How we avoid a second corona wave

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The relaxation of the measures to curb the spread of the coronavirus has not led to a new rise in the number of infections. Virologists are beginning to hope that a second wave can be avoided with the right measures. Ski plans and New Year’s Eve parties are better in the fridge.

aIf we’re being honest, we have to admit that things may look better than we and the experts expected at the moment. ”It was somewhat lost due to the many easings Prime Minister Sophie Wilmès (MR) announced Wednesday after the National Security Council But the Prime Minister pointed out that, to many people’s surprise, we got the coronavirus smaller than we thought. Although there is extensive testing, fewer than 100 new corona cases have been added daily since Tuesday. Friday there were 140 more. But at peak times in early April, there were 2,000 new cases a day. The number of patients in the hospital has shrunk from more than 6,000 on April 7 to 700 on Friday.

10,000

Death
Nearly 10,000 Belgians were killed by the corona virus

A hundred days after Covid-19 has started circulating in our country, we can say that the first wave of the epidemic has erupted. “These great results are the result of the collective effort of all of us,” said Wilmès. Although there is a jet black downside: almost 10,000 people lost their lives because of the corona virus and the lockdown, which was necessary to get the virus small, leaves deep economic and in some also psychological traces. To put it in the terms of war that some politicians liked to use at the beginning of the epidemic, the first battle was won, but it cost blood, sweat and tears.

The lockdown prevented the rapid spread of the virus and prevented hospitals from coping with the influx of patients. In May, the situation had stabilized sufficiently to allow all businesses and shops to reopen and social life to proceed cautiously. On Monday the cafes and restaurants are also open again and people outside their family can see up to ten others every week. As yet, there is no question of a feared outbreak of the virus. “That’s what we hoped for, but we didn’t have certainty,” says virologist and national corona fighter Steven Van Gucht. “If Wilmès says it looks better than we expected, she probably means that.”

Second wave

Due to the new easings, the number of daily infections may increase again. But there is no major fear of a rapid second wave, once again going to more than 1,000 infections a day. So far, there is no example of a country that reversed the corona measures and where the virus quickly swept around again. “Everyone is now a virologist. People know what is and is not and they adjust their behavior, which makes the virus less likely to spread, “says Van Gucht.

Covid-19 has a number of properties that allow it to advance quickly in normal situations. Patients are infected up to two days before they develop symptomsUgly and others don’t even develop symptoms, often causing the virus to be passed on unconsciously. It differs from previous deadly coronaviruses: SARS and MERS. With the SARS virus, patients are only contagious when they develop symptoms, making it difficult for the virus to spread unnoticed. MERS, on the other hand, is very deadly, but unlike corona, quite intense contact is required to transfer it.

Nevertheless, we have managed to get Covid-19 small for the time being. Because we have less physical contact, the number of people in the supermarket is limited and we wear masks on public transport, we have created barriers. In March society, the virus could quickly spread again, which has become much more difficult due to those barriers. Above that there may be a summer effect. The virus may not thrive in good weather and sunlight quickly kills the virus, but it is not clear how important that is.



A Japanese study shows that the risk of becoming infected is 19 times higher in indoor areas than outside.

It is certain, however, that the virus does not spread as quickly outdoors, where we like to stay in good weather. A Japanese study shows that the risk of becoming infected is 19 times higher in indoor areas than outside. The virus circulates through relatively large drops of saliva, which fall to the ground within 1.5 meters. These are mainly spread through sneezing or coughing, speaking loudly or singing. But it can also travel through smaller drops, called aerosols, that float in the air. In poorly ventilated areas, people can become infected by inhaling them. Outside, that contaminated air is diluted by the wind, which drastically reduces the chance of an infection.

Now that the virus is under oppression, some virologists are striving to deliver the final blow. This can be done, for example, when 100 people are infected every day, by opting for a hard two-week lockdown in which everyone has to stay at home. But according to Van Gucht, that makes little sense. “In veterinary medicine, you can try to eradicate a virus that euthanizes animals that do become infected to avoid infecting others. You can’t do that in humans. “

Belgium is not an island. Even if the virus were to be eradicated after a hard lockdown, it would soon return from abroad. Closing the borders completely for months would be economic suicide. “We have to live with the virus being present in our society, but we have to try to keep it as small as possible,” says Van Gucht. In addition to keeping a distance, intensive testing and tracing contacts of infected people and isolating them is crucial to avoid a new outbreak.

Contact tracing

The regions have set up so-called contact tracing for this. Those who test positive are called and asked about their contacts. Those people are then contacted, asked to isolate themselves and have them tested. The system still has some teething problems. Infected patients are reluctant to share their contacts. Partly because they are afraid to admit that they have seen more people than they should, partly because they want to avoid quarantining their contacts. “It is still a bit of a search for the best approach,” Van Gucht admits.



London researchers assume that 80 percent of the infections were caused by barely 10 percent of the cases.

What makes the corona virus special is that it spreads through clusters. Scientists assume that someone with corona infects two to three others. But that’s an average. While many people do not light anyone, others infect tens of people. Researchers at the London School of Hygiene and Tropical Medicine and the Alan Turing Institute assume that 80 percent of the infections were caused by barely 10 percent of the cases.

These are super spreaders who infect many people at once during busy events such as a festival, a church service or a football match. A South Korean example shows how it works: one woman, through a few visits to a church of the Christian Shincheoij sect, was at the root of half of the first 500 coronation cases in the Asian country. There is also a more recent German example. Since last month, church services are again allowed under certain conditions. However, during a mass of the Baptist faith community in Frankfurt, the mandatory masks went off and believers started to sing. More than 100 infections resulted.

Clustering is a problem because it causes the virus to spread explosively. But it also offers an opportunity: if super-spreading moments are curbed, the virus can be combated quite efficiently.

For this reason, no festivals take place in July and August and they also become groupsactivities as much as possible. But moments of super diffusion cannot be completely ruled out, because even during a church service or a restaurant visit, one visitor can infect a large group of people. If that large group infects a series of others in the next phase, the virus can quickly regain its strength.

Mini lockdown

It is therefore important to immediately intervene drastically. It is the approach that Japan, which has fewer than 1,000 corona deaths, has applied successfully since the onset of the crisis. If someone tests positive who was involved in a potential superspreading event, all attendees are immediately asked to isolate themselves. This is necessary because those who do not (yet) have any symptoms can pass on the virus. Call it a mini lockdown, which is used to avoid a later lockdown from across the country.

In this sense, it is not reassuring that the National Security Council dropped the obligation to register customers of bars and restaurants, which is mandatory in Germany. It makes it almost impossible to identify potentially infected people.

Professor Steven Van Gucht
© James Arthur

Van Gucht speaks of a government error. “Leaving a name and a telephone number is not such a big effort, is it? But it does mean that we can switch quickly in the event of a contamination risk. “

In the fight against super dispersers, Flanders is examining whether mobile teams of corona hunters can be established. If there is a possible superspreading event, they will visit, for example, the restaurant, the banquet hall or the church where the infections took place. An attempt is then made with the owner to identify as much as possible who was present when the infected person was walking around. Flemish Minister of Welfare Wouter Beke (CD&V) confirms that he is preparing those mobile teams, but does not want to provide any further information.

Apps can also play a role in this. If people who go to a restaurant, take public transport or come into contact with many others in the workplace can be convinced to register with whom they come in contact via an app, they can be easily alerted if it turns out that they are with someone who have tested positive for corona.

In an opinion piece, Frank Robben, the head of the federal e-health platform, the architect of the most important digital health applications in this country, pointed out the importance of this on Friday. The possible roll-out of such an app has been delayed.

In his heavily listened podcast, well-known German virologist Christian Drosten said that if we manage to avoid further infections after super-spreading events, we may also be able to stop a second wave of the virus. Van Gucht is on the same line. “Our behavior has changed and we now know more about the virus than in March. It will be a tough job, but I believe there is a chance that there will not be a second wave before hopefully a vaccine will be available early next year or we have medicines available. “

Great test

The big test comes in the fall and next winter. We then crawl closer together inside, which increases the chance of infections. Many people will also catch common colds or the flu again, with symptoms often the same as corona, leading to confusion.

Anyone who has symptoms should stay at home. This requires a culture change, which will have a major impact on the companies that will have to make do with significantly fewer people at times.

The end-of-year celebrations, traditionally the beginning of the annual flu peak, are certainly a risk. People sit close to each other, kiss and hug each other and sometimes drink a glass too much, making it difficult to keep their distance. The same happens in the ski stations, traditionally breeding grounds for viruses.

Because people are so close together in ski lifts and in the après ski bars, ski trips make a disease as rare as measles return to our country every year. It is also from the northern Italian and Austrian ski stations that the coronavirus was able to spread all over Europe in early March.



The hair on my arms straightens when I think about those ski stations. We will have to think again about skiing next winter.

Steven Van Gucht

Virologist

“The hair on my arms stands up when I think about those ski stations,” says Van Gucht. “While I think the all-inclusive holidays in a hotel in Southern Europe will not necessarily lead to an outbreak of the virus this summer, it will inevitably be the case with the ski holidays. We will have to think again about skiing next winter, just like about the end of year celebrations. They are potential super spreading events that can do a lot of damage. “

The rock-hard reality is that the virus is not gone, it has only been temporarily reduced. If given the chance, it will inevitably start spreading again. We saw in March and April how quickly that can happen and how dangerous it can be. But by adjusting our behavior and quickly isolating potentially infected people, we may be able to avoid a second wave. Now that we can go on holiday this summer, it is a pleasant thought.

But that thought also poses a danger, because it threatens to lead to complacency. That is dangerous, because if too many people revert to their old habits, the second wave will come.

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