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Thursday, August 13, 2020

Could we see a second wave of coronavirus? | Canberra’s time

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Following the emergence and rapid spread of COVID-19, several countries have managed to control local epidemics. The most dramatic of these is China, where large-scale restrictions on the movement of people appear to have interrupted internal transmission. South Korea, Singapore and Taiwan have also had early success in containing local epidemics, using a combination of contact tracing, testing, border measures and varying degrees of social distancing. However, COVID-19 is now widespread worldwide and these countries remain at risk of a second wave of infections, caused either by arrivals abroad or by undetected pockets of infection. As China begins to lift travel restrictions, the world is watching to see if it can avoid a second wave of epidemics. Infectious diseases are spread through contact between infectious and susceptible people. In the absence of any control measures, an outbreak will develop as long as the average number of people infected with each infectious person is greater than one. If people recovering generate a protective immune response, the epidemic will leave a growing trace of people who are immune. Once enough people are immunized, there are fewer people who can be infected and the epidemic will go away. When an epidemic is brought under control through social isolation and other measures, it is possible that only a small proportion of the population has been infected and acquired immunity. If a population has not achieved collective immunity, there may be enough people left to feed a second wave if the controls are released and the infection reintroduced. Despite the scale of the epidemic in Hubei and other Chinese provinces, it is likely that most residents remain susceptible to the infection. Even for people previously infected, immunity to COVID-19 is an open question. Reinfection seems rare, and a study in rhesus macaques suggests that a protective immune response occurs. But we need more data to understand if this is common in humans and how long immunity can last. The strong social distancing measures used to control COVID-19 in China come at a human cost and cannot be sustained indefinitely. As China reverses its social distancing measures, new infected cases could, if not detected and isolated quickly, trigger a second wave of COVID-19. A recent modeling study indicated that a second peak of infection could arrive in Wuhan in the middle of the year if the interventions were lifted too quickly. During the influenza pandemic of 1918, it was the second wave which was the most important and the most deadly. But it probably won’t happen today. As we learn more about COVID-19, we become better placed to control its transmission. If a rapid increase in transmission is detected in China, it is likely that the authorities would quickly reintroduce restrictions that have successfully contained the first wave. When the first wave of an epidemic is large enough, a sufficient part of the population could become immune so that there are only too few people left to feed a second wave. But the potential human cost of an uncontrolled outbreak is immense and unacceptable. Alternatively, a globally coordinated response that eradicated the virus could prevent a second wave, as was the case with SARS in 2003. However, the milder nature of many infections and the wide worldwide distribution of COVID-19 make it a much more difficult challenge to eradicate. . Another end point is the rapid development of a vaccine that could help achieve collective immunity without widespread infection. In any event, after the first wave has passed, preventing a second wave will require continuous monitoring and testing to detect and isolate any new cases as control measures are implemented. We use mathematical models to explore the dynamic behavior of infectious diseases. They can help explore how factors such as the strength and timing of control efforts can affect the likelihood and timing of a second wave. However, the models offer a simplified view of reality. One of the complexities they often (but not always) overlook is human behavior and how it could change in response to government and media communication, social and economic realities, and the direct experience of COVID. -19. Australia’s current efforts are aimed at “smoothing the curve” of the first wave of COVID-19. Border measures have significantly reduced the arrival of imported cases, and the coming weeks will show how successful social distancing has been in slowing down community transmission. The decline in the number of new cases reported in recent days is promising. But this is just the start. If social distancing measures are to be relaxed, continued vigilance will be necessary to avoid a second wave. And even if we avoid a second wave, the path to long-term control is not easy. We will need a wide variety of expertise, including modeling, to help Australia navigate beyond the first wave of COVID-19.

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