APD | Asian nations worried about next waves of coronavirus infection

By APD writer Alice

Asian nations are now worried about next waves of novel coronavirus (SARS-CoV-2) infection as they are gradually easing restriction and lockdown measures- which have been imposed to control the spread of the virus.

The second wave of coronavirus (SARS-CoV-2) infection has been much mentioned in recent days in Asia. The number of confirmed cases of coronavirus reported to the World Health Organization (WHO) has exceeded 3 million worldwide, including 211,000 deaths, according to the latest statistics from the WHO on Wednesday. As the first epicenter of the pandemic, Wuhan province of China now has no cases at the hospital, but experts still believe that SARS-CoV-2 is very "variable" with its dangerous, unpredictable spreading ability.

In fact, the developments of COVID-19 in the world has revealed a series of "abnormal" factors: one-third of the coronavirus-positive cases in China having no symptoms and called "silent virus carriers"; nearly 200 cases of re-infection in South Korea only a short time since they were declared to have recovered; many cases showing a long incubation period or cases of unidentified infection sources.

These factors make concerns about the "second wave of infection" even more grounded, especially after the "warning bell" from Singapore, which was once considered a "role model" in epidemic prevention and control in the first period of late January and early February. It has become a "hotspot" of COVID-19 in Asia in general and Southeast Asia in particular after just only one month.

Singapore was assessed to have effectively controlled the "first wave of infection" thanks to strong measures such as tight border control, active tracing of suspected people, strict quarantine, travel restrictions and deployment of massive testing as soon as the first cases in the country were announced in late January. The situation began to get out of control with an outbreak at a restaurant in the entertainment area of Safra Jurong in early March, as public gatherings continued, schools and restaurants still operated normally.

The Singapore Ministry of Health in mid-March confirmed that about one-fifth of the 160 cases of COVID-19 in the island state at that time did not limit contacts, continued working, left home and used public transport.... Following was a strong spread of the disease in dormitories for migrant workers.

From more than 100 cases (early March), the number of COVID-19 patients in Singapore after one month increased to more than 1,000 and by April 28, ranking country first in Southeast Asia in the number of cases - 14,951.

Experts said that COVID-19 cases soared in the 5.7 million-strong island nation, mainly from the second wave of infection, with nearly 80% of cases related to migrant workers residing in 43 dormitories across the country as well as Singaporeans returning from the US and the UK. Although Singapore decided to impose strict restrictions from April 7, the virus has been spreading in the community.

More worrisome, despite efforts to trace contacts to cut off the infection chain and lock down the country for two weeks, the community infection has not yet been controlled and there are more and more cases with sources lost.

Statistics show that currently Singapore cannot find the sources of infection of 17 out of the 25 new cases per day. This means that about 68% of cases spread in the community. Many people are likely to have the disease but yet to be discovered. Singapore had to extend the national lockdown until June 1 to deal with the second wave of infection.

In China, in early April, when the local people were still joyful as Wuhan city was allowed to remove lockdown, on April 23, Harbin city – an important center of politics, economy, science and culture in the Northeast of China and also a major industrial hub, had to lockdown because of a COVID-19 case who is a 22-year-old student returning from New York (the US) in March.

Because the initial test result was negative and there were no common symptoms of COVID-19, the patient was isolated at home. This student later infected his neighbor. Since a new case was recorded in Harbin on April 9, more than 80 people in this city have been infected with the virus, making the 11 million-strong city the epicenter of the second wave of infection in China.

In Hokkaido, northern Japan, the early removal of lockdown was thought to be one of the reasons for the return of the SARS-CoV-2. Also considered a "successful model" in controlling COVID-19, when the epidemic hit Japan in late February, Hokkaido was the first locality in Japan to declare a state of emergency, close schools, ban gatherings and encourage people to stay home.

These policies were somewhat effective when the number of new cases per day was counted on the fingers, and on March 19, the local government decided to end the state of emergency. However, 26 days later, the authorities had to declare a state of emergency again when the number of new cases increased by 80% in less than a month.

Dr. Kiyoshi Nagase, President of the Hokkaido Medical Association, admitted: “We are very regretable. We should not have removed the emergency.”

According to Nagase, the second wave of infection began when the notice to remove the lockdown came just before the weekend and the people of Hokkaido flooded the streets, sat in cafes and joined congratulatory parties after weeks of "staying home" Meanwhile, Japanese people from other regions began to visit Hokkaido, students returned to school, and businesses sent workers to Hokkaido from Tokyo or Osaka.

Japanese experts also acknowledged that the authorities saw the risk from people coming from abroad, but did not think that the movements within the country was also likely to bring the virus back and "what happened in Hokkaido shows the virus is very dangerous even when we controlled the first wave of infection, we cannot be satisfied with initial success."

According to Justin Lessler, associate professor of epidemiology at Johns Hopkins University, diseases are like fires, when fuel is available, they will break out uncontrollably, and when the fuel runs out, they still burn silently.

This means that a disease that has temporarily calmed down can recur when there are suitable conditions, and this risk is even more serious when disease carriers in the community are not detected because many infected people do not have symptoms or many become re-infected with the virus after being declared cured.

The World Health Organization (WHO) also said it is unlikely that those who tested positive for SARS-CoV-2 and have been given the all-clear will not be re-infected.

Even in countries assessed to be successful in disease control like Vietnam, with 270 cases as of April 28, of which 82% were cured (222 cases), no deaths and consecutive 12 days without any community infections, health experts said that the risk of virus return is still high as in Vietnam, many cases have become positive again after the negative results.

In fact, Vietnam has experienced three stages of COVID-19 prevention and control, and each phase saw new risk factors that required drastic measures to prevent.

In the first phase, Vietnam succeeded in preventing the epidemic from abroad with drastic and prompt measures since the first cases were detected on January 23, and after only one months, the first 16 cases of COVID-19 in Vietnam were cured. However, after more than 20 days with no new cases, Vietnam entered the second stage, with community infections recorded after cases 17 and 34 returning home from abroad.

With decisions to suspend entry for all foreigners from 0:00 on March 22, and apply a 14-day compulsory concentrated quarantine measure for all entrants, Vietnam has blocked all sources of infection from outside. But at the same time, Vietnam recorded three cases that commenced the third stage of COVID-19 fight: the community infection stage, with outbreaks at Bach Mai Hospital (Hanoi), Buddha bar (Ho Chi Minh City), and then Ha Loi commune, Me Linh district (Hanoi). Through timely and drastic social distancing measures, Vietnam has controlled the spread of the virus.

Even so, experts said social distancing is unable to completely eliminate the disease as well as its spread in the community. It only minimizes virus carriers’ contacts with healthy persons and vice versa, thus limiting the spreading of the virus.

In the context of the pandemic’s complicated development in the world, with about 40% of virus carriers showing no symptoms, it is not possible to exclude virus carriers living in the community, not to mention cases positive again. They are "silent infection sources" that would create an uncontrolled “second wave of infection” when there is still no vaccine or cure for SARS-CoV-2.

It is right when Paul Anantharajah Tambyah, President of the Asia Pacific Society of Clinical Microbiology and Infection said “We are not safe in any place until everyone all over the world is safe.”

A historic lesson, the 1918 influenza pandemic, which killed 50 million people, is a prime example indicating that a pandemic attacks humans in successive waves, the latter more severe than the previous. The re-outbreak of COVID-19 in Japan and Singapore also showed that the second wave of infection can penetrate, exist and develop in a community and it is only detected when the virus has infected many people. That means the risk of a second or even third or fourth wave of COVID-19 infection is still lurking, and a little subjectiveness and negligence will also lead to unpredictable consequences.

(ASIA PACIFIC DAILY)