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We need to lift the block to prepare for a deadlier second wave in winter, writes JOHN NAISH

In November 1918, the San Francisco authorities thought they had reported the deadly Spanish flu pandemic that had spread around the world within months. The number of infections in the city was at its peak and then decreased to seemingly insignificant.

A whistle rang in the city center, marking the official end of four weeks of closure. Thousands of people tore off their mesh masks and trampled them as they poured onto the street. Bars and theaters opened their doors. The revelers ignored official calls to keep those masks.

Then a new wave of flu infections broke out that was far more deadly than what had happened before. It eventually left San Francisco by the spring of 1919 with one of the highest mortality rates in the United States.

History shows how pandemics for deadly diseases seem to have a habit of shrinking – but then suddenly returning in successive waves. Strangely enough, these last waves can be much more deadly.

History shows how pandemics for deadly diseases seem to have a habit of shrinking - but then suddenly returning in successive waves. Oddly enough, these last waves can be much more deadly (file photo)

History shows how pandemics for deadly diseases seem to have a habit of shrinking – but then suddenly returning in successive waves. Oddly enough, these last waves can be much more deadly (file photo)

While British authorities are trying to make a map to shut down Covid-19, infectious disease experts are trying to fathom the next step in the deadly coronavirus. Almost everyone agrees on one grim reality: that the infection will no doubt recur in a second wave.

For example, Professor Jonathan Van Tam, deputy chief physician for England, warned during the government’s daily briefing last week that the virus “will definitely come back.”

But what will that second wave be like? When does it strike? And can we do something to tone down its deadly edge? As an expert – Simon Clarke, an associate professor of cellular microbiology at the University of Reading – told Good Health, “All of these essential questions are at best the subject of substantiated guesswork.”

However, history gives us terrifying lessons, in the form of the pandemics of the Spanish flu and before that the Russian flu, which swept the world in the late 1800s and early 1900s.

For example, last week Professor Jonathan Van Tam, deputy chief physician for England, warned during the government's daily briefing that the virus will 'definitely come back'

For example, last week Professor Jonathan Van Tam, deputy chief physician for England, warned during the government's daily briefing that the virus will 'definitely come back'

For example, last week Professor Jonathan Van Tam, deputy chief physician for England, warned during the government’s daily briefing that the virus will ‘definitely come back’

Most notorious is the 1918 Spanish flu that infected a third of humanity – 500 million people worldwide – and killed some 50 million people.

Still, the first wave in the spring of 1918 seemed to be just a more contagious and virulent form of seasonal flu. It quickly spread through England, France, Spain and Italy.

Fortunately, symptoms such as high fever and illness usually lasted only three days. The death rate was comparable to seasonal flu, with less than 1 percent.

Business dropped out in the summer. In August, it seemed that the infection had started. Instead, the flu turned into a vicious strain that could kill healthy young men and women within 24 hours of the onset of symptoms.

When the war ended, thousands of British Imperial and American troops returned home carrying the deadly contamination. The second wave of the Spanish flu pandemic began.

The second wave’s global death toll is still disputed, although experts generally agree that it killed about ten times more than the first.

The infection was characterized by pneumonia filling their lungs with suffocating fluid.

Decades later, doctors realized that these symptoms could be caused by a cytokine storm – a massive overreaction in the patient’s immune system that causes catastrophic inflammatory damage to their lungs. Such storms are now considered a common cause of death with Covid-19 infection.

The same symptoms had also killed more than 130,000 Britons during the Russian flu pandemic a quarter of a century ago. The infections also came in waves.

The first wave arrived in Britain in December 1889, killing about 27,000 people and keeping the prime minister, Lord Salisbury, on his bed for two weeks. This wave started to subside in February 1890.

The second wave, a year later, proved much more deadly, killing 80,000. Worryingly, there was a third outbreak in 1892, which killed 25,000 people.

The idea that herd immunity could protect us from a second wave of Covid-19 is rejected by Mark Honigsbaum, a medical historian at the City, University of London, and the author of The Pandemic Century, who says evidence of these flu pandemics indicates that it is not feasible.

SOCIAL MEDIA MYTH BUSTER

We unmask the Covid-19 hoaxes that circulate online. This week: the use of mouthwash prevents coronavirus

A social media post publishes claims’ you can gargle with disinfectant solutions [such as those in mouthwash] which eliminate or minimize the amount of virus that can enter the throat. This removes the virus before it goes to the windpipe and then to the lungs. However, this is nonsense, says dentist Sunny Sihra of Simply Teeth in Essex. “Mouthwash is antibacterial – there is no mouthwash that I know is known to kill a virus,” he says.

Viruses and bacteria behave in completely different ways. Mouthwash is generally good for oral hygiene, but using mouthwash does not help with coronavirus – it is critical that it is generally injected into your lungs through your nose. ‘

It is currently thought that to achieve herd immunity, where enough people in a community have resistance to a virus or bacteria, it is no longer spreading. About 60 to 80 percent of the population must have been exposed to the virus and have therefore developed natural immunity. But that may not be possible with Covid-19, says Mr. Honigsbaum. “Historically, influenza pandemics have seen a significant population of people have had some immunity, because they had previously been exposed to flu viruses that are sufficiently similar to the pandemic virus so that their immune systems can recognize it as an enemy,” he says.

However, no one has prior immunity to this new coronavirus because it was not there before. In addition, we don’t know if people who have recently recovered from it are immune. ‘

And as seen with previous flu pandemics, even if large numbers of people are infected, that’s still not enough to keep the virus from returning in a second wave.

He adds, “While up to 80 percent of the population must have been exposed to the coronavirus to develop herd immunity, no more than a third of the UK population has ever fallen ill during a pandemic.” This means that livestock immunity appears statistically impossible.

Dr Shovonlal Roy, an associate professor of ecosystem modeling at the University of Reading, is equally skeptical about building herd immunity to Covid-19 – not least because it appears that the block affects most people exposed to the virus stopped.

“While we have no confirmed idea of ​​how many people have developed immunity, the numbers seem far too low to develop any kind of resistance at the community level,” he told Good Health.

Indeed, the World Health Organization reported earlier this month that studies indicate that only about 3 percent of people have been infected with Covid-19 so far.

“Lockdown doesn’t remove the virus from the population,” Dr. Roy warns. As soon as you release the block, the virus transmission returns. My statistical modeling suggests that a second wave will be more serious, because while the first wave was brought in by only a few foreign travelers, for the second there will be a significant number of already infected people in the UK for it to be in the population. ‘

As for when that second wave will strike, Professor Carl Heneghan, an epidemiologist at the University of Oxford, told Good Health that he is now sure it will come this winter.

As for when that second wave will strike, Professor Carl Heneghan, an epidemiologist at the University of Oxford, told Good Health that he is now confident it will come this winter

As for when that second wave will strike, Professor Carl Heneghan, an epidemiologist at the University of Oxford, told Good Health that he is now confident it will come this winter

As for when that second wave will strike, Professor Carl Heneghan, an epidemiologist at the University of Oxford, told Good Health that he is now confident it will come this winter

“We know that other coronaviruses are usually seasonal, and respiratory infections are generally seasonal,” he says.

In addition, the available evidence suggests that warm temperatures and humidity suppress the virus.

“You can see this by comparing the low contamination levels in warm Australia and New Zealand [which last week declared it had almost eliminated Covid-19], with spiral in cold New York and London.

“About 75 percent of Covid-19 deaths are currently in Northern Hemisphere countries,” adds Professor Heneghan. The most plausible explanation is that the contamination works seasonally. This was also noted in 2002 with the outbreak of SARS [a similar virus].

This means the virus may disappear in the Northern Hemisphere in July. As with Spanish flu, it can change between the Northern Hemisphere and Southern Hemisphere – moving south in our summer and returning in winter, following the pattern of the cold seasons. ‘

Professor Heneghan urges the UK authorities to start opening up the economy as soon as possible to help fight a second wave.

“We have to respond quickly to get society going,” he says. “I would open earlier than later. If our economy fails as we go into winter, we will face fiscal and logistical challenges to fight the resurgence of the virus. ‘

Professor Heneghan emphasizes that, in order to facilitate early termination of the blockage, the government should rapidly increase its test and contact tracking (which begins by contacting anyone who tests positive for Covid-19, then track that person was in contact with, and then test them).

An NHS app to do the job should initially be tried out on the Isle of Wight, with every resident there being asked to download it this week before launching nationally. However, it is not without its problems – some fear it may violate people’s right to personal privacy as the government will have a database of each user’s whereabouts.

The app works by automatically creating a list of the people we come in contact with and using the signal on our smartphones to identify other phones nearby. If any of the people on that list are identified as infected, the app should notify us immediately.

Meanwhile, the prospect of a second wave in winter poses another danger: that it may coincide with the flu season. Both epidemics happening simultaneously can cause “unimaginable tensions” in health care, said Robert Redfield, director of the U.S. Health Service, the Centers for Disease Control and Prevention.

Professor Heneghan says that while NHS leaders urgently need to plan for the second wave of Covid-19, he adds, “We must also recognize that it is very difficult to predict what the second wave will be. Viruses can weaken and become much less severe.

“The best we can do is to focus on what is happening and what we can do to help the victims of the current wave.” A similar piece of advice – that we should accept the deep uncertainty about the second wave and the work in it – comes from Professor Clarke.

“The closure didn’t put us in a different place,” he says. “The virus is spreading in the population just as much as it was three months ago.

“You have to suppress the possibilities of spreading the virus from person to person. How that is done can only involve trained guesswork.

“The virus has only been around for four or five months, which is an instant in infectious disease research,” said Professor Clarke. “The decision to lift the lockdown cannot be fact-based. Instead, there should be a series of deliberate guesses. ‘

Relief from the threat of further waves of Covid-19 infection comes only in the form of a vaccine. Until it arrives, we can only hope for the best – and prepare for the worst – in the shadow of the threat of the second wave of Covid-19, if it reappears early in winter.

Professor Clarke says, “It must be clear that whatever the consequences of leaving the lockdown is no one’s fault. This is what we are dealing with. ‘

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