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After declining for months, U.S. coronavirus cases are rising again. Has the 'fall wave' begun?

Summer just ended. The weather is cooling. School is back in session or trying to be. People are spending more time indoors. 

And now, after nearly two months of slow but steady decline, new daily U.S. coronavirus cases are rising again, with the seven-day average increasing by 21 percent — from 34,588 to 41,868 — since Sept. 12.  

Is this the start of the pandemic’s dreaded “fall wave”?

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States reopen, relax guidelines to prevent coronavirus spread

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NEW YORK, NEW YORK - MAY 06: An employee wearing a mask cleans the inside of the restaurant, Blue Stripes Cacao Shop as it prepares to reopen for takeaway and delivery orders after being closed for over a month amid the coronavirus pandemic on May 6, 2020 in New York City. Governor Andrew Cuomo made the announcement that all bars and restaurants must close by on March 16th unless it was takeout or delivery. COVID-19 has spread to most countries around the world, claiming over 263,000 lives with over 3.8 million cases. (Photo by Alexi Rosenfeld/Getty Images)

NEW YORK, NEW YORK - MAY 06: An employee wearing a mask cleans the inside of the restaurant, Blue Stripes Cacao Shop as it prepares to reopen for takeaway and delivery orders after being closed for over a month amid the coronavirus pandemic on May 6, 2020 in New York City. Governor Andrew Cuomo made the announcement that all bars and restaurants must close by on March 16th unless it was takeout or delivery. COVID-19 has spread to most countries around the world, claiming over 263,000 lives with over 3.8 million cases. (Photo by Alexi Rosenfeld/Getty Images)

THOUSAND OAKS, CA - MAY 06: A Cadillac Dealership displays a sign stating its reopened during the Coronavirus Pandemic on May 06, 2020 in Thousand Oaks, California. The coronavirus pandemic worldwide has claimed over 263,000 lives and infected over 3.7 million people. (Photo by Josh Lefkowitz/Getty Images)

HOUSTON, May 5, 2020 -- Customers shop at a shopping mall in Frisco, on the outskirts of Dallas, Texas, the United States, May 5, 2020. After closed for several weeks due to the outbreak of COVID-19 pandemic, the shopping mall reopened with shortened business hours on Tuesday. (Photo by Dan Tian/Xinhua via Getty) (Xinhua/ via Getty Images)

HOUSTON, May 5, 2020 -- Cars are parked in front of a shopping mall in Frisco, on the outskirts of Dallas, Texas, the United States, May 5, 2020. After closed for several weeks due to the outbreak of COVID-19 pandemic, the shopping mall reopened with shortened business hours on Tuesday. (Photo by Dan Tian/Xinhua via Getty) (Xinhua/ via Getty Images)

Dawson Padilla (L), owner of a protein shakes store, works behind the bar on May 5, 2020 in Stillwater, Oklahoma. - In the face of intimidation against employees and the threat of an armed attack by local residents wielding their individual liberties, the mayor of Stillwater had to give in: he gave up imposing the wearing of masks on customers in shops. This demand was included in a 21-page document that was supposed to accompany the gradual reopening of restaurants and shops from 1 May, as authorized by the state of Oklahoma. "About three and a half hours after the law came into effect" of the text, "we started receiving calls from stores claiming that employees were being threatened and insulted, and threatened with physical violence," said Norman McNickle, the city's director of services. (Photo by Johannes EISELE / AFP) (Photo by JOHANNES EISELE/AFP via Getty Images)

A worker of the Aspen Cafe wears a mask as she makes coffee on May 5, 2020 in Stillwater, Oklahoma. - In the face of intimidation against employees and the threat of an armed attack by local residents wielding their individual liberties, the mayor of Stillwater had to give in: he gave up imposing the wearing of masks on customers in shops. This demand was included in a 21-page document that was supposed to accompany the gradual reopening of restaurants and shops from 1 May, as authorized by the state of Oklahoma. "About three and a half hours after the law came into effect" of the text, "we started receiving calls from stores claiming that employees were being threatened and insulted, and threatened with physical violence," said Norman McNickle, the city's director of services. (Photo by Johannes EISELE / AFP) (Photo by JOHANNES EISELE/AFP via Getty Images)

Kelly Lyda, owner of the Aspen Cafe, stands in his Cafe on May 5, 2020 in Stillwater, Oklahoma. - In the face of intimidation against employees and the threat of an armed attack by local residents wielding their individual liberties, the mayor of Stillwater had to give in: he gave up imposing the wearing of masks on customers in shops. This demand was included in a 21-page document that was supposed to accompany the gradual reopening of restaurants and shops from 1 May, as authorized by the state of Oklahoma. "About three and a half hours after the law came into effect" of the text, "we started receiving calls from stores claiming that employees were being threatened and insulted, and threatened with physical violence," said Norman McNickle, the city's director of services. (Photo by Johannes EISELE / AFP) (Photo by JOHANNES EISELE/AFP via Getty Images)

Computer specialist Toby Angel drinks his coffee on May 5, 2020 in Stillwater, Oklahoma. - In the face of intimidation against employees and the threat of an armed attack by local residents wielding their individual liberties, the mayor of Stillwater had to give in: he gave up imposing the wearing of masks on customers in shops. This demand was included in a 21-page document that was supposed to accompany the gradual reopening of restaurants and shops from 1 May, as authorized by the state of Oklahoma. "About three and a half hours after the law came into effect" of the text, "we started receiving calls from stores claiming that employees were being threatened and insulted, and threatened with physical violence," said Norman McNickle, the city's director of services. (Photo by Johannes EISELE / AFP) (Photo by JOHANNES EISELE/AFP via Getty Images)

WESTPORT, CONNECTICUT - MAY 05: A cafe along a shopping street in the affluent community remains mostly empty of pedestrians and open stores on May 05, 2020 in Westport, Connecticut. A growing number of states have begun reopening parts of the economy amid demonstrations like the one yesterday that targeted the Connecticut state capital and the governor's mansion in Hartford. (Photo by Spencer Platt/Getty Images)

WESTPORT, CONNECTICUT - MAY 05: A cafe along a shopping street in the affluent community remains mostly empty of pedestrians and open stores on May 05, 2020 in Westport, Connecticut. A growing number of states have begun reopening parts of the economy amid demonstrations like the one yesterday that targeted the Connecticut state capital and the governor's mansion in Hartford. (Photo by Spencer Platt/Getty Images)

LAGUNA HILLS, CA - MAY 05: Customers maintain safety protocols at The BarberHood in Laguna Hills, CA, on Tuesday, May 5, 2020. The shop is one of the first to re-open and defy the state"u2019s stay-at-home order during the COVID-19 (coronavirus) lockdown. (Photo by Paul Bersebach/MediaNews Group/Orange County Register via Getty Images)

SAN CLEMENTE, CA - MAY 05: Visitors walk on the beach south of the pier in San Clemente, CA on Tuesday, May 5, 2020. The city opened its beaches for daily active use after coordinating with Gov. Gavin Newsom"u2019s office to maintain social distancing during the COVID-19 (coronavirus) lockdown. (Photo by Paul Bersebach/MediaNews Group/Orange County Register via Getty Images)

SAN CLEMENTE, CA - MAY 05: Surfers were back on the waves at T Street in San Clemente, CA on Tuesday, May 5, 2020. The city opened its beaches for daily active use after coordinating with Gov. Gavin Newsom"u2019s office to maintain social distancing during the COVID-19 (coronavirus) lockdown. (Photo by Paul Bersebach/MediaNews Group/Orange County Register via Getty Images)

KENMORE, WA - MAY 05: Lynette Fisher-Charles and her dog Gracie, a two-year-old springer spaniel, go for a hike in Saint Edward State Park on May 5, 2020 in Kenmore, Washington. The first phase to reopen the state begins today easing some restrictions including opening some parks, that were put in place during Governor Jay Inslees Stay Home, Stay Healthy order last March to help reduce the spread of COVID-19. Kenmore, WA is located northeast of Seattle. (Photo by Karen Ducey/Getty Images)

KENMORE, WA - MAY 05: Daryl Kline, a park ranger at Saint Edward State Park removes a sign saying the park is closed on May 5, 2020 in Kenmore, Washington. The first phase to reopen the state begins today easing some restrictions that were put in place during Governor Jay Inslees Stay Home, Stay Healthy order last March to help reduce the spread of COVID-19. Kenmore, WA is located northeast of Seattle. (Photo by Karen Ducey/Getty Images)

LAGUNA BEACH, CA - MAY 05: Lifeguards keep a lookout at Laguna Beach, CA after officials reopened access to the sand on Tuesday, May 5, 2020. The beach has been closed since March 23, 2020 due to the COVID-19 (coronavirus) outbreak. City parks along the beach are still closed and people cannot sit or linger on the sand. (Photo by Paul Bersebach/MediaNews Group/Orange County Register via Getty Images)

NEW YORK, May 4, 2020 -- Photo taken on May 4, 2020 shows Times Square in New York, the United States. Amid the ongoing COVID-19 pandemic, New York Governnor Andrew Cuomo on Monday outlined additional guidelines regarding when regions can reopen. According to the Governor's Press Office, the state will monitor four core factors to determine if a region can reopen: number of new infections, health care capacity, diagnostic testing capacity and contact tracing capacity. (Photo by Wang Ying/Xinhua via Getty) (Xinhua/Wang Ying via Getty Images)

NEW YORK, May 4, 2020 -- A worker cleans a cafe's signboard at Times Square in New York, the United States, May 4, 2020. Amid the ongoing COVID-19 pandemic, New York Governnor Andrew Cuomo on Monday outlined additional guidelines regarding when regions can reopen. According to the Governor's Press Office, the state will monitor four core factors to determine if a region can reopen: number of new infections, health care capacity, diagnostic testing capacity and contact tracing capacity. (Photo by Wang Ying/Xinhua via Getty) (Xinhua/Wang Ying via Getty Images)

ASBURY PARK, NJ - MAY 4: People walk near the closed boardwalk due to the outbreak of COVID-19 in the state on May 4, 2020 in the Jersey Shore in New Jersey. Some towns at Jersey Shore expect the reopening of beaches soon. (Photo by Eduardo MunozAlvarez/VIEWpress/Corbis via Getty Images)

NORTH ANDOVER, MA - MAY 4: Although all golf courses in Massachusetts are still ordered to stay closed by governor Charlie Baker, workers at the North Andover Country Club in North Andover, MA work on the grass on May 4, 2020, getting the course ready for when they eventually are allowed to re-open. (Photo by Jim Davis/The Boston Globe via Getty Images)

LOS ANGELES, CA - MAY 04: Gov. Gavin Newsom announced select retail businesses will be allowed to reopen starting Friday in California during the coronavirus pandemic on Monday, May 4, 2020 in Los Angeles, CA. (Jason Armond / Los Angeles Times via Getty Images)

SANFORD, UNITED STATES - MAY 04, 2020: Customers enjoy a meal at Racks Billiards Sports Bar and Grill on the first day that retail stores and restaurants in all Florida counties except Palm Beach, Broward, and Miami Dade were permitted to reopen as COVID-19 restrictions are eased. Under phase one of the plan to reopen the state, stores and restaurants are limited to 25 percent of their indoor capacity.- PHOTOGRAPH BY Paul Hennessy / Echoes Wire/ Barcroft Studios / Future Publishing (Photo credit should read Paul Hennessy / Echoes Wire/Barcroft Media via Getty Images)

SANFORD, UNITED STATES - MAY 04, 2020: A customer leaves a Books-A-Million store on the first day that retail stores and restaurants in all Florida counties except Palm Beach, Broward, and Miami Dade were permitted to reopen as COVID-19 restrictions are eased. Under phase one of the plan to reopen the state, stores and restaurants are limited to 25 percent of their indoor capacity.- PHOTOGRAPH BY Paul Hennessy / Echoes Wire/ Barcroft Studios / Future Publishing (Photo credit should read Paul Hennessy / Echoes Wire/Barcroft Media via Getty Images)

BOZEMAN, MT - MAY 04: Sales staff wear masks at the reopened Schnee's Boots, Shoes and Outdoors on Main Street on May 4, 2020 in Bozeman, Montana. Wyoming health officials today reported that the state's confirmed coronavirus cases grew by nine to a total of 444. (Photo by William Campbell/Getty Images)

BOZEMAN, MT - MAY 04: Signs for restaurants and stores announce their reopenings on Main Street on May 4, 2020 in Bozeman, Montana. Wyoming health officials today reported that the state's confirmed coronavirus cases grew by nine to a total of 444. (Photo by William Campbell/Getty Images)

JENSEN BEACH, FLORIDA - MAY 04: Cole Hunter carries Harper Hunter, 1, as Holly Hunter,4, follows along as they arrive at the beach on May 04, 2020 in Jensen Beach, Florida. Restaurants, retailers, as well as beaches and some state parks reopened today with caveats, as the state continues to ease restrictions put in place to contain COVID-19. The counties of Palm Beach, Broward and Miami Dade continue to maintain restrictions. (Photo by Joe Raedle/Getty Images)

JACKSONVILLE BEACH, FLORIDA - MAY 04: People are seen dining outside at Cruisers Grill as the state of Florida enters phase one of the plan to reopen the state on May 04, 2020 in Jacksonville Beach, Florida. Restaurants, retailers, beaches and some state parks reopen today with caveats, as the state continues to ease restrictions put in place to contain the coronavirus (COVID-19). (Photo by Sam Greenwood/Getty Images)

JACKSONVILLE BEACH, FLORIDA - MAY 04: People are seen at a department store as the state of Florida enters phase one of the plan to reopen the state on May 04, 2020 in Jacksonville Beach, Florida. Restaurants, retailers, beaches and some state parks reopen today with caveats, as the state continues to ease restrictions put in place to contain the coronavirus (COVID-19). (Photo by Sam Greenwood/Getty Images)

SAINT AUGUSTINE, FLORIDA - MAY 04: A mask is seen on the statue of Henry M. Flagler as the state of Florida enters phase one of the plan to reopen the state on May 04, 2020 in Saint Augustine, Florida. Restaurants, retailers, beaches and some state parks reopen today with caveats, as the state continues to ease restrictions put in place to contain the coronavirus (COVID-19). (Photo by Sam Greenwood/Getty Images)

A man works on power lines in Los Angeles, California on May 4, 2020, amid the coronavirus pandemic. - California governor Gavin Newsom earlier today announced the gradual reopening of the state later this week as dismal US employment figures are expected with the release of figures Friday May 8 for April's US jobs report, as 30 million Americans filed for unemployment in the last six weeks. (Photo by Frederic J. BROWN / AFP) (Photo by FREDERIC J. BROWN/AFP via Getty Images)

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The short answer is… it’s complicated. Much of the current uptick in coronavirus cases is tied to geography. In some previously hard-hit places — California, for instance — it’s almost certainly a by-product of increased testing. In others, such as Texas, college outbreaks are a driving force. Meanwhile, a state like Wisconsin — where the average positive testing rate has soared from about 6 percent in early August to more than 17 percent today — seems to have a more widespread problem.

And so even though it’s too soon to say whether a fall wave has begun, it’s not too soon to see the recent rise in U.S. cases for what it is: a warning. 

Regardless of whether President Trump thinks we’re “rounding the final turn” of the pandemic, the truth is, we’re barreling into the riskiest months of the year averaging more than 40,000 new cases per day (and possibly rising). That level of spread in turn sets the stage for precisely the sort of fall wave that experts are worried about — and that they’re already starting to see in foreign countries where the virus appeared to be, until recently, under far better control than it has ever been in the U.S. 

“The concern I’ve had and continue to have [is] this baseline of cases that we have every day,” Dr. Anthony Fauci, the nation’s top infectious disease expert, told CNN earlier this week. “We’re looking straight at the fall coming upon us. We’re looking at the winter coming upon us. If we don’t get that baseline down sharply to a very low level … when you have a lot of cases floating around, it’s much more difficult to contain.”

Wisconsin might be the most worrisome state in America right now. Last week, it cleared 2,000 daily cases for the first time — then hovered above that mark for three straight days. Health officials are currently detecting a “high level” of coronavirus activity in 71 of the state’s 72 counties. And while much of that spread appears to have originated with returning college students — the University of Wisconsin system has campuses in six of the eight cities with the fastest rise in cases — it has since blanketed the state. 

According to a report Wednesday from Wisconsin Public Radio, K-12 school districts statewide have been forced to revert to remote learning amid growing community outbreaks. Wisconsin’s COVID-19 hospitalizations hit an all-time high on Tuesday, rising nearly 40 percent over the last week to surpass the previous record set on April 9. In response, Gov. Tony Evers just declared a new public health emergency.

“We continue to learn more about this virus, but what we do know is that we are facing a new and dangerous phase of the COVID-19 pandemic here in Wisconsin,” Evers said. “We are seeing an alarming increase in cases across our state.”

Wisconsin’s worsening situation reflects a broader trend across the Midwest, which, unlike the Northeast, South and West, never experienced much of a peak — but which now, belatedly, is setting new daily records with more cases per capita than any other region. Over the last week, the 11 states with the most cases per capita were, in order, North Dakota, South Dakota, Wisconsin, Oklahoma, Iowa, Utah, Arkansas, Missouri, Texas, Nebraska and Kansas. 

But surges in states that haven’t suffered yet are one thing. A resurgence in a state that was already pummeled by the pandemic is what would, in theory, distinguish the tail end of the first wave from the start of the second — which is why Texas’s inclusion on that list is troublesome. 

As the New York Times recently reported, “inconsistencies and problems with COVID-19 data collection in Texas have clouded the picture of the pandemic’s trajectory in the state.” In fact, Texas suddenly reported 22,276 cases on Tuesday — 7,000 more than it had ever reported before. The vast majority of them weren’t new; instead, they were backlogged or overlooked infections from some previous date. 

Yet the Times database, which adjusts for such anomalies, still shows the average number of new daily cases in Texas rising 16 percent over the last two weeks. The South as a whole is still registering nearly as many new cases per capita as the surging Midwest — another disturbing sign. 

To be sure, Texas’s current seven-day average (about 4,200 cases) is less than half its July peak (about 10,400). But it’s still moving in the wrong direction. As in Wisconsin, much of the spread seems to be starting on college campuses. According to the Texas Tribune, cases have grown 34 percent since Aug. 19 in counties where four-year college students make up at least one-tenth of the population; that’s compared with 23 percent in counties with a smaller proportion of students.

The problem, as Harvard infectious-disease researcher Stephen Kissler told the Texas Tribune, is that “diseases don’t stay isolated in the populations where they start.”

That trend is already clear in Lubbock, which houses Texas Tech and other colleges. Local health authority Dr. Ron Cook told the Texas Tribune that a “mild uptick” in rates of hospitalizations and intensive care unit admissions there has accompanied rapid growth in cases since students returned to campus. 

If that pattern replicates itself statewide, it will test whether the virus infected much of Texas’s vulnerable population during the first wave or whether there’s still enough susceptibility left for an even bigger second wave — a frightening possibility with fall and winter ahead.

For now, California seems to be in better shape than either Texas or Wisconsin. As recently as Aug. 15, the state was averaging 9,400 new cases per day; now it’s averaging 3,600. Even a slight recent rise in new daily cases — the seven-day average appears to have bottomed out at 3,300 on Sept. 13 before inching upward again — may be misleading. Over the same period of time, the average number of daily tests conducted increased from 92,000 to more than 125,000, and the state’s positive testing rate actually fell from 3.54 percent to 2.79 percent, a new low. In other words, increased testing more than accounts for California’s recent rise in cases. 

Yet California could also be the state to watch to see how complacency factors into the fall equation. With the positivity rate now below 3 percent for the first time and hospitalizations down to their lowest level since April, California’s reopening took a significant leap forward on Tuesday as officials granted five more counties — Riverside, San Luis Obispo, San Mateo, Alameda and Solano — the freedom to resume indoor dining, moviegoing and other activities. Even nail salons were given the go-ahead to reopen statewide, pending county approval. In-person schooling could resume within weeks. 

The state’s four-tier reopening plan is relatively conservative, with benchmarks for the percentage of positive tests and new cases per capita that each of its 58 counties must meet for two consecutive weeks before advancing.

But Europe offers a sobering preview of what might lie ahead for states such as California if they simply assume the worst is behind them. After lockdowns this spring helped to smother the pandemic there — positive testing rates were lower than 2 percent — the virus once again is tearing across the continent as people proceed with their lives. Driven by soaring case counts in France, Spain and the U.K., Europe as a whole is now averaging 52,000 cases per day — nearly 20,000 more than it was detecting during its spring peak. 

At the same time, Israel, which has seen its average daily case count more than double since the start of September, imposed a second countrywide lockdown last week — which it furthered tightened Thursday, ordering all nonessential businesses to close and requiring residents to stay within 1,000 meters of their homes. 

None of this is to say that America’s fall wave is already underway. For now, new infections are skewing young. Deaths are trending downward. Therapeutics are improving. The U.S. can still avoid the worst if it collectively continues to take the kind of precautions that eventually stalled California’s summer spike — masking up, staying distant, avoiding indoor gatherings. 

Or not. The U.S. is unlikely to have enough vaccine doses for every American until next spring, according to Fauci. The most perilous months of the pandemic fall between now and then. It’s largely up to us what happens next. 

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