Coronavirus: Curbs gone, numbers rise; time to brace for a second wave?
--
It’s been two weeks since the Indian government announced lifting of restrictions in a phased manner across the country. After four phases of lockdowns, the government allowed most activities, which were banned earlier, to be opened up in areas outside COVID-19 containment zones from June 1. Effective till June 30, the government issued this new set of guidelines to free up the economy and allow movement of goods and services.
India’s COVID-19 rank: From no. 7 to no. 4 in 14 days
However, in the two weeks since ‘Unlock 1.0’ there has been a massive spike in COVID-19 cases, with the numbers crossing the 3-lakh mark. From 1,82,143 cases on May 31, 2020, the last day of Lockdown 4.0, the number stood at 3,32,424 on June 14, 2020, as per data from the Union Health Ministry.
And for the past one week, about 10,000 new cases are being reported in the country every day. Though the country is ramping up COVID-19 tests, it is also surpassing other countries in terms of number of cases. From being the seventh worst-hit country in the world on May 31, India, on June 14, was ranked at №4, after the United States, Brazil, and Russia.
So, though the government has started to open up the economy, it needs to be on its guard even more now, as the spike in cases may lead to a second wave of infections. Anyone who still hasn’t got the disease, is just as susceptible to catching it now as they were at the beginning of this year.
In the United States and Europe, experts have warned of the dangers of a second wave during the winter flu season. Dr Hans Kluge, the WHO’s regional director for Europe, told nations beginning to ease restrictions that they should brace themselves for a deadly second wave of coronavirus infections, adding that now, when the pandemic has slowed down marginally, it was time to strengthen public health systems.
Spanish flu: What can we learn
If we look at history for answers, in the middle ages, around the 1300s, the Black Death came in waves. It was the same with the Spanish Flu of 1918, the deadliest pandemic in modern history. The influenza had three waves of infection, with the second being the most fatally severe. The first wave happened in the spring of 1918, and wasn’t particularly deadly, with the symptoms lasting for around three days. Then came the second wave in fall (September-November), during which the death rate skyrocketed. Finally, after a third wave, which occurred in the spring of the following year, the pandemic ended. By then, 50 million people had died worldwide.
Although looking at the past may give us an idea of how the coronavirus pandemic may unfold, these comparisons should be taken with a grain of salt, since a lot has changed since then. When the 1918 influenza pandemic occurred, the World War I was coming to an end. Healthcare systems were not as nearly as good or developed as they are now. Also, no epidemics of infectious diseases behave in the same way. So, the circumstances around COVID-19 outbreak aren’t the same. Having said that, we still have a lot of challenges.
First, a vaccine is not available yet. In such a scenario, restrictions are being lifted and immunity is still not clear. New outbreaks are possible if physical distancing measures aren’t followed. So, there is the possibility that the virus could reignite in clusters, which could go on to become outbreaks.
Factors before a potential ‘second wave’ kicks in
Doctors and scientists across the world still don’t know much about coronavirus, including the full extent of the COVID-19 disease. So, before planning for a potential second wave, the government needs to take these factors into consideration:
· How long an immunity for COVID-19 might last amongst people who have already had it once?
· After recovering, is it possible to be re-infected?
· Is there any significant seasonal variation in the way the virus spreads?
· Will the virus mutate to become more or less lethal?
Newer cases in South Korea, China
While most countries are gradually opening up, few that had already opened up have rescinded the go-ahead call after a spike in new cases.
Let’s take the case of South Korea: The country, which reported its first case on January 20, took a rapid-testing and contact-tracing approach since the start of the pandemic. Though it was praised for its ability to contain the first outbreak, the country recently saw a cluster of new cases in Seoul, sparking fears of a second outbreak. Now, following the biggest spike in coronavirus infections in nearly two months, strict lockdown measures have been implemented in Seoul.
Similarly, in China, a couple of weeks ago, 20 new infections were reported, which forced authorities to impose restrictions in two cities. In Wuhan, where the pandemic first emerged, authorities ordered testing of all 11 million inhabitants after new infections emerged. On May 31, the country reported two new confirmed cases and four new asymptomatic cases.
These are painful reminders that newer cases are likely even after period of lull. What’s important is to remember that this is an asymptomatic pandemic. People can feel absolutely fine and yet be carriers of the virus at the same time. That’s why it’s even more important to do sensible testing.
Contact tracing holds the key
One way of significantly reducing chances of a second wave is by maintaining social distancing norms, mass testing and contact tracing — measures that will have to be a part of our lives for a long time to come. It’s not possible to test everyone since there are only so many testing kits and resources available. So, it’s best to find a middle ground — by testing the most-at-risk populations. By doing that, it can be established who was exposed. That’s where contact tracing assumes importance, as it provides answers to the following questions:
· Where did they get it from?
· Who is out there spreading it?
· What contacts the new case might have with other people, who might then get sick?
On the basis of this information, it could be quickly identified who was exposed. Those people can then be sent to self-isolation. By self-isolating, the spread can be stopped and the risk of a second wave can be reduced.
However, till now it’s not certain that a second wave will happen. More recently, second waves of viruses such as SARS or MERS were avoided. But we still can’t afford to make mistakes. One small mistake, and the virus could spread rapidly again. No country in the world has yet achieved herd immunity. A single contact can endanger an otherwise completely healthy community. And once the infection spreads, results can be disastrous. Only a vaccine can allow us to get back to normalcy.
A report on vaccines in The New York Times on June 12, 2020 states: 125-plus are in the pre-clinical stage (not yet in human trial phase), seven in the first phase (vaccines testing safety and dosage), another seven in the second phase (vaccines in expanded safety trials) and two in phase three trials (vaccines in large-scale efficacy tests). Some coronavirus vaccines are now in phase I/II trials, for example, in which they are tested for the first time on hundreds of people.”
However, experts have said that an effective vaccine could take at least 12 to 18 months from the start of development. So, for the time being, mass testing and contact tracing will be key in India.
