The second wave

The sharp increase in Covid-19 cases in the U.S., Canada and Europe starting at the end of October make it impossible to deny that we are in the second wave. 

Many epidemiologists and infectious disease experts who are regular commentators on the CBC National News have looked shell shocked or despondent and express disappointment. Public health officials and provincial political leaders keep threatening that if people don’t work harder to reduce their social interactions, they will bring in more severe measures. In the meantime, they cycle backwards and forwards making minor changes to policies that will not flatten this steep second wave, such as decreasing the size of social gatherings and changing the times that bars and restaurants are allowed to stay open.

What is wrong with these people?

The coronavirus second wave was predicted back in March 2020 by the Imperial College of London model and has been repeated by numerous other epidemiological models. Bonnie Henry, the Provincial Health Officer of B.C. was one of the first public health officials to admit that their model did predict a second wave. So it has been known for a long time that the second wave was most likely coming in October/November.

Governments revealing projections

In June, this blog stated that it was “pie in the sky” to think that any combination of social distancing measures that did not include a full lockdown would be able to keep the virus transmission rate below 1.

Opening up the economy

It’s easy to see on the following charts that the transmission rates in Canada and the U.S. declined below 1 during the lockdown period but then started to move up in August and have kept moving up ever since.

Reproduction Rate Canada

Reproduction Rate (New York)

So there has been a clear indication since August that the second wave was on its way. But health authorities have had their head in the sand.

Did they do anything to prepare for it?

It seems like they didn’t.

They don’t have a planned policy. Some jurisdictions are keeping schools open and closing bars and restaurants and while others are closing schools and keeping bars and restaurants open.

In the first wave, many provincial premiers announced, on multiple occasions, that the high death toll in long term care homes was unacceptable and would be remedied. Those conditions are already repeating.

In the U.S. the virus is probably already out of control and this is before another big spike that will likely show up soon, two weeks after the election on November 3, when millions of people spent hours standing in lines and polling stations, many of which were probably poorly ventilated school gyms.

In Canada, if lockdowns are not initiated soon, the virus could get out of control. It is hard to believe that provincial governments have not acted more quickly to try and save December Christmas shopping and family Christmas celebrations.

Why have things gotten so bad?

It’s fundamentally a battle between those who are opposed to any kind of lockdown that will lead to a loss of income through businesses closing and jobs being lost versus people who see the devastating impact of the virus on the lives of millions of people. 

This graph shows the number of Covid-19 deaths compared to all causes of death in the U.S. While some people may find that 15% of deaths from Covid-19 is alarming, many others will not.

In fact, most people have not been touched directly by Covid-19. They do not know anyone who has died from this virus and so they don’t regard it as an imminent threat. It is just another remote risk of dying such as from an illness or an automobile accident.

What is going to happen?

In Canada and Europe where governments have a commitment to the health of their citizens, as evidenced by comprehensive public health insurance, the balance will shift to protecting lives and governments will institute full lockdowns. The key question is whether they will act quickly enough.

In the U.S. public health is the domain of private enterprise and the government does not accept responsibility for the general health of its citizens, except for seniors and some low income people through Medicare/Medicaid. Many state governors will be able to continue to ignore the health guidance of scientists and refuse to implement lockdown. The number of corona virus deaths will continue to increase to unheard of levels compared to the rest of the world and this will continue until a vaccine is available to reverse that trend.

Vaccine News

The recent news has not been all bad. Pfizer released preliminary results of its coronavirus vaccine clinical trial. Earlier results had shown that the vaccine generated antibodies which are the basis for an immune response but these results were the first direct evidence that the vaccine actually protects against infection. Not only that, but it was estimated to be 90% effective. Vaccine developers were hoping for 50% to meet the FDA requirements for early approval. There are still a lot of important questions that have not been answered yet, such as how long the immunity will last, but it was extremely encouraging news.

Moderna is also scheduled to release preliminary results in November. Since its vaccine uses a similar approach as Pfizer, based on messenger RNA (mRNA), it is expected to also show some very good results.

This confirms earlier timeline estimates for when a vaccine will be distributed widely enough to slow down the spread of Covid-19. When you will get a vaccination depends on the distribution policy of the country.

In the U.S. the CDC is favoring the WHO recommendation to break transmission ahead of vaccinating the vulnerable. It is estimated that it will take three months to vaccinate front line health workers before the general population gets vaccinated.

On the other hand, Canada is planning that those over 70 will be first in line for the vaccine, followed by health care professionals and then essential workers.

In any case, it will likely take at least 10 months to vaccinate enough of the population to reach an immunity level that will slow the spread of Covid-19. This assumes that all the challenging logistics of distributing and vaccinating millions of people can be managed without major delays. Given the track record of public health with the coronavirus this does not seem likely.
https://www.nytimes.com/2020/11/14/health/covid-vaccine-distribution-plans.html

However, to be optimistic there is a best case scenario that the pandemic can be brought under control in North America and Europe by November 2021.

CDC Mask Guidelines

The U.S. Center for Disease Control and Prevention updated its guidance to say face coverings can help protect the wearer as well as those around them. This now matches the recommendations of the World Health Organization (WHO).

Huh?

If face masks block the virus from traveling out from your mouth and nose to the air around you, it is just common sense to conclude that air going in the reverse direction will also be filtered by the mask. Why it took the CDC three months to arrive at this rather simple conclusion is unfathomable.

The CDC’s changing recommendations on face masks have been a total disaster, and the damage continues. In spite of Joe Biden’s plea, made on numerous occasions, for all Americans to wear a face mask thereby saving 100,000 lives, there are many Americans who have already decided that they don’t need to wear a mask. There will not be a big increase in the use of face masks unless it is mandated by law. However the governors in most of the conservative states have stated that they will not enact such a law. If the CDC had come out from the beginning strongly recommending face masks because it would protect the wearer, this situation could have been much different.