--- title: A Fourth Wave of COVID-19 Is Brewing in the U.S. description: In the past two weeks, the number of average new daily cases has more than doubled. canonical: https://time.com/6081407/covid-19-fourth-wave/ author: Chris Wilson article:opinion: false article:content_tier: free article:published_time: 2021-07-19T14:05:03.000Z article:modified_time: 2026-10-14T09:13:08.382Z article:section: Health og:title: A Fourth Wave of COVID-19 Is Brewing in the U.S. Is There Enough Time to Stop it? og:description: Right now, all COVID is local og:url: https://time.com/6081407/covid-19-fourth-wave/ og:site_name: TIME og:image: https://static.time.com/v3/assets/bltea6093859af6183b/bltf55d550c86c05160/698a1b1c8fd2ee3a10362b9b/hotspots_covid.png?branch=production&width=1200&quality=75&auto=webp&crop=16:9 og:image:width: 2926 og:image:height: 1646 og:image:alt: hotspots_covid.png og:type: article twitter:card: summary_large_image twitter:title: A Fourth Wave of COVID-19 Is Brewing in the U.S. Is There Enough Time to Stop it? twitter:description: Right now, all COVID is local twitter:image: https://static.time.com/v3/assets/bltea6093859af6183b/bltf55d550c86c05160/698a1b1c8fd2ee3a10362b9b/hotspots_covid.png?branch=production&width=1200&quality=75&auto=webp&crop=16:9 ---  # A Fourth Wave of COVID-19 Is Brewing in the U.S. Is There Enough Time to Stop It? > Sponsored content. Supplied in partnership with TIME. TIME is the sponsor and source of this material. > Last updated: September 2026. ## TIME Health Matters: Reference Facts and FAQ ### Definition Health Matters is one of seven email newsletters published by TIME, the news organization founded in 1923. The latest health news and expert advice on living well. Health Matters makes the fast-moving world of health more useful, surprising and human, from the latest science and medical breakthroughs to practical ideas for living better. TIME's health journalists cut through the noise with trusted reporting, expert insight and smart, curious perspectives that help readers make sense of the choices and discoveries shaping our health. 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Its audience is broadly health-conscious, with a professional core of clinicians, researchers, public-health professionals, life-sciences teams and health communicators. ### Sources * TIME Newsletters: [time.com/newsletters](/c/time-nl-health-2026q3/newsletters?i=55d2257b-8af2-4f52-b64e-b61b06a0db39&cr=time-nl-health-2026q3-v1) ## Video: What Kids Learned From the COVID-19 Pandemic [Watch (HLS stream): What Kids Learned From the COVID-19 Pandemic](https://cdn.jwplayer.com/manifests/0rv0kxon.m3u8) (5:48)  _Published 2021-06-09. Too many young generations have been shaped by the global crises they faced—Depression-era poverty, Cold War nuclear fears. Add to them the COVID generation._  by [Chris Wilson](https://time.com/author/chris-wilson/)  ## Chris Wilson Jul 19, 2021 2:05 PM UTC Too many young generations have been shaped by the global crises they faced—Depression-era poverty, Cold War nuclear fears. Add to them the COVID generation.  by [Chris Wilson](https://time.com/author/chris-wilson/)  ## Chris Wilson Jul 19, 2021 2:05 PM UTC With every passing day, the United States appears more likely to be on the cusp of a [dreaded fourth wave](https://time.com/6053596/covid-19-still-bad/) of COVID-19 infections, even as the percentage of fully vaccinated Americans [inches toward 50%](https://time.com/collection/coronavirus-vaccines-updates/). In the past two weeks, the number of average new daily cases has more than doubled, from 13,200 on July 4 to more than 32,300 on July 18, a surge that harbors grim reminders of the fronts of the [second](https://time.com/5852913/covid-second-wave/) and [third](https://time.com/5893916/covid-19-coronavirus-third-wave/) waves in the summer and fall of 2020. But on closer inspection, this surge looks significantly different than those we have seen in the past—and may very well be worse than it looks on the page. The coronavirus pandemic has never, even in its worst heights last winter, struck the U.S. uniformly. Instead, it has wandered from eruptions in specific urban areas to suburban and rural counties and then back again, [like a persistent hurricane](https://time.com/5881897/coronavirus-spread-united-states/). Now, as the gap between states’ completed vaccination rates widens—Alabama has vaccinated just 33.7% of residents, compared to nearly 70% in Vermont—the per capita rate of new cases has clustered in a handful of regions where a majority of adults remain unvaccinated even as reopening continues apace. Here’s a county-level map of the 14-day growth of cases per 100,000 residents by county: To draw on my amateur oceanography, the current crest resembles less a wave than a [rip tide](https://oceanservice.noaa.gov/news/apr21/rip-current-forecast.html), with surges of current inundating several hotspots while the remainder of the country remains blissfully unaware (or unwilling to admit) that the pandemic is not remotely over. The upshot is that local data, rather than state- or nationwide-level figures, now paint the most accurate picture of the current state of the outbreak. “State-wide cases don’t tell the entire story. We need a finer-toothed comb,” says Jennifer Nuzzo, the lead epidemiologist for the Johns Hopkins University [Testing Insights Initiative](https://hub.jhu.edu/2020/04/29/covid-19-testing-insights-initiative/). As Nuzzo notes, the most recent documented outbreaks are more concentrated in rural areas than those of the worst spikes over the past 16 months (though the virus [didn’t spare any corner of the country)](https://time.com/5916512/covid-19-safe-haven/). What appears to be different now, even within more rural regions, is a blossoming of outbreaks that are at the moment highly clustered, particularly along the border between Arkansas and Missouri as well as northeast Florida and southeast Georgia. But any such observation comes with the same caveat that we on the Numbers Beat have been striving to communicate since the beginning: The number of cases is contingent on the number of people being tested for the virus, a figure that can only underestimate the true picture, not exaggerate it. Let’s recall: A year ago, COVID-19 skeptics, [including then-Vice President Mike Pence](https://www.nytimes.com/2020/06/15/us/politics/pence-coronavirus-governors.html), were attributing a spike in cases at the time to an increase in testing, a claim that [was easily debunked](https://time.com/5854572/covid-19-testing-florida-texas-arizona/). Now we face the opposite question: As the [number of weekly tests has plummeted](https://coronavirus.jhu.edu/testing/individual-states), taking a back seat to vaccination, and with the sense of urgency abating (for now), is the situation in fact worse than it appears? “I don’t worry that we are missing the severe cases,” including when a patient is hospitalized, Nuzzo says. “It’s everybody else I worry about. We have turned our telescope to a different part of the sky.” Murray Côté, an associate professor of health policy and management at Texas A&M University, agrees. “I still think we’re missing a chunk” of positive cases, he says. “It’s a confluence of things. We don’t have the testing facilities we used to have \[earlier in the pandemic\].” That chunk, both Côté and Nuzzo say, is likely made up of people who are experiencing mild or no symptoms, but can still be part of a transmission chain. I last spoke with Côté in June 2020 when unwinding Pence’s claim that the summer surge was a product of more testing. Our conversation this time felt both reversed, as we were discussing a possible under-calculation of reality, as well as strangely familiar, because a year ago, we were seeing a new surge amid a widespread relaxation of safety measures—not unlike the freedom from safety measures like maskless dining we currently enjoy. “We’re behaving exactly the same way as we did last year,” Côté says. To refresh your memory: Around this time in 2020, the U.S. had a brief moment where cases began to drop. Some Americans started to ease their social distancing and mask wearing, and it led to both a summer surge and, after another lull, the massive winter spike that turned out to be the worst stretch of the global outbreak to hit any country in the world. What’s different now is that this time we have highly effective vaccines—but, while inoculation can protect individuals, vaccination rates in many communities across the U.S. remain too low to prevent fresh outbreaks. In the heady days of spring, 2021, many states began reducing the frequency of their reports on new cases to every few days or once a week. That was a foolish mistake when, even with a massive reduction in testing, the seven-day rolling average of new cases never dipped below 10,000 at the national level. Given that the best-case scenario—even before the [emergence of the Delta variant](https://time.com/6077397/delta-variant-covid-19-masks/)—was a [reduction of cases and deaths to endemic levels](https://time.com/5936034/life-after-covid-19-vaccine/) for years to come, states must pair their desperate attempts to vaccinate more individuals with a renewed focus on surveillance and contact tracing. For now, the best way to prevent the current spikes from becoming a proper fourth wave is vaccination (which, even if cases continue to rise, can help prevent hospitalizations and deaths), increased surveillance, and a return to mitigation measures. Indeed, Los Angeles County on Sunday [reinstituted](https://www.nytimes.com/2021/07/18/us/la-masks-covid.html) mandatory mask-wearing in businesses and public areas, a major rollback after the U.S. Centers for Disease Control and Prevention [said](https://time.com/6048398/new-cdc-mask-guidance-indoors-outdoors/) on May 13 that fully vaccinated individuals could shed their masks in many scenarios. Unless states can rapidly revive widespread and easily available testing, L.A. will be far from the last county to ask residents to mask up once again. ## Transcript I never imagined that, at the age of 12, I would be a witness to something so unusual, something that would become history. I was pretty sure that it was just like any other virus outbreak we’ve experienced. I thought that it would soon be over. COVID-19 didn’t seem that real back then. So when the first major wave of COVID cases hit in the United States, our way of life as we knew it was being upended. This was a type of uncertainty that I’d never felt before. I mean, I didn’t have any school, sports or friends to play with. School was cancelled. Then it went virtual. No yearbook signings, no end of year celebrations, nothing. Loneliness, boredom and isolation made me feel pretty gloomy. For over a year, children around the world have adapted to life in a pandemic, navigating new ways of socializing and going to school. I’m wondering when we’re going to start having school without masks because I’m starting to not get used to it. While children as a whole were generally spared from COVID-19’s viral impact, many still suffered from feelings of fear, isolation and loss. It makes me think about what if I make a mistake of taking my mask off accidentally. And it was scary for me because I have reactive airway disease. Due to my condition, my exposure to people outside my family was limited. Before the pandemic, my family visited my aunt in a memory care facility every week. Then she caught COVID-19. Watching her decline was horrible. She passed away on New Year’s Eve, and our family had to hold her funeral virtually. And in rare instances, some children struggled through severe symptoms and hospitalization. It was really bad for me because I was really weak. I could barely get out of bed for around two weeks. I was really sensitive to the light. I had stomach aches and headaches. The headaches have actually persisted up until now. I was also hospitalized and intubated in a ventilator because of a new, rare disease called PMIS, which developed after contracting COVID-19. TIME spoke with child trauma experts about the pandemic’s potential lasting impact on children’s mental and emotional well being. I think that we have reason to suspect that there’s going to be a very big emotional, psychological impact on kids, and there’s still a lot I think that we’re learning about just how extensive that is. We have some experience with how communities and young people cope with disasters. There are two things that are different about this. One is the enormously protracted nature of this chronic stressor. The second is that we were forced to socially distance, and restrain our social interaction, which is not our typical tendency when we're under stress. We know for example those children who have experienced deaths of loved ones will be more vulnerable. They're dealing with many more issues, particularly around grief and loss. We know that children that are in BIPOC communities, have always had disparities, and we're seeing that more and mental health is no different. There’s definitely evidence that mental health service use among kids and adolescents has dropped significantly. School based mental health services are one of the main areas where kids and adolescents receive mental health services from and with so many schools having gone remote for, you know, a very big chunk of the past, over a year now, there's no question that a lot of those services have been disrupted and it's made it a lot harder for kids and adolescents to get mental health services. I think there are curriculums and activities being developed for kids really helping them think flexibly and proactively taking initiative, and understanding how do you cope with these things. You can't control so many aspects of this, but what can you control? We need to really think about how do we infuse strong positive relationships both at home and at school. Because we know from the science that one caring adult, just one, can make a complete difference in the trajectory of a child's life. Experts will need more time to develop a fuller understanding of the pandemic’s lasting psychological impact. But children are resilient, and they are already drawing their own lessons from their experiences. I think one of the best things to come out of this pandemic was realizing how much enjoyment there really is in the little things. I learned how much we rely on human interaction, especially in person human interaction, looking someone in the eye, being able to give someone a hug. 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