COVID-19: Why infectious disease wave is likened to a ‘war’

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People at the beach in Huntington Beach, Calif., on Sunday, June 14, 2020, amid the coronavirus pandemic.Apu Gomes / AFP – Getty Images
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Dubai: There’s a sense things are getting back to normal. 

The reality, however, is far from normal. Except in geographically distant Pacific island nations with zero COVID-19 cases, most places in the world still face some form of social distancing rules, though adherence to such rules is another story altogether.

As of Wednesday, global coronavirus cases already topped 8.1 million, with nearly 450,000 deaths, according to the Johns Hopkins University tally.

There are indications the virus is fighting back, or we’re allowing it to — with blithe disregard for basic safeguards like social distancing and extensive testing as businesses and borders start to reopen.

Some experts warn about a “second wave” of COVID-19 infections. For example, Prof. William Schaffner, of Vanderbilt University School of Medicine, has blithely declared: “The second wave has begun. We’re opening up across the country, but many, many people are not social distancing, many are not wearing their masks,” he told CNBC.

Claims dismissed: No second wave

Others, however, dismiss this claim. Instead, they suggest, what we’re seeing is the tail-end of the first wave, and the spike in cases is due to more extensive testing.

The crux behind the no-second-wave argument, as suggested by US Vice President Mike Pence is this: The world knows so much more about the virus today than six months ago, and we’re better informed about treatments that work, while vaccine trials are being ramped up.

In short, it’s been claimed, humanity is far better off in dealing with the virus now — compared to SARS-CoV-2 contagion’s early days — than the media is willing to report.

What is a wave?

Experts liken waves of infectious disease to ocean waves. Infectious diseases are a major factor regulating the mortality rates of species.

In general, infectious diseases are like wars, which can be both local (epidemic) or global (pandemic). Infections can have the potential to regain much of their power. As suchm they’re seen as a key factor in limiting the size — or expansion — of human populations.

Waves of infectious diseases have been recorded in the past: chickenpox, measles, mumps, rubella, diphtheria, TB, polio, leptospirosis, sores, West Nile fever, rabies, etc.

There are numerous triggers for those waves, spanning a broad range of diseases. Often they come without a common denominator.

What’s an epidemic wave?

If you’ve seen a football match where spectators stand up and sit back down again — in unison and in sequence — that’s sort of a human wave. The effect is dramatic, but it requires individuals to behave in a proper sequence in time and space.

The same with epidemics. An epidemic wave is a graph which traces the development of an infection over time and/or geographic space. There’s a time horizon, with numbers (cases) plotted from left to right.

Waves numbers

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The epidemic wave plots new cases against time. During an epidemic the number of new cases (infected individuals) increases rapidly to a peak and then falls more gradually until the epidemic tapers off, or completely goes away.

What factors come into play in tackling waves of infectious diseases?

A number of factors and “vectors” come into play in the spread of diseases: pharmacology, epidemiology, ecology, genetics and demographics.

Pharmacology (study of drug or medication action) is a man-made intervention through which infectious diseases are dealt with, or fought.

Epidemiology, the study and analysis of the incidence, distribution, patterns and determinants of health and disease conditions in defined populations, is a cornerstone of public health. This specialisation also studies possible control of diseases and other factors affecting human health.

Ecology is the branch of biology (study of life) that deals with the relations of organisms to one another and to their physical surroundings.

Genetics is a branch of biology concerned with the study of genes, genetic variation, and heredity in organisms.

Demographics is the statistical study of populations, especially human beings.


In epidemiology, a disease vector is any agent which carries and transmits an infectious pathogen into another living organism; agents regarded as vectors are organisms, such as intermediate parasites or microbes.

Who are the vectors of infection?

Despite the recent uproar over WHO statements on “asymptomatic” carriers, there’s growing evidence that infections do come primarily from close contacts or crowds. But here’s the point: close contacts are traceable and crowds are avoidable.

The asymptomatic cases debate is an emotionally-charged one, fanned by fears about privacy, loose regulation and a negative attitude about testing and contact tracing. Yet evidence shows the key driver of the disease appears to be people who do get sick.

Moreover, those who do fall ill can spread the disease the most, at “peak shedding”, which takes place before the illness itself manifests, according to this study. There’s also evidence that deaths can be curbed by finding people with symptoms, tracking their recent contacts, and isolating those who test positive.

In many countries, including the UAE, combining extensive and routine testing and contact tracing have helped stem a heavy death toll.

Why is a wave of infection likened to a ‘war’?

Indeed, it’s a constant war — a sustained conflict between mankind and pathogens.

This is where genetics comes into play. So do vaccines, anti-sera, antibiotics, and antivirals. As pathogens (disease-causing agents) evolve, they change genetically and develop tolerances towards the drugs we use to neutralise them.

Antibiotics treat bacterial infections, but don’t kill viruses. As for us, vaccines remain a key anti-viral weapon, by harnessing or “training” man’s immune system to fight new pathogens. But anti-viral preparations that can kill virulent viruses like SARS-CoV-2, can be difficult, expensive and time-consuming to develop.

So in a way, the race to specific COVID-19 vaccine is gearing up war against SARS-CoV-2, one that humanity is tooled up to win — perhaps until the next pathogen strikes.

Vaccines remain a key anti-viral weapon, by harnessing or “training” man’s immune system to fight new pathogens. But anti-viral preparations that can kill virulent viruses like SARS-CoV-2, can be difficult, expensive and time-consuming to develop.

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Is this a second wave we’re seeing?

Most experts who study epidemics has this much to say: No, this isn’t a second wave.

“When you’re 10 feet up on the shore and the wave hits you, it recedes all the way back,” said epidemiologist Dr. David Weber of the University of North Carolina Medical Center in Chapel Hill. “Now you’re on dry land with no puddle beneath. We still got a big puddle there.”

A second wave of the coronavirus suggests that the first wave has come and gone. That hasn’t happened, Dr Weber argued, adding: “We never made it out of the first wave.”

How does the genetic mutation of the coronavirus raise or affect its virulence?

A study by US researchers shows that a specific mutation in the new coronavirus can significantly boost its virulence the ability to infect cells.

On June 12, 2020, a team that published their work on Scripps Research said this may help explain why early outbreaks in some parts of the world did not end up overwhelming health systems — but other outbreaks, such as the one in New York and Italy did.

The mutation, named D614G, increased the number of “spikes” on the coronavirus — which is the part that gives it its distinctive shape. Those spikes are what allow the virus to bind to and infect human cells.

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The mutation, named D614G, increased the number of “spikes” on the coronavirus — which is the part that gives it its distinctive shape. Those spikes are what allow the virus to bind to and infect human cells.

“The number — or density — of functional spikes on the virus is 4 or 5 times greater due to this mutation,” said Hyeryun Choe, one of the senior authors of the study.

Where are the COVID-19 cases spiking?

A dramatic rise in infections in severel countries are fanning concerns of a “second wave”:


Over the past week, several US states reported record numbers of new cases. Since the start of the pandemic, the US has recorded 2,2088,486 cases and 119,133 deaths, as of Wednesday, according to In the last seven days, more than 157,000 cases and 4,860 deaths reported in the country.

US epidemiology experts point to the failure of people to adhere to social distancing precautions, even during mass protests, as the main reason for the increasing likelihood of a feared COVID-19 “second wave”.

Demonstrators protest against racial inequality in the aftermath of the death in Minneapolis police custody of George Floyd, in New York City, New York, US.
Image Credit: Reuters


Russia has the third-largest number of confirmed cases globally, with over 553,000 infections reported and 7,478 deaths. The country registered 7,843 COVID-19 cases in the past 24 hours (8,248 the day before), bringing the overall tally to 553,301, the national coronavirus response centre said on Wednesday.


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The country says it has a high number of cases due to its widespread and comprehensive testing regime. It lifted a lockdown imposed on Moscow for more than two months on Tuesday even though the capital is still reporting over 1,000 cases daily.


China has imposed lockdown on 11 districts in the capital Beijing, which had largely escaped from the pandemic having insulated itself from Wuhan. Now, the Chinese capital has reported a “mini-outbreak” as infections were detected in about 100 people in one part of the city and is now cordoned off in what amounts to a lockdown.


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On Sunday (June 14, 2020), of the 57 new cases logged by Chinese authorities, 36 were domestic infections in the capital. The shock resurgence in domestic infections has shaken China, which has largely contained the disease after the initially outbreak in Wuhan. On Tuesday (June 16. 2020), hundreds of flights were cancelled in the Chinese capital.

Doctors in China are also seeing the coronavirus manifest differently among patients in its new cluster of cases in the northeast region (provinces of Jilin and Heilongjiang) compared to the original outbreak in Wuhan, as cited by Bloomberg.

Sourth Korea:

South Korea saw an alarming spike in daily new infections. On June 10, the toll soared to 32, the highest in nine days, prompting authorities to consider enforcing tougher safety measures. The country has carried out extensive testing and recorded 12,000 infections, with fewer than 280 deaths, with no national lockdown.

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Schools reopen in South Korea
Image Credit: AFP

Despite its relative success in curbing the virus’ spread, however, there have been an increasing number of outbreaks have flared up at churches, call centres, clubs, conference halls, logistics centres and even a Zumba dance studio.

A total of 50 new COVID-19 cases, including 43 local infections and two fatalities, were reported by the Korea Centers for Disease Control and Prevention, raising the country’s overall count to 11,902 with 276 deaths.

New Zealand:

New Zealand, which seemed to have all but eliminated coronavirus, faced a border fiasco involving two overseas arrivals that were not tested, prompting the government to place COVID-19 quarantine in the hands of the military.

New Zealand commuters

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It is the world’s fourth most populous nation. As of Wednesday (June 17, 2020), Indonesia has recorded 41,431 cases and 2,276 deaths. Coronavirus cases keep rising across the country. On Wednesday, the Indonesian Health Ministry announced 1,031 new coronavirus infections. Indonesia resumed domestic flights this week, while the capital Jakarta started easing social restrictions last week.

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A woman buys hand sanitizers at a market in Jakarta, Indonesia, on Wednesday. Indonesia recorded its first death from coronavirus in the case of a 53 year-old foreign woman who had existing health problems when she was admitted to a hospital, a health ministry official said Wednesday.
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The island-nation drew attention for what was seen as success in containing the early stages of the outbreak, experienced fresh outbreaks in recent months, showing how easily the virus may return. On Wednesday, the health ministru reported 247 new cases, the majority of them foreign workers living in dormitories. There were 5 cases reported in the non-workers community.

The country’s total count has gone up to 41,216.

Visitors boarding a boat for a tour along the Singapore river in Singapore, as the city’s financial district is seen in the background in February.
Image Credit: AFP

On Monday, the COVID-19 multi-ministry task force announced Phase 2 of Singapore”s reopening. Phase 2 will involve the resumption of “most activities”, subject to safe distancing principles. Small gatherings of up to five people will be allowed to resume, along with dining in at food and beverage outlets. Retail businesses may also reopen their physical outlets.


New cases have surged in Pakistan since the government lifted lockdowns on May 9, citing economic reasons. Since early June, the country has reported record number of new infections, which was also partly due to more extensive testing. Of 23,000 daily tests, more than one in five have been positive over the last 10 days. As of Wednesday, Pakistan has recorded 155,000 cases with 2,975 deaths

Pakistan Friday prayers
People attend Friday prayers along a road at a business area, after Pakistan eased lockdown restrictions, as the outbreak of the coronavirus disease (COVID-19) continues, in Karachi, Pakistan June 5, 2020.
Image Credit: Reuters

Before the lockdown was lifted the number of positive tests was approximately 1 in 10, government statistics show. The WHO recommended this week that Pakistani authorities reimpose “intermittent lockdowns” of targeted areas, saying the country did not meet the WHO’s conditions for lifting restrictions.


In Britain, one of the worst hit countries, with nearly 300,000 confirmed infections, Prime Minister Boris Johnson said on Wednesday the rate of infection was slowing to “manageable levels” but cautioned restrictions could re-imposed. By Wednesday (June 17, 2020), the death toll neared 42,000.



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India had 354,000 confirmed cases and 11,903 deaths from COVID-19 as of Wednesday, June 17, 2020. On Wednesday alone, India posted a record jump in death toll to 2,000 in 24 hours. Since India started gradually easing lockdowns of its 1.3 billion people imposed in March, the pace of the virus spread has spiked sharply. India has reported roughly 10,000 new infections daily over the last week and the country’s case count surpassed Britain, making it the fourth most-affected country globally.

The western state of Maharashtra, home to financial hub Mumbai, has been the hardest hit with roughly a third of all cases in India. With 113,000 cases, Maharashtra alone has recorded more infections than all of China.



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It reported 929,000 cases as of Wednesday, making it the second-highest after the United States. Shops in the country’s two largest cities, epicenter of a still surging epidemic in Brazil, have reopened, just a day after the most populous state Sao Paulo reported a record number of COVID-19 deaths. In Sao Paolo State along, 178,000 cases had been reported, with 10,694 deaths as of June 17, 2020.


Since the third week of April, the number of daily new cases is Turkey has gradually declined. But two weeks after a partial easing of lockdowns, a spike of nearly 50% in daily new coronavirus cases fanned fears of a “new wave” of infections.

As of June 16, Turkey had 181,000 COVID-19 cases and 4,842 deaths recorded. Health experts and authorities sounded alarm about a potential rise in new infections as the daily cases jumped back to the highest in nearly a month.

On June 13, Health Ministry data posted its largest number of daily new coronavirus cases since May 16 with 1,459 new patients. While the death toll continued to decline, the spike in new cases triggered a fresh set of warnings by the country’s health experts and authorities.


The initial wave of transmission has passed its peak everywhere except for Poland (30,195 infections; 1,272 deaths) and Sweden (53,323 infections; 4,939 deaths), according to an analysis by the European Centre for Disease Prevention and Control.

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A woman with her luggage stands outside Rome’s Termini train station, as Italy relaxes more of its restrictions and allows free movement across the country to unwind its rigid lockdown due to the coronavirus disease (COVID-19) outbreak, in Rome, Italy, June 3, 2020. REUTERS/Guglielmo Mangiapane
Image Credit: REUTERS

But the risk of a second wave big enough to require lockdowns to be reimposed is “moderate to high”, the agency said, and fending it off will depend on the gradual easing of restrictions and how people stick to them. Spain has 244,000 COVID-19 cases, with 27,136 deaths; Italy recorded 238,000 cases with 34,400 deaths; France has 158,000 cases and 29,547 deaths as of Wednesday (June 17, 2020).

What should we do about inaccurate antigen tests?

An antigen test is a point-of-care test that directly detects the presence/absence of an antigen. Experts rightly point out that these tests tend to have a low rate of sensitivity — they catch only about 80% of infections, and even may yield up to 30% “false negatives”.

Antigen tests detect “true positives” (a correct positive reading) at between 50% and 90% of the time, according to a Science report. In theory that would still be useful — if random sampling of people to locate possible outbreaks are done.

Moreover, repeatedly tests of suspected cases over several days would mean that a test with 80% sensitivity will catch almost everyone, say experts. Therefore, using catching 80% of infections among an asymptomatic population is better than catching nothing and no one. Testing and surveillance are critical for keeping the economy running without risking new spikes of disease. The key lies in making routine tests relatively easy and fast.

This simple test can save lives by detecting active infections.

How can we stop a second wave?

There are solutions available now to stop it. The science is established the and economies of scale in manufacturing helpful in mass producing COVID-19 routine test kits.

These tests are fairly accurate, inexpensive and quickly deployable, as demonstrated by the UAE, with drive-through test centres

Antigen tests could also now flag new infections quickly in homes, offices or medical centers.

In May, the US FDA approved two new types of diagnostic COVID-19 tests, the first antigen test and the first at-home test that uses saliva samples.

Another simple, practical solution: Use wearable devices that flag infection early. These wearables can detect subtle changes in heartbeat that occur before people show symptoms.

Researchers have proven that our heart rates change when we catch the flu virus. This change can be seen on a wearable device days before we come down with symptoms.

This early detection capability is the key in the fight against COVID-19, in whcih peak shedding, the moment it most virulent (infectious), occurs during the early stages, when those who are already infected are yet “asymtomatic”.

Scientists at Stanford, UC San Francisco and Scripps Research Institute have repurposed the device to detect COVID-19, and said such devices could pick up infections days before people show symptoms or in people who report no symptoms.

The technology exists to fight coronavirus today. It takes commitment to win. Humans are infinitely smarter than this virus. There are early signs we’re beating it. And we will, as long as we fight the good fight.

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