America begins to unlock for summer – but is it inviting a disastrous second wave?

Monday is Memorial Day – the traditional start of the American summer. Shutters are going up, doors are being unlocked, barriers removed. Every state is relaxing quarantine rules to some extent, betting that the country finally has Covid-19 under control.

There are signs that for some Americans quarantine fatigue is overcoming fear of infection. With the economy reeling, others have dismissed the pandemic as a political plot – for them relaxing quarantine rules can’t come soon enough. But people on the front line are worried, and experts warn the outbreak has proved a “trust-destroying disaster” that could have devastating consequences.

No masks allowed: stores turn customers away in US culture war

On Friday, White House coronavirus taskforce member Dr Anthony Fauci said new localized outbreaks were “inevitable” as mitigation measures are relaxed. He said a full-blown second wave could be avoided if the holy grail of containment measures – testing, quarantine and contact tracing – continued to be adhered to.

Fauci said he was hopeful that the US would be ready, though a recent study by Harvard University found that only nine states were conducting, or near to conducting, the minimum recommended testing. Hours after Fauci spoke, Donald Trump ignored health guidance and ordered houses of worship to open for in-person services at the weekend.

These disparate responses to the pandemic are not just happening in the White House, but across America.

After 51 days on lockdown, Minnesota ended its statewide stay-at-home order on Monday. A new order, dubbed “Stay Safe MN”, will allow more flexibility and social interaction amid the pandemic.

For nurses in Minneapolis, it’s too soon. In emotional testimony at the state Capitol last week, they told lawmakers they feared that a surge in cases would cost more lives, including those of health workers.

A surge of Covid-19 infections would exhaust the state’s personal protection equipment (PPE) supplies, warned Mary Turner, a critical care nurse at North Memorial Health Hospital and president of the Minnesota Nurses Association.

“We are approaching the surge point very fast,” Turner said.

Some 17,700 cases have been reported in the state, and 777 deaths. It is far from the worst outbreak in the US – but numbers are still rising. In the meantime, hospitals have been reusing N95 masks that technically expired in 2001 and 2002. Supplies of gowns ran so short last month that some local hospitals ordered rain ponchos as a backup.

Even governor Tim Walz believes worse is to come. “It is going to get worse here before it gets better. That is an absolute guarantee,” Walz, a Democrat, told reporters as he outlined his cautious reopening plan.

Social scientists at Northwestern University have surveyed 200 people per day since mid-March, and have found that unlike in other disasters, the US is not unifying in response to this crisis.

“It has been a solidarity- and trust-destroying disaster,” said Beth Redbird, the primary researcher. “We usually see disasters as unifying. They bring us together, they unite us, they increase support for our neighbors, to help each other out. But while we see anecdotal stories of that in the press, we haven’t actually seen a lot of data supporting that that’s what’s going on.”

The majority of Americans still seem to oppose Trump’s attempts to downplay the crisis. Northwestern’s surveys last week showed 64% of people are still in support of stay-at-home orders, and they are mostly avoiding seeing friends and eating out at restaurants.

But while Northwestern’s survey found 86% said they trusted scientists to tell them what to eat for a healthy diet, those who said they trust a scientist to tell them how Covid-19 works was only at 55%.

‘Like adding kindling to embers’

We have been here before. The threats of a second wave were borne out in the 1918 influenza pandemic, in which a third of the world’s population were infected with the virus.

The spread was successfully curtailed in San Francisco thanks to the prompt implementation of mitigation measures including a city-wide shutdown and requirement to wear masks in public.

As the infection rate dwindled, city leaders relaxed the lockdown measures in November 1918; bars, restaurants and sports arenas reopened, and people poured out onto the streets in celebration, tossing their masks in the process. A month later, the second wave hit San Francisco, but this time much of the public – including the Anti-Mask League – resisted public health mandates. The city ended up with nearly 45,000 cases and over 3,200 reported deaths. San Francisco ended up being one of the country’s worst-hit major cities.

Stephen Morse, director of the infectious disease epidemiology program at Columbia University medical center, said as long as the virus is circulating in humans, there will be flare-ups as soon as it’s introduced to a street, town or county with enough susceptible people.

“It’s like adding kindling to embers,” said Morse.

Whether these inevitable localized outbreaks are contained or will multiply depends on the golden trio of testing, quarantine and contact tracing. If enough places implement these measures comprehensively, the chain of transmission could be broken, and the flare-ups snuffed out.

“We don’t know what’s going to happen next, we have to proceed with caution and we could get lucky,” Morse said. “The big fear is that with the virus still in circulation, if we allow it to have unfettered access to people, then we certainly have the makings of a second pandemic of even larger proportions.”

It’s not all about timing. The country’s patchwork response to the outbreak has also played an important role – and will likely continue to do so.

“For the first time in my lifetime, there’s been an almost total lack of global coordination and US federal leadership, whose confusing and contradictory messages have been counterproductive and very destructive,” Morse said.

‘To think the virus has changed is a fantasy’

It’s unclear whether the US has even fully emerged from the first wave, but the virus remains as infectious and lethal as it was when it emerged.

And the conditions that have left low-income groups, communities of colour and Native Americans the hardest-hit remain, with infections and complications including death.

“To think the virus must have changed just because we’re tired of being at home is almost a fantasy,” said Chandra Ford, founding director of the center for the study of racism, social justice and health at UCLA’s Jonathan and Karin Fielding school of public health.

Ford warned subsequent outbreaks are likely to disproportionately affect these same communities.

“The US response to the pandemic at the federal level has lacked a meaningful public health response,” said Ford. “So it’s not surprising that the push to reopen isn’t driven by public health indicators. In fact, it appears to be driven against public health indicators, in the interest of political or economic gains.”

From the beginning, the Centers for Disease Control and Prevention’s most basic guidelines to stem the spread of Covid-19 ran up against some fundamental injustices in the US system. Workers are not guaranteed paid sick leave and healthcare is not universal.

Prisons, meatpacking plants and nursing homes have seen a disproportionate amount of cases. In New York City, the impact has overwhelmingly been felt in poorer communities where mostly immigrants and people of color live.

“Historical and current experiences of discrimination and medical racism provide fodder for people to be willing to accept explanations that are not true,” Ford said. “Trust matters tremendously. Mistrust of healthcare providers and public health messages will fuel the pandemic itself and disparities in the pandemic.”

In Georgia, one of the first states to start reopening, even business owners are worried.

Brian Maloof, owner of the Atlanta’s famous Manuel’s Tavern, said: “The attitude is that it’s too early to open with the population density. This is where the predominance of the cases are.”

He lives in the outskirts of the city and said there, parking lots are jammed with cars and people are packing into shopping malls and restaurants. He doesn’t expect the same crush of people inside the city. Maloof said: “There is a tremendous amount of fear here in Atlanta.”

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