The spread of COVID-19 in the U.S. is accelerating, and mortality is increasing exponentially, putting the U.S. on a potentially worse trajectory than Italy’s, according to an analysis by Morgan Stanley.

Biotechnology analyst Matthew Harrison said he expects President Donald Trump will have to extend the social-distancing timeline again, pushing it into May. Harrison’s new forecast for the U.S. calls for a peak of approximately 570,000 cases in about 20 days. That’s roughly triple the prior forecast of about 200,000 cases at the peak.

See:COVID-19 case tally: 800,049 cases, 38,714 deaths

Also:Trump extends national social-distancing guidelines through April 30

The biotech expert’s worry is that, while the first wave of infection growth could start slowing in late April, the U.S. will be hit with a “second wave” of growth, emanating from the central regions.

“Importantly, this new forecast continues to assume more social distancing and a continued rapid increase in testing,” Harrison wrote in a note to clients. “We would highlight that the biggest risk to this forecast is that while we have reasonable confidence the East and West coasts will reach peak cases in the next 2-3 weeks, the interior of the country is now exhibiting signs of new outbreaks.”

He said there is also risk that the second wave delays the U.S. peak, or causes “recontamination” of the coastal cities.

“Current U.S. trends are concerning, suggesting a course potentially worse than Italy,” Harrison wrote in a note to clients. “We highlight five dynamics to watch [which we] believe suggest the U.S. is facing a broad and accelerating outbreak.”

1. U.S. cases are growing the fastest

“The U.S. [now has] the largest number of cases among all countries, while the growth rate of U.S. cases is now the highest among all countries we follow ... and is accelerating faster than Italy when adjusted for the start of the respective outbreaks.”

Read:Dispatches from a Pandemic: ‘We’re now experiencing the aftershock’: As Italy’s death toll exceeds 10,000, Italians anxiously wait for coronavirus surge to peak.

2. U.S. mortality is not slowing despite social distancing

“Mortality is increasing at an exponential rate in the U.S. at a slightly lower slope than Italy prior to its lockdown. While mortality will lag new cases, other countries have been able to slow from exponential growth after lockdowns.”

3. New cases are growing faster than testing capacity

“Rates of testing positivity continue to trend higher across the U.S. as testing rates lag other countries and cases are growing faster than tests, suggesting the U.S. continues to lack enough testing capacity.”

Don’t miss:Trump on coronavirus tests and treatments, the economy and the Canada border: his claims vs. the facts

4. New ‘hot spots’ are exhibiting growth above other regions

“Case rates for emerging U.S. ‘hot spots’ are growing at rates faster than all countries or U.S. states. This suggests new U.S. cases could continue to accelerate.”

The new hot spots include Louisiana, Michigan and Illinois, alongside New York and Florida.

5. U.S. social-distancing measures remain less strict than those of other countries

“The U.S. has more limited quarantine measures compared to Italy or China.”

Italy is exhibiting stabilization, and is now likely to reach a peak about 15 days after China. That represents a time-to-peak ratio that is two times that of China and three times that of South Korea.

“With the U.S. potentially trending worse than Italy, we would expect more social distancing to reduce the risk of tracking significantly worse than Italy.”

Data suggest faster spreading in the U.S., with the “reproduction number” of the U.S. at 2.44, higher than Italy at 1.48, while the doubling time of cases in the U.S. of about 3.7 days is lower than Italy’s at 10 days, “pointing to a significantly faster elevation of case numbers in the U.S. than Italy.”