Has a true second wave arrived, with the historical precedent of increased virulence? Let’s start with two points:
- (The Hill, 7/28) More than half of Spanish coronavirus patients suffering from neurological problems: research.
- (Guardian, 10/30) Coronavirus strain from Spain accounts for most UK cases – study.
This combination, combined with uncertainties yet to be resolved, could define an actual second wave.
“Second Wave” does not have an exact medical meaning. It stems from historic pandemics, dating back to the first written histories. Back then, people-mobility was occasional, except for traders and soldiers. The traders carried the news of the Silk Road, which ran between southern Europe and China.
Western forest fires are the visual. A new plague-wave started in a single place, moving with the slow carriage of goods and people along the Road. A forest fire leaves a wake of burned-out land. As a plague moved along the Silk Road, it left a decimated population. Because mobility was so slight, ancient plague waves had sharp dates of arrival.
With the extreme mobility of the jet age, the sharp dates-of-arrival picture is replaced by fuzzy blobs. The U.K./Spain connection of the new strain, 20A.EU1, is clear enough. But since constant mutation of COVID-19 is the norm, is this significant enough to justify a “second wave”?
A new strain arises by mutation in a single patient, possibly recombining in multiple patients. How a particular strain wins Darwin’s selection to become dominant is too heavy to discuss just days before Election Day. We want to know whether 20A.EU1 follows an historical pattern of previous plagues, when the second wave was more virulent than the first. Only then does it become dire.
Increased frequency of neurological involvement may indicate a more virulent second wave. Discriminating a second wave depends on both signs and symptoms, but symptoms are much harder to interpret. A sign can be measured, like blood pressure, body temperature, brain waves (EEG), or death. Symptoms can’t be measured. They are just are described by the patient.
Is this the start of a classic second wave like the 1918 Spanish flu? Or is it just a variation on a horrible theme? The clinicians will have to tabulate, palaver, and consider. It would not be wise to scoff at a “yes.”
Some time after the election, we’ll continue with the deeper discussion of COVID Second Wave; Of Hares and Foxes; Primer for Policy Makers, Part 5.
In the meantime, save your brain. Save your life. Wear a mask.