We thought we had COVID beat in this country, but our second wave is much worse than our first. Why has it resurged, and what can we do about?
The national efforts including school closures, enforced social distancing, holiday lockdowns, and corona hotels brought us from 780 new cases on April first to 1 single new case on May seventeenth. Then began the short period of cautious re-entry. We wore masks until it was too hot during the heat-wave at the end of May, had capsule classes until it was too restrictive in the beginning of June, we worked from home until the kids were in school and we were free to return to the office.
We felt that we had won since we had “flattened the curve”. But the numbers began rising quickly. That was to be expected on re-entry, we thought. The death-rates are still low, we reasoned. June 16: 200 new cases, June 26: 500 new cases, July 4: 1500 new cases – a new record, double our highest daily case-rate even in the first wave. July 18: 2658 new cases. Today, over 25,000 people in Israel are confirmed positive for coronavirus, and we have the dubious distinction of being the only country whose second wave is worse than its first (with the possible exception of Iran, which is not great company).
Why have other countries been successful in reopening, while we have failed? From the natural laboratory of the world responses, a formula has become apparent which makes it possible to control this virus while keeping society open and functioning:
1. Mass testing with quick results. While Israel did pretty well making tests accessible, the turn-around time is still days. That’s too long. People are in quarantine waiting for results, or worse – not in quarantine while waiting. Take some of the many people who are unemployed right now and teach them to process tests!
2. Contact Tracing. South Korea requires all citizens to download an app on their phone which tracks their movement. Its pretty invasive, I agree, but it works better than telling us to call a hotline if we were at Osher Ad last Thurday between 11 – 2.
3. Central quarantine. Quarantine at home is not reliable and the enforcement right now relies on neighbors knowing, noticing, and calling the police to report infractions. Corona hotels, especially for travelers and new immigrants have been a key part of other countries’ control strategies.
4. Widespread use of masks. We’re not doing too badly but we can do better here.
5. Clear public health communications. Countries which have been most successful in controlling the virus have crystal-clear public health messaging. The public needs to understand where people are getting sick so that they can understand how to keep themselves safe.
Some argue that the infection rate is less important than the low death rate which we have thankfully experienced in Israel. After all, if people are not dying en masse and the healthcare system remains functional, maybe it acceptable to have so many thousands sick with COVID. Perhaps it is even desirable, as it will “get the virus over with” (ie through herd immunity). To that point, though there is remains much unknown, we have learned a few important things in the months of living with this virus.
Firstly, COVID appears to be a blood-clotting disease. What we first thought was a flu or pneumonia, turns out to clot the blood causing what are essentially strokes to the lungs. It also causes clots in the heart, brain, and other vital organs. Many if not all who becomes ill from the virus are left with permanent or long-standing damage from these strokes. A foundational tenant of COVID treatment at this point is anticoagulation for this reason. Why is this important? Death rates are only the tip of the iceberg, and the consequences of mass infection in the population (and on a personal level) may not be apparent for years to come.
Secondly, after the virus can follow a strong immune response. Children, with strong immune systems, seem to be more prone to post-viral inflammation which can be disabling or occasionally deadly. In the US and UK, sadly, there are many children in the ICU from this post-COVID syndrome. The good news is that its still seems that because generally young children have a less severe form of the virus itself, they therefore are less likely to transmit it to others. It should be noted that recent studies find that children from age ten transmit COVID as efficiently as adults. What is the implication? That grade schools and up reopening with masking as the only change will spike the number of cases in the general population as well as put children at risk.
Third, the development of antibodies appears to be limited. The best reports I have seen so far show that the stronger your immune response, the stronger the antibodies which you develop. Mild cases or asymptomatic do not guarantee protection. While positive antibodies are at least somewhat protective, the antibodies appear to wear off in a few months, and are gone by 6 months leaving you vulnerable to COVID again. This is incomplete information but the best we have right now. Expect scientific updates coming. Why this matters: Herd immunity does not appear to be possible right now.
Finally, its airborne. The virus travels in the air, through air-conditioning systems and lingering in elevators, busses, and rooms, and can make you sick that way. I’m sorry to say, but the 2 meter rule, though helpful to avoid direct coughs and sneezes, is not effective enough to rely on. If you are in a building with people other than your housemates, you are at risk. This risk increases as the number of people in that building increases (large groups), and when masks are removed (restaurants, bars, gyms, etc). Key points here: Indoor spaces where masks come off simply must be closed down or reimagined. We need our outdoor spaces more than ever. Beaches, parks, travel to isolated outdoor spaces should be encouraged. If these spaces are too crowded, create a system which allow families to go one week out of the month according to family name or by reservation as is working in the national parks. Allow eateries to put out socially-spaced tables outdoors. We need to expand and reimagine our outdoor spaces to adjust to the new reality – the outdoors can keep our economy and us alive.
The lockdowns were never meant to be a solution, but rather to buy us time. That time was needed to develop quick-result testing, roll out national contact-tracing and quarantine strategies, and make long-term plans to schools, work-flows, and life alongside a virus we want to avoid contracting. Unfortunately, the worsening health of the country demonstrates that these things were not done. But it is not too late. We know more now about the virus and what works to control it. COVID is here for the foreseeable future; now we need to do the hard work of changing the way things have always been to face the new reality.