After spring and summer brought persistent surges in COVID-19 cases, California’s rates appear to be on the decline for the fall. But as businesses reopen with modifications, some children go back

to school and the weather slowly cools, health experts have a uniform message: It’s not over.

About 2.8% of tests conducted statewide are currently coming back positive — the lowest it’s been since the pandemic started, according to the latest state data. Experts say that’s due to public health messaging about mask-wearing, six-foot distancing and handwashing.

It’s also been easy during the warm months, with the exception of smoky days, to gather outdoors to help reduce the risk of COVID-19 spread.

But in the colder season, and with businesses in certain counties being permitted to welcome guests indoors, University of California, Berkeley epidemiologist John Swartzberg is fearing the worst.

“If we’re not really careful we could have a third surge sometime in November, December, January,” he said. “It could be far worse than the two we’ve seen … We know COVID is going to be with us. It was with us last winter and there’s no reason to think it’s going away and we have influenza on top of it.”

We asked experts what they expect to see in the next few months.

Indoor Activity

Under the state’s new blueprint for reopening, schools can return to in-person classes after a county has been in the red, or “substantial” tier, for two weeks. (Check here to see which counties are in which tier.)

“We’re now in the phase of kids getting back to school, both elementary school, secondary school, high school and colleges and universities,” said Dr. Grace Lee, a pediatric infectious disease specialist at Stanford University. “We have to be very cautious as we’re reopening in these various settings.”

Outbreaks at universities that have resumed in-person learning have already caused those campuses to shut down.

Swartzberg says colleges and universities could be perpetuating a worst-case scenario for the fall. There are a number of other factors he says could lead to a major surge.

“That fires continue through early December and result in lots of particulate matter that damages people’s airways and makes them more susceptible to serious disease,” he said. “That it turns out children are an important reservoir and they spread it to their parents and family … that influenza turns out to be a bad year, that we loosen up society too quickly.”

He warns that people taking their backyard parties inside for the holidays will be a major problem, and he also worries about holiday travel around Thanksgiving and Christmas.

“That would portend a very bad prognosis for 2021,” he said.

Changing Tiers

In Sacramento, officials have made it a goal to get to the moderate (orange) tier by Halloween. The county is currently in the most risky tier (purple), but is poised to move to the next category (red) in one week.

Public health officer Dr. Olivia Kasirye says lowering the positivity rate will make it feasible to allow more indoor activities.

“The only way we can assure that is by bringing the numbers down low enough so that it makes it safe enough so that when we start opening, we’re not going to see that huge surge in cases,” she said.

The county is also trying hard to get people to make safe plans for Halloween. They’re recommending people leave candy at the end of the driveway for trick-or-treaters instead of having children come up to the door. They’re also suggesting solitary activities such as virtual costume contests or family scary movie nights.

Kasirye said they will be keeping an eye on the numbers following the holiday.

“If there is spread we start seeing the spike within one to two weeks,” she said. “We were watching after Labor Day, and so far we haven’t seen any significant increase. Our hope is that that will continue for Halloween as well.”

Flu Season

California’s flu season typically begins in late fall and continues through early spring. Influenza vaccines are already available at doctor’s offices, pharmacies and other locations, and health experts say the time to get one is now.

“While we continue to grapple with COVID-19, we run the risk of further straining our already-taxed health care infrastructure if we don’t take simple and effective precautions against the spread of influenza,” said Dr. Jack Chao, a Los Angeles-based physician with the California Medical Association.

In the Southern hemisphere, which experiences an earlier flu season than the Northern hemisphere, influenza was uniquely mild this year, which could mean the United States will be spared from high spread.

“I am optimistic about influenza,” said Swartzberg, of UC Berkeley. “I think more people are going to get immunized against it than they usually do. And the same things that prevent COVID prevent influenza.”

But there’s still a risk of both diseases spiking at the same time, which officials have referred to as a “twindemic”.

Find information about free flu clinics in Sacramento County here.

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