The curve has been flattened, nay crushed, and we’re slowly getting back to normal.
But we’re left with the fear that all the hard work we’ve done could be undermined by a second wave of the coronavirus pandemic.
This week, Australia has registered more than triple the locally-acquired cases of the previous week, and almost all of them are in Victoria.
In the past seven days there were 21 community transmission cases where a source of infection can’t be found, up from just six the week before, although health authorities may yet find a source for some of these.
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A big second wave of infections isn’t inevitable, but the possible consequences could be huge, and it’s worth doing as much as possible to avoid it.
So how would we know if Australia is about to start rising up another curve?
Facing a second wave
That’s precisely what occurred in the last global pandemic on this scale: the 1918 Spanish Flu pandemic. Its second wave was more severe than the first outbreak.
But that doesn’t mean we should expect the same thing this time around.
Associate Professor Hassan Vally from La Trobe University says there are some big differences between the influenza virus and SARS-CoV-2, the virus that causes COVID-19.
The second wave of the Spanish Flu outbreak was more deadly than the first.(State Library of Queensland)
We know that influenza viruses prefer winter, and they also mutate much more dramatically than SARS-CoV-2.
“For the Spanish flu, what you saw was the seasonal effect of the virus actually disappearing,” Dr Vally says.
“Then it came back and what people speculate is that it had taken a pretty significant mutation… [it] was more virulent and caused all of the damage.”
SARS-CoV-2 has not been mutating anywhere near as quickly.
“So what people are referring to as a second wave here is not actually a second wave,” he says. “It’s not going to disappear and then come back in a different form, the way influenza does.”
That makes things a little more predictable, but it doesn’t stop the possibility of a resurgence.
Iran the first country to see a second peak
After an early outbreak, Iran is already dealing with a deadly second wave.(AP: Vahid Salemi)
Iran was one of the earliest global hotspots in this pandemic.
The virus never completely receded from the country, but new infection numbers did dip as low as 800 a day in early May, before surging again. Testing rates are higher now, but not by enough to solely account for the increase in cases.
The upward surge began less than two weeks after shopping malls and bazaars reopened and travel restrictions between provinces were lifted. There has also been a spike in COVID-19 deaths in Iran this week.
In Australia, it helps that infections were down to a trickle when restrictions started to be eased. Iran’s best day in the pandemic still saw far more cases recorded than on Australia’s worst.
The more a virus has spread within a community when shutdowns end, the higher the chance of a second serious outbreak.
Nonetheless, the Federal Government has been desperate to avoid a new wave of infections, fearing both the public health cost and the damage it will do to businesses that have already endured lengthy shutdowns.
Where many countries are now trying to cope alongside the virus, Australia wants to keep it suppressed.
The warning signs
Dr Katherine Gibney from the Doherty Institute and Royal Melbourne Hospital says the chance of a resurgence will increase if community transmission rates pick up.
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“When there are a lot more cases, and a lot of them don’t have an identified source, is the time that you’d think there’s a lot of transmission going on in the community that you haven’t detected,” Dr Gibney says.
“At the moment I definitely don’t think we’re there.”
The country-wide slowdown bought health authorities important time to build testing and hospital capacity. That vastly improves the country’s chances of catching the further outbreaks before it is too late.
But of course all outbreaks start somewhere, and Australia has seen a small lift in locally-acquired cases this week.
Spotlight on Victoria
Most of Australia’s cases are being imported from overseas, but Victoria in particular is still uncovering cases of community transmission.
Victoria’s public health authorities have conceded the higher levels of community transmission do make them “nervous”.
Why are cases in Victoria increasing?
The exact reason why the state is recording more cases than the rest of the country is hard to pinpoint, but returned travellers are at least part of the equation.
“We remain vigilant, we would rather have less cases than we are having,” Victoria’s Deputy Chief Health Officer Annaliese van Diemen said yesterday.
“We’re hoping not to have a second wave, we’re hoping to be able to continue with our suppression strategy for as long as we need to.”
Some community transmission is to be expected, but the state hopes this week’s numbers will stabilise.
“If we have case numbers like we’ve had in the last couple of weeks bubbling along that would be manageable,” she said.
More restrictions are due to be lifted in the state on Monday.
Minister Jacinta Allan says a further easing of restrictions in Victoria is still planned for Monday.
“We’re monitoring the data on an hourly basis, we’re keeping a really close eye on the numbers, taking the careful advice from the Chief Health Officer,” Victorian government minister Jacinta Allan said yesterday.
“If there’s any change to those restrictions we’ll give that information to the Victorian community as quickly as we can,” she said.
Dr Vally says we’re at “constant risk” of a resurgence.
“If this continues the way it’s going and gets bigger, then we may have to adjust our restrictions or work out what’s going on,” Dr Vally says.
“But I wouldn’t say I’m concerned. Now that we’ve got some level of control of the virus, we basically have to have really good surveillance.”
Teams of contact tracers quickly uncovering clusters will be key to staying on top of the situation.
“We’re still in a vulnerable position because the only way we’ve exerted control over the spread of the virus is not by people getting immunity, and it’s not been through a vaccine,” he says.
That’s why the international borders are staying closed to non-citizens and permanent residents, at least for now.
China’s border dilemma
Beijing’s outbreak has been traced to the sprawling Xinfadi wholesale food centre.(AP: Andy Wong)
If China hadn’t reopened its borders it probably wouldn’t now be reimposing restrictions in parts of Beijing.
An apparent outbreak centred on a seafood market could spark a new wave, and it’s being treated extremely seriously. China believes the outbreak started with a case imported from Europe.
The entire country is still recording fewer than 60 cases a day but this is a notable spike for the capital, which hadn’t previously been severely hit by the virus.
In part because of the number of people that trade at the market it’s more than 20 times the size of the now-infamous wet market in Wuhan spread of the virus is difficult to track.
Schools have been shut and most flights to Beijing have been cancelled. A lot of countries will be watching closely how the Beijing outbreak is handled.
“France and the UK are now lifting quite a lot of restrictions [and] they obviously still have quite a lot of virus around,” Dr Gibney says. “I think they’d be a bit nervous.”
A second wave would have big consequences
There is a very big incentive for Australia to try its hardest to avoid a new round of infections.
If the country was to see an increase in the spread of the virus, it could mean slowing the speed we return to normality, or in the more extreme case, the reimposition of restrictions.
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That would undoubtedly be a big blow to confidence. But Dr Vally says the resilience of Australians shouldn’t be underestimated.
“With things like modelling, the biggest variable is the unpredictability of human behaviour,” he said.
“One of the lessons to take away from this is how resilient Australians have been, both in taking up the public health messages and acting on them.
“We’ve just got to keep people’s hopes up, and keep them understanding that by doing the things we’re doing, we’re saving lives.
“I think if we all started to see lots of cases, that would be a huge motivator for people to just buckle down, and we do know it’s not going to be forever, even if it feels like it.”
New restrictions could further devastate the economy
Scott Morrison says he’s devastated by the job losses
More than a fifth of the labour market is now unemployed or underemployed, and the Federal Government is warning the job figures are likely to worsen further before they improve.
Would businesses which have survived up to now be able to survive a second slowdown? Economics Professor Richard Holden from the University of New South Wales says a resurgence would be “really bad”.
How bad? It depends.
“There’s one version where restrictions remain exactly as they are and the proposed relaxations continue as they are, but that people just get nervous and they want to congregate less,” Dr Holden said.
“There’s a little bit of a pullback and a sort of mini lockdown. That would be bad for businesses, particularly the ones that are just starting to get back to something closer to normality.”
The “next to worst version”, he said, is it delays the relaxation timetable. “And then the worst of all is we have to go backwards in terms of lockdown, and that would be really dramatic.”
Dr Holden said extensions of public health measures would put businesses that have thus far handled the supply shock under more strain.
“There are going to be more people that are incapable of riding that out. We’re still then faced with very high unemployment, even higher underemployment,” he said. “Confidence is still damaged.”
If the JobKeeper program ends before businesses are ready to stand on their own feet, unemployment rates could be forced even higher. An extension to restrictions would also delay the recovery of other sectors that are yet to see much activity resume.
“International trade is still under a cloud, sectors of the economy like tourism and university education, and performing arts and others are still not really back to normal.”
Many countries are still in their first wave
Australia’s situation is dramatically different from many countries overseas, many of which are still in their first wave.
“We’re relaxing restrictions when we’ve seen a huge suppression in virus transmission, but in the US and in the UK, they’re kind of relaxing things before they’ve really got control over virus spread,” Dr Vally says.
New infections are growing again in the United States, largely in states in the south that didn’t see large epidemics in March and April.
“If we’re in any doubt that what we’re doing is worthwhile you just have to look to these other countries,” Dr Vally said.
“There’s no reason why we couldn’t have been the US or we couldn’t have been Italy.
“The only difference is we’ve acted really decisively as a country, and we’ve saved thousands of lives.”
What you need to know about coronavirus:
The curve has been flattened, nay crushed, and we’re slowly getting back to normal.