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The pandemic is changing not only society but also the language. The term Covid-19 is considered a hot candidate for inclusion in the Duden. Blocking, closing and social distancing have been common words even in German. The term wave will probably never be used as impartially as before. It is now associated with an increase in the number of crown cases experienced by all states involved at the start of the epidemic.
In some countries, including Germany, the first wave has ended. In others, like the United States, it is still happening. The anxious question is: when will the second wave come? And how dramatic will it be?
At least the experts at the Robert Koch Institute (RKI) have little doubt that the world is facing a second wave and possibly even more waves. There will be “with great certainty” a second wave, said RKI President Lothar Wieler. “This is a pandemic. And in a pandemic, this virus will cause disease until 60 to 70 percent of the population is infected.”
“The risky situation is, of course, less than four weeks ago, but it’s still there,” Wieler’s MP Lars Schaade said at a press conference on Tuesday. If everyone “behaves sensibly,” Germany has an opportunity to “avoid a second wave,” Schaade said. “We can only control this through our behavior.”
“It is not about overcoming the summit, as some people seem to believe,” the New York Times quotes, quoting the T.H. Marc Lipsitch Chan School of Public Health at Harvard University in Boston. Instead, the pandemic should be managed for months and years. A single round of social distancing will not suffice, Lipsitch said.
No one likes to hear such statements, after all, Germany is relaxing again: gyms are opening, hotels are welcoming tourists, restaurants are happy with guests. On the other hand, experts had already pointed out at the start of the pandemic that restrictions on public life would be necessary for a long time. When in doubt, until an effective vaccine is available in sufficient quantities.
Epidemiologist Lipsitch is one of the authors of two scientific publications that address forecasts of the development of the pandemic. One of the articles was recently published in Science, the other is a peer-reviewed publication by the Center for Infectious Disease Research and Policy at the University of Minnesota, Minneapolis.
In this publication, the researchers describe three possible scenarios:
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Scenario 1 (“peaks and valleys”): after a first wave, the current one, there will be more for many months. These bring equally high case numbers. Only gradually do outbreaks become less violent, because the number of immune systems increases after illness. The occurrence of the waves can vary geographically, according to the researchers. Depending on the height of the wave peaks, restrictions on public life would sometimes be necessary.
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Scenario 2 (“Summit in Autumn”): This scenario is based on the course of the so-called Spanish flu in 1918/19. The pandemics in 1957/58 and 2009/10 also followed this pattern. Consequently, a first summit is followed by a much higher one in the following autumn or winter months. Currently, it is difficult to assess how realistic this variant is, mainly because researchers still know very little about the effect of summer weather on the spread of the Sars-CoV-2 virus. If the scenario did occur, strict rules would be required again in the fall at the latest to avoid overloading health systems.
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Scenario 3 (“Slow Burning”): Here, the first outbreak is followed by a long restless phase with a repeated outbreak of the epidemic, which never reaches its initial peak again. Local differences are also possible here and should be taken into account when deciding on stricter measures. “While this third pattern was not seen in previous influenza pandemics, it remains an option for Covid-19,” the researchers said.
It is currently not possible to say which of the scenarios actually occurs, according to the Minnesota team. But: “We have to be prepared for at least another 18 to 24 months of significant Covid-19 activities, with hot spots occurring periodically in different geographic areas.”
The scenarios are always based on a variety of assumptions. Anyone who modifies them reaches different results. The results in the “Science” document are somewhat less graphic than those in Minnesota. But they also basically say one thing: There will always have to be periods with stricter contact restrictions. Depending on the assumptions, the only question is how often such periods are necessary and how long they have to last.
Therefore, it is possible to have a longer phase with less stringent rules in the summer, if the pathogen is not actually spreading as much. This year, according to the team’s guess, a seasonal effect is likely to be fairly small because there are simply too many people whose immune systems can’t counteract the virus.
“It can not be done”
The researchers propose 350 new infections per 100,000 inhabitants as the limit above which stricter rules should apply, although it may vary locally. The end of the restrictions is conceivable for 50 cases per 100,000 inhabitants. As a reminder: in Germany, the federal government and federal states have agreed to impose local restrictions on 50 or more cases per 100,000 inhabitants. Only Saxony-Anhalt has announced that it wants to impose stricter rules before. The Federal Association of Physicians of the Public Health Service has criticized the mark of 50 infections per 100,000 inhabitants as too high. “How the health authorities should deal with this is a mystery to me. That cannot be done,” complained the association’s president, Ute Teichert.
According to RKI’s status report on Monday, three counties are above the limit of 50 cases per 100,000 inhabitants: Greiz and Sonneberg in Thuringia and Coesfeld in North Rhine-Westphalia. If you look at the data from the local health authorities, the city of Rosenheim in Bavaria has also broken the upper limit. Incidentally, there he would like to use a dubious arithmetic trick and accommodate asylum seekers from statistics.
Until now, there have been no stricter crown rules in Germany. This may not always be the case. “We have to wait and see how the reduction of control measures works,” says epidemiologist Ralf Krumkamp of the Bernhard Nocht Institute for Tropical Medicine in Hamburg in an interview with SPIEGEL. He is one of the authors of a statement by the German Epidemiological Society on the spread of the virus.
The April 27 document is primarily about the success of the exit and contact restrictions applicable at the time. Without the measures, according to experts, “a significant overload of the health system would have been expected.” At the time of publication, there were approximately 2,000 new infections reported per day. This number is now not half as high.
But was it the right time for relaxation today? “I find the strategy somewhat ambitious,” says researcher Krumkamp. “The policy has changed a lot at the same time.” In two to three weeks you will know how infection numbers develop. However, the epidemiologist already warns: “An increase in the number of cases would take place much faster than the current decrease.”
“If the disease persists at a low level without the ability to examine groups, there is always a risk that the virus will reappear,” warns Mike Ryan of the World Health Organization (WHO) emergency program.
Then it would be there, the next wave.
