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After the number of infected persons from the coronavirus or Covid-19 crossed 6 million and now in kissing distance of reaching 7 million worldwide with close to 4 lakh fatalities in about 213 countries,1 many countries that took resort of emergency, lockdowns and other measures to combat the further spread of the virus have begun to introduce relaxation such as reopening public spaces, religious institutions, businesses and other institutions over the last several days with safety restrictions. This is despite that there is a silent threat amid reopening. A second and even a third wave is feared but economic activities and normal human activities cannot be allowed to remain restricted for an indefinite period either.
In less than four months since its outbreak, the US recorded more Covid-linked deaths than any other country. On May 28 the US officially surpassed 100,000 people, profoundly altering daily lives and ravaging the economies of many countries. Though the elderly people and those with pre-existing medical conditions have proved to be more vulnerable, the virus has sickened all age groups of all identities, including children afflicted what remains a little-understood inflammatory syndrome. In an effort to contain the contagion, many countries closed borders, businesses, issued economic stimulus packages to rescue those severely affected and to check the soaring unemployment rate. These did not prevent some countries to slip into depression. Social distancing, wearing masks, staying at home, work from home, e-learning, etc were some measures that divided some societies along partisan lines. These became soon the “new normal”.
In the US, the state of California saw nearly 1 lakh confirmed cases of Covid-19. Even when the second wave is feared, relaxation was announced allowing salons and barbershops to reopen, marking a transition to the third stage of plan to ease the stay-at-home order. Though there are some who push forward with reopening the economy, there are others criticise the decision to lift stay-at-home restrictions, saying it poses “very serious risk”. Nursing homes have become the fertile ground for the Covid-19 pandemic as elderly people with underlying health conditions living in close quarters provide an almost perfect breeding ground for the lethal new virus.2 The same is true in other countries as well where old age homes are popular.
Restrictions such as physical distancing, use of face marks and limiting the number of people in confined spaces such as cremation sites, places of worship, wedding, etc. are essential to combat the spread of the virus. This is because of “silent spreaders”, which means peoples who have the virus but do not show symptoms but potentionally can spread it. Such people might look normal and healthy but still infect others because the virus has not manifested yet. Even saliva droplets from mouth could be silent spreader as those can infect others.3
The World Health Organisation (WHO) has warned that the world remains in the midst of the Covid-19 outbreak as countries continue to struggle to contain as the number of cases continue to surge. The Executive Director of WHO, Mike Ryan, warned that the world is in the middle of the first wave globally and the disease is still surging. 4 The cases are climbing in South America, South Asia, Europe, Southeast Asia and other parts of the world and even in countries where it was brought under control are seeing a second wave, and therefore relaxing control measures is not an option in combating the menace. The possibility of a second wave of cases spiking should put those who advocate for reopening to rethink.
The credibility of the WHO has also come under question after President Donald Trump accused the organisation as of Chinese stooge. First he suspended the US contribution and soon pulled out from the organisation, thereby further diminishing its global role in combating the virus.
The warning by WHO diminishes expectations for a swift worldwide economic recovery and renewed international global travel. The societal composition, people’s attitude, government response and the country’s laws are some of the factors that could either lead to spike of cases or reduce the surge. For example, in South Korea, early testing and stringent government measures and cooperation of people helped to control the spread of the virus.5 Similarly, Japan known for its law-abiding people cooperated with the government’s request. This yielded results even though Prime Minister Shinzo Abe announced a state of emergency without enforcing authority. Though the number of 903 deaths (as of 4 June) in a population of 126 million might look small, in percentage terms in proportion to total population, the number is not small. Vietnam is a model case for others to emulate the way it controlled the Covid-19 with zero death.6 Taiwan is another example of success story. The South Pacific island nation of Fiji too has seen zero death and all infected persons have recovered. The variables in all these countries are distinctive to the particular country itself and cannot be replicated in totality in other countries but lessons can be leant.
India too is continuing to struggle combating the virus as the numbers continue to surge. Its total numbers of infected cases as of 4 June stand at 227,029 with 6,363 fatalities.7 India has emerged Asia’s new hotspot. Since the lockdown cannot be kept indefinitely and economic activities have to resume, some relaxation have already been announced.
Brazil too is grappling with a surge. The US announced a ban on travellers from the South American country from 26 May in an effort to stop the spread of Covid-19. The ban applies to foreigners entering the US who have been in Brazil at some point during the prior 14 days. It takes two- to 14 days before symptoms appear in someone who contracts Covid-19, the disease caused by the coronavirus.
Brazil has emerged as a new coronavirus hot spot, trailing only the US in the number of confirmed cases, with 615,870 and with 34,039 fatalities according to Worldometer COVID-19 Data.8 While the one-day toll on 25 May for Brazil was 807, it was 602 for the US.
Despite the surge in cases , Brazil's far-right President Jair Bolsonaro played down the seriousness of the coronavirus. He allowed businesses to reopen, dismissed social distancing measure and brushed off the virus as nothing more than "a little flu". He“called Brazilians worried about the coronavirus neurotic”.9
The 2020 coronavirus pandemic is the deadliest public health threat in a century and perhaps the most consequential event since the Second World War. The Carnegi Endowment for International Peace in a web discussion on 2 June dissected if the world is in peril and if there is a way out. It noted that the Covid-19 is not only an epidemiological threat, but a systemic crisis affecting the political, social, and economic structures of modern life. It raised the issue if the world could learn any lesson from the Great Influenza of 1918. Since there does not seem to be a finality in the immediate horizon and governments around the world begin to open up, debates center on strategies for mitigation, risk management, and for preparation for the possibility of a second wave. It further probed if there are reasonable expectations for the development of a vaccine. The crucial point is to sculpt a long-term international strategy that combats the virus and safeguards economies at the same time.10
Scientists are racing against time to find the elusive vaccine. Several efforts are being made to experiment at laboratory stage but no clinical trial has been made so far. Several countries, including India and the US saw the use of hydroxychloroquine as a potential cure but the WHO “temporarily” suspended clinical trial of the anti-malaria drug on Covid-19 patients11 but soon reversed its decision on experts’ advice. The initial position taken by the WHO was in sharp contrast to the position taken by Trump who touted hydroxychloroquine as an effective coronavirus treatment and claimed he had taken it even though he was not tested positive for the virus.12
The head of China’s Centre for Disease Prevention and Control, Dr.Gao Fu, claims that the first coronavirus vaccine could be ready in less than five months, by September 2020. That could be tall claim. According to Dr. Gao, the vaccination would be used in emergency situation, such as a new wave of the virus outbreak. China now has three coronavirus vaccine candidates undergoing clinical trials. The virologist said that China is leading the world’s efforts to develop vaccines for the contagion. 13 Not many are ready to buy this claim. Also in Europe, British scientists at the Jenner Institute, University of Oxford, are in the race to find the illusive drug. 14
In Japan, Prime Minister Abe Shinzo vowed to share coronavirus vaccine even as he announced lifting the state of emergency on 25 May.15 Calling for international cooperation, Abe underscored the importance of the development of effective drugs, including a vaccine, and finding other ways of containing the virus, which needs to be done on a worldwide scale.
Despite the current worry to contain the virus from spreading further, many countries has decided to reopen business and relax restrictions as keeping such measures for a longer time is not an option. Saudi Arabia decided to relax some of its lockdown orders, including lifting bans on domestic travel, holding prayers in mosques and dining in restaurants and cafes. It has decided to end all restrictions on 21 June, except for the city of Mecca. As of 4 June, Saudi Arabia had 93,157 confirmed cases and 611 deaths. Chile had 118,292 confirmed cases and 1,356 deaths.16
Countries in East Asia too saw a second wave of the virus. Hong Kong’s biggest jump in cases the pandemic was connected to were infected travellers, who returned from abroad after being prevented from going home before. Experts warn that the virus is not going away for some time and it will not be eradicated from the world in months. The world needs to be prepared for another wave potentially. Many Asian countries such as Hong Kong, South Korea, Singapore and Taiwan, that saw initial success are now battling a second wave . Social distancing, among other measures such as 3Ts (trace, test and treat), is the key.
After South Korea reported new Covid-19 cluster of 23 cases linked to 13 churches, it started re-imposing some lockdown measures after a spate of new infections cropped up. The Korea Center for Disease Control and Prevention (KCDC) reported 35 new cases on 1 June, including 30 local infections, raising the total number of Covid-19 cases in the country to 11,668 with 273 deaths.17 Of the new cases, 23 patients were traced to 11 churches in Incheon and two churches in the Gyeonggi province. Seoul, Incheon and Gyeonggi make up the capital's metropolitan area, home to half of South Korea's population.18 It was presumed that transmission occurred between participants through events such as prayer meetings and praise meetings which the churches took turns hosting. Contact management and investigation on the source of infection then followed. Transmission also occurred through a gathering in Jeju Island during 25 May to 27 May in which 25 members from 12 churches participated, making the new church-linked cases to a total of 74 patients detected in May who were related to various church groups. After the country eased social distancing measures and millions of students went back to schools, a series of infections tied to high clubs and an e-commerce warehouse occurred in Seoul.
Infectious disease experts however recommend to lift social-distancing and other measures slowly as these would be difficult to maintain for an indefinite period of time.19
Most of the several modelling studies done on the effectiveness of social distancing, whether dampens disease spread, show that when the practice is not followed, cases will surge again, which is why lifting social distancing measures slowly is recommended. This could be the first step to minimise the extent of a second wave. Unless that is done, it could overwhelm health-care system of countries and negate everything they have been done for the past few months. The key will be to change social distancing policies "very slowly and carefully”.
Eleanor Fish, a professor of immunology at the University of Toronto whose research group conducted treatment studies during the 2003 outbreak of SARS in Toronto, opines that a second wave involve community transmissions.20 Even during the 1918 Spanish flu pandemic, there was both a second wave and a small third wave of the outbreak. Notwithstanding physical distancing measures, the long-term strategy has to be the creation of an effective vaccination, which does not seem to be in the immediate horizon.
In Japan too, after Abe lifted the state of emergency on 25 May, it ended the restrictions nationwide allowing businesses to reopen. Though it marked a major step forward in returning the nation to a normal daily life, it did not mean that the insidious virus had disappeared. The government is geared to prepare for a possible second and third wave. Now the government is trying to make efforts to establish a “new lifestyle” including maintaining proper social distancing. The Japanese case is unique in some way. While assessing the effectiveness of ‘Japanese approach’, it needs to be factored in that “unlike lockdowns imposed in many other countries, the restrictions on outings and business operations in Japan are based only on “requests” from the government.”21 Japanese law does not allow the government to enforce emergency conditions or even award punishment to violators. Under this unique approach which depended on voluntary compliance by individual citizens, Japan managed to avoid entering a phase of exponential growth in cases of infection. The total number of confirmed deaths from the pandemic in Japan so far is 903, far lower than the figures for most major Western industrial nations, which have reached tens of thousands.22
Despite Abe’s claim of success of the “Japanese model”, what need not be overlooked is that the number of polymerase chain reaction (PCR) tests that were carried out in Japan is much lower than in most other major countries. This leaves with the suspicion that there may be a large number of cases that have not been detected. Viewed from this perspective, lifting the emergency prematurely could possibly hasten the second wave of infections. Abe’s claim could have been based on the premise that the country’s health care system is adequate enough to deal with a second wave but the plethora of challenges for Abe still remains to be huge.23
The reality on the ground was however different. Because of inadequate institution support, some who tested positive were deprived of timely treatment, leading to their deaths. Critics saw flaws in Abe’s claim of addressing the challenge adequately. Some people with suspicious symptoms such as fever and breathing difficulty suffered as they could not visit a hospital. In order to flatten the curve, the first order of business for the government should have been to prepare the nation for a possible resurgence of the virus was to ensure that suspicious cases are immediately tested.This did not happen, exposing deficiency in the system.24
No wonder, the public took a dim view of the Abe administration’s response to the health crisis. In an Asahi Shimbun survey in late May, 57 percent of the respondents disapproved the manner the government handled the situation. This figure was nearly double the rate of people who expressed positive views. While only 5 percent of those polled said their confidence in the prime minister had increased,25 nearly half, or 48 percent to be exact, said the opposite.
As more states and countries re-open for business and remain alert at the same time to monitor how the virus is behaving, health experts warn not to let allow the guard down as a second wave of the virus seems inevitable. Though most respiratory illness cases are seasonal, experts hope the light at the end of the tunnel is near but not likely though. Based on the current situation, one could expect a second wave, and even a third and fourth wave. Yet this does not guarantee one that he/she is immune and even if immune, there is no guarantee on its duration. Though no one would rejoice such a phenomena takes place, there is no guarantee about its success. Despite efforts being made worldwide, no one can fix an expiry date on the Covid-19. So the battle continues and no one knows how long. This seems to be the biggest battle for mankind in this 21st century.
(Please note all figures of infected persons and deaths are as of 4 June 2020).
(The paper is the author’s individual scholastic articulation. The author certifies that the article/paper is original in content, unpublished and it has not been submitted for publication/web upload elsewhere, and that the facts and figures quoted are duly referenced, as needed, and are believed to be correct). (The paper does not necessarily represent the organisational stance... More >>
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Links:
[1] https://www.vifindia.org/article/2020/june/08/global-scenario-of-covid-19-some-reflections
[2] https://www.vifindia.org/author/prof-rajaram-panda
[3] https://www.worldometers.info/coronavirus/
[4] https://www.latimes.com/california/story/2020-05-28/coronavirus-nursing-homes-testing-california
[5] https://www.latimes.com/california/story/2020-05-26/coronavirus-silent-spreaders-bigger-risk-as-california-reopens
[6] https://time.com/5842619/who-coronavirus-first-wave/
[7] https://www.vifindia.org/article/2020/may/09/south-korea-a-model-case-for-combating-covid-19
[8] https://www.vifindia.org/article/2020/may/20/after-south-korea-vietnam-another-example-to-emulate-in-fighting-covid-19
[9] https://www.voanews.com/covid-19-pandemic/trumps-brazil-travel-ban-begins-tuesday
[10] https://carnegieendowment.org/2020/06/02/infected-world-in-peril-is-there-way-out-event-7346
[11] https://www.msn.com/en-in/news/world/who-suspends-clinical-trial-of-hydroxychloroquine-on-covid-19-patients-temporarily/ar-BB14B1uw
[12] https://www.dailymail.co.uk/news/article-8253689/First-coronavirus-vaccine-ready-September-head-Chinas-CDC-claims.html
[13] https://japan-forward.com/shinzo-abe-vows-to-share-coronavirus-vaccine-to-the-world-as-japan-lifts-state-of-emergency/
[14] https://www.channelnewsasia.com/news/asia/covid-19-south-korea-seoul-church-cluster-cases-12792310?cid=emarsys-cna_20200602_0100_FINAL+CNA+Mon+to+Sat+newsletter+%280740%29_newsletter_
[15] https://www.cbc.ca/news/health/canada-covid-19-second-wave-1.5507522
[16] http://www.asahi.com/ajw/articles/13404436
[17] https://www.thestatesman.com/opinion/abe-confronts-corona-1502881300.html
[18] https://www.thestatesman.com/opinion/abe-combats-covidi-1502891157.html
[19] https://www.thestatesman.com/opinion/abe-combats-covidii-1502891381.html
[20] https://www.ecdc.europa.eu/sites/default/files/styles/is_large/public/images/novel-coronavirus-COVID-19-geographical-distribution-world-2020-06-07.jpg?itok=xWb2dDx2
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