The Second Wave? — Growing Anxiety Surrounding Further Disaster
Is it too soon for the UK to start easing its lockdown?
‘ A second wave really is a clear and present danger ’.
Statement by Mark Woolhouse, Professor of Infectious Disease Epidemiology at the University of Edinburgh and a member of SAGE (Scientific Advisory Group for Emergencies).
The obscurity and misinformation characterizing political and media coverage, alongside various attempts to distribute blame and politicize this health crisis, has made it increasingly difficult to obtain a clear picture of where we presently stand with the COVID-19 pandemic.
As of 1 June 2020, Westminster began implementing its plans to ease the nationwide lockdown, a decision that has elicited much skepticism from the scientific and medical communities as well as the wider general public.
Calum Semple, Professor of Outbreak Medicine and Child Health at the University of Liverpool, voiced his concerns surrounding the decision by stating that:
‘ Essentially we’re lifting the lid on a boiling pan and it’s just going to bubble over ’.
These circumstances prompted me to conduct historical research into previous epidemics to have afflicted the UK, namely the Great Influenza pandemic of 1918, constructively exploring how this event compares with our current crisis.
Before progressing further, it is certainly worth urging caution whenever undertaking selective readings of past and present pandemics.
For one, influenza and coronavirus are not the same illness, (a useful article highlighting their discernible characteristics is available here).
Furthermore, the socio-political, demographic, and medical factors contributing to the ascension of both viruses to global pandemic proportions, especially in the case of the former, largely vary.
Nevertheless, drawing certain parallels with the colloquially-named ‘Spanish Flu’, particularly with regards to how government and society perceived and responded to viral epidemics historically, benefits us by being able to refreshingly assess the effectiveness of our current approach.
The Great Influenza pandemic reportedly emerged in Western Europe during the spring of 1918, eventually reaching the UK via infected soldiers returning from Northern France in May 1918.
By August 1918, people in Britain had unanimously conceded that the virus was no longer active. However, the month of October witnessed a devastating secondary resurgence of infections that terrorized the entire country.
Watch Dr. Wise on Influenza - BFI Player
Dr Wise is here to advise! As Britain fell under the grip of the Great Influenza of 1918-19, the Local Government Board…
Dr. Wise on Influenza was a (very rare) public information film commissioned by the Local Government Board (later the Ministry of Health) in early 1919.
It provides a revealing insight into how authorities attempted to aggressively challenge complacency within the general public and to encourage people to actively embrace preventative measures.
Unfortunately, its release came far too late once the deadly second wave had already passed to instigate any notable change. Even then, its distribution to local health authorities was poorly managed.
Regardless of this, considering that it reflects society’s findings from dealing with the second wave in 1918, then it certainly warrants our attention now as we prepare ourselves for the likelihood of a second peak of infections.
One prominent success of Dr. Wise is its visualization of how the R number functions, (the rate of secondary contaminations caused by an infected individual).
We observe our case in point, a Mr. Brown, as he gradually infects everyone within his workspace with influenza. His actions, unbeknown to him, resulting in his colleagues becoming grievously ill and, in some cases, losing their lives.
At one point, Mr. Brown supposedly further infects a crowded bus of people by ‘scattering’ his germs through sneezing. He arguably fits the profile of a ‘super-spreader’ in today’s context.
So what are the key preventative measures mentioned by ‘Dr. Wise’ ?
Stay At Home & Self-Isolate
This significance of this measure cannot be overstated. Whether symptomatic or not, it is everyone’s responsibility to avoid all external contact unless absolutely necessary. In cases where this is impractical or unavoidable, social distancing rules should be observed to limit the spread of infection.
We mostly recognize this nowadays as the ‘two-metre distance rule’. Like me, you might consider this a somewhat arbitrary guideline. Incidentally, its scientific validity has been contested since its introduction in the 1930s.
In response to concerns surrounding this rule, Simon Clarke, an Associate Professor in Cellular Microbiology at the University of Reading, aptly summarises as follows:
‘The two-metre rule is recommended, not because staying two metres away from all other people provides you with a force field against infection, but because it is a reasonable distance to stay away from people to reduce risk of infection’.
Sanitation & Ventilation
Notwithstanding that medical understanding surrounding germ theory and viral epidemiology was still in its infancy during the early twentieth-century, this film demonstrates that people were already acknowledging the importance of disinfecting surfaces and ensuring that interior settings were sufficiently ventilated with fresh air.
This remains a crucial practice today, considering that aerosol droplets infected with COVID-19 can survive up to 24 hours on soft surfaces and up to several days on hard surfaces.
Wear A Face Mask
We are later introduced to two nurses. One demonstrates how to correctly apply both an improvised and a medical facemask.
Debates are currently still ongoing within the medical discourse surrounding the effectiveness of facemasks.
However, institutions such as the CDC (Centers for Disease Control and Prevention) have recognized their viability as a preventative rather than a protective measure.
Facemasks have been a mandatory requirement in countries such as the Czech Republic where to overcome the national shortage of masks, people have been fashioning their own from available household textiles.
Of course, not every aspect of the UK’s approach in 1918 materialized as promisingly as Dr. Wise suggests.
Mass confusion, insufficient medical knowledge, and the persisting distraction of the First World War rendered the majority of efforts to combat the spread of infection futile or devoid altogether.
This meant that less helpful solutions became rife, particularly within the media, who advised people to drink milk, clean their teeth regularly, and to eat porridge!
Official responses were also generally lacking overall. Sir Arthur Newsholme, the Chief Medical Officer of the Local Government Board, was a leading figure tasked with coordinating the state’s response to the epidemic.
In a report he composed for the Royal Medical Society in 1919, he wrote:
‘Ask if we are prepared to pay the heavy price in personal restrictions which its [influenza’s] prevention…will necessarily imply until further means of prevention, so far undiscovered, become available’.
This statement undoubtedly resonates closely with many people currently enduring lockdown measures. Unfortunately, for those awaiting a vaccine in 1918, it never came.
‘There are national circumstances in which the major duty is to “carry on,” even when risk to health and life is involved’.
While it seems easy to criticize his approach retrospectively, Newsholme’s thinking was largely understandable contextually.
Needless to say, his testimony prompts the resounding question of:
What circumstances are motivating the Government’s decision to ease the lockdown today, and do they justify the risks to health and life involved ?
The case fatality rate of the UK has already surpassed countries such as France, Spain, and Italy, subsequently leaving it with one of the highest death records in Europe. Incidentally, these countries also responded quicker to the crisis by imposing their own lockdowns earlier.
Despite this grim reality, the Government has proceeded with gradually lifting lockdown restrictions, a decision most regard as being politically and financially motivated.
Dr. Jeanelle de Gruchy, President of the ADPH (Association of Directors of Public Health), stated in her blog that:
‘There must be a sustained and consistent fall in the daily death rate’,
‘ Deaths are a measure of what happened roughly two weeks before- the effect of easing measures now will only become evident in two weeks ‘.
‘Two weeks’ being the estimated timeframe before a patient becomes visibly symptomatic, as well as the recommended quarantine period following positive diagnosis.
Considering the implications of Dr. de Gruchy’s statement in conjunction with the graph presented below, recent developments attest to peoples’ concerns that official leadership has averted from the scientific framework which has informed its approach thus far.
So far there have been 284,868 confirmed cases of COVID-19 and approximately 40,465 fatalities across the UK, according to GOV.UK.
Meanwhile, the ONS (Office of National Statistics) registered closer to 44,000 deaths in England and Wales alone between 28 December 2019 and 22 May 2020.
Realistically, there are multiple variables explaining these inconsistencies, too numerous to mention here, but which mean we will not recognise a wholly accurate total number of fatalities until this pandemic has passed .
Figure 1 illustrates that from late April to early May, daily case fatalities appeared to be receding. Then a peak of 693 deaths occurred on 5 May, a rise of 405 deaths from the day before.
The daily fatality rate has since fluctuated sporadically with its pattern resembling a heartbeat.
This instability may be accounted for by the deaths of individuals who had become infected with COVID-19 two weeks prior.
It could further incorporate cases whose death certificates were delayed and thereby excluded from the appropriate daily fatality registration.
However, if such factors cannot account for at least a large part of these anomalies, then this alarmingly implies that new cases of COVID-19 are still emerging, consequently meaning we are still a long way from ‘flattening the curve’ to a steady and sustainable level.
The number of daily diagnosed cases was similarly witnessing a gradual decline, until a dramatic peak of 3,287 new cases were recorded on 22 May, contrasting with the 2,615 recorded the previous day, and the 2,959 recorded the following day.
Of course, these inconsistencies are more than likely due to a greater degree of testing being carried out by the NHS.
Even so, considering this data contradicts the Government’s earlier forecast claiming there would only be 1,000 cases per day by mid-May, this is disconcerting.
John Edmunds, Professor of Infectious Disease Modelling at LSHTM (London School of Hygiene & Tropical Medicine), interestingly reflected on this mixed data set by commenting that:
‘Even if we don’t get a second peak and we just keep the incidence at this level that will still result in large numbers of infections over time and people will die’.
So What Can We Do To Minimise The Risk Of A Second Wave?
We are currently confronted with a difficult decision between prolonging lockdown measures to stabilize the incidence rate — which is not absent its continued risks to the economy and peoples’ mental health — and ending lockdown prematurely in favour of investing our hopes in a relatively new test and trace system.
However, considering that the easing of lockdown restrictions shows no signs of stopping, then second only to practicing the same preventative and protective measures we have so far, (thinking as ‘Dr. Wise’ would), all the majority of ordinary peoples can realistically do in further aid of this is to:
Use common sense, and avoid succumbing to panic .
The UK has endured and overcome many epidemics throughout its history, including the 1918 influenza pandemic which is universally considered as the worst medical disaster to occur since the Bubonic Plague.
Both of whom assert that epidemics are characteristically sensationalized and their significance overtime exaggerated, corroborated by how the media’s most dramatic premonitions typically fail to materialize, and by how most people today have seemingly forgotten about the 1918 epidemic, as well as the smaller-scale epidemics which followed in 1957 and 1968.
Their argument is certainly credible to a large extent. Today’s epidemic has similarly witnessed its fair share of scaremongering and conspiracy theories, including the careless labelling of this crisis as being ‘unprecedented’, which it, evidently, is not.
Alternatively, there is a midpoint I would say between being stoically impassive to it all and hopelessly hysteric wherein we all ought to lie. This comes down to, to reiterate, using common sense, whatever your social or political standing in society.
This is more important now than ever before, as people become increasingly disheartened by the direction the Government is leading us.
Unfortunately, however, this message is still yet to manifest.
Just as tens of thousands of people flocked to the streets to celebrate Armistice Day on 11 November 1918 while a second peak was still prominent, renewed social mobility now has witnessed mass crowds congregating outdoors for leisure activity or to participate in the anti-racism protests unfolding across America, and now within the UK.
As justifiable and significant as these events undoubtedly are, their effect on the global incidence rate of COVID-19, considering the patterns and trends evident within the data accumulated so far, is up for anyone’s speculation.
I see no better alternative than to conclude with a further statement by Dr. de Gruchy, in which she offers a refreshing perspective concerning the social and economic reasoning used to justify the lifting of lockdown restrictions so far:
‘ The risk of a spike in cases and deaths- and of the social and economic impact if we have to return to stricter lockdown measures- cannot be overstated ’.