepared to absorb those additional hospitalizations,” he said. “And then when you can’t provide adequate care, the death rates get worse.”

Epidemiologists and public-health leaders have continued to urge Americans to stay vigilant to avoid this outcome.

“The most frustrating thing for me as an epidemiologist is to know that we can make a change and we can make a difference in the trends. We know what to do,” said Loren Lipworth, an epidemiologist at Vanderbilt University Medical Center. “The virus is not going away.”

As European countries cope with a second wave of infections, data indicate that tourism has helped the coronavirus spread in popular destinations and travelers’ home countries. WSJ explains how summer travel has made it harder to control the pandemic. Photo: Damir Sencar/Agence France-Presse/Getty Images

Write to Jennifer Calfas at Jennifer.Calfas@wsj.com

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