Second wave of the epidemic and quarantine withdrawal: virologist forecasts on the development of the situation with coronavirus

Why is the second wave of coronavirus infection more dangerous than the first? When can I quarantine and what should I consider? Frequently asked questions were answered by Dr. Muhammad Munir, a British virologist from Lancaster University, in an interview with the Balkan service «Radio Svoboda».

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— Dr. Munir, in the United States and some European countries, where mortality and infection rates from coronavirus are declining, authorities have taken measures to restore the economy. Is this a good time [to ease quarantine]?

“If we look at the overall spread of this infection, it has different intensities. Some countries are ahead of others, such as Italy, Spain and France. Some countries are relatively behind, such as Denmark, the Netherlands or Sweden. Therefore, due to this difference in outbreak intensity, different control measures are introduced. For the same reason, the number of cases has now begun to decrease in Italy and Spain. They slowly began to lift the restrictions they had put in place.

But I think it is too early to remove any [restrictions], mainly because we do not know much about this infection. The virus boils for only three and a half months. And much more needs to be studied about him before we can understand that there were enough measures to suppress him and so that he would not return. Because if the virus came back again, it would be a much worse situation, because people would already be exhausted, and the government would also be economically affected. Therefore, it would be really difficult to return [restrictions when people will be back] in the workplace. So, the premature withdrawal of control measures must be taken very carefully.

— What are the greatest health risks associated with premature lifting of restrictions?

“As we know, this virus spreads through very close contact between different people, and the whole point of movement restrictions is that we will interfere with this transmission of the virus and suppress the infection. Therefore, if control measures are lifted prematurely, people will return to contact with each other. And then the virus will spread quite quickly between people who have not previously been infected. And even people who have already been infected before and have immunity - we don't know how long this immunity will last. Thus, these people will be able to become reinfected and the number of cases will increase significantly.

This would be really problematic, especially since the primary control measures are simple, but measures to control the second wave of infection that has returned to society are already more difficult. And this is not very surprising, because in any pandemic that we saw, the second wave was inevitable.

Therefore, this time, I think that the precautionary measures must be taken very seriously, and we must make sure that [the virus] does not return again.

— Has the likelihood of re-infection with coronavirus been confirmed?

— [April 13] and the day before, the World Health Organization received a report from South Korea of ​​91 cases of the disease in patients who had already tested negative for coronavirus. They were allowed to return back to society.

But then their test again showed a positive result, although we do not know exactly what is behind this phenomenon, because it is a new virus, a new disease, and much more information needs to be obtained.

But there are fair chances that the tests that were used in the previous diagnosis of the patient were not effective enough.

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— You mentioned the second wave - a new wave of infections - and said that it could be more deadly. Why?

“One of the reasons why a second wave is always [more] deadly is because people who have already been quarantined for, say, six to seven weeks are exhausted. So they begin to return to their normal lives. And if you decide to apply restrictive measures again, the tendency to comply with these measures will already be lower. Thus, this will make it more difficult to get the disease under control again.

The second problem is that people who do not have immunity, without getting infected for the first time, may face a more terrible defeat due to the virus, since they have never experienced its influence.

But the relative advantage of this is that if, for example, we had 20-30% of people [with] infection on the first wave, this means that people should acquire immunity, and this would slow down the spread of infection in smaller clusters. But clusters that were not previously exposed will be affected very much. And the government will be reluctant to return restrictions, since governments with limited economic opportunities do not want to have another round of complex decisions.

— Quarantine in Wuhan was officially lifted after 76 days. What can we learn from the experience of this city, once the global epicenter of the coronavirus?

— This is a very important question, and thank you for asking me this, because quarantines in other countries are basically a mirror image of what China practices.

China has begun to impose unprecedented quarantine. [Never] has yet been aware of such a scale of quarantine in history. Therefore, this made a fairly good impression, as it quickly enough reduced the number of new infections.

Thus, this gave confidence to other countries to impose quarantine at home. But now they have lifted the restrictions, and this is another example that other countries will try to repeat. But there are some important messages.

Although the quarantine in Wuhan was lifted, it was done in a relatively symbolic [way] because people are actually still under restricted movement rules. Only people who have a green QR code (on their smartphones) were allowed to go out - these are people who have enough antibodies in their blood, so they are protected.

These are also people who work in critical jobs, such as in the manufacture of medicines or medical devices, and they can go out. But, of course, there is a risk of gradually abandoning restrictions in other countries, since the geopolitical differences between the countries are very large. For example, we cannot expect such a scale of increase or removal of quarantines in European countries, where the level of personal choice is relatively higher and the level of expression of an independent opinion is quite high.

So, we certainly have aspects that can be learned from the general scenario of Wuhan. However, they must be treated with caution, depending on which country we are talking about.

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— Accordingly, what is the strategy for getting out of this situation?

“This is truly an unprecedented situation, and someone must have some kind of crystal ball to predict how and when exactly we will be able to get out of it.” Different countries have different levels of restrictions. Therefore, such an exit strategy should be determined at the state level or at least at the continental level.

Therefore, I can tell you that there are certain criteria that will determine when you need to apply an exit strategy and when to quarantine.

The first criterion is that when the number of cases of new infections begins to decline significantly for 14 consecutive days, this is the time when you can begin to think about mitigating restrictive measures.

A second important criterion for removing restrictive measures is that your national health system can cure every infected person.

And the third criterion is that you have created enough capacity to identify each person through testing and then be able to isolate those who test positive for coronavirus. Those who test negative can be tested for antibodies.

Therefore, it is very important to consider that this is not really a simple strategy, but these are three key criteria by which you can determine when restrictive measures can be canceled.

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