The ‘second’ wave (the first part)

A lot changed across the UK (and indeed Europe and the world) in the last week that may leave many people very worried… I’d like to apologise for the delay in this post about second waves, this has been one of the hardest things I’ve ever had to write because I know I’m not an expert virologist or Mystic Meg – I can’t predict the future.

However, what happened in the UK was actually pretty predictable. Not because we are out of control or run by idiots (we may be, but recent events don’t prove it…), but because I think that this was exactly what needed to happen… In fact this was probably the plan, but perhaps not in the way you may think.

<p class="has-text-align-justify" value="<amp-fit-text layout="fixed-height" min-font-size="6" max-font-size="72" height="80"><strong>Take home message: No, we are not doomed to a second COVID-19 wave like the last one. At least not yet. And now more than ever, we have to back our leaders and continue to pull together to get through this. </strong>Take home message: No, we are not doomed to a second COVID-19 wave like the last one. At least not yet. And now more than ever, we have to back our leaders and continue to pull together to get through this.

There’s a lot to unpick, and much will be building on ideas from my previous posts. So deep breath, and let’s dive in…

The ‘second’ wave

There’s a lot of debate between experts around the term ‘second‘ wave, especially if we may not be out of the ‘first‘ wave. For those of us just trying to understand what the hell is going on, I’d say it doesn’t matter if we call it the ‘first’ or ‘second wave. If your ship is sinking, do you really care about the number of the wave that sinks you?…

Even if the band played as the Titanic sank, no one was counting how many bits broke off the iceberg…

What we’re probably more interested in is the question:

“Is the same thing that happened in February/March about to happen again?”

Short answer, in my opinion: no.

Post 6 explained why the first sign of a second wave for the general public will be an increase in case numbers. If you still have any doubts about this, let’s look at the US. Certain people would say that the increase in case numbers in the US is just due to more testing:

Thanks to Google and Twitter for these.

As explained in Post 4, if increased testing may affect the number of COVID-19 cases, we can just divide the number of positive tests by the number of total tests to see if COVID-19 is spreading (the % positive tests). In fact, we don’t even have to do the math(s) now… We can just look it up here:

Credit to Our World in Data (it’s a really useful site and this can be done for any country – check it out here)

So the cases and % positive tests both started increasing on June 15th. On July 4th I wrote that a second wave in the US death toll would start to appear from about July 6th – and tragically, here is what happened:

Again, thanks Google.

To reiterate, I’m not an expert and I’m not Mystic Meg… This could have been a lucky guess… or it could be simple logic that if it takes about 3 weeks to die from COVID-19, then the death toll will follow the case numbers with about a 3 week delay… US cases started increasing June 15th, and 3 weeks later is July 6th. (If there’s a sliver of ‘good news‘ for the US, it’s that states halting/reversing relaxations already caused cases to plateau on July 12th, so the deaths should plateau too from about now.)

So I absolutely cannot stress this point enough when trying to understand our current situation:

When the case numbers start to increase, that is the time when we have to act.

The Plan

My analysis of the government’s current actions in the UK is based on the principal of “Chesterton’s Fence” mentioned in Post 1: Basically, just because we don’t know what they’re doing, it doesn’t necessarily mean they don’t know what they’re doing… (you know exactly who I’m talking about)

Firstly, no, the UK plan is definitely not still ‘herd immunity’. Restrictions are already tightening with under 1,000 new cases per day. There’s over 66,000,000 people in the UK. It would take over 144 years to reach 80% immunity at this rate. That’s clearly not the plan.

I’ve written before about how we can use the timeline of COVID-19 to guide how we can spot signs of another wave earlier or even choose the best options to protect ourselves. So let’s use this timeline approach one last time to think about what the progression would be going from lockdown to a second wave… We can also include how the R number (the average number of people one infected person infects) would change at each point. This timeline would go:

Remember that as long as R is under 1 then COVID-19 will keep receding. So the plan for many countries seems to be to adapt to a way of living where R is under 1, that will keep COVID-19 receding, and get as much economic activity as possible (Point 2 on that timeline). If restrictions relax too far, R goes over 1 and the daily cases start increasing (Point 3), but not at the rate we saw in February/March… Relaxing further (Point 4 or 5) would start a second wave at a similar rate to February/March. At that point it would then be back into lockdown to get the outbreak under control, and then start again from Point 1

So, the question becomes how can we know what ‘restrictions relaxed just the right amount‘ (Point 2) actually is?

Well, as we’re dealing with an unprecedented situation in our lifetimes, I guess the best way to know what restrictions at Point 2 actually look like is by easing restrictions to Point 3, and then when the case numbers start increasing, tighten restrictions again… And if you look at what has just happened with the spike in the North of England, this is exactly what the government (Westminster) has done. The guidance for the North of England is not a full lockdown (Point 1), it’s a tightening of restrictions to bring things back from Point 3 to Point 2 (here is the actual guidance). I’d imagine there will be a slight re-jig of these rules pretty soon, and potentially a roll-back of some recent relaxations – because importantly we are now at the limit of how relaxed restrictions can be at the moment:

This is ‘the new normal‘ we heard about during lockdown.

And I would say to people in the North of England, don’t feel this is anything you did wrong compared to the rest of the country – if this crisis has shown us anything, it is that people everywhere act in a similar way – the rest of the UK will probably reach this point soon, the North of England just happened to be the area that got there first.

There also seems to be quite a bit of talk about how the Westminster government has messed up again because cases increased and they rapidly tightened restrictions – however, I would fundamentally disagree. This is exactly how we should have hoped they would act (I certainly did):

The government have learned the lesson that they missed in February/March, and they acted when cases started to increase.

If cases numbers are the most up-to-date reading of our current situation, then the UK is now actually doing better than about half the countries in Europe despite having had the worst outbreak on the continent…

The UK is now in-between countries that have been praised for their response like Germany and Iceland. Data processed from the European Centre for Disease Prevention and Control.

You may be thinking ‘how can he possibly be trying to say the UK isn’t doing that badly at the moment when the country is suffering about 100 COVID deaths every day still?’… And let’s be honest here, England is racking up about 100 COVID deaths every day, not the rest of the UK! That’s over 6x more than most other nations in the EU in July!

Although… Doesn’t that seem a bit odd?… Scotland, Northern Ireland and Wales go days without deaths, but England has about 100 per day?… And if there were maybe 500 cases per day in England 3 weeks ago, then the English case fatality rate is 20%?... Yet despite this incredibly high fatality rate, the UK has also stayed below the five-year average for deaths for six weeks in a row?… If that doesn’t make sense – it’s because it shouldn’t.

It appears Public Health England have been processing ‘COVID-19 deaths‘ as anyone who has tested positive for COVID-19 and died – that doesn’t take into account if someone actually recovered from COVID-19, and then subsequently died from something else months later… Essentially, by this definition it is impossible to ever recover from COVID-19 in England (see here for more details)… That obviously doesn’t make sense, but it’s probably a result of the earlier problem when England was only reporting ‘hospital COVID deaths’. Basically, don’t be surprised if we see the English (and UK) death toll revised down soon because of this (rapidly followed by people claiming Westminster are fudging the numbers).

‘COVID zero’

Lastly, people in the UK may be wondering why we can’t just stay in lockdown till we have pretty much zero cases and pull up the drawbridge on our little island (or brick up the Channel Tunnel or whatever), then get back to life as it was in 2019 (Point 5 on our timeline)? I don’t have the expertise to evaluate a ‘new normal’ approach vs. ‘COVID Zero’, but what I can see is that ‘COVID Zero’ may not work out the same way for every island (e.g. international transport hubs, needs for imports, the weather, etc.)… And even with all that, ‘COVID Zero’ may still not get us around the COVID problem anyway… The challenge is that living life as in 2019 (Point 5) relies on quarantines and track and trace stamping out every single COVID-19 case… This means those systems cannot fail. If they miss cases, and the restrictions are at Point 5, then cases grow rapidly making it even harder to track and trace them and then that is the start of a second wave at the rate of February/March… At that point it may be too risky to try to tighten restrictions back to Point 2 to slowly suppress the outbreak, because if we miss and land at Point 4 or Point 3 there will be a larger number of cases that are still increasing, so the only option is to go back to lockdown and Point 1, and then to start over… Australia have responded to their latest outbreak with another lockdown, even after their great response to the first outbreak and ‘COVID Zero’ strategy.

The UK and Australia are both islands, have similar size populations, similar numbers of new cases daily, and similar % positive tests – yet the spread of the infections is going in different directions because of one taking a ‘COIVD Zero’ approach and the other relaxing from lockdown to Point 2/Point 3. Credit OurWorldinData again.

I can’t comment on the economic impact of cycling between lockdowns<->waves compared to adapting to a new normal, so I guess it remains to be seen which strategy is sustainable in the long run (and we may be in this for the very long run). Any strategy to manage COVID-19 probably has to depend on both the actions a government takes (e.g. quarantines, contact tracing) and the actions the population takes (e.g. social distancing, masks). The more there is of one, the less of the other that may be accommodated – so for most countries there probably needs to be a balance between the two. When a country comes out of a second lockdown, or a third, will people want to relax as far as they did the first time? Again, I don’t know, but I guess we shall see – one way or another we may find that many countries end up at pretty similar definitions of a ‘new normal‘ eventually. COVID-19 is not going away, and this situation is far from over.

Ultimately, if you are lucky enough to live in a country where the leaders (government, regional, local) have learned to act when COVID-19 cases rise, either after a great first/second response or after having been badly burned, then I’d say you need to get behind them now… There may be no universal strategy that will work for every country, but the way out will undoubtedly require people to act together regardless of the strategy taken, and there will undoubtedly be more challenges along the way regardless of the route taken… I’ve previously likened our situation to us trying to row a boat out of a storm, and like in that situation, those of us rowing will have our backs to the direction we are going – our only option is to trust the person stood up who can hopefully see a way out the storm...

Next time I’ll try to write about the potential second wave in winter, because for many of us winter is coming.

3 thoughts on “The ‘second’ wave (the first part)

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