Bill Gates warned of a big spike in COVID-19 cases across the U.S. this fall if behavior does not change and called the country’s handling of the outbreak “embarrassing” compared to other countries.

The Microsoft co-founder and global health expert was back on the news this week as COVID-19 cases rise again in several states. Florida reported more than 8,900 daily cases Friday while Texas closed bars after a reopen attempt.

Gates warned the world of a COVID-19-like pandemic back in 2015. This year he has been outspoken about the need to take more aggressive action in the fight against the novel coronavirus.

“As you get into October and November, this thing will be back in big numbers if we don’t restrain our behavior more than it looks like we are right at the moment,” Gates said on CNN.

The U.S. has reported more than 2.4 million cases of COVID-19, with a sharp rise over the past month in California, Florida, Nevada, Oklahoma, and other states. The country has nearly 125,000 COVID-19 deaths, according to The New York Times.

Gates said the U.S. is “not as tough” on contact tracing, enforcing quarantine, or wearing masks compared to countries in Asia and Europe.

“Our behavior and our contact tracing is not working well,” he said. “We continue to have a very large case spread. It is embarrassing versus Europe or other countries.”

Asked about claims of the U.S. having the most cases because the country is doing the most testing, and allegations that testing is giving a false sense of the spread of the virus, Gates called that “completely false.”

“It’s fair to say that you can find more cases when you do more testing,” he said. “But the U.S. is experiencing a rebound even once you factor out the increased testing.”

Gates did express optimism for the death rate going down as new treatments such as dexamethasone emerge.

“As we’re learning how to treat people better, we’re less overloaded,” he said. “But the global picture and the U.S. picture are both more bleak than I would have expected.”

White House health adviser Dr. Anthony Fauci said Friday that despite death counts decreasing, the country will “be seeing more deaths” given rising cases, CNBC reported.

Gates said he’s also worried about the spread of COVID-19 in countries such as Brazil and India.

“We do need to think about the world here,” he said. “Without U.S. leadership it’s been hard to pull together a response. And now the developing countries are bearing the brunt of the burden.”

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