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Year : 2020  |  Volume : 8  |  Issue : 3  |  Page : 73-74

The second wave of COVID-19: What can be predicted from the literature till now?

Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission18-Feb-2021
Date of Acceptance24-Feb-2021
Date of Web Publication10-May-2021

Correspondence Address:
Dr. Rimjhim Kanaujia
Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpsic.jpsic_6_21

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How to cite this article:
Biswal M, Angrup A, Kanaujia R, Ray P. The second wave of COVID-19: What can be predicted from the literature till now?. J Patient Saf Infect Control 2020;8:73-4

How to cite this URL:
Biswal M, Angrup A, Kanaujia R, Ray P. The second wave of COVID-19: What can be predicted from the literature till now?. J Patient Saf Infect Control [serial online] 2020 [cited 2023 Feb 9];8:73-4. Available from: https://www.jpsiconline.com/text.asp?2020/8/3/73/315746

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus rapidly spread globally in the first half of 2020 since the first case was reported in Wuhan on 31st December 2019. As a response, many parts of the world were under either partial or complete lockdown. This, however, resulted in immense economic losses and other collateral damage forcing many countries to open up again. Leung et al. at that time had predicted a second surge of COVID-19 if these lockdowns were relaxed prematurely.[1] Truly enough, after an initial decrease, the number of cases surged again in the many regions of the world.[2] This is very marked in the European countries.[3] Even though the availability of vaccine is becoming a reality, the adherence to the preventive measures and understanding the epidemiological pattern of the ongoing second wave is imminent to protect the population until herd immunity is achieved.

Some lessons about the course can be drawn from previous pandemics that have hit us. If we go back in history, the 1918 Spanish flu pandemic, which has been called the 'greatest medical holocaust in history', presented in a total of three waves, starting in March 1918 and subsiding only by the summer of 1919.[4] The pandemic peaked in the U. S. during the second wave in the fall of 1918. While the first and third waves were fairly mild, the second wave resulted in huge global losses, with deaths reaching into tens of millions. The trend of the second wave was visible in few countries. In a study by Vuong et al., the number of critical cases in the second wave was significantly higher than the first wave.[5] The natural history of pandemics suggests that pandemics are not abruptly eradicated. There is evidence now that the COVID-19 pandemic is following a similar route in terms of the epidemiological pattern. The first wave of COVID-19 pandemic brought a wave of social isolation, disrupted services and global economy crisis. The so-called second wave has been predicted since April 2020 by Leung et al. who warned that premature relaxation of public movement restrictions would lead to a surge in cases after a decline.[1] This prediction has been borne out to be true in many countries.[3],[5],[6],[7]

There are marked differences in the epidemiology, demographics and outcomes of the disease that have been reported in the two phases in various studies. Long et al. reported that patients affected in the second wave were significantly younger and suffered from fewer co-morbidities.[7] Gautret et al. noted a significantly lower hospitalisation rate and proportion of sick patients transferred to the intensive care unit.[3] The lethality rate was ten times less in the second phase from 1.1% to 0.1%. Lymphocyte, platelet count, fibrinogen and D-dimer levels were also significantly lower. In South Korea, Shim et al. noted an increase in the mean doubling time of cases from 3.6 to 10.1 days with the reproduction numbers exceeding 3.0 in the second wave.[6] In Vietnam, the proportion of critical cases requiring extracorporeal membrane oxygenation or ventilator raised 1.2%–10%. From the findings were different where the proportion of critical cases was more than 10%.[5]

To study the genetic changes that are causing these differences in the clinical presentation, Long et al. performed the analysis of the molecular architecture of SARS-CoV-2 belonging to the two infection waves in Houston, Texas.[7] Virtually, all strains in the second wave had a Gly614 amino acid replacement in the spike protein. Patients infected with the D614G variant strains had significantly higher virus loads in the nasopharynx on initial diagnosis. This polymorphism is hypothesised to be linked to increased transmission and infectivity in the second wave, along with other factors such as relaxation of some of the social constraints, the celebration of Memorial Day and July 4th holidays and imposed during the first wave.

Many theories in the past have been given regarding the different waves in the 1918 flu. One study has stated the waning herd immunity may be for the reason of next wave.[8] The trial of herd immunity was used as a defence startegy in the United Kingdom and the strategy failed. Furthermore, countries reported a second rise of cases when the community lockdown was lifted.[9] Another study stated that differences in the temperature and humidity played a significant role in influenza transmission. Furthermore, human behavioral responses such as restriction of human contact patterns affect infectious disease transmission.[10] Before drawing final conclusions, it has to be emphasised that all these studies have reported the situation till the middle of August. As in the study by Gautret et al., the authors have noted that the case fatality rate had risen to 0.8% by the end of September, which is comparable to the first wave. It is possible that the scenario might change as more data about the later phase of the second wave emerges. In a modelling study by Griffiths et al., tracing and isolation of the contacts and increased testing of individuals can prevent the rebound of the second wave.[11] Optimal guidelines are required for testing the individuals. Initial testing with low cost and rapid antigen test should be done.[12] Hence, to conclude, although the overwhelming literature till now suggests that generally younger patients without co-morbidities are becoming diseased and that even their clinical course is milder, we cannot become complacent. COVID-19 is nowhere near over. We should continue taking rigorous precautions such as wearing masks, physical distancing and hand hygiene.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Leung K, Wu JT, Liu D, Leung GM. First-wave COVID-19 transmissibility and severity in China outside Hubei after control measures, and second-wave scenario planning: A modelling impact assessment. Lancet 2020;395:1382-93.  Back to cited text no. 1
WHO Coronavirus Disease (COVID-19) Dashboard | WHO Coronavirus Disease (COVID-19) Dashboard. Available from https://covid19.who.int/. [Last accessed on 2020 Oct 14].  Back to cited text no. 2
Gautret P, Colson P, Lagier JC, Camoin-Jau L, Giraud-Gatineau A, Boudjema S, et al. Different pattern of the second outbreak of COVID-19 in Marseille, France. Int J Infect Dis 2021;102:17-9.  Back to cited text no. 3
CDC. 1918 Pandemic Influenza: Three Waves | Pandemic Influenza (Flu) | CDC. 2019. Available from: https://www.cdc.gov/flu/pandemic-resources/1918-commemoration/three-waves.htm. 20. [Last accessed on 2020 Nov 17].  Back to cited text no. 4
Vuong NM, Le Quyen NT, Tra DT, Do Van T, Tuan NQ, Co DX, et al. The second wave of COVID-19 in a tourist hotspot in Vietnam. J Travel Med 2020;28.  Back to cited text no. 5
Shim E, Tariq A, Chowell G. Spatial variability in reproduction number and doubling time across two waves of the COVID-19 pandemic in South Korea, February to July, 2020. Int J Infect Dis 2021;102:1-9.  Back to cited text no. 6
Long SW, Olsen RJ, Christensen PA, Bernard DW, Davis JJ, Shukla M, et al. Molecular architecture of early dissemination and massive second wave of the SARS-CoV-2 virus in a major metropolitan area. medRxiv 2020;11:e02707-20.  Back to cited text no. 7
Mathews JD, McBryde ES, McVernon J, Pallaghy PK, McCaw JM. Prior immunity helps to explain wave-like behaviour of pandemic influenza in 1918-9. BMC Infect Dis 2010;10:128.  Back to cited text no. 8
He D, Dushoff J, Day T, Ma J, Earn DJ. Inferring the causes of the three waves of the 1918 influenza pandemic in England and Wales. Proc Biol Sci BMJ. 2020;368:m1284.  Back to cited text no. 9
He D, Dushoff J, Day T, Ma J, Earn DJD. Inferring the causes of the three waves of the 1918 influenza pandemic in England and Wales. Proc R Soc B Biol Sci 2013; 280:20131345. Available at: https://royalsocietypublishing.org/doi/10.1098/rspb.2013.1345. [Last accessed on 2020 Dec 29].  Back to cited text no. 10
Panovska-Griffiths J, Kerr CC, Stuart RM, Mistry D, Klein DJ, Viner RM, et al. Determining the optimal strategy for reopening schools, the impact of test and trace interventions, and the risk of occurrence of a second COVID-19 epidemic wave in the UK: A modelling study. Lancet Child Adolesc Heal 2020;4:817-27.  Back to cited text no. 11
Candel FJ, Barreiro P, Román JS, Abanades JC, Barba R, Barberán J, et al. Recommendations for use of antigenic tests in the diagnosis of acute SARS-CoV-2 infection in the second pandemic wave: Attitude in different clinical settings. Rev Esp Quimioter 2020;33:466-84.  Back to cited text no. 12


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