What a resurgence of Covid-19 around the world tells us about the risk of a second wave

Several countries around the world are already seeing a resurgence of cases, some more severe than the first.

But are they second waves, spikes or simply a continuation of the first wave? And what do they tell us about the likelihood of a second wave hitting the UK this winter?

By Anne Gulland and Paul Nuki, Global Health Security Editor, London www.telegraph.co.uk 

When the Spanish flu pandemic hit the world after the First World War it came in three waves, with the second being the most deadly.

And this is not an oddity. Of the last 10 big respiratory disease outbreaks, five have had significant subsequent waves, and four came after a summer trough.

“Influenza pandemics tend to come in three waves; a spring wave, followed by a severe winter wave and another spring wave,” says Prof Francois Balloux, an epidemiologist and director of the UCL Genetics Institute in London.

Sars-Cov-2 is not an influenza virus but a coronavirus. Nevertheless, it is droplet spread and Prof Balloux is not optimistic for the coming winter.

“To me, the most likely scenario for the Covid-19 epidemic is that there will be a winter wave in the northern hemisphere, which I expect could be worse than the spring/summer waves we’ve [already] experienced”.

Several countries around the world are already seeing a resurgence of cases, some more severe than the first.

But are they second waves, spikes or simply a continuation of the first wave? And what do they tell us about the likelihood of a second wave hitting the UK this winter?

United States – a failure of political leadership

The curve of the US outbreak has been described as a ski slope, with the number of new cases first climbing before plateauing and then steeply rising again.

On Wednesday the number of cases passed the three million mark, confirming the assessment by the leader of the country’s coronavirus taskforce, Dr Anthony Fauci, that the US remains “knee deep in the first wave”.

It is hard to see the US epidemic as caused by anything other than poor leadership. The US is one of the world’s richest nations with a highly developed public health infrastructure but it was slow to react initially and then too quick to open up.

Confused messaging from the White House has left some of the 328 million population terrified and others wondering if the virus really exists at all. Violence and protest caused by the killing of George Floyd will not have helped.

As the chart shows, the latest surge in cases is being led by fast-growing outbreaks across the sun-belt states, stretching from Florida to California.

The outbreaks are thought to have been led by younger cohorts, via parties, bars and restaurants. Poor and black and minority ethnic populations have been hardest hit and are grossly over-represented in hospital admissions, which have been rising sharply for over a week.

Experts say the delay between new cases and deaths will be greater than at the start of the pandemic because mass testing now means younger age groups are being detected earlier.

Nevertheless, Covid deaths – while still falling for the country as a whole – are now rising again in Florida, Arizona, Tennessee, Texas, South Carolina and Nevada.

Having failed to control the first wave of the virus, the US is likely to be in a poor position going into winter.

“Respiratory pathogens tend to be highly seasonal with a peak in winter,” says Prof Balloux, echoing the warnings of the chief medical officer for England, Prof Chris Whitty.

“Transmission is facilitated by low temperature/humidity, and maybe less UV light. Crowding indoors likely plays a role. Worse general health of the population might also play a role,” he says.

Australia – the first true winter wave?

The city of Melbourne has now gone into a fresh six-week lockdown after a spike of coronavirus cases, with a further 191 infections reported on Tuesday.

Australia had been hailed as a global success story in suppressing the spread of Covid-19 and even at the height of the initial outbreak it only reported a little over 600 cases a day.

The virus did not take hold at first because of quick shutdown measures, including border closures and the mandatory quarantining of travellers. By the end of May the country was reporting just a handful of new infections every day.

However, since the end of June the number of cases has started to rise in Melbourne, in the southern state of Victoria where it is now winter. As the chart shows, the area is now suffering a peak that is worse than its first.

Professor Raina MacIntyre, an expert in influenza and emerging infectious diseases at the University of South New Wales, said the situation was more serious than in late March.

“It is possible there has been seeding of infection to other states, and silent epidemic growth which has not yet been detected. I would not be surprised to see epidemics detected in New South Wales and other states within the next few weeks,” she said.

Prof Balloux said rising case numbers in Victoria provided “putative evidence” for a seasonal influence on the virus. The “apparent ‘winter wave’” would be in line with the “dynamic for seasonal influenza and other respiratory pathogens in the southern hemisphere”, he added.

Israel – the danger of opening up too early

On Sunday Israel’s head of public health, Dr Siegal Sadetzki, said the country was experiencing a second wave of Covid-19 after more than 977 cases were registered.

On Tuesday she resigned and was scathing of the government’s response, saying it had opened up too early, against her advice.

“The achievements in dealing with the first wave [of infections] were cancelled out by the broad and swift opening of the economy,” said Dr Sadetzki shortly after announcing her resignation.

Israel responded rapidly and successfully to control the virus in March, quickly flattening the initial peak with a country-wide lockdown. But its lifting of restrictions in May was equally rapid, some would say crude. At the beginning of June, the Israeli government put the “emergency brake” on the re-opening measures after schools appeared to spark a rise in cases. But it was too late and now the country has been forced back to square one.

Prime minister Benjamin Netanyahu is known as a man of action but not patience – and perhaps that is part of the problem.

“The pandemic is spreading; it is as clear as the sun,” Mr Netanyahu said on Monday. The country, he added, was “at the height of a new corona offensive”.

Iran – poor adherence to social distancing

Iran was one of the first countries outside Asia to be hit hard by the coronavirus and in total has had more than 240,000 cases and 11,000 deaths – although many believe this is an underestimate.

The virus peaked at the end of March when there were just over 3,000 cases a day but then began to fall to under 1,000 by the end of April.

In late April the country began a phased easing of lockdown and by the end of May the country was back to normal, with Iranians packing into shops, restaurants and onto public transport.

This reopening coincided with an increase in the number of cases, which peaked in early June, fell but then started to rise again.

On Tuesday a health ministry spokeswoman, Sima Sadat Lari, blamed the resurgence on people not sticking to social distancing and gathering in large numbers at weddings and other ceremonies.

On Sunday the country belatedly introduced mandatory mask-wearing but there are fears it may be too little too late.

Saudi Arabia – migrant workers, poor living conditions

The oil-rich Middle Eastern country is experiencing a second peak, with the number of cases climbing steadily up until mid May when they appeared to top-out at just over 2,800 a day.

They then fell before starting to rise again and peaking at 4,700 in mid June, although they have hovered around the 3,000 to 4,000 mark since then.

It’s unclear what is behind the country’s unusual epidemic curve. The authorities instituted a strict lockdown but the virus spread throughout the dormitories housing the country’s many migrant workers, who, according to Amnesty International live in crowded and unsanitary conditions.

The authorities insist it will continue with this month’s Haj – the annual pilgrimage to Mecca undertaken by millions every year – although in a much reduced version.

Japan – cluster busting

Japan – a country of around 125 million people – appeared to have escaped the worst of the pandemic and as of July 6 it had registered just under 20,000 cases and 977 deaths.

However, a spike in infections in Tokyo over the weekend – not enough to be described as a second wave – has sparked concern. Authorities reported more than 100 new cases on three consecutive days.

The spike is linked to the city’s entertainment districts, whose bars and clubs have been packed. Some 70 per cent of the new diagnoses are among people in their 20s and 30s.

The national government insists that it is not planning to reintroduce a state of emergency for the capital, with the previous restrictions on bars, restaurants, sporting venues and other places where large groups of people gather lifted after a month on May 25.

For the moment, it looks like Japan is simply fighting new clusters – in much the same way as we are in the UK. And it will be interesting to see if the packed bars and pubs seen in the UK last weekend will lead to a similar spike in cases.

How successful Japan’s cluster busting is will almost certainly determine our success in battling a second wave should it come.

Romania – health or the economy?

Like much of Europe Romania was hit hard by the pandemic in March and April when a strict lockdown was imposed on the country.

Cases fell and in May the government introduced a softer state of alert which is set to run until the middle of this month.

However, at the beginning of June the number of daily infections began to rise again and on Wednesday it recorded the highest number of new cases during the pandemic – 555.

President Klaus Iohannis said if the numbers continue to rise he may be forced to put the country back under lockdown but is wary of hurting the economy – a dilemma that many countries, including the UK, may face in the coming months.

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