Is there a way to avoid a second wave?

In my 1 Jul 2020 post,  I found out that of the world's top 50 countries in terms of the total number of Covid-19 cases,  there were 12 countries with a second wave.

How have these 12 countries performed over the last 2 weeks? 

• 5 are still experiencing an increased number of cases

• 3 countries are bringing it down

• 4 are at a plateau

 

Countries	Covid-19 status
US	Still increasing
Iran	Plateau
Turkey	Decreasing
Saudi Arabia	Decreasing
UAE	Decreasing
Kuwait	Plateau
Ukraine	Plateau
Portugal	Plateau
Philippines	Still increasing
Panana	Still increasing
Romania	Still increasing
Israel	Still increasing

The conclusion is that it is not so simple to control the virus.

The last time, I only looked at the top 50 countries.   

This time I decided to extend it to cover the No 51 to No 100 in terms of the total number of cases. For this group there are

• 13 countries with the second wave

• 14 countries still having an increasing number of cases

• 15 countries with decreasing number of cases

• 8 countries where the number of cases is at a plateau

The list of these countries is presented in the Appendix.

It is interesting to note that the number of countries with the second wave is about the same whether you look at the top 50 or the next 50 countries.

If you look at the statistics, about 1/4 of the top 100 countries in terms of the number of Covid-19 cases are facing a second wave.

So is there a way to avoid a second wave? 

I thought it was evident that as long as the virus has not been eliminated (I would imagine a country would require at least 14 to 21 continuous days of zero reported infection before it can conclude that the virus has been eliminated) there is always a chance that it would reappear. 

So it is not surprising to see second waves among those countries that did not eliminate the virus.

In this context I think we should not be surprised by the news that Australia or even Japan is facing a second wave - they never eliminated the virus ( as defined above,) before they opened up the economy.  The daily charts for both these countries show what I mean. 

Source: Worldodometer

Along the same lines, Malaysia is in the same boat as we never eliminated the virus. We just got the numbers to be low when we opened up the economy,. 

So will we have a second wave like those of Japan or Australia?

I don’t think so because, by definition, the second wave is the result of another exponential growth. 

As long as the number of cases in Malaysia can be kept below the exponential trigger point, we can avoid a second wave.   

I have not seen any number from the authorities about this trigger point, but I have in my 2 May 2020 post I estimated that if we have less than 30 daily cases (excluding the imported), we safe from exponential growth. 

These 30 cases should be sporadic cases ie not from one or two clusters.  By sporadic cases, I mean that we have not been able to identify the cause/source of the infection.  

In this context, the daily numbers for Jul to date have been below this 30-cases threshold.

But more importantly, a large part of our Jul numbers came from clusters.  Although as of today we have 19 active clusters, 13 of them actually started in Jul ie the index case was reported in Jul.

This meant that in Jul we actually had 13 index cases that spread it to 23 others so far (the test results for some of the clusters are still pending).  

• 4 of the index cases were identified as being infected when overseas

• Several were identified as part of MOH “critical group” testing

So not only are the numbers small, MOH is still testing to identify cases before they have a chance to spread further.

Apart from testing, what else do we need to do?

Prevent the virus from coming into the country.  I have already voiced my concern about our self-quarantine procedures.  

I was thus happy to note the 16 Jul media report that MOH is reconsidering the possibility of placing returnees from high-risk areas, either in hotels or quarantine centres.

At a press conference on Thursday (July 16), the DG of MOH added that those coming to the country must take a test before boarding the plane.

Now MAS has this travel advisory on its website

"Effective 20 July 2020, all Malaysian nationals and foreigners entering Malaysia through International Arrivals are required to undergo a mandatory Polymerase Chain Reaction (PCR) COVID-19 test,  three days prior to the date of departure. Those with negative results will be allowed entry into Malaysia. The result or medical certificate issued must be in English"

Conclusion - how do we prevent a second wave if we have yet to eliminate the virus?

• continue the "random" testing so that we can identify and isolate cases before they have a chance to spread further.  

• control imported cases

I would like to add "social distancing" and wearing masks but I think the reality is that in Malaysia, most of us have not been following the social distancing guidelines although many still wear masks.  

My view is that as long as the number of cases out there is very small, we can get away with it.  But the moment we have a surge, I think we need to be strict about social distancing. 

Appendix:  Countries in the No 51 to No 100 ranked position in terms of the total number of Covid-19 cases. 

A) Those with the 2nd wave: 

1. Romania - No 46
2. Japan - No 57
3. Algeria - No 58
4. Serbia - No 60
5. Morocco - No 63
6. Chechia - No 67
7. Australia - No 71
8. North Macedonia - No 77
9. Bulgaria - No 81
10. Luxembourg - No 93
11. Djibouti - No 94
12. Croatia - No 96
13. Paraguay - No 100

Note:  The No refers to the ranking as per Worldodometer

B) Those with increasing Covid-19 cases

1. Honduras

2. Ghana

3. Azerbaijan

4. Kyrgyzstan

5. Uzbekistan

6. Kenya

7. Venezuela

8. El Salvador

9. Costa Rica

10. Bulgaria

11. West Bank and Gaza

12. Bosnia and Herzegovina

13. Madagascar

14. Albania

C) Those with decreasing Covid-19 cases

1. Switzerland

2. Ireland

3. Austria

4. Nepal

5. South Korea

6. Denmark

7. Sudan

8. Norway

9. Malaysia

10. Finland

11. Haiti

12. Tajikistan

13. Mauritania

14. The Central African Republic

15. Hungary

D) Those with Covid-19 at a plateau

1. Moldova

2. Cameroon

3. Ethiopia

4. Senegal

5. Congo

6. Guinea

7. Gabon

8. Greece

Note:  I referred to the John Hopkins Coronavirus Resource Centre daily case chart to identify the virus trajectory (eg declining, the second wave).  However, I referred to Worldodometer to identify the top 100 countries. I noticed that there were 2 countries in the John Hopkins database ( Cote d'Ivoire and Kosovo) that are not covered by Worldodometer. 

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PS: This blog is for me to better understand COVID 19 as this will impact my investments. If you are also into equities, follow me at i4value.asia.

Disclaimer:  I am not an epidemiologist, healthcare worker, pharmacist, or staff in the Ministry of Health, but rather is someone with a strong interest in numerical analysis.  The content is an attempt to understand what is happening in the battle against COVID 19 from a data-based perspective. The opinions expressed here are based on information extracted from readily available public sources but I do not warrant its completeness or accuracy and should not be relied on as such.