Updated: Jul 7, 2020
Many countries are fearing the possibility of experiencing a second wave. Singapore kept infections flying over 100 until the second week in March reaching a total of 1,000 in April and 10,000 three weeks later after the very few cases in January. A sign that the fresh wave barrelled in a new infection resurgence?
The Hubei province (China) has seen rising numbers of infected people at its northern border with Russia, the majority of which are imported patients or infected foreigners. The Hokkaido province (Japan) had to recently declare another lockdown because of a fresh influx of cases from Tokyo. Hong Kong faced a similar fate when in March an influx of overseas residents returned home but sent Coronavirus patients soaring.
But what does it all mean? In the first stage of the pandemic, also called “the first wave”, many countries were able to identify and even isolate those first infected cases because people arrived from abroad, bringing the virus with them.
However, the lack of tests and the discovery of asymptomatic patients increased the number of infected people. This new phase has been called a “secondary spread” of the virus. Dr Jeremy Lim, a global health expert at the National University of Singapore, in a recent interview, affirmed that when enough people have been infected with Covid-19, the virus is then passed through other individuals by asymptomatic transmitters. He stated: “This phenomenon constitutes a second wave, which means it has passed from imported cases to individuals of a local community who pass it on to others.”
From Dr Lim explanations, this Covid-19 reappearance scenario occurs after a country deals with its first Coronavirus cases and assumes it has the infection under control.
Yet, many professionals agree it is complex to avoid a second virus wave. Professor Kenji Shibuya, World Health Organisation health policy chief of King's College (London), publicly confirmed: “There is always the potential risk of a virus resurgence, therefore each country that was successful able to contain the first wave has to keep watching out for the next possible resurgence.”
The possibility of a new virus’ contagion means that the threat does not automatically end after a first or second wave. Does this then mean it is likely to be part of our lives for the next months or years?
Professor Dale Fisher, chair of the Global Outbreak Alert and Response Network committee of the WHO, claims: “I don't look at the statistics in terms of waves, I look at them in terms of current transmission”. “It's more like a relationship, rather than a wave.”
According to the WHO, the resurgence of a second wave can result from different factors, such as a weak governmental response at the start of the pandemic outbreak -leading to a mass of untraceable asymptomatic spreaders-, but also from a fiasco when informing the population about the full range of infection, or even from big numbers of people not respecting the social restrictions.
It is clear that the public, to comply with the severe restriction measures, need to be informed from reliable governmental institutions and understand few and clear messages, as in this period it is easy to get fake news and mixed communications.
From the WHO messages, the reinforcement of international cooperation is key to fight the pandemic while developments and scientific discoveries continue in the search for a vaccine.
While the threat of a new wave of coronavirus lingers, Prof Shibuya announces: “It's problematic to avoid new imported cases and the resurgence possibility from that. The only chance we have is preparing for the next wave”. “If we don’t work together and invest in a joint effort to tackle the virus, I believe we are losing the battle.”
Experts also warn that nations should watch out for every blind spot in their communities, for it's there where the virus could make its base. Even if authorities rightly focus on the cities at large, the virus also blooms in the margins, in most forgotten places on the outskirts of the cities that might seem invisible. It could be the most vulnerable places like dormitories, prisons, asylum seekers camps, nursing homes.
The WHO chief Tedros Adhanom Ghebreyesus does not stop warning the globe, saying that when countries will begin relaxing lockdown restrictions they are potentially at their most vulnerable, and lifting limitations too early can stimulate an infection resurgence unless effective and carefully planned measures are put in place to keep infections under strict control.
Once again, the basics dictate the path to follow: test and isolation, while infection rates will have to be constantly monitored and if the number of new infected people starts rising again some restrictions may have to be reintroduced.
Prof Fisher utters: “If the public thinks I've done my two months of lockdown - the price paid. This isn't over until it's over and too many experts are thinking second half of next year would be a good outcome while some degree of social restriction will be inevitable.”
It is therefore probable to start learning how to live with this virus, as “it would be very, very difficult to eliminate Coronavirus” Prof Lim says.
It seems that only possible permanent protection against new waves of Covid-19 is an effective vaccine, which, unfortunately, “May take up to 18 months” Lim confirms.
Wuhan is an excellent model to look at, as it began reopening in April after being sealed off in January, and only when daily cases flattened to zero, the city cautiously began restoring social and economic life but measures to prevent a second wave have never gone away. Schools remained closed, people's temperatures constantly monitored when they entered buildings and homes, masks were commonplace, and the number of time people spent outside restrained.
Whatever package of freedoms governments decide on, the lifting of restrictions will have to be incremental and authorities will have to be ready to immediately respond to any new outbreak. And once again, it will depend on the public behaviour.