Former CDC Official Warns Of 2nd COVID-19 Wave: Most Americans Are Still Susceptible

May 6, 2020
Originally published on May 6, 2020 7:38 pm

Since the beginning of the coronavirus outbreak in the U.S., officials have been warning about the prospect of a second wave. Some even say additional COVID-19 spikes in the country could be worse than the first wave.

Dr. Ali Khan, former director of the Office of Public Health Preparedness and Response at the Centers for Disease Control and Prevention, says he is confident that a second wave will happen. That's because, he says in an interview with NPR's Morning Edition, the vast majority of people in the U.S. are likely still at risk of contracting the virus.

He says a second wave might be described as a mountain range rather than a big peak. "Even though we call it a pandemic, it's really multiple hundreds of different outbreaks in the U.S. going on at the same time," he says. "A lot of separate outbreaks will feel like sort of a second wave coming."

Khan says the implementation of additional protocols is necessary to minimize the risk of a second wave via community transmission. These include ramping up testing and contact tracing as well as a continued adherence to public health practices such as washing hands, social distancing and wearing masks.

Even as President Trump pushes to reopen the economy and states begin to relax stay-at-home orders, Khan says that "it's important to recognize that we haven't canceled the pandemic."

"We just are able to reopen because we've got a better sense on the availability of health care resources within our community," he says. "We're sort of plateauing our cases, and we're hoping that we'll slowly start to decrease our cases."

Interview Highlights

On what the second wave will look like

This is a brand-new virus. It's a good time to remind people that 90% of America is probably still susceptible. And if you weren't on the East Coast, you might think, "Oh, this wasn't so bad." ... And that's why there's this concern about a second wave of seeing additional spikes in cases, especially in large metropolitan areas that were relatively spared during the first fight in the United States.

On how to minimize risk as states begin to relax restrictions

We will be washing hands; we will be wearing masks; we will be continuing to social distance, but what's most important is we need to continue to decrease community transmission. So we need to continue to work on efforts to make it less likely for any of us to get infected. ... And so we need to make sure we have testing in America. We need to find those cases. We need to isolate them. We need to do the contact tracing. And we need to make sure we're quarantining people. ... And that's currently not happening as much as it should. So we're testing about 250,000 people a day right now. We should be testing 350,000 to 700,000 people a day right now.

We need to combine that with good protocols in all sorts of settings where we're likely to have higher risk — for schools, for example, that are going to be opened, other large businesses, warehouses. We are already seeing this obviously in prisons and meatpacking places, etc. And we need to make sure health care is protected, health care workers are protected.

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DAVID GREENE, HOST:

Since the beginning of the coronavirus outbreak in the United States, officials have kept warning about the prospect of a second wave.

(SOUNDBITE OF MONTAGE)

ANTHONY FAUCI: We will have coronavirus in the fall. I am convinced of that.

ROBERT REDFIELD: This virus is going to be with us. I'm hopeful that we'll get through this first wave and have some time to prepare for the second wave.

CRAIG FUGATE: What do we need to do differently to prepare for the next pandemic, the next wave of COVID-19, the next major disaster?

GREENE: The voices there, Dr. Anthony Fauci, the nation's top infectious disease expert and a member of the White House task force; also CDC director Robert Redfield and former FEMA administrator Craig Fugate.

Now, what the country is doing right now - what we're all doing right now - will have huge implications for this possible future resurgence, which some say could be worse than the first wave. And here to talk about this is Dr. Ali Khan. He's the former director of the Office of Public Health Preparedness and Response at the Centers for Disease Control and Prevention. He joins us on Skype this morning.

Dr. Khan, thanks for taking the time for us.

ALI KHAN: Good morning, David. And thank you for the opportunity.

GREENE: So are you confident, like those officials seem to be, that we are going to see a second wave here in the United States?

KHAN: Well, more than confident because we've still not gotten through the first wave. Unlike many countries in Europe that have decreased cases, we still are at the plateau. For the last month, we're still seeing 30,000 cases a day.

GREENE: Then what does it mean when we talk about a second wave? I mean, states are beginning to reopen. We're seeing the curve flattened in some places. Are we going to get to a point where life gets closer to back to normal and then all of a sudden we're having to take all these precautions again and we see cases starting to spike again?

KHAN: I think that's what people are talking about, is that potentially cases could spike again. So even though we call it a pandemic, it's really multiple hundreds of different outbreaks in the U.S. going on at the same time. So the greater New York area, for example, is seeing a decrease in cases without a doubt. But Chicago is seeing an increase in cases. So as we reopen, it's important to recognize that we haven't canceled the pandemic. We just are able to reopen because we've got a better sense on the availability of health care resources within our communities and we're not, you know, increasing our cases every day. We're sort of plateauing our cases. And we're hoping that we'll slowly start to decrease our cases. But there's a lot that we can talk about of, you know, what we're hoping to happen as now we reopen our economy.

GREENE: So just to be clear, this is not going to feel like here we go again, the exact same course. This is going to be like putting out different fires in different parts of the country. And maybe, you know, a lot of fires would be burning at once and it would feel like sort of a second wave coming.

KHAN: Correct. That's why it would probably - that's potentially what it could look like. You know, some people talked about this as being sort of a mountain range as opposed to sort of a big peak again. So again, this is a brand-new virus. It's a good time to remind people that 90% of America is probably still susceptible. And if you weren't on the East Coast, you might think - oh, this wasn't so bad. But lots of people are still susceptible to this disease. And that's why there's this concern about a second wave of seeing additional spikes in cases, especially in large metropolitan areas that were spared - relatively spared - during the first spike in the United States.

GREENE: I want to listen to a little bit of sound here from President Trump. This is in an interview yesterday with ABC. I mean, he was basically saying that there will likely be more deaths as states begin to relax their restrictions and relax these stay-at-home orders.

(SOUNDBITE OF ABC BROADCAST)

PRESIDENT DONALD TRUMP: It's possible there will be some because you won't be locked into an apartment or a house or whatever it is. But at the same time, we're going to practice social distancing. We're going to be washing hands. We're going to be doing a lot of the things that we've learned to do over the last period of time. And we have to get our country back.

GREENE: Dr. Khan, I mean, the president there is speaking as he is talking about winding down his White House task force dealing with this crisis, trying to strike a balance, in his words, you know, to move on and try to get the economy opened. Do you like what you're seeing from this government in terms of finding that balance?

KHAN: So he is correct that the new normal will include the fact that we need to protect ourselves because the pandemic - we may be opening up, but we haven't canceled the pandemic. So we will be washing hands. We will be wearing masks. And we will be continuing to social distance. But what's most important is we need to continue to decrease community transmissions. We need to continue to work on efforts to make it less likely for any of us to get infected. And that part is the public health part. And so we need to make sure we have testing in America. We need to find those cases. We need to isolate them. We need to do the contact tracing. And we need to make sure we're quarantining people.

So that piece needs to happen, and that's currently not happening as much as it should. So we're testing about 250,000 people a day right now. We should be testing 350,000 to 700,000 people a day right now. We need to combine that with good protocols in all sorts of settings where we're likely to have higher risk - so schools, for example, that are going to reopen, other large businesses, warehouses. We're already seeing this, obviously, in prisons and meatpacking places, et cetera. And we need to make sure health care is protected, health care workers are protected. So all these things need to be put in place to make sure as we reopen, we reopen safely and minimize the risk for Americans as they go out and about their business.

GREENE: Well, can I ask you very specifically about that? I mean, I couldn't help but noticing when the president was in Arizona yesterday, he was at a factory that is making masks. He was not himself wearing a mask. And I started thinking to myself, what would a doctor like yourself tell me? If I went to visit a factory like that, should I be wearing a mask as I go forward in the coming weeks and months?

KHAN: Everybody should be wearing a mask.

GREENE: Why is that so important?

KHAN: It's important for two reasons. The main reason it's important and why this disease has been so bedeviling to us is that you are infectious probably at least two days before you feel sick. So that's a problem because even if you're a wonderful citizen and when you're sick, you stay home, perfect. But two days before you feel sick, you're out and about the world and you're actually infecting people. So wearing a mask is called source protection, and then you're not infecting other people. And then, also, you don't want people spitting and coughing and sneezing in your face.

GREENE: Dr. Ali Khan, former director of the Office of Public Health Preparedness and Response at the CDC. Thanks so much for your time this morning.

KHAN: Thank you very much. It was a pleasure speaking with you. Transcript provided by NPR, Copyright NPR.