When we leave lockdown, life will have to be different
Our unprecedented curfew style lockdowns, to check the deadly coronavirus’ spread are showing signs of signs of success, several countries have succeeded in bringing local outbreaks under control, but they can’t last forever, health and government officials are scrambling to figure out when and how they might ease the restrictions without unleashing a surge of new infections.
When they let us go out again, will we still be expected to wear masks? Will they be continuing to check our temperatures or our COVID-19 status to enter hotels, stores and workplaces? Will there still be six-foot spacing restrictions or limited number of entry of customers at supermarkets?
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The most dramatic of these is China, where large scale restrictions on people’s movement appear to have halted domestic transmission. COVID-19 cases in the Chinese province of Hubei, where the coronavirus first emerged have dropped to practically zero, and last week authorities lifted travel restrictions in and out of the province. Now scientists- and the rest of the world- are watching closely to see whether easing the intense measures to keep people apart results in an emergence of new cases.
South Korea, Singapore, Japan and Taiwan also had early success containing initial outbreaks, using a combination of extensive contact tracing, testing, and border measures and differing degrees of social distancing, but are now bracing for what some scientists fear is the second wave. Actions are being taken in those countries to curb the rise of a second wave of the pandemic after the number of new cases have been accelerating.
What causes a second wave of a disease outbreak?
Infectious diseases spread via contact between infectious and susceptible people. In the absence of any control measures, an outbreak will grow as long as the average number of people infected by each infectious person is greater than one.
If people who recover generate a protective immune response, the outbreak will leave a growing tail of immune people. Once enough people are immune, there are fewer susceptible people to become infected and the outbreak will die away.
When an outbreak is brought under control by social distancing and other measures, it’s possible only a small proportion of the population will have been infected and gained immunity. If a population has not achieved herd immunity, enough susceptible people may remain to fuel a second wave if controls are relaxed and infection is reintroduced.
Even for those people previously infected, immunity to COVID-19 is an open question. Reinfection appears uncommon, and a study in rhesus macaques suggests a protective immune response does occur. But, we need more data to understand if this is common in humans, and how long immunity might last.
Preventing a second wave of COVID-19
When the first wave of an outbreak is sufficiently large, then enough of the population could become immune that there are few susceptible people remaining to fuel a second wave. But the potential human cost of an uncontrolled outbreak is immense and unacceptable.
During the 1918 influenza pandemic, it was the second wave that was the largest and most deadly. However, with the ability of researchers to marshal technology and science to quickly develop and/or test drugs for disease, has never been as strong as it is now. There are more than 100 ongoing clinical trials worldwide of experimental and already approved drugs that might be repurposed to fight COVID-19, with literally dozens of companies globally working on developing vaccines against the SARS-CoV-2 virus that are already in clinical trials might be available to battle a second wave of the disease and when or if a vaccine is developed. The rapid development of a vaccine could help achieve herd immunity without extensive infection.
Alternatively, a globally coordinated response that eradicated the virus could prevent a second wave, as was achieved for SARS in 2003. However, the milder nature of the SARS infection, and the broad global spread of COVID-19 make it a much greater challenge to eradicate.
In any event, after the first wave has passed, preventing a second wave will require ongoing surveillance and testing to detect and isolate any new cases as control measures are unwound.
