COVID-19 Second Wave - Op-ed

Are we in the first wave of coronavirus infections or the second? And what happens when the flu season arrives?

In Egypt and many parts of the world, cases of COVID-19 are declining, while other areas are seeing spikes. But the pandemic is still are we in the first wave of coronavirus infections or the second? And what evolving, Dr. Magdy Badran says.

Doctors, public health experts, and researchers are trying to answer tough questions: When will this first wave be over, and will there be a second wave of COVID-19 in the fall?

Spikes of COVID-19 Infections  

The first wave will end when the rate of positive coronavirus tests drops to the low single digits. Basically, you can't have a second wave until cases and deaths from the first wave drop close to zero for a sustained period. If cases spike again after that point, that's a second wave.

You can think of it like waves on the sea. The number of infections goes up and then comes back down again - each cycle is one "wave" of coronavirus. Yet there is no formal definition. To say one wave has ended, the virus would have been brought under control, and cases have fallen substantially.

For a second wave to start you would need a sustained rise in infections. As communities begin to reopen, people are eager to be able to go out and resume some of their regular activities. But we don’t yet have an effective treatment or vaccine, so the reopenings are intended to take place safely while maintaining social distancing, and masking and hand-washing.

Some people relax these infection prevention efforts as soon as places begin to reopen, and this can cause the number of coronavirus infections to rise.

As countries reopen businesses, they might not see any effects, such as an increase in the number of COVID-19 cases or hospitalizations, a week or even two weeks later. It seems to take much longer, perhaps as many as eight weeks, for effects to appear in the population-level data.

When a person is exposed to the coronavirus, it can take up to two weeks before they become sick enough to go to the doctor, get tested, and have their case counted in the data. It takes even more time for additional people to become ill after being exposed to that person, and so on.

When an area relaxes social distancing guidelines and “reopens,” the effects of that change might take a month or more to be seen. Of course, surges after reopening also depend on the behaviors of people when they start moving around more.

Lockdowns have caused massive disruption around the world - destroying jobs, affecting people's health, and taking children out of school - but they have controlled the virus. The ultimate challenge is how to maintain control while minimizing daily disruption.

That is why measures are being lifted in stages and new ways of controlling coronavirus are being introduced, such as contact tracing or face coverings. This is already starting in Germany, where hundreds of people have tested positive for the virus after an outbreak at an abattoir.

South Korea, which has been widely praised for its handling of the coronavirus, has had to reimpose some restrictions because of such clusters.

Herd Immunity From Coronavirus?

A lack of immunity could lead to the second wave of COVID-19 infections in any country. Herd immunity is a public health term.

Herd immunity would happen when enough of a population has become immune to the disease to prevent it from spreading, but questions remain about how long that immunity would last.

About 70% of the population needs to be immune to this coronavirus before herd immunity can work. People might be immune from the coronavirus if they have already had it, but we don’t know this yet. A widely available, safe, and the effective vaccine may not be available for many months.

COVID Season

COVID-19 is caused by a coronavirus, a large family of respiratory viruses including some that cause common colds. Since these illnesses wax and wane with the seasons, some research has suggested COVID-19 would, too. But others found lesser or no impacts from weather changes.

Cold and influenza viruses spread more easily in the winter in part because the air is drier. Warmer summertime air naturally holds more moisture. Virus particles don't travel as far in the humidity.

At the beginning of the pandemic, some experts wondered if warmer weather would slow down the spread of the coronavirus. In one study, warm weather reduced coronavirus spread by 20%. Even if that trend is accurate, the pandemic might slow down but it would be unlikely to end.

Other diseases could complicate the picture. An increase in COVID-19 cases in the fall could be troublesome because seasonal flu is likely to be accelerating at the same time.

If the coronavirus surges in the fall and the flu season is bad, the combination could put hospitals and patients at risk. In the U.S. during the 2019–2020 flu season, the Centers for Disease Control and Prevention reported 39 million cases and 24,000 deaths.

Another concern is that since the COVID-19 pandemic began,  far fewer children globally have been getting their regular vaccinations. An outbreak of pertussis (whooping cough), measles, flu, or other preventable diseases in children could also complicate the picture, making it harder for doctors and hospitals to care for all patients.

Will a Second Wave Be The Same As The First?

How bad the second wave could remain unknown. A few possibilities: we might experience a series of waves similar in intensity to the first, a second wave that’s far more severe than the first (which is what happened during the 1918 influenza pandemic), or a “slow burn” of ups and downs in various “hot spots” depending on differing responses to the virus around the world.

A second wave could, theoretically, still end up bigger than the first because so many people are still susceptible. But if cases climb again, we can reintroduce lockdown to suppress a second wave.

One argument against a deadly second wave is that viruses become less dangerous as they evolve, to better infect people. Even HIV seems to be getting milder.

The theory goes that viruses will spread further if they don't kill their host and so become milder. It is also something that takes place over long periods.

Prevention of the Second Wave of Coronavirus

Continue to practice COVID-19 precautions, such as physical distancing, hand-washing, and mask-wearing.

Stay in touch with local health authorities, who can provide information if COVID-19 cases begin to increase. Make sure your household maintains two weeks’ worth of food, prescription medicines, and supplies.

Ensure that everyone in your household, especially children, is up to date on vaccines, including this year’s flu shot when it is available.

Since the second wave might hit this fall or winter, getting your yearly flu vaccine is a must. While a flu shot won’t protect you from catching the novel coronavirus, it can reduce your risk of being hospitalized for the flu—which could leave an ICU bed open for someone who needs it to recover from COVID-19.

Contact tracing (or identifying who has been infected with COVID-19, tracking who they’ve been in contact with, and enforcing quarantine to stop the spread of the virus) will also be important as we prepare for a second wave.

Find a new way to say “hello”. Coronavirus is changing social interaction. Handshakes, cheek-kisses, and hugs are not as welcome as they used to be.

We need to figure out a new way to greet other people without touching. Now’s the time to pick a new go-to greeting, whether that’s a friendly wave, an air high-five, elbow-bumps, foot shakes, or namaste. Namaste means “I bow to you”. It is a common Hindu/Indian greeting.