DUBAI: Is the “second pandemic wave” happening now? Or is it just a term people use?
The first wave of coronavirus pandemic continues to accelerate, and some experts have pointed to warning signs of a possible, or impending, repeat of the contagion.
Take this: The last one million cases have come in a mere eight days, a stark contrast to the three-month runup for the first million.
Resurgence of cases
Many countries have managed to put a lid on COVID-19 even as the worldwide infections surged past 9.2 million. But some of those countries, which were thought to have been free of the virus, are reporting a resurgence in cases.
China is one of them. So is South Korea. In the Middle East, new bunches of cases were found in Iran, Israel and Turkey. The resurgence is not limited to Asia. Germany, Portugal and some areas of Spain have also seen the re-emergence of COVID-19 cases, and have reimposed the restrictions. Yet, the spike in Europe is not alarming.
The United States is yet to recover from the first wave of cases. But officials have to keep a close watch since all states have lifted the lockdown. The Victoria state in Australia too is grappling with a spate of infections.
Fresh ‘outbreak’ in China
After the Wuhan outbreak, Chinese officials imposed stringent measures to prevent the spread of the virus, SARS-CoV-2. It helped, and normal life returned to China. After a lull for two months when there were no locally transmitted cases, a new outbreak was reported on June 12. The dreaded second wave.
Scores of new cases were found in the capital Beijing with the outbreak centring around the Xinfadi Wholesale Market, a market that attracts 15,000 shoppers a day. Beijing has raised its emergency level, suspended schools and cancelled hundreds of domestic flights, besides a ban on outbound travel.
At least 10 more Beijing neighbourhoods were locked down over a new virus cluster as of June 15.
South Korea, Japan and Australia
South Korea had flattened the curve with some aggressive tracing, tracing and lockdown measures during the first wave of infections from February to April. The country is now experiencing a second wave in and around Seoul. Officials say that a holiday weekend in May may have been the trigger for the new wave of infections in the densely populated capital.
New cases in Japan are in the region of 40 a day. So a second outbreak is still far away.
Dozens of cases were reported from Australia last week, and 21 were identified in a single day in Victoria prompting Premier Daniel Andrews to warn that the coronavirus pandemic is far from over.
Iran, Turkey and other Middle East woes
Across the Middle East, restrictions have been eased, and commercial activities have resumed. Although the malls are not buzzing, the public response is encouraging. Flights too have been restored to some sectors. So normalcy is returning.
But some countries have reported an uptick in new infections. Among the Gulf countries, Saudi Arabia has seen a spate of new cases. It still doesn’t constitute a second wave. It’s more an extension of the first. So is the case with Egypt.
In recent days, Iranian officials have been increasingly critical of the public, accusing them of ignoring the curbs as a new wave of infections surfaced.
By mid-April, Iran seemed to have reined in the spread of the virus after reporting around 200,000 cases. The second wave hit after a month after the restrictions were lifted in May. Newer infections are averaging 3,000 a day.
In neighbouring Turkey, which is second to Iran in coronavirus cases in the region, there are signs of a second tide. These come at a time when the country is reopening for international tourism, a major moneyspinner.
Official figures from Israel indicate that new cases have been rising steadily for the past three weeks.
Germany and Portugal are worries in Europe
The World Health Organisation had warned European countries of a second wave in September or October. But after most countries eased out of lockdowns, many cases have been reported from some areas. The numbers are not alarming, and there are more like clusters.
This time, the countries are more prepared, having trained personnel to handle COVID-19 cases. Surgeons, cardiologists, internal medicine physicians and nurses from other departments have been retrained, and they are ready to work the intensive care units when needed.
Germany, France, Portugal and Spain have reported the emergence of new cases of COVID-19 in some clusters. Restrictions have clamped in some areas of Germany, Spain and Portugal. But these numbers are not increasing at a worrying rate to be classified as a second wave.
Recently, German authorities have re-introduced lockdowns in two districts — Gütersloh, home to 360,000 people in the state of North Rhine-Westphalia (NRW), as well as of Warendorf, with 278,000 residents. Tests have been ramped up in the community, after 1,500 workers at a meat processing plant all tested positive.
Germany has 193,000 reported cases and 8,986 deaths from COVID-19, with 176,000 recoveries.
US still in the first wave
Health experts had warned of the second outbreak in the United States in winter, but many are wondering if it is already there. After nearly two months of staying at home, Americans got back to work as almost all states have lifted the lockdowns. Now, 30 states have reported a spike in new cases.
Some say that “second wave” is probably the wrong term to describe what’s happening. “When you have 20,000-plus infections per day, how can you talk about a second wave?” said Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases in the US. “We’re in the first wave. Let’s get out of the first wave before you have a second wave.”
Daily counts of new cases in the US are the highest they’ve been in more than a month, driven by alarming recent increases in the South and West.
1,500
Number of German workers at a meat processing plant who tested positiveTests are now targetting patients and nurses in hospitals and nursing homes and supermarkets staff. They would also try to determine how many workers from other companies came into contact with the people working for the meat producer Tönnies.
“This virus likes cold, damp conditions. Most of these factories that are under 5 degrees Celsius, as well as people working in very close conditions and not distancing, probably not wearing masks, and having to shove each other, which means droplets could be spreading.”
What’s the second wave?
Epidemiology experts liken waves of an infectious disease to ocean waves. The concept of a wave comes from the curve on a graph that shows the number of cases during an outbreak. The curve is flat when are no new cases, which is why the expression “flattening the curve”. The curve looks like a wave if more people become sick.
A second wave in the graph indicates a renewed increase in infections after the initial surge has been eliminated in a particular region. There is no official definition of a second wave. It’s not a scientific term with clearly defined parameters.
Prof Brendan Murphy, Australia’s chief medical officer, says there is “no definite definition” of the second wave. “If this [second] outbreak escalated and we had several hundred cases, that would be the sort of situation where I would be extremely concerned,” he said.
Some health experts say the idea of a second wave is flawed. They believe it stems from a poor comparison with the influenza virus. Since SARS-CoV-2 shares some similarities with the flu virus, scientists initially expected the new coronavirus to behave in the same manner: like going away for a while and returning with renewed virulence. This notion fails to factor in current preventative actions.
Other scientists disagree. BBC quoted Jennifer Rohn, a cell biologist at University College, London, saying that a second wave of coronavirus infections is no longer a matter of “if” — but of “when, and how devastating”.
What are the possible triggers for a second wave?
Lack of social distancing is one. The experience of other countries shows that lifting lockdown restrictions much before the virus threat recedes could leadLifting lockdown restrictions too early, much before the virus threat recedes, is reported as the main reason for the second wave of infections. The situation worsens when people ignore safety guidelines. Poor hygiene practices, refusal to wear masks in enclosed spaces and the absence of social distancing make a bad situation worse.
The movement of people to newer areas can set off a wave of infections. This is especially true in cases where people with viral load moves into places where the population haven’t been exposed to the virus and don’t have immunity.
Mutation of the virus can result in a fresh spate of cases. A more infectious strain is always a worry since pathogens continuously mutate while replicating, leading to a more severe outbreak. A similar episode was reported during the Spanish flu pandemic. to the second wave of infections. The threat is exacerbated by poor hygiene practices and people who refuse to wear masks in enclosed spaces.
There are other factors, including vaccine development, efficacy and availability of repurposed drugs, age, as well genetics.
Is this a second wave we’re seeing?
Most experts who study epidemics has this much to say: No, this isn't a second wave. Or at least not yet.
"When you're 10 feet up on the shore and the wave hits you, it recedes all the way back," said epidemiologist Dr. David Weber of the University of North Carolina Medical Center in Chapel Hill. "Now you're on dry land with no puddle beneath. We still got a big puddle there."
Other experts agree, saying we're still in the first, and that “second wave” is the wrong term for what’s happening. “When you have 20,000-plus infections per day, how can you talk about a second wave?” said Dr. Anthony Fauci of the National Institutes of Health. “We’re in the first wave. Let’s get out of the first wave before you have a second wave.”
When you have 20,000-plus infections per day, how can you talk about a second wave? We’re in the first wave. Let’s get out of the first wave before you have a second wave.
How does genetic mutation affect SARS-CoV-2's virulence and possible second wave?
A study by US researchers shows that a specific mutation in the new coronavirus can significantly boost its virulence — the ability to infect cells.
On June 12, 2020, a team that published their work on Scripps Research said this may help explain why early outbreaks in some parts of the world did not end up overwhelming health systems — but other outbreaks, such as the one in New York and Italy, did.
The mutation, named D614G, increased the number of “spikes” on the coronavirus — which is the part that gives it its distinctive shape. Those spikes are what allow the virus to bind to and infect human cells.
“The number — or density — of functional spikes on the virus is 4 or 5 times greater due to this mutation,” said Hyeryun Choe, one of the senior authors of the study.
Experts rightly point out that these tests tend to have a low rate of sensitivity — they catch only about 80% of infections, and even may yield up to 30% “false negatives”.
How can we stop a second wave, or curb its effect?
There are solutions available now to stop it, and more will come later. The science is building up, while economies of scale in manufacturing could help mass produce vaccines and COVID-19 rapid test kits.
1. Vaccine
There are at least 10 leading coronavirus vaccine candidates in advanced stages of human trials (Phases 2 and 3), out of the 160 currently in the works. One of these could hurdle the Phase III trials soon.
On Tuesday (June 23, 2020), Abu Dhabi has announced the start of the world’s Phase III trials of a COVID-19 vaccine. The trial will check the safety and effectiveness of jab vaccine in a much larger sample, usually several thousand people.
The Sinopharm CNBG inactivated vaccine yielded already passed Pahsese I & II, with no serious adverse reactions seen and with 100% of the volunteers generating antibodies after two doses in 28 days. Sinopharm is based China, the country with the most number of vaccine candidates. If it hurdles Phase III, the test is deemed successful. Then the vaccine will go into large-scale production phase.
2. Social distancing, good hygiene
There’s no denying now that SARS-CoV-2 is a highly transmissible virus. Social distancing is the best thing we can do, and one we should not forget. While quarantine measures had been lifted in most places, that doesn’t mean we must all let our guard down.
Pre-COVID, improper hand hygiene was commonplace. A UK study suggested most people flouted basic hand washing practices: only 32% of men and 64% of women washed their hands after using a public toilet. Social distancing and good hygiene need commitment from young and old alike.
3. Regular antigen/saliva testing
Antigen tests could now flag new infections quickly in homes, offices or medical centers. In May, the US FDA approved two new types of diagnostic COVID-19 tests, the first antigen test and the first at-home test that uses saliva samples.
In the next few months, testing will become absolutely essential to keep the number of infections as low as possible, said Prof. Sridha. She recommends regular (weekly) tests for those working in care homes, hospitals and, possibly, teachers.
In April, the FDA also gave emergency use authorisation for the first diagnostic test with a home-collection option, which uses a sample collected from the patient’s nose with a nasal swab and saline.
4. Laser testing
A research team in Abu Dhabi recently announced a new test using lasers (photonics) to detect specific SARS-CoV-2 viruses in a given sample. It works literally in a flash. The rapid new test kit which promises to detect the virus with "high specificity" from a low-concentration sample, was developed by the Abu Dhabi-based QuantLase Imaging Lab, the medical-research arm of International Holdings Co. (IHC).
5. Wearables
Early detection capability is the key in the fight against COVID-19, in which peak shedding — the moment it's most infectious — occurs during the early stages, when those who are already infected are yet "asymtomatic", or "pre-symptomatic".
Scientists at Stanford, UC San Francisco and Scripps Research Institute have developed a wearable device to detect COVID-19, and said such devices could pick up infections days before people show symptoms or in people who report no symptoms.
6. Therapy and repurposed drugs
In the last six months of diligent study, the scientific community has accumulated an immense deposit of knowledge about the SARS-CoV-2 virus and ways to deal with it.
Health authorities and decision makers are making full use of the arsenal of drugs and therapies that are already proven to work: Convalescent plasma therapy, stem cell therapy (pioneered by Abu Dhabi), remdesivir and dexamethasone.
Takeaways
- We're all responsible in thwarting the emergence and effects of a "second wave".
- One thing we know for sure: humans are infinitely smarter than this virus.
- There are early signs we’re pushing it back already.
- Humanity, fully alive and using good sense, has always won against pathogens.
- We just carry on fighting the good fight, individually and as a community. This is not easy.
- Our worst enemy is ourselves. Only when we realise this can we heal as one.
