In his last speech in Parliament, the President Pedro Sánchez noted that “we have stopped the virus united, we must now unite that victory“, a triumphalist message in line with the campaign that the Government has launched this week and which has the motto ‘We came out stronger’. I am sorry to destroy this epic narrative. In reality, and despite the improvement in the figures, the war against the virus still you many battles remain in front.
To define what stage of the pandemic we are in, it is more convenient in this case to use the words of another leader. Specifically those that Winston Churchill delivered in November 1942 after bend the Nazis in Egypt: “This is not the end. It is not even the beginning of the end. But is perhaps the end of the beginning“
“There are many models that advance many probabilities,” said Asturian María Neira, WHO director of Public Health, yesterday in a interview with RAC-1. “They speak from a punctual regrowth to a significant wave, but this last possibility is increasingly discarded plus”.
In parallel, Hans Kluge, WHO director for Europe, has called on citizens to prepare for an even more deadly second wave of the virus next winter. Not just because of a return of SARS-CoV-2 in an insufficiently immunized population. “I am very concerned about a double wave” Kluge told ‘The Telegraph‘. “In the fall, we could have a second wave of covid and another of seasonal flu or measles.”
Please note that we are not talking about sporadic upturns like the ones we can see these days in regions that have eased confinement. We are talking about a cataract of contagions and deaths similar – or perhaps greater – to this one from which we have not yet emerged.
The precedents of the pandemic
It is very difficult to predict what will happen to this virus. In the beginning, epidemiologists observed the evolution of other coronaviruses to try to predict this close cousin. The closest, SARS, was declared content by WHO on July 5, 2003. It had reached 30 countries, infected 8,439 people and killed 812 before all transmission chains could be broken. SARS-CoV-2 currently carries 5,453,784 infections and 345,886 deaths around the world. It has no sign of being contained in the short term and has destroyed the records of all the precedents of its same viral family.
Therefore, neither SARS nor MERS serve as a crystal ball. Looking back and building on the behavior of pandemics that have plagued humanity for the past 250 years – most notably influenza, the virus that causes the flu – four leading American epidemiologists designed three possible scenarios for the course that SARS-CoV-2 it can take for the next two years. Because that is the first question: no one doubts that the coronavirus will continue in our lives until within, at least 18 or 24 months.
The first scenario involves a series of increases and decreases in incidence, of a magnitude similar to that which we have already suffered in Spain, which would be repeated in the spring and autumn of 2020 and 2021. second scenario is the one everyone fears And it represents a pattern identical to that of the 1918 Spanish influenza pandemic: a first warning (the one we are experiencing now) followed six months later by a catastrophic outbreak and much greater that, unfortunately, would not mean the end of the disease. The last and most improbable, according to the authors, is that after this blow the incidence of the covid-19 will gradually fade, consuming itself like a candle.
One of the authors of this report, published by the Center for Research and Policy on Infectious Diseases (Cidrap) from the University of Minnesota is Michael Osterholm, an epidemiologist who has spent years proclaiming to the four winds that this pandemic was going to happen. “People have to understand that we are at the beginning of the pandemic, that virus will continue to be transmitted through society, when it can, where it can and how it can”, recently explained. “We all hope that there will be a vaccine at some point, but hope is not a strategy.”
The models they propose are, in short, their ‘best guess’, the strongest guesses where can an illness happen given that the vast majority of the population remains devoid of immunity, and those who have it still do not know how long it will last.
When predicting the course of the current pandemic, “we cannot use influenza as an absolute model, it is probably a good model but we do not know for sure.” Model number 2 or ‘terror in autumn’ is mainly based on the behavior of major global influenza outbreaks —It must be remembered that, in addition to the Spanish flu of 1918, there have been other influenza pandemics in 1957, 1968 and 2009, so, although this time it is a different virus, it could follow the same pattern of swine flu 10 years ago, modest incidence in spring, apparent stoppage in summer and succession of major outbreaks in fall.
Or hybrid scenarios could occur, of one type in one area and another in others. “We cannot say for sure which of these scenarios is going to happen, but we can safely say that this virus will not stop spreading and he will not stop killing, “says Osterholm.
To be fair, we now have tools that we have not had in any past epidemic and that could help us avoid that terrifying scenario in six months. Stephen Moro, a researcher in human dynamics currently at the Massachusetts Institute of Technology, explains that “one of the main ingredients to understand the development of an epidemic and the possible strategies for containment is human behavior: where we go what sites we visit, if we move more or less … “.
Thanks to real-time mobility data Obtained from mobile phones, they are now working “both on a project in New York and a future one in Spain, in knowing where people meet, how they get together and how they have their contacts”, Moro details, “the good thing is that, as the disease has a development of several days, we can go ahead and know where they have contracted it: in that time, we can also monitor if people are gathering too much or there is something wrong. “
This, ideally, could root out any future covid-19 outbreaks and allow the world to get back to normal. The question is whether it will be on time. For the Spanish researcher, as the current situation is, “a second wave is inevitable“But we will be able to better control the time it comes and how it comes, we also know much more how the coronavirus spreads.”
What determines the size of the wave
Often, we tend to hear that citizens, maintaining hygienic measures or wearing a mask, can condition the future of this virus. Unfortunately, this is not entirely possible at the moment. Like in a rodeo, we are riding on the back of a runaway bull. We can try not to fall, but we cannot tell the bull where we want it to go.
Even doing everything right, the SARS-CoV-2 will knock on our door. But how strong? That part does depend on us.
Yamir Moreno, physicist and researcher in complex systems at the University of Zaragoza, is with Moro author of a recent ‘pre-print’ in ‘medRxiv’ that estimates the impact of social distancing measures, tests or ‘contact tracing’ could have an eventual second wave of coronavirus. “We did the study based on the city of Boston, and we saw that it would be enough to identify 50% of cases with symptoms and trace 40% of their close contacts” for the impact of that wave to go from dramatic to tolerable. Moreno adds that “the results of these measures could be generalized to other cities or countries, because they are associated with the dynamics of the disease, perhaps in another city instead of 50%, 45% will suffice, but in essence it is the same, to have an impact it is enough to do ‘contact tracing’ at the level 1, not even at level 3 as they do in South Korea, “where epidemiologists manage to identify even the neighbors of the neighbors of a positive for covid-19.
Moreno believes that predicting when there will be a second wave “is very difficult, because it has a lot to do with when people mix again and with what intensity of contact, so the temporal part is complicated, But that this wave is going to come? That’s a conceptual question. The only way to avoid this is for the population to acquire immunity. ”
“We still don’t know well how this virus behaves in terms of temperature or seasonal variations, we also do not know if it has a cycle and it will fall in the summer to reappear in the months of October and November, “explains epidemiologist Daniel López-Acuña, former director of WHO Health Action in Crisis.” If it behaves like other viruses respiratory, even like other coronaviruses, this is expected to occur, but there is no nobody right now who has a crystal ball, the hypothetical models do not stop being hypothetical models “.
The behavior of his cousin, SARS, was to go fading as heat arrived in the northern hemisphere, but while the theory has proven true for temperate regions, it is also evident that SARS-CoV-2 is now wreaking havoc in Brazil or Eastern Europe.
Top 10 countries with the most active cases
* Last update 05/24/2020
Source: John Hopkins University
For this reason, for López-Acuña, it is prudent “to deal with the hypothesis that the scenario that we may have in October or November is of a resurgence, the potential for recurrence and for a new epidemic cycle to occur It is very high now … But where is it going to happen and how? “Here will be another of the main keys. Perhaps next time it will not be northern Italy but the south. Or Denver instead of New York. it is the great unknown and what will determine to a good degree that the second wave is a storm surge and not a tsunami.
“If the cases occur in isolation in a country where rapid and reinforced containment of the virus is achieved, we may have an outbreak that is not of the same magnitude,” says the epidemiologist. “There may be thousands of cases, but if a sanitary cord is managed and all contacts are tracked, we can achieve what must be our main objective: stop community transmission”
But what could happen if those same cases occur in any country that have neglected primary care or not reinforced its sanitary structure, that there is not established a robust contact tracking system, that you have not implemented during that ‘transition’ technological solutions that alleviate or facilitate this detection work or that you have seen proliferate in your society a political divide that is entertained in the banal while preventing essential agreements, such as industrial plans from indigenous manufacture of essential ‘stock’ as individual protection materials or test reagents? What do you think could happen?
- Crowds on the terraces and large bottles on the street
(Video: The Country)