Around the world, coronavirus infections are beginning to fall. For the first time in ten weeks, Italy’s restaurants, bars, hairdressers and museums are reopening their doors. In some regions of Spain, people are venturing into small shops and outdoor bars and restaurant terraces; while those in the UK are able to sunbathe in parks without fear of incurring a fine. Slowly but surely, people are emerging out of lockdown.
But while we might be on the downward slope, we aren’t yet out of the woods. As the UK eases its lockdown, a second wave of infections is all but inevitable. “There will be another peak,” says Chris Smith, consultant virologist at the University of Cambridge. “As soon as you afford the virus more opportunities to spread, which is exactly what the de-escalation of a lockdown will do, then there will be another peak.”
Those second spikes of infection have already been observed in countries further along in the pandemic than the UK who were thought to have brought the virus under control. South Korea, a country often praised when discussing the successful management of coronavirus, saw a spike in infections linked to nightclubs and bars in the capital city of Seoul in early May, shortly after venues reopened. In Germany last week, public health officials announced that the effective reproduction number (R) had risen above one to 1.1. Before the country had begun lifting restrictions on April 20, officials estimated that R was at 0.7.
Guidance from UK public health authorities agree that to avoid the risk of a second wave, R needs to stay below one. “The concern here is that we’ve spent a huge amount of time and effort and resource and, of course, loss of life in trying to quell this first wave,” points out Michael Head, senior research fellow in global health at the University of Southampton. “If you then release all these quite stringent measures too soon, there’s enough cases out there to then propagate and transmit the virus further.”
History has also shown that subsequent second and third waves of outbreaks of disease can be deadlier than the initial wave of disease, which is what happened in 1918 when the Spanish Flu ravaged across the globe. Like Covid-19, little was known about the disease, and there was no vaccine. The pandemic began in January and began to taper off around August, but in September, October and November, a more devastating second wave struck.
We can try and avoid a deadlier second wave by continuing some of the public health measures that we have already been practising. Head says that now that cases are going down, measures need to be put in place to keep them low. “It should include a lot of testing and a lot of contact tracing,” he says.
Contact tracing is the process of tracing all the people who an infected person has been in contact with, testing them for the infection and asking them to isolate to prevent spreading the infection further. It has always been one of the most effective interventions in public health.
Traditionally, contact tracing is done using a team of people conducting extensive interviews with infected individuals over the phone to identify where they have been or who they have visited. Contact tracing isn’t an easy job, however. It requires people to remember everyone they’ve come into contact with since they contracted the infection. This is harder because some people don’t show symptoms at all.
To make the NHS’s job of contact tracing easier, the UK government has developed a contact tracing app. If you become ill with coronavirus symptoms, you can self-report your symptoms to the app, which will alert other app users that someone with symptoms has been in close proximity to them in the past two weeks.
The issue, however, is that a substantial number of people will need to be using the app for it to be effective. According to a paper from researchers at the University of Oxford, at least 60 per cent of a population needs to use a contact tracing app in order for an outbreak to be brought under control. Martin Hibberd, a professor at the London School of Hygiene and Tropical Medicine, also worries that while the app might be effective at alerting someone if they’ve been in contact with someone who has reported symptoms, there’s no way of ensuring that they will self-quarantine for 14 days. “I think that the contact tracing app should be combined with testing,” he says. “If the message said, ‘You’re a contact, get tested today and stay quarantined until you get your results’, I think that’s a more urgent message.”
But contact tracing and testing isn’t the only thing we need to do to decrease the severity of a second wave. Though it is the primary thing that needs to be achieved. Hibberd says that to help avert a deadlier second wave, contact tracing and testing will need to be combined with continued social distancing. This is so that if the UK’s contact tracing and testing capacity aren’t up to scratch, social distancing can ensure that the R number will remain low.
As it has already done, social distancing will continue to change how we work, how we travel and how we socialise with each other. Head says he imagines that businesses will start to stagger shifts for office workers, while schools might send half of its pupils into school in the morning and half of the pupils in the afternoon to help reduce social interaction. “There will be lots of measures like that across every industry being considered at the moment,” he says. “It’s all just to try and reduce close contact between people. You can’t do that if you’re opening up businesses and schools.”
And until we have that crucial vaccine, it’s possible we’ll have to return back into our homes for another lockdown again and again. “If the numbers are rising exponentially, if we get back up to [an R of] 2 as we did in earlier stages, then it suggests that all our other methods are failing,” says Hibberd. “We will probably have to go back into lockdown to prevent it.”
Modelling from researchers at Imperial College London suggests that we might need to keep re-entering lockdown if the number of intensive care admissions gets too high. According to the paper, if the number of ICU admissions top 100, school closures and social distancing will have to be triggered. Furthermore, researchers from Harvard University say that in order for ICU admissions to remain low, prolonged or intermittent social distancing might even be necessary until 2022.
For a while, we will be able to live our lives, open up businesses and try and function as before. But as we interact with others outside of our household, cases will likely rise again. Ultimately, Smith says, by giving the virus more chances to spread, we’ll inevitably get more cases, and the numbers will begin to climb. “If it runs out of control, and it’s like a runaway mine Train, then all the testing in the world isn’t going to stop it, because there’s no way you can possibly contact trace that many people,” he thinks. So, until we find a vaccine, we’re going to have to get used to our new normal.
Alex Lee is a writer for WIRED. He tweets from @1AlexL
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