Fight’s not over yet as the coronavirus is winning — for now

SINGAPORE — Let’s face it: Things won’t be getting better any time soon.

The stark warning from global health experts comes after July yielded nearly as many new coronavirus infections as the first six months of the pandemic put together – and the curve continues edging steadily upwards.

More than eight million new Covid-19 cases were recorded last month, with numbers doubling every six weeks. The global total now stands at nearly 20 million, and over 700,000 people have died of the disease worldwide. August does not bode any better.

“Nothing I have seen so far makes me optimistic,” public health strategist Bill Bowtell, an adjunct professor at the University of New South Wales in Australia, told The Sunday Times. “Globally, we are still in the first wave and there is little sign of abatement.”

The pessimistic outlook has Prof Bowtell advocating a more ambitious strategy in curbing the pandemic – striving for elimination of the virus, rather than merely trying to keep numbers low.

One in every four infected in July was from the United States, which reported a record 1.87 million cases last month, more than double its previous record month in April. Brazil saw 1.2 million infections last month out of its current total of nearly three million, while India saw 1.1 million cases of its two million tally.

The fresh surges in the Americas and South Asia came even before the regions witnessed any notable decline in their epidemics despite scattered lockdowns. Other countries in Europe and the Asia-Pacific saw spikes from new outbreaks after initial success in containment.

Asia’s cautionary tales

The Philippines became Southeast Asia’s latest coronavirus epicenter last week as its cases soared above 120,000 and its sprawling capital of Manila and surrounding areas went back under lockdown. The country had emerged from one of the world’s strictest and longest lockdowns only in June, as President Rodrigo Duterte sought to restart the economy that was spiraling into its deepest recession ever.

But as people returned to normal life almost immediately, infections quickly rose again, from a seven-day average of 600 on June 1 to more than 4,200 on Friday. Yesterday, it reported another 4,131 new cases and 41 deaths.

Vietnam, which had gone 100 days without community transmission and had not seen a single Covid-19 death initially, detected its latest outbreak in the central city of Danang in late July. In the span of a fortnight, the outbreak has spread to 13 cities and provinces, including the urban centers of Hanoi and Ho Chi Minh City, and led to over 300 new cases and 10 deaths. Its source remains unclear.

In Malaysia, a nascent cluster of cases that originated from a restaurant owner, who had returned to Kedah from India and failed to follow quarantine rules, has spread to neighboring Perlis and Penang states, infecting about a dozen people.

Japan, which had earlier been lauded for its successful model of limited testing and lack of lockdowns and legal enforcement, is also facing an aggressive resurgence of the virus that has spread rapidly from its capital of Tokyo to other urban areas and from younger, healthier people to the elderly over the past month. It now sees a daily average of over 1,300 cases compared with 100 at the beginning of last month. Experts have pointed the finger at complacency among both the government and its population that led to the economy and society reopening too much, too soon.

Hong Kong, which was also thought to have had the virus under control despite never having imposed a lockdown, saw a growing number of new infections from last month, many with unknown origins. Its cases have more than tripled from around 1,200 at the start of July to over 4,000 yesterday as it added another 69 new infections. The death toll has also risen sharply to 47, from just seven before the new outbreak began.

The city had relaxed social distancing restrictions in June, removing dining limits in restaurants and allowing gatherings of up to 50 people. That same month, mandatory quarantine rules were lifted for business elites from some 480 Hong Kong-listed firms entering from mainland China.

Hidden infections in the community, quarantine-exempt people who brought in new cases, and looser social distancing rules that allowed people to come into greater contact, all contributed to the city’s recent spike, said Professor Keiji Fukuda from the University of Hong Kong’s School of Public Health.

“Hong Kong is regaining control over this current upsurge,” Prof Fukuda told The Sunday Times. “But the overall global outlook is continued growth of infections.”

Careening out of control

In the US – by far the most severely affected country in the pandemic, accounting for over a quarter of all cases and one in every five deaths – its leaders’ oscillation between inaction and ineptitude has been blamed for letting the virus run rampant across the nation. It has now seen more than five million infections and over 160,000 deaths.

A sluggish government response, chronic under-funding of public health, discriminatory policies that rendered minority groups particularly vulnerable, and a decades-long shredding of the nation’s social safety net that forced low-wage essential workers to risk their lives for their livelihoods, were among a multitude of factors that led to this crisis, The Atlantic said in a damning report published on Tuesday that was the culmination of interviews with over 100 experts in various fields.

The practice of mask wearing and debate over school reopening have divided the nation, as state and local officials imposed conflicting orders over the past month. President Donald Trump has insisted that increased testing is the reason for the surge in numbers, though his assertion has been widely disputed by health experts.

“The spike in cases… has been due to under-testing, inadequate masking, and complacency around reopening,” Dr Thomas Tsai, an assistant professor at Harvard T.H. Chan School of Public Health’s Department of Health Policy and Management, told The Sunday Times.

“Of much greater concern, when data emerged that cases were rising… policymakers seemed to be frozen, unwilling to re-shutdown to contain the pandemic.”

In India, the third worst-hit nation after the US and Brazil, the infection curve has not once plateaued despite four months of lockdowns of varying degrees in different regions. While some larger cities are on a tentative road to recovery, smaller towns and even villages are now reporting more cases. India’s daily average of new infections stands at more than 55,000, with the vast majority of its national tally recorded in July alone.

The soaring cases could be attributed to the partial resumption of travel and the uninhibited gathering of crowds post-lockdown, said Dr K. Srinath Reddy, president of the Public Health Foundation of India and a member of the Indian Council of Medical Research Covid-19 task force. While increased testing may be one reason for the higher numbers, “the rising count does represent the reality that a large number of people are being infected”.

“Globally, we are seeing the mixed effects of a still untamed first wave induced by human folly, and a genuine second wave in some places where the virus is revisiting as international travel resumes,” Dr Reddy told The Sunday Times.

“It is unlikely the global graph will see a turnaround till the virus’ free rein is halted in many regions. We will probably have to wait till end-September to judge if the virus is getting chained at the global level.”

The World Health Organization, too, struck a dispiriting tone when it warned this past week that no magical cure for the coronavirus may ever be found even as scientists around the world continue in efforts to manufacture a vaccine.

‘Eliminate, not suppress’

The University of New South Wales’ Prof Bowtell is among a group of prominent health experts advocating that governments pursue an ambitious strategy of eliminating the virus altogether rather than simply seeking to suppress its spread while awaiting a vaccine.

Australia, which has followed a suppression strategy aimed at keeping cases numbers low, is still battling a massive outbreak that emerged in its second most populous state of Victoria a month ago. It has set new daily records for both infections and deaths over the past fortnight, with its national tally now topping 20,000 infected and over 270 dead.

“There is too much delay of measures that could be taken now in the fond hope that a vaccine is around the corner,” Prof Bowtell said. “But a vaccine is not a cure.”

This past week, Victoria declared a state of disaster and put its state capital of Melbourne under a six-week lockdown. The harsh restrictions came after a recent door-knocking campaign to check on 3,000 infected people found that 800 of them were not at home. The state added another 466 new cases and 12 deaths yesterday.

Neighboring New Zealand, on the other hand, has gone 100 days since its last locally transmitted case, though its government remains on high alert and has urged its people against complacency.

“We must now pursue elimination. There is no stable level of infection – it is either going up as it is now, or forced down and then out,” Prof Bowtell said. “What is stopping the pursuit of this strategy is a combination of powerful economic forces, inertia, timidity and – in the US at least – anti-science.”

The difference between elimination and suppression is mostly a matter of degree, the University of Hong Kong’s Prof Fukuda said. But seeking to eliminate the virus altogether may come at a higher, more immediate cost.

“It comes down to the question of whether a society is willing to accept the costs – emotional, mental, economic, etc – of achieving fewer cases. The answer will depend a lot on the population, especially its leadership and culture,” he said.

“Given the persistence of Covid-19 worldwide, the real question before countries is what is an acceptable degree of combined control measures – such as border controls, reduced travel, social distancing, school closures, testing, masks etc – and duration of such measures to achieve relatively low levels of infections and deaths.”

For India’s Dr Reddy, the likelihood that the coronavirus is here to stay looms large.

“The virus may become endemic,” he said. “That it chooses to spread is in its nature, but to slow it down is within our capability – if we heed common sense and apply the lessons of science.”