This article was originally published May 15, 2020, and updated October 15, 2020.
When a global outbreak of disease begins to slow, feelings of relief and a sense of moving on ensue. But historically, based on past pandemics involving diseases like the plague, cholera, and influenza, that feeling of security has been short-lived. Pandemic diseases, once clear of their initial peak of activity and seemingly on their way out, have a tendency to re-emerge in a different segment of the population and spread anew, giving rise to a second wave of disease.
In the modern era, public health experts have warned that highly contagious infectious diseases, including pandemic influenza and coronavirus disease 2019 (COVID-19), have the potential to re-emerge and produce second and possibly even third waves of disease. And these subsequent rounds of disease are sometimes worse than the first. The influenza pandemic of 1918–19 occurred in three waves, which took place over the course of a year. Whereas the first wave of that pandemic did not deviate noticeably from typical influenza epidemiology, the second and third waves were unusually deadly for 20- to 40-year-olds. The influenza (H1N1) pandemic of 2009 had two waves, the second of which caused significantly more illness than the first.
There was much speculation about whether a second wave of disease would sweep the world during the COVID-19 pandemic. To investigate this possibility, scientists developed models of different intervention scenarios and found that the likelihood of an additional round of illness and death by COVID-19 increased significantly when interventions to limit the spread of disease were relaxed. In particular, experts warned, the premature reopening of the economy in areas where new cases of disease continued to be reported all but ensured that a second wave would happen.
China, where the COVID-19 outbreak was first detected, was the first country to move past the initial wave of disease, a milestone of relief that came in the first half of February 2020. But, just weeks after newly reported cases dropped to zero in many places in China, researchers became concerned about re-emergence of the disease particularly in areas where restrictions on social distancing and travel had been eased. These concerns were realized in mid-May, when a cluster of new COVID-19 cases was detected in western Wuhan, after a stretch of just 35 days without new infections.
In late September 2020, while countries such as the United States and India were still in their first wave of the COVID-19 pandemic, health officials declared the emergence of a second wave of the disease in Europe. In most European countries, daily cases were higher during the second wave, compared with the first.