Judyta Watoła: People want to know when the coronavirus outbreak will reach its peak. Looking at the statistics, we have only seen about 300-400 new daily infections in the past month. The rate is flat.
Prof. Robert Flisiak, head of the Polish Society of Epidemiology and Infectious Diseases: The spread of each epidemic can be visualised using the Gaussian bell curve. If the curve has not reached its highest point yet, it means that the peak has been obscured and our data is incoherent. We cannot have even an approximate idea of how the disease spreads if we are not doing enough testing. If in the past four weeks our rate of new infections was more or less steady, it tells us that the numbers are underreported. But instead of focusing on the rates for the entire country, we should rather be looking at the regional situation. There are some voivodeships, like Lubelskie, Lubuskie, or Podlaskie, where the curve aligns perfectly with the increasing rate of infections.
Those regions hardly register any new infections at all.
-Precisely! Take Podlaskie: that is a classic bell curve. No new cases in the last few days. There is no reason to believe the declining numbers are not accurate. Our laboratories are still doing about 200 tests a day. If we are not seeing new infections here, it means that the epidemic is fading-out.
The Mazowieckie voivodeship, for example, is a different story altogether. Despite the current decline in the number of newly registered cases, the peaking point characteristic for the Gaussian curve is not there. In Śląsk, on the other hand, we see the numbers go up instead of decreasing. It means that the highest point of epidemic is yet to come, although we are not sure if we will be able to do enough tests to capture it. So, the question presents itself: should we relax the restrictions in regions where the epidemic is fading out and keep them in place where it is not?
Some doctors see the calls for more testing as a purely populist manoeuvre. They claim that even though there is an increase in the number of conducted tests, the infection rate remains largely unchanged.
- Wide spread testing still makes a lot of sense considering that it is the asymptomatic carriers, and not the diagnosed patients, who mostly spread the disease.
You mentioned that the epidemic is fading out in Podlasie and Lubuskie, yet the minister of health keeps saying that “we’re just delaying the peak”.
-The minister’s musings on an upcoming peak of coronavirus epidemic are based on data epidemiologists are not aware of. Unless he means the global situation. If so, we can indeed expect a wave of new infections in South America. Also in Africa, but because the testing capacities there are very limited, we will not know the exact spread of the outbreak.
In Europe, however, the peak is clearly behind us. In terms of the situation in Poland, I will repeat what I have already said: instead of focusing on the entire country, we should be looking at the particular regions because the difference in numbers is immense. Of course, even in places that do not register new infections, we cannot entirely exclude a scenario where a potential hotspot like a nursing home leads to a renewed outbreak. This only speaks in favour of doing more tests.
Besides, in our discussion about the possible scenarios for the progression of COVID-19 epidemic we keep forgetting about one fundamental immunological phenomenon, namely: cross-immunity.
What is that?
It means that our immune system can mistake a new pathogen for another one it already knows. The new pathogen can resemble an “old” one so much that our organism could have already developed an immunity to it. There are all kinds of different coronaviruses in the environment but not all of them are pathogenic. If we assume that most of us are already immune to “old” coronaviruses, it would be possible that our organisms can successfully fight the new ones, or at least weaken them significantly. This could be one way of explaining why so many infected people are asymptomatic or show only mild symptoms.
Unfortunately, we still do not know enough about the immunogenicity of coronaviruses, nor about our cross-immunity to them. We also still don’t know much about the geographical movement of coronaviruses. It should be noted that the main factor causing an epidemic to fade out is the increased percentage of immune individuals. It is possible to imagine that in regions where the number of people who developed cross-immunity is relatively high, the number of people still vulnerable to SARS-CoV-2 is marginal.
But the health minister does not only talk about a delayed peak of the outbreak. He is also making grim predictions about two different epidemics awaiting us in autumn.
-Again, these musings also seem to be based on some sort of secret knowledge inaccessible to regular epidemiologists.
What can we expect then?
- We will have a creeping epidemic. My assumption is that the numbers will oscillate around a several dozens of new daily infections popping up in several different hot spots. If not for the hot spots in Śląsk’s coal mines, we would already see this scenario come to life. It is likely that the situation remains fairly calm until autumn, and we will see the seasonal outbreak of flu and similar diseases after that. The only difference being that if someone sneezes, they will immediately be suspected of being potentially infected with SARS-CoV-2.
Hordes of infected and sneezing people? It will trigger mass psychosis!
- Not if we manage to prepare accordingly. The testing capacity of our laboratories should be higher. We should also consider if the current model utilising specialised infectious disease hospitals turned out to be effective. In my opinion, it did not. The high number of patients will require all hospitals to have both isolation wards for confirmed cases of infection and patients who are only suspected to be infected.
Organising the logistics will be yet another problem. We need to consider reorganising the emergency services; at the moment, family doctors face major difficulties sending a patient to the hospital. There is a shortage of personnel and the ambulances lack the appropriate equipment to transport infected patients. General health care centres should also be ready to collect testing samples. The question remains: what will the health ministry do about it?
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