Covid-19: a third wave?

‘Where are we in this pandemic?’ is the most common question I encounter. People really want to know if we are getting out of it and I too am now exhausted by the precautions and missing in-person socialising. In most outbreaks we are either moving up on a graph (increasing daily cases) or coming down (decreasing daily cases). So as a field epidemiologist, the daily case graph gives us a lot of valuable information. We could tell if an outbreak is single source or from multiple sources, if it has reached the peak or if control measures are effective? To get all this information through just a graph, we need good reliable data on most cases. Unfortunately, that is not the case for this pandemic.

Data is not being collected in a proper way. Different diagnostic tests with different levels of accuracy are being used even in individual countries. There is no effort in most countries to identify additional cases. The numbers we see are of those who go to laboratories to get tested. Most people now are unwilling to get tested despite symptoms. Another data source is from hospitals and that is also incomplete. The collection of these haphazard numbers does not help anyone decipher the situation. It is as if we are in a major war with no interest in collecting military intelligence against our enemy. Hence, it is not surprising that most countries are suffering and those who are not, don’t know why they have been spared. The young age of a country is certainly a protective factor but it also means that this country has a bad health system so not many survive the early years of life. If we are being spared due to our population’s young age, then it is a shame for our country. Few countries even with older populations have managed and controlled the pandemic well by following tested public health measures and getting good quality data. Unfortunately, these are just a few.

So, where are we in the Covid-19 pandemic? Will there be a third or even fourth wave? Are our cases stabilising or coming down? With the compromised data, there is a limit to our interpretation. But one thing is definite: that there is a wave phenomenon in this pandemic. Most countries are in the second wave, and some in the third. The US may be now riding the fourth wave. Another thing which has become clearer is that the successive wave is always bigger than the previous one. This was true for both the US and UK. The huge increase in numbers in the third wave was not due to more availability and access to tests alone. After each wave, cases decreased but things were never back to normal. Why the third wave has been so devastating in many countries? It shows the virus has now more areas where it is spreading compared to the first wave when each country had few geographical areas of virus spread. It also shows how seriously we must follow public health measures even when case numbers fall. Claiming a premature victory on SARS-CoV-2 could be suicidal.

Pakistan’s second wave was a bit stable in the last part of December, but numbers never came down as they did after the first wave. On Saturday, Pakistan reported a 5.7% positivity rate. These are dangerous signs and with much underreporting it will be difficult to predict the future. But one thing is certain that we will have a bumpy road ahead so keep your masks on, maintain social distance, hand hygiene and fresh air ventilation. The finish line may be near, but we must survive till then.

Published in The Express Tribune, January 18^th, 2021.

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