In the early days of the pandemic this blog sought to try and answer questions such as “Will there be a second wave?”, “What will happen in winter?” and “What is happening in other countries?”
In a two part piece I will look back on some of those early predictions and reassess them against what we now know. Part one will focus on Europe and the USA and part two on Africa and Asia.
As Europe struggles with its second wave of COVID-19 and the USA continues to see a dramatic rise in both its cases and deaths, it is clear that the pandemic in the Western world is far from over.
The Second Wave
On 10 June 2020 I wrote the piece “Will there be a second wave?” (click here to read) and on 4 August 2020 the piece “Is Europe starting a second wave?” (click here to read).
Back then I wrote that certain factors would influence the probability of a second wave. These included establishing if people mixing indoors was the most potent route of infection spread, the role so-called “superspreaders” were playing and whether or not we had any pre-existing immunity that could work in our favour. It was also considered of paramount importance that a robust track and trace system was in place before lockdown was lifted to keep future outbreaks under control. (1) (2)
What we know now
We now know that COVID-19 is most likely to spread in confined and indoor spaces. A study in Japan has found that the risk of infection indoors is almost 19 times higher than outdoors. (3)
It is clear that the vast majority of spikes of infections seen when lockdowns are eased can be traced back to gatherings of people in confined spaces who are not adhering to social distancing measures. (4)
The role of the superspreader in COVID-19 is now well established. Studies in Hong Kong estimate that 80% of cases of COVID-19 come from just 20% of the infected people. (5)
This phenomenon makes it hard to predict when an increase in cases might occur as an area with a high number of super-spreaders is more at risk of a sudden surge in cases than one with a low number.
The presence of superspreaders at social events can quickly lead to a large outbreak. Given the fact many are asymptomatic, and therefore unaware they are infectious, it is not easy to identify potential superspreaders. They can only be identified by tracing backwards through a disease outbreak and that can lead to stigmatisation of the person involved as happened in the UK when the press named a man identified as a super-spreader. (6) (7)
At the early stages of the pandemic it was hoped that previous exposure to other coronaviruses would offer people a degree of immunity against this new one. We now know that this is unlikely with epidemiologists at Harvard University in the USA predicting that COVID-19 will occur in sporadic outbursts until 2025 as immunity comes and goes in the population. (8)
A robust track and trace system allows new disease outbreaks to be quickly identified and hopefully shut down. Finding and testing new cases quickly and tracing their contacts is a vital way to stop outbreaks. The UK’s track and trace system has been plagued by setbacks and failings which has resulted in clusters of infection not being identified in a timely manner. (9)
Coupled with a lack of testing capacity in many areas, and the nonsensical situation where people were sometimes asked to travel hundreds of miles to access a test, precious time was lost during which the virus was able to spread unabated. (10)
In June 2020 I wrote that “a second wave of infection is not inevitable but to try and avoid it we will need to accept continuing with some level of restrictions in our daily lives. This will become harder as people yearn to return to normal and begin to resent the measures needed to control the virus. In the end a backlash against the restrictions protecting us from a second wave may be the very thing that causes one. It will likely be human actions, rather than anything the virus does, that allows a second wave to happen.” (1)
The virus has not changed its modus operandi and our knowledge of how to deal with it has vastly increased. Despite this it has been able to exert a tighter, second grip than it should perhaps have been able to.
Winter and COVID-19
In July 2020 I opened the piece " "Winter and COVID-19" (click here to read) with this observation: "UK Warned of Winter Resurgence in COVID-19" and "It'll be Over by Christmas" have been the completely contradictory headlines in the UK this week.
The piece also predicted that “The outcome may be determined by how large the number of people infected with COVID-19 still is as we go into winter, the larger the number the more susceptible to a winter resurgence we will be. This could be mitigated by continued social distancing measures and ongoing local lockdowns where an increase in cases is seen.” (11)
What we know now
It is now very clear that the pandemic is accelerating again as we head into winter. The most dire warnings in the summer predicting that the R number could rise to 1.7 in September have proven accurate with it estimated to have reached 1.6 in early September. (12)
(For further explanation of the reproduction value, or R number, of a disease click here for a previous blog piece on the subject.)
Unfortunately we have headed into winter with COVID-19 case numbers rising exponentially which does not bode well for the months ahead. (13)
Whilst there is hopeful news on the vaccine front, the reality is that vaccination will not happen in time to mitigate against the impact of COVID-19 this winter. England is currently back in a nationwide partial lockdown and it seems likely such measures will continue, perhaps intermittently, until the spring of 2021.
Europe
The UK is not alone in experiencing a second wave of COVID-19.
Not a single country in Europe has escaped a resurgence of infection. (14)
Lockdowns have been re-imposed in many nations across Europe including France, Germany, Italy, Spain and Greece. (15)
Countries that appeared to do well in early 2020 are now struggling.
Germany in particular was left relatively unscathed by its first wave of COVID-19 but is now battling to stay in control of infections. Younger people ignoring health guidelines are being blamed by officials for the rapidly increasing case numbers. (16) (17)
Sweden, thought by many to be exemplar in its handling of the pandemic, is also struggling to contain infections (18)
Having not imposed a restrictive lockdown in the spring, Sweden hoped to avoid a second wave. This has not transpired and by mid-November the rate at which people with COVID-19 were being admitted into hospital was growing faster in Sweden than any other European country. Sweden has now imposed lockdown measures similar to those elsewhere in Europe. (19)
The USA
The USA has had a varied approach in its response to the pandemic because of the devolution style of government whereby individual states, and even counties and cities within those states, can set their own parameters around lockdown.
Many US public health experts called for a complete shutdown of the nation concerned that within weeks the country would be overwhelmed with cases. However, with little political consensus, no coordinated healthcare system and swathes of the public demanding the restrictions be lifted, different states went in widely different directions.
Many lockdowns that were imposed were lifted early and against the advice of the country’s own medical advisors. The states that implemented lockdown late and lifted it early are seeing their case numbers soar but cases are rising in all the states. (20)
The USA has recorded nearly 12 million confirmed cases and just under 257,000 deaths from COVID-19 across the country. The US accounts for 4% of the world’s population but has recorded 20% of all the world’s cases and deaths from COVID-19. (21)
The politicisation of the pandemic in the run up to the presidential election may have had a catastrophic effect on COVID-19 numbers. Mask wearing in particular became a divisive weapon in the election propaganda. (22)
It is of note that those states that encouraged mass rallies and a rejection of mask wearing now have higher numbers of COVID-19 infections despite the fact that they have lower population densities. (23) (24)
The situation in the US is alarming. Even when adjusting for population sizes it is currently the worst affected country in the world and the data suggests it has not yet seen the peak of its pandemic although there is huge variation between the individual states. Politically the country is likely to remain in turmoil for months to come because of the fallout from the presidential election.
Be it political bickering or poor planning; a lack of guidance or a refusal to follow guidance, we are currently witnessing what happens when a disease is politicised or downplayed or ignored. Viruses have no interest in politics, borders or human sensibilities and we would do well to remember that.
(6) https://www.sciencemag.org/news/2020/05/why-do-some-covid-19-patients-infect-many-others-whereas-most-don-t-spread-virus-all
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