CORO­N­AVIRUS SEC­OND WAVE WHICH ASIAN COUN­TRIES ARE MOST AT RISK?

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Maria Siow is a long-time Chin­abased correspond­ent and an­a­lyst with keen in­ter­est in East Asia. She has a mas­ters de­gree in in­ter­na­tional re­la­tions.

Anew out­break of the coro­n­avirus in China has sent rip­ples of fear through the world of a sec­ond wave of in­fec­tions, es­pe­cially in coun­tries that have had some suc­cess in con­trol­ling the pan­demic and are mov­ing ahead to re­open their bat­tered economies.

Sev­eral Asian coun­tries that have eased re­stric­tions and re­sumed some level of eco­nomic ac­tiv­ity, in­clud­ing Aus­tralia, Ja­pan and South Korea, have in the last month re­ported new out­breaks num­ber­ing in the tens to a few dozens.

Cap­i­tal cities have been the sites of most in­fec­tions, partly due to their high hu­man traf­fic. China’s sec­ond out­break is cen­tred in Bei­jing, with at least 184 new cases re­ported since last week, as au­thor­i­ties can­celled scores of do­mes­tic flights, banned out­bound travel and im­posed a par­tial lock­down. On the prospect of deal­ing with the sec­ond wave of the coro­n­avirus, ex­perts gen­er­ally agree that re­gional gov­ern­ments ap­pear to be bet­ter pre­pared to cope af­ter the sub­stan­tive ex­pe­ri­ence they have gath­ered tack­ling the ini­tial out­break of the pan­demic.

Chal­lenges that re­main

How­ever, an­a­lysts also point out that chal­lenges re­main, es­pe­cially in main­tain­ing vig­i­lance and en­sur­ing that small clus­ters are swiftly con­tained so they will not morph into big­ger and more un­con­trol­lable in­fec­tions.

Paul Ananth Tam­byah, pres­i­dent of the Asia-Pa­cific So­ci­ety of Clin­i­cal Mi­cro­bi­ol­ogy and In­fec­tion, said coun­tries and com­mu­ni­ties most at risk of a sec­ond wave were those with on­go­ing cases of lo­cal trans­mis­sion, with daily num­bers in the hun­dreds or thou­sands. “Al­though it could be ar­gued that this is still the tail end of the first wave, there are likely to be mul­ti­ple chains of trans­mis­sion in those coun­tries which have not been cut off,” Mr Tam­byah said.

Coun­tries with high in­fec­tions that Mr Tam­byah al­luded to in­clude In­dia, which on Fri­day recorded the high­est one-day spike of 13,586 coro­n­avirus cases, rais­ing the to­tal to 380,532, the fourth high­est in the world, af­ter the United States, Brazil and Rus­sia. Its death toll stood at 12,573.

In neigh­bour­ing Pak­istan, 136 more deaths were re­ported on Fri­day, bring­ing coro­n­avirus-re­lated fa­tal­i­ties to 3,229 and over­all in­fec­tions to 165,062.

In In­done­sia, the coun­try has boosted sam­ple test­ing to meet Pres­i­dent Joko Wi­dodo’s tar­get of 20,000 per day. The coun­try re­ported 1331 new coro­n­avirus in­fec­tions on Thurs­day, its big­gest daily in­crease since the out­break started lo­cally, bring­ing the to­tal num­ber of cases to 42,762. Fa­tal­i­ties stood at 2339.

In the clear­est sign that the pan­demic is here to stay, coun­tries that have over­come the first wave are now gear­ing up to stem the emer­gence of a sec­ond wave.

South Korea

South Korea added 49 new cases on Fri­day, in­clud­ing 32 lo­cal in­fec­tions, rais­ing the to­tal caseload to 12,306, ac­cord­ing to the Korea Cen­tres for Dis­ease Con­trol and Preven­tion.

The num­ber of new daily COVID-19 cases marks a slight slow­down from a three-week high of 59 a day ear­lier. Of the lo­cally trans­mit­ted cases, 26 were re­ported in densely pop­u­lated Seoul and nearby metropoli­tan ar­eas.

Lee Hoan-jong, Emer­i­tus Pro­fes­sor at the Seoul Na­tional Univer­sity Chil­dren’s Hos­pi­tal, said it was in­evitable for the virus to spread wider and faster, af­ter the coun­try eased so­cial dis­tanc­ing about a month ear­lier.

“A sec­ond wave of in­fec­tions can come at any time un­til a vac­cine be­comes widely avail­able or some 60 per cent of peo­ple get in­fected” to have herd im­mu­nity, Pro­fes­sor Lee said.

Health au­thor­i­ties said the coun­try had to brace it­self for yet more clus­ter in­fec­tions in the greater Seoul and other ar­eas, and warned that the pan­demic’s spread might stretch into sum­mer.

Na­tional Can­cer Cen­tre’s Epi­demi­ol­ogy Pro­fes­sor Ki Mo­ran said at a sem­i­nar last week that the coun­try “must tighten so­cial dis­tanc­ing, oth­er­wise, we may have 800 new cases ev­ery day in a month’s time”.

Also wor­ri­some is the sit­u­a­tion in Ja­pan, where health ex­perts say there is a high like­li­hood of a sec­ond wave of the coro­n­avirus hit­ting the coun­try.

Ja­pan

Of­fi­cials in Tokyo con­firmed 41 new coro­n­avirus in­fec­tions on Thurs­day, mark­ing the third time in the week that the cap­i­tal logged more than 40 cases in a day. This brings the to­tal cases in Tokyo to 5674.

Ac­cord­ing to Kazuhiro Tateda, pres­i­dent of the Ja­pan As­so­ci­a­tion of In­fec­tious Dis­eases (JAID) and a mem­ber of the com­mit­tee set up by the gov­ern­ment to com­bat the spread of the virus, many of the re­cent cases in Tokyo can be traced back to the city’s nightlife dis­tricts. Mr Tateda said that even though th­ese clus­ters were eas­ier to con­trol as they were linked to trace­able parts of the city, there was al­ways the risk of more lo­calised out­breaks.

“We do know that there is a lower risk of trans­mis­sion in the sum­mer months, which means that there is a chance of a sec­ond wave … from Oc­to­ber on­wards,” Mr Tateda added.

To guard against a sec­ond wave, au­thor­i­ties have drawn up a se­ries of guide­lines that the nightlife in­dus­try is be­ing en­cour­aged to abide by.

How­ever, Yoko Tsukamoto, a pro­fes­sor of in­fec­tion con­trol at the Health Sciences Univer­sity of Hokkaido, said it was hard for busi­nesses to fol­low the rules as staff needed to be close to cus­tomers to serve them drinks or light their cig­a­rettes.

“It’s not re­al­is­tic to ex­pect them to keep two me­tres apart, so the gov­ern­ment is stuck be­tween do­ing what it has done and shut­ting th­ese busi­nesses down,” she said.

She said au­thor­i­ties might have no choice but to reim­pose a state of emer­gency on Tokyo if cases rose to 100 a day.

JAID’s Mr Tateda was con­fi­dent that if that were to hap­pen, the gov­ern­ment, health care pro­fes­sion­als and the Ja­panese pub­lic would be bet­ter pre­pared and re­act far more swiftly.

“We have gained a lot of ex­pe­ri­ence in what to do and what not to do,” he said. “We will re­spond more quickly and more ef­fec­tively and ap­ply the lessons that we have learned. The gov­ern­ment has in­creased the bud­get to fight the dis­ease and doc­tors and nurses are bet­ter pre­pared to deal with the virus. They are as ready as they can be if a sec­ond wave does come.”

New Zealand

Michael Baker, Pro­fes­sor of Pub­lic Health at the Univer­sity of Otago in Welling­ton, said the term “sec­ond wave” dated back to the 1918 in­fluenza pan­demic, which had three dis­tinct waves in some parts of the world, with the sec­ond gen­er­ally be­ing the most se­vere. He said the like­li­hood of a sec­ond wave would vary de­pend­ing on the strate­gies coun­tries used.

“New Zealand, for ex­am­ple, came out of a lock­down very cau­tiously into a virus-free coun­try, so there were no cases that could start a fresh out­break,” Baker said. “Sev­eral other coun­tries in Asia are also con­tain­ing this virus in a sim­i­lar way, so [we] will not ex­pect to see many cases as they re­duce their lock­downs.”

By con­trast, in the US, sev­eral states com­ing out of lock­down were ex­pe­ri­enc­ing large rises in cases be­cause there was still a lot of virus cir­cu­lat­ing that could start new chains of trans­mis­sion, Baker said.

On what lessons Asia could learn from its first round of tack­ling the pan­demic, Baker pointed to the im­por­tance of face masks for re­duc­ing trans­mis­sion, as well as “the need for test­ing and high-per­form­ing con­tact trac­ing sys­tems”. Equally im­por­tant, ac­cord­ing to Baker, was “good sci­ence, good lead­er­ship, and re­spond­ing rapidly to the pan­demic. The con­tain­ment and elim­i­na­tion ap­proach de­vel­oped dur­ing the Sars era also works for COVID-19”.

China

Bei­jing, which was one of the worst hit dur­ing Sars, has adopted stricter mea­sures in its sec­ond phase of deal­ing with COVID-19, such as in­stalling 24-hour se­cu­rity check­points in lo­cal com­mu­ni­ties, clos­ing schools and ad­vis­ing peo­ple to step up on so­cial dis­tanc­ing. Baker said the risk of im­ported cases start­ing fresh out­breaks would re­main the main threat to China, where a swift and vig­or­ous re­sponse would be needed to con­tain the out­break.

“[The re­sponse] is highly likely to be suc­cess­ful, given China’s demon­strated ex­pe­ri­ence with such con­trol mea­sures,” Baker noted. Zhang Qiang, deputy head of Bei­jing’s epi­demic con­trol team, said at a mid­week brief­ing that Bei­jing had ex­panded mass test­ing among its res­i­dents, cov­er­ing all who have been to, or had close con­tact with, key food mar­kets which have been shut down. Health work­ers have tested some 356,000 peo­ple since June 13.

How­ever, some Bei­jing res­i­dents are still find­ing it dif­fi­cult to get tested. Fu Lin­shan, a web de­vel­oper, said he needed to get the test done and ob­tain an all-clear be­fore he was al­lowed to re­turn to work. “But when I ar­rived at the hos­pi­tal early in the morn­ing, all the to­kens for test ap­point­ments had al­ready been snapped up,” Mr Fu said.

Bus pas­sen­gers in South East Asia prac­tis­ing so­cial dis­tanc­ing while wear­ing face-masks as a health pre­cau­tion.

Maria Siow

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