Pandemic Waves

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Many people are concerned about what appears to be a second wave of COVID-19, the pandemic disease caused by the SARS-CoV2 virus. Indeed, some states that were relatively unaffected by the virus are now reporting high numbers of cases. Concern about hospitals’ abilities to deal with severe cases is again on the rise.

In recent articles and videos, I stated that second waves are inevitable in a pandemic. One thing you should know about pandemic waves is that they have peaks and troughs; that’s why we call them “waves”. Health officials take measure in an attempt to delay them, but they can’t stop them anymore than the waves in the ocean. In the case of a very contagious disease, you can only hope to flatten the curve and not overwhelm the medical infrastructure’s ability to handle the case load.

A pandemic disease doesn’t begin everywhere in a country (especially not one as big as ours) all at once. Some places experiencing a rise in cases now are actually in their first wave.

When alarms went off in places like New York and California, hospitals elsewhere should have already had plans of action for when the very contagious COVID-19 hits their area.

Why should they have been ready for the invasion of a new contagious infectious disease? Because we have faced similar viral threats in the recent past. A few words: Swine Flu, SARS, MERS, Ebola, Zika, Chikungunya, and more. Besides swine flu, these diseases didn’t reach true pandemic status, but they all occurred in the last decade or two.

We’ve known for a long time how fast infectious disease can spread and had years to prepare. I often say that the most pernicious way that an infection spreads is not due to airborne or contact means, but because of complacency. Lack of preparedness and overconfidence can damage any society, even an advanced one.

The Spanish Flu of 1918-1919 is an example of second and, yes, third waves. After it slowed down in the spring of 1918, it came back at least twice within the next year, and the second wave was deadlier than the first. The virus infected 500 million people worldwide and killed an estimated 50 million victims. More recently, we experienced a second wave with the Swine flu pandemic in 2009.

Second waves may affect different segments of populations differently. In 1918, the first wave of the Spanish flu sickened poorer folks, while the second affected more affluent people that may not have had much contact with the folks affected by the first wave. The second wave turned out to be deadlier than the first.

 I believe we’ll experience second and third waves of COVID-19 over the next year or so, and that they’ll appear at different times in various parts of the nation. They may even be entirely new mutated versions of the virus, quite a number of which have already been identified. The strain currently causing a rise in new cases seems to be affecting young adults more, but appears somewhat less lethal.

Infectious disease outbreaks can last a long time. How long?  The Plague decimated the population of Europe between 1347 and 1351. It didn’t completely go away for a century and returned just as deadly in the 1500s and 1600s. Even to this day, a few cases in the American West are reported every year.

Yet, people are suffering from COVID fatigue, and itching to get out and about. They hope that the hot weather of summer will slow the spread, just as it does in many influenza epidemics. But flu viruses and coronaviruses aren’t identical, and the break we hoped to get in the summer of this year isn’t materializing (at least, not yet). That means that we still need to wear masks, especially in situations where we can’t social distance, keep away from crowds, and wash hands or use hand sanitizer.

Of course, critics blame the second wave on the reopening of the economy. They may be right. But with a very contagious disease like COVID-19, reports of new cases are likely to be reported for quite some time. Keeping a nation on lockdown until there are no cases (a year, maybe two?) guarantees major and probably permanent damage to the economy.

Wear a mask if you can’t social distance

This doesn’t mean that you have to wear a mask as you attempt to hike the entire length of the Appalachian trail. The CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain. That means if you can’t stay 6 feet apart from others. Bottom Line: Use common sense.

By the way, I can’t say that I’ve hiked the entire length of the Appalachian trail, but I have hiked the entire width.

Joe Alton MD

Dr. Alton

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