COVID-19, Is There Going to be a Second Wave?

An editorial by Richard Horton in The Lancet 27 June discusses the spectre of a second wave of COVID-19. 

Some infectious disease specialists believe that SARS-CoV-2 might be losing virulence.  However, some are less sanguine and Dr Tedros Ghebreyesus, the WHO’s Director General reported last week that the pandemic was accelerating, especially across the Americas, South Asia and The Middle East.

He declared that “the world is in a new and dangerous phase” – “the virus is still spreading, it is still deadly, most people are still susceptible”.

If one reviews the 1918 influenza pandemic it is noted that the first wave of outbreak took place between March and July.  This stage proved relatively mild.  The second wave arrived in August – it was much worse and most of the 50-100 million deaths took place during the 13 weeks between September and December 1918.

In the United Kingdom, new infections are still taking place across the whole country.  Professor Tim Spector, Professor of Genetic Epidemiology at King’s College argues – what is needed is a campaign to educate the public to suspect infection not when they have later stage symptoms of fever and cough but when they have earlier symptoms of muscle pains, fatigue, headache, diarrhoea and rashes.  He suggests self-isolation at this earlier stage would reduce the risk of others becoming infected.

If all infections could be identified within 48 hours, there is every possibility that a second wave would be avoided. If we were to get to fewer than 1,000 new infections per day (the current number is estimated to be 3,612 per day), the test, trace and isolate system would have the capacity to detect and follow up every new case.

Prolonged lockdowns are certainly not the answer to future waves of COVID-19.  School closures are not sustainable. The economy cannot be shut down again.  The risks to mental health are evident.

The Institute for Health Metrics and Evaluation, IHME, in Seattle suggests that SARS-CoV-2 displays strong seasonality.  They predict that a second wave will arrive in September, peaking by the end of 2020.  They contend that the public will have less tolerance for future government mandates to shut down society.

It is suggested that if there are local outbreaks, brief lockdowns for say two weeks followed by relaxations for between two and six weeks might be enough to cut off virus transmission.  However, there is now a lack of trust with the public and politicians in these models which attempt to forecast the course of the pandemic.

Gabriel Leung’s team at the University of Hong Kong describes one solution to managing a second wave – real-time tracking of transmissibility by closely monitoring the instantaneous effective reproduction number, RT.  Measurement of the RT should be supplemented by early diagnosis, contact tracing, isolation and continual efforts to keep public awareness high. 

Here in the United Kingdom, the test, trace and isolate system is still not functioning fully.  There has also been much debate about whether physical distancing should be 1 metre or 2 metres.  However, no single preventive measure is adequate to control this virus transmission.

What is essential is a combination of prevention; in the case of coronavirus, a mix of measures which include hand washing, respiratory hygiene, mask wearing, physical distancing and avoiding mass gatherings.

A further lesson which was learnt from the HIV epidemic is the importance of protecting key populations. SARS-CoV-2 exploits and accentuates inequalities and on this aspect the dangers of a second wave to those both socially and physically vulnerable needs to be prevented with proper education and preventative techniques.

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