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Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

Here we go again.

Health experts are warning the U.S. could be headed for another COVID-19 surge just as we enter the holiday season, following a massive new wave of infections in Europe — a troubling pattern seen throughout the pandemic.

Eighteen months into the global health crisis that has killed 5.1 million people worldwide including more than 767,000 Americans, Europe has become the epicenter of the global health crisis once again.

And some infectious disease specialists say the U.S. may be next.

“It’s déjà vu, yet again,” says Eric Topol, yasmin or yaz founder and director of the Scripps Research Translational Institute. In a new analysis published in The Guardian, the professor of molecular medicine argues that it’s “wishful thinking” for U.S. authorities to believe the nation is “immune” to what’s happening in Europe.

Topol is also editor-in-chief of Medscape, WebMD’s sister site for medical professionals.

Three times over the past 18 months coronavirus surges in the U.S. followed similar spikes in Europe, where COVID-19 deaths grew by 10% this month.

Topol argues another wave may be in store for the states, as European countries implement new lockdowns. COVID-19 spikes are hitting some regions of the continent hard, including areas with high vaccination rates and strict control measures.

Eastern Europe and Russia, where vaccination rates are low, have experienced the worst of it. But even western countries, such as Germany, Austria and the U.K., are reporting some of the highest daily infection figures in the world today.

Countries are responding in increasingly drastic ways.

• In Russia, President Vladimir Putin ordered tens of thousands of workers to stay home earlier this month.

• In the Dutch city of Utrecht, traditional Christmas celebrations have been canceled as the country is headed for a partial lockdown.

• Austria announced a 20-day lockdown beginning Monday and on Friday leaders there announced that all 9 million residents will be required to be vaccinated by February. Leaders there are also is telling unvaccinated individuals to stay at home and out of restaurants, cafes and other shops in hard-hit regions of the country.

• And in Germany, where daily new-infection rates now stand at 50,000, officials have introduced stricter mask mandates and made proof of vaccination or past infection mandatory for entry to many venues. Berlin is also eyeing proposals to shut down the city’s traditional Christmas markets while authorities in Cologne have already called off holiday celebrations, after the ceremonial head of festivities tested positive for COVID-19. Bavaria canceled its popular Christmas markets and will order lockdowns in particularly vulnerable districts, while unvaccinated people will face serious restrictions on where they can go.

Former FDA Commissioner Scott Gottlieb, MD, says what’s happening across the European continent is troubling.

But he also believes it’s possible the U.S. may be better prepared to head off a similar surge this time around, with increased testing, vaccination and new therapies such as monoclonal antibodies and antiviral therapeutics.

“Germany’s challenges are caution to world, the COVID pandemic isn’t over globally, won’t be for long time,” he says. “But [the] U.S. is further along than many other countries, in part because we already suffered more spread, in part because we’re making progress on vaccines, therapeutics, testing.”

Other experts agree the U.S. may not be as vulnerable to another wave of COVID-19 in coming weeks but have stopped short of suggesting we’re out of the woods.

“I don’t think that what we’re seeing in Europe necessarily means that we’re in for a huge surge of serious illness and death the way that we saw last year here in the states,” says David Dowdy, MD, PhD, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health and a general internist with Baltimore Medical Services.

“But I think anyone who says that they can predict the course of the pandemic for the next few months or few years has been proven wrong in the past and will probably be proven wrong in the future,” Dowdy says. “None of us knows the future of this pandemic, but I do think that we are in for an increase of cases, not necessarily of deaths and serious illness.”

Looking Back, and Forward

What’s happening in in Europe today mirrors past COVID-19 spikes that presaged big upticks in cases, hospitalizations and deaths in the U.S.

When the pandemic first hit Europe in March 2020, then-President Donald Trump downplayed the threat of the virus despite the warnings of his own advisors and independent public health experts who said COVID-19 could have dire impacts without an aggressive federal action plan.

By late spring the U.S. had become the epicenter of the pandemic, when case totals eclipsed those of other countries and New York City became a hot zone, according to data compiled by the Johns Hopkins Coronavirus Resource Center. Over the summer, spread of the disease slowed in New York, after tough control measures were instituted, but steadily increased in other states.

Then, later in the year, the Alpha variant of the virus took hold in the United Kingdom and the U.S. was again unprepared. By winter, the number of cases accelerated in every state in a major second surge that kept millions of Americans from traveling and gathering for the winter holidays.

With the rollout of COVID vaccines last December, cases in the U.S. — and in many parts of the world — began to fall. Some experts even suggested we’d turned a corner on the pandemic.

But then, last spring and summer, the Delta variant popped up in India and spread to the U.K. in a third major wave of COVID. Once again, the U.S. was unprepared, with 4 in 10 Americans refusing the vaccine and even some vaccinated individuals succumbing to breakthrough Delta infections.

The resulting Delta surge swept the country, preventing many businesses and schools from fully reopening and stressing hospitals in some areas of the country — particularly southern states — with new influxes of COVID-19 patients.

Now, Europe is facing another rise in COVID, with about 350 cases per 100,000 people and many countries hitting new record highs.

What’s Driving the European Resurgence?

So, what’s behind the new COVID-19 wave in Europe and what might it mean for the United States?

Shaun Truelove, PhD, an infectious disease epidemiologist and faculty member of the Johns Hopkins School of Public Health, says experts are examining several likely factors:

• Waning immunity from the vaccines. Data from Johns Hopkins shows infections rising in nations with lower vaccination rates.

• The impact of the Delta variant, which is three times more transmissible than the original virus and can even sicken some vaccinated individuals.

• The spread of COVID-19 among teens and children; the easing of precautions (such as masking and social distancing); differences in the types of vaccines used in European nations and the U.S.

“These are all possibilities,” says Truelove. “There are so many factors and so it’s difficult to pinpoint exactly what’s driving it and what effect each of those things might be having.”

As a result, it’s difficult to predict and prepare for what might lie ahead for the U.S., he says.

“There’s a ton of uncertainty and we’re trying to understand what’s going to happen here over the next 6 months,” he says.

Even so, Truelove adds that what’s happening overseas might not be “super predictive” of a new wave of COVID in the U.S.

For one thing, he says, the Pfizer and Moderna vaccines, the two mRNA vaccines used predominantly in the U.S., are far more effective — 94-95% — than the Oxford/AstraZeneca COVID shot (63%) widely administered across Europe.

Secondly, European countries have impose much stronger and stricter control measures throughout the pandemic than the U.S. That might actually be driving the new surges because fewer unvaccinated people have been exposed to the virus, which means they have lower “natural immunity” from prior COVID infection.

Truelove explains: “Stronger and stricter control measures … have the consequence of leaving a lot more susceptible individuals in the population, [because] the stronger the controls the fewer people get infected. And so, you have more individuals remaining in the population who are more susceptible and at risk of getting infected in the future.”

By contrast, he notes, a “large chunk” of the U.S. has not put strict lockdowns in place.

“So, what we’ve seen over the past couple months with the Delta wave is that in a lot of those states with lower vaccination coverage and lower controls this virus has really burned through a lot of the susceptible population. As a result, we’re seeing the curves coming down and what really looks like a lot of the built-up immunity in these states, especially southern states.”

But whether these differences will be enough for the U.S. to dodge another COVID-19 bullet this winter is uncertain.

“I don’t want to say that the [Europe] surge is NOT a predictor of what might come in the U.S., because I think that it very well could be,” Truelove says. “And so, people need to be aware of that, and be cautious and be sure get their vaccines and everything else.

“But I’m hopeful that because of some of the differences that maybe we’ll have a little bit of a different situation.”

The Takeaway: How Best to Prepare?

Dowdy agrees that Europe’s current troubles might not necessarily mean a major new winter surge in the U.S.

But he also points out that cases are beginning to head up again in New England, the Midwest and other regions of the country that are just experiencing the first chill of winter.

“After reaching a low point about 3 weeks ago, cases due to COVID-19 have started to rise again in the United States,” he says. “Cases were falling consistently until mid-October, but over the last 3 weeks, cases have started to rise again in most states.

“Cases in Eastern and Central Europe have more than doubled during that time, meaning that the possibility of a winter surge here is very real.”

Even so, Dowdy believes the rising rates of vaccination could limit the number of Americans who will be hospitalized with severe disease or die this winter.

Still, he warns against being too optimistic, as Americans travel and get together for the winter holidays.

None of us knows the future of this pandemic, but I do think that we are in for an increase of cases, not necessarily of deaths and serious illness, Dowdy says.”

The upshot?

“People need to realize that it’s not quite over,” Truelove says. “We still have a substantial amount of infection in our country. We’re still above 200 cases per million [and] 500,000 incident cases per week or so. That’s a lot of death and a lot of hospitalizations. So, we still have to be concerned and do our best to reduce transmission … by wearing masks, getting vaccinated, getting a booster shot and getting your children vaccinated.”

Johns Hopkins social and behavioral scientist Rupali Limaye, PhD, MPH,  adds that while COVID vaccines have been a “game changer” in the pandemic, more than a third of Americans have yet to receive one.

“That’s really what we need to be messaging around — that people can still get COVID, there can still be breakthrough infections,” says Limaye, a health communications scholar. “But the great news is if you have been vaccinated, you are very much less likely, I think it’s 12 times, to be hospitalized or have severe COVID compared to those that are un-vaccinated.”

Topol agrees, adding: “Now is the time for the U.S. to heed the European signal for the first time, to pull out all the stops. Promote primary vaccination and boosters like there’s no tomorrow. Aggressively counter the pervasive misinformation and disinformation. Accelerate and expand the vaccine mandates…

“Instead of succumbing to yet another major rise in cases and their sequelae, this is a chance for America to finally rise to the occasion, showing an ability to lead and execute.”

Sources:

The Guardian: “Covid cases are surging in Europe. America is in denial about what lies in store for it.”

The Associated Press: “WHO: Coronavirus cases declining everywhere except Europe,” “Vaccine reluctance in Eastern Europe brings high COVID cost,” “Not out of the woods: COVID cases rising in Western Europe.”

Johns Hopkins: “Coronavirus Resource Center,” “Media Briefing November 17.

Twitter: @Scott Gottlieb, Nov. 12, 2021.

USA TODAY: “US COVID-19 map: Tracking cases and deaths.”

Sean Truelove, PhD, infectious disease epidemiologist, faculty member, Johns Hopkins School of Public Health.

CDC: “Moderna mRNA vaccine.”

New England Journal of Medicine: “Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine.”

World Health Organization: “The Oxford/AstraZeneca COVID-19 vaccine: what you need to know.”

New York: “COVID-19 Cases Surge Across Europe.”

The Wall Street Journal: “The U.S. Has Followed Europe in Previous Covid-19 Surges. Will It Happen Again?”

Los Angeles Times: “COVID-19 surge in Europe as it heads into winter could bode ill for U.S.”

The Washington Post: “Austria orders lockdown for the unvaccinated amid coronavirus surge,” 

“As coronavirus cases surge, more European countries consider lockdowns.” 

The New York Times: “Germany’s Fourth Covid Wave: ‘A Pandemic of the Unvaccinated.”

NBCnews.com: “Covid is Surging in Europe. Experts Say it’s a Warning for the U.S.”

Politico: “Austria becomes first Western country to resort to mandatory coronavirus vaccination.”

DW.com: “COVID in Germany: Bavaria cancels Christmas markets.”

NPR: “With record-high deaths, Moscow and other parts of Russia enter a partial lockdown.”

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