A few thoughts about language and the pandemic. We are hearing a lot of talk of ‘second waves’, which I think has the capacity to seriously mislead. Talk of a wave suggests that you can avoid it by sheltering until it passes. That's not the case for the pandemic. Here's why 1/n

Think about waves in the ocean, they rise and fall independently of us. The surfer does not create the wave, they only ride it. In contrast the falling numbers of cases in the NEof the US (and Europe) are the consequence of human actions to limit transmission 2/n

It’s not independent of us. We made it happen. The roots of the confusion lie in the 1918-19 Influenza pandemic, when there were distinct waves of disease either side of relatively little activity in the summer. That is not a good model here 3/n

Influenza has trouble transmitting in the summer. It is subject to strong seasonal forcing. That’s not the case for SARS-CoV-2. Far from melting away in the sun, the record numbers of cases we are now seeing are now spread across the south (see also Brazil) 4/n

(I wonder out loud how much this has to do with the summer heat driving people into indoor spaces as they emerge from shutdown, where transmission is more likely especially in absence of mask use) 5/n

This is why I prefer to talk about ‘surges’. This both emphasizes that increases in pandemic activity can happen at any time, and concentrates on the most damaging aspect of them – the increase that threatens healthcare 6/n

A wildfire is a better metaphor. Even if we have doused the area around us with water, we should not be surprised to find the fire still burning elsewhere. If there is dry brush and oxygen, there will be more fire (HT @CarolineColijn for the image) 7/n

As far as the virus is concerned, we are the dry brush, and opportunities to transmit are oxygen. And an ember can be carried a long way before it sparks another blaze. We should get used to this and accept complete normality is a long way off 8/n

Finally the relatively young median age of cases suggests better testing right now than in the spring (it could hardly be worse) identifying milder infections. This is good, but not altogether comforting 9/n

It suggests that the outbreaks are at an earlier stage because we’re not becoming aware of them through more severe illness (which is a relatively rare outcome). Increases in hospitalizations and death reflect transmission in the past remember 10/n

However we should remember that given how long it takes people to get seriously ill, even if *all* transmission were stopped right now, we would expect hospitalizations to keep climbing for a few weeks 11/n

We will need to hope that the virus does not find its way into older, more vulnerable, age cohorts. And we need to remember that there's not only a long summer ahead, after that comes the fall, and then winter 12/end