By Bertalan Meskó, MD, PhD
In short? Yes, there most certainly will. Or, looking at it from another perspective, there might not be a second wave as the first one won’t end. In any case, which scenario is more probable depends on your country’s leadership and decisions and whether people will be compliant enough to go along with the restrictions. Because how governments are preparing for it over the next few weeks will be crucial in the fight against the pandemic.
The search is still on for a vaccine and it certainly won’t be ready by the time experts say the second wave hits the stage. Technically, to talk about a second wave, the first wave needs to end. And in order to say one wave has ended, the virus would have to be brought under control and cases have to fall substantially. In some parts of the world we’ve seen that happening, while we also see record numbers in new infections elsewhere – so the disease is on fire again.
Waves of infections and the epic test of leadership
Epidemiologists use the metaphor of ocean waves when trying to explain the typical runoff of a virus. Remember “flatten the curve”? Well, the wave of a virus (be it the seasonal flu or COVID-19) means that the number of infections and deaths are up. And when the wave or the curve flattens, that means keeping the infections at a manageable level. Just like the waves of an ocean. A hundred years ago, the Spanish Flu also had a second wave. And it was far deadlier than the first one.
Looking at the data now, this rise and fall of cases clearly indicate a country’s response to the virus. Where leadership and science went hand in hand, and the pandemic response was effective, this curve went down after the initial rise. And ‘effective’ here translates to human lives saved or lost, so it’s not empirical but an epic test of leadership. Typical examples are New Zealand, Iceland, South Korea or Germany. Others, like Brazil and the U.S., took a different path. Their struggle is still on. However, even the most successful countries need to face that their successful virus response gives only temporary relief.
Antibodies for long-time immunity
Researchers are after the fact whether you can catch the coronavirus again after you’ve already had it – and, regrettably, this seems to be the case. Antibodies are proteins the immune system is producing responding to an infection. In some diseases, they can prevent reinfection. Unfortunately, it is still unclear if that stands for coronavirus. How long antibodies stay in one’s blood is also unknown. A new study from King’s College London inspired a swarm of headlines suggesting that immunity might vanish in only a few months; while other studies claim the opposite.
If there’s a chance to reinfection, herd immunity (when the majority of the society has had the virus and therefore radical protection measures become unnecessary) is out of the question. However, none of the studies are definitive, and there’s still a lot to be learned about this novel virus. Anthony Fauci even warned in an interview that “the coronavirus might not ever be eradicated.”
This leaves us with the vaccine as the safe solution.
When will we have a vaccine for COVID-19?
Researchers around the world are currently developing more than 160 types of vaccines against the virus. There are already over two dozens of them in human trials. There are now promising results from British, Chinese, and Russian labs, where early tests show that the first vaccines induced antibody and T-cell response as well. It remains to be seen though, whether these vaccines are safe in the long term, and whether they could protect people for an extended period of time. Experts warn, however, that even with a vaccine produced, it’ll take a long time to have everyone vaccinated, starting with people with immune deficiencies, medical workers and the elderly. And then there are the resistant masses who refuse to get vaccinated. In the U.S. alone it is an estimated 60 million people.
The search for and the development of a new vaccine is extremely expensive, time-consuming and risky. Even with a worldwide collaboration, it’s a desperate rush; and while first responses were about cooperation, more recent news are about how, for example, Russia is trying to hack vaccine trials.
Seasonal flu AND the coronavirus?
Whether there will be a seasonality of COVID-19 is also unknown. It is likely that the spring and summer in the Northern hemisphere helped slow down the disease. Thus, logically, autumn is about to light the fires again. Added to that, the virus spreads much better in inside spaces. While out in the open it is more easily swept away with a breeze or is damaged by the sun. Reopening of schools will also contribute to the spread. And there are studies that say cooler, drier weather helps the virus linger on surfaces longer.
“The real risk is that we’re going to have two circulating respiratory pathogens at the same time,” explained Dr Robert Redfield, the head of the CDC in an interview. In last year’s flu season the CDC reported 39 million cases and 24,000 fatalities. If the coronavirus surges in the Autumn and the flu season hits hard, that’d put serious pressure on hospitals and healthcare personnel – again.
In our video back in April, we drew three scenarios on the possible outcomes of the virus. We see now that we are indeed living through the second: our battle with COVID-19 goes on over the majority of the year with travel restrictions, masks and social distancing. Most likely the rest of this year will continue to be about our struggle with this virus, until the vaccine becomes available.
Will there be another lockdown?
We see it all over the globe that as soon as restrictions are loosened, the cases jump up again. Currently, there’s a new surge in a number of countries: from Australia to India, Ukraine, Brazil or Israel. But now Europe’s main holiday time is approaching. Their numbers are about to rise as well, possibly leading to renewed lockdowns or restrictions. We already see it in a number of countries. In the U.S., numbers in the most affected states are rising again sharply, but it isn’t a second wave. As Vice President Mike Pence writes in an NYT op-ed: “there isn’t a coronavirus second wave.” That much is true. They are knee-deep in the first one.
Another lockdown will come when the numbers reach a critical level again – like recently in South Korea or Israel. What these critical levels might be, depends mainly on individual governments and the capacity of their healthcare systems. But we can expect that the second coming will be better. A new surge can be mitigated by the better response. Now that governments, hospitals, doctors and even people know what they are facing, the next peak will definitely be easier than the first one. If not, then something has gone seriously wrong.
Discipline is key in the second wave
Due to the novelty of the disease, making dire conclusions of a possible second wave is way too hasty. But today, most of us are wearing masks in public, social distancing and washing hands like we always should have. In those countries, where individuals oblige restrictions and are more conscious about practising good hygiene, people, in general, are going to be safer. Where a majority of people (or the government itself) did not accept the mere existence of the virus, the pandemic took its toll. Hopefully, the second time around those countries will also be better in their approach and measures.
For this reason, the second wave of COVID-19 will most likely be relatively slower and hospitals will be more prepared to deal with the influx of patients.
But without the discipline we showed at the beginning of the first wave, it also has the potential to be bigger.