Cases are rising and young people are part of it

young people are ignoring social distancing measures and testing positive. young people are ignoring social distancing measures and testing positive.

The major hotspots of new coronavirus cases in the United States are in the South and West, where officials say more young people are ignoring social distancing measures and testing positive.

The increases highlight America's systemic failure to control the pandemic, in sharp contrast to its trajectory in Europe and Asia. There, coronavirus cases sharply increased in the early weeks of 2020, were met with fierce efforts to stop its spread, and then markedly declined.

The good news? Young people are more likely to have milder outcomes from a coronavirus infection. The bad news? They can still infect others who may be at higher risk for a more severe course of disease.

"With younger age of recent infections in at least some places such as Florida, expect a lower death rate in this wave ... until the 20-40-year-olds who are infected today go on to infect others," Dr. Tom Frieden, former director of the US Centers for Disease Control and Prevention, said on Twitter.

The issue hinges on the mobility of those younger people and how likely they are to spread the virus. This is a bit of a question mark, and its answer could shape how we plan for the fall, the winter -- and even beyond.

Anti-viral drug's important next step

Drugmaker Gilead Sciences says it's starting a new trial using an inhaled version of the antiviral drug remdesivir, which is currently administered through intravenous infusion.

Remdesivir is the only drug that has emergency use authorization from the US Food and Drug Administration to treat coronavirus infections. The company said it received the green light from the FDA to move forward and is beginning Phase 1 trials this week -- testing the new formulation of the drug in healthy people, before starting studies in patients with Covid-19 in August.

"If the trials are successful, this could represent important progress. Remdesivir, our investigational antiviral medicine, is currently given to patients intravenously through daily infusions in the hospital," said Daniel O'Day, Gilead Sciences chairman and CEO. "An inhaled formulation would be given through a nebulizer, which could potentially allow for easier administration outside the hospital, at earlier stages of disease. That could have significant implications in helping to stem the tide of the pandemic."

The federal government is preparing for a second wave

White House trade adviser Peter Navarro said the administration is preparing for the possibility that a second wave of Covid-19 could hit the United States in the fall.

"We are filling the stockpile in anticipation of a possible problem in the fall. We are doing everything we can beneath the surface, working as hard as we possibly can," Navarro told CNN.

"You prepare for what can possibly happen. I'm not saying it's going to happen, but of course you prepare," he added.

Navarro's comments come as Vice President Mike Pence, who's leading the Trump administration's coronavirus task force, downplays the threat of a second wave that public health experts are warning about.

But it's also important to consider that in many -- if not all -- parts of the US, the first wave of coronavirus still isn't over. In fact, cases have taken only a small dip and are once again on the rise in some places, months after the pandemic hit first American shores.

And it's not clear that the country will completely get out of the first wave. Instead of having a true, uniform peak and then drop in cases, it may just be micro peaks and dips in different parts of the country for the foreseeable future.

The role of masks

The CDC is reviewing the public health benefits of wearing masks to better understand how they stop coronavirus transmission.

We already know they're effective at keeping the wearer from spreading Covid-19 to others, but health experts (and the public) want to know if -- and how much -- masks protect the wearer from getting Covid-19, too. 

Here's what the research says: One comprehensive study published in The Lancet found the use of a mask was one of the best ways to prevent disease spread. The chance of transmission for someone not wearing a face mask was 17.4%, and just 3.1% when a mask was worn.

The CDC guidelines for masks have evolved during the pandemic, as we've learned more about the disease.

Emerging research has focused on the role of asymptomatic and pre-symptomatic individuals in spreading the coronavirus. The hope is that wearing a mask in public could help keep an infected person from spreading virus-filled droplets before they show signs of being sick, or even if they never do.

From the desk of Dr. Gupta

I recently had the chance to talk to Dr. Zeke Emanuel, who was an adviser to President Barack Obama. We talked about what he would say to President Trump if he had the chance. What he said was really interesting, in part because he told me he did advise President Trump toward the end of February.

Here's a bit of what Dr. Emanuel told me: "I did say to the President that you've got to do what Lyndon Johnson would have done or Franklin Roosevelt would have done -- is you create a tornado of activity. So you've got a task force that deals with testing, a task force that deals with PPE, and a task force that deals with ventilators and contact tracing. And they created a small task force that was supposed to do all of that. That was totally inadequate, and I think it would have made a huge difference."

What Dr. Emanuel made clear was the feeling this administration came nowhere close to understanding the scope of the challenge.

What that means is we're now in a place we shouldn't be. For example, if you look at South Korea, they never went into a lockdown phase. Yet fewer than 300 people died there. Why is that? Because they did exactly what Emanuel talked about: They brought in a biotech company to figure out the best way to test and contract trace, and they took the virus seriously.

In the United States, we're now faced with the challenge of having to play catch-up, with the hope that we can somehow stem the number of cases and keep the death toll from climbing as best we can.

By Dr. Sanjay Gupta