By Dr Edward Nazareth
Nov 9: As the numbers of COVID 19 positive cases are steadily declining and the deaths due to the complications of this infection are less, it is natural for people to express a sigh of relief now. Many are hoping that by the end of this year, that is by another two months we may discard the tiring masks, forego social distancing and return to our activities of normal living, the life we were living exactly a year ago. But, will that be possible?
The resurgence of infection and fresh lockdown in many countries of Europe is a warning to us; we may have to be careful. In the months of March, April and May, Europe as a whole reported between 35,000 and 38,000 new COVID19 cases every day, at its peak. The numbers steadily declined in Europe but the new cases in United States, and, later, India were at its peak and these emerged as the epicenters of the epidemic. In the months of June, July, and even August, Europe reported less than 20,000 cases a day, almost a third or fourth of what India alone was reporting.
In the last one month, however, there has been a significant rise in cases in Europe. The second wave of infections in Europe is far worse than the first. On 8 November 2020, more than 9 million( 90,63,320) new cases are reported in the European Union and the UK: France (17,48,705), Spain (13,28,832), United Kingdom (11,71,441), Italy (9,02,490), Germany (6,58, 505). Whereas, in India the number of new cases are 50,356 on 7th November and on 8th November 45,674.
As the number of infected cases declined, many countries across the world lifted their lockdown restrictions and began to unlock the process. However, the recent resurgence of COVID-19 cases in Europe has yet again forced the countries to retrace their steps back to imposing lockdown measures to control the spread of virus.
Will it be dangerous?
In March 1918, towards the final years of the First World War, the first wave of Spanish Flu was observed. Like COVID 19, the early wave of Spanish Flu was thought to be brought by Chinese laborers who were working in Europe. It spread first in the European war zones and soldiers on all sides took the disease deep into their countries as they returned or were released from prisons. By June 1918, the infection had reached Australia, Russia, China, India, Africa, Japan, and most of Europe. Then in July 1918, the infection subsided. The first wave was mild, many people fell sick, but the mortality remained so low that virtually no quarantine measures were imposed. Then in September 1918, the second wave arrived. By that time the infection had reached all over the world and it proved to be extremely deadly. In the first wave, the victims were mostly the very young or the very old – and younger ones were spared with little or no symptoms as it happened with COVID19.
But the second wave of Spanish Flu in the winters of 1918 showed what is called the W-Curve, where a high number of deaths were among the young and old, but also a huge spike was seen in the middle, healthy 25 to 35 years, in the prime of their life. Within 3 to 4 months of the second wave of Spanish Flu in 1918, the US lost 300,000 lives, Mumbai reported 15,000 deaths in a population of 1 million, and across India the death toll was about 20 million within this short span of time.
We do not know how the second wave of COVID19 will affect us. Will it repeat the history of the Spanish Flu? While we have only experienced the implications of the COVID19 virus in the summer, we do not know what the winter season has in store for us.
Why ‘the second wave’?
Though we are not very sure the reasons for this renewed surge in Europe and the US, two possible factors are pointed out. One-there has been a general lowering of safety measures after the numbers began to dip in the summer, people started travelling, partying without precautions. The second factor could be the drop in temperature that is pushing most activities indoors in these affected countries. The cold, dry weather could also be helping the virus survive longer and remain potent, though the evidence on that is not conclusive.
The possibility of disappearance of antibodies to COVID 19 in asymptomatic infected individuals cannot be ruled out. As reported, the antibodies likely to last not more than 90 days. It means, there is possibility of many individuals who were infected, were asymptomatic getting infected again. This fact is yet to be established.
Though change in the climate is not in our hands, precautions could have avoided the second wave. For example, Australia could avoid a major surge during the winter because of much better compliance with wearing masks. In Australia there has been a significant decline in cases of flu, because people have been wearing masks. The people in Australia did not give up masks and they were able to avoid the second wave. This important message has to reach everyone.
Is this a new strain?
A new study, published recently on a pre-print server (yet to be peer-reviewed), suggests that travel within Europe, particularly Spain, could be spreading the virus. It reports that a new variant of the virus, first detected amongst people in Spain in July, has now spread through many countries in Europe. Named 20A.EU1, this variant is particularly prevalent in the UK, Switzerland, the Netherlands, France and Norway. It accounts for the majority of the recent infections in Europe, and was dispersed across Europe by travelers to and from Spain.
However, the study also says there was no direct evidence to suggest that this new variant spread faster than others, or that it resulted in more serious disease. In effect, while the new variant is becoming dominant, it is not yet clear whether it is also leading to the rapid rise in numbers.
Second wave in India
In India, the number of daily new cases touched a peak in the middle of September, and has been declining ever since. On September 16, India detected 97,894 new cases, the highest for any country in a day. Currently between 45,000 and 50,000 new cases are being detected.
But states like Delhi, Haryana and Kerala are already witnessing a fresh wave of infections. It is believed that, Delhi is going through a third wave now, having seen two cycles of peaks earlier — each peak higher than the previous one.
It is not possible to predict, whether India will also go through a Europe-like resurgence during the winters. The experts have been warning of the risk in the festival season and the approaching winter when air pollution too will be high. The impact of festivals and elections in states like Bihar might become evident only by another few weeks from now.
However in most parts of India, winter is not as severe as in Europe and people hardly remain indoor. This might save many parts of India from a severe second wave like situation of Europe. But, that is not certain.
Better to be cautious
We have to be cautious now. We do not know how this deadly virus will behave in the winter season in our country. We have only seen this virus in summer, the times when it was probably weaker, and its effect in winters remains to be watched. There is also a growing threat of combination infections – where COVID 19 is coming with dengue, malaria and other infections. Even the USA is bracing for a combination infection season of seasonal flu and COVID19. We have to remember the Spanish Flu second wave of a century ago which affected young and healthy. We may not like to wear a mask, may hate social distancing, may like to celebrate Deepavali, Christmas and New Year as we did before, however, we should remember COVID19 has not gone. No matter how much we dislike it, life cannot go on normally with this virus still around us.
Vaccine - a hype or reality?
As written earlier in this forum, I still believe, we may have to be more skeptical about the COVID 19 vaccine. Many of the vaccines are in trial phase and we are not sure when we will get them. Some of the states have already identified the storage spaces and the means of distributing the vaccine. There is lot of uncertainty about the effectiveness of the vaccines also.
Recently, Dr Randeep Guleria, director of AIIMS who is also the member of the national task force on the corona virus management in the country has said that common people will have to wait till 2022 for a dose of COVID 19 vaccine.
Even if a vaccine is available by the end of this year – it would take several months for it to reach common people. Even if one gets it, there is no guarantee that it will be effective beyond a few months, as the virus is already showing the ability to mutate (alter its structure). As stated already, there are reports that the antibodies developed after the true infections disappear in a few months! If it is true, then the usefulness of the vaccine may have to be watched.
Till that day, we only have the mask, the social distance, and all other precautions that keep the virus away from us.