The novel coronavirus, now spreading through the smaller towns of Brazil’s interior, risks returning to major cities in a so-called “boomerang effect”, as a lack of specialised medical treatment forces patients into larger urban centers.

The impact of a potential second wave of new cases in urban centers could complicate attempts to reopen businesses and get the economy going again, experts said.

“The boomerang of cases that will return to the (state) capitals will be a tsunami,” said Miguel Nicolelis, a leading medical neuroscientist at Duke University who is coordinating a coronavirus task force advising the state governments of Brazil’s northeast.

Brazil, home to the world’s second worst coronavirus outbreak behind the United States, has over 1.2 million cases of the virus, which has killed nearly 55,000 people. On most days, it is spreading faster in Brazil than in the United States, the top country by cases.

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