The recent spike in Covid-19 cases in some of the countries thought to have best contained the virus — first Singapore, now South Korea and, potentially, Germany — is a glimpse into America’s possible future as states start reopening businesses and public activities after several months of lockdown.
All it can take to reverse the positive trends is a single undetected case. As Vox’s Alex Ward reported this week, one South Korean man who went out for a night on the town at several Seoul dance clubs has been linked to nearly 80 new cases there. Suddenly the country’s curve is rising again and the local government ordered bars and restaurants to be closed, an abrupt reversal of its reopening plans.
Since we’re thinking of things in terms of curves and waves these days, here is the situation in South Korea:
South Korea had been a poster child for an effective Covid-19 response, having learned from its experience with SARS last decade. As Ward notes, the country had even held a national election without any obvious public health consequences. It had started to see days with no new domestic cases. The government was warning the virus could rebound, but it was possible to look at South Korea as evidence that a country could beat coronavirus and get life back to normal in short order.
But then a man who didn’t yet know he was infected decided to go dancing, and now businesses are being shuttered again.
The news out of South Korea would be worrying enough on its own. But it’s not the only place to see the start of a second wave. Vox’s Jen Kirby reported in mid-April on the second waves hitting Singapore and Hong Kong. She wrote in stark terms about the implications:
This may be the world’s new normal, at least until an effective medical therapy is widely available that lessens the intensity of the disease, or the world acquires immunity, most likely through a vaccine. Social distancing measures may be a recurring tool — intensifying, easing, and intensifying again as outbreaks surge, diminish, and surge again.
Because as long as the coronavirus is spreading somewhere, it can spread everywhere. That is why no country has beaten the coronavirus yet.
“We will not get rid of the disease until every country has a system to detect the disease and stop it near the origin, as or as close to the origin as possible, before it spreads,” Olga Jonas, a senior fellow at the Harvard Global Health Institute who formerly helped to coordinate the World Bank’s response to avian and pandemic flu threats, told me.
A month later, Singapore’s curve is on a gradual but steady incline. The coronavirus has not been beaten back again.
And now Germany, a paragon of good testing and early containment in an otherwise ravaged Europe, is seeing a sudden and worrying jump in cases. As Business Insider reported, the number of new coronavirus cases there tripled from Monday to Tuesday, up to more than 900 in 24 hours. The leap came just about a week after schools and shops started to reopen; astute readers might remember the virus’s incubation period is four or five days on average.
The bump could be a mirage due to inconsistent or delayed reporting. But if the new case numbers continue to rise, Germany would go right back into lockdown. The government has established thresholds that, if crossed, would trigger the resumption of social distancing measures.
This could be America’s future, too. Vox’s Brian Resnick laid out some of the reasons to worry that state plans to relax social distancing could backfire and lead to a new wave of cases. Jeff Duchin, an epidemiologist for the King County, Washington, public health department, told me that critical to any reopening plan is an ability to “cut off the transmission chains.”
Better testing and contact tracing would enhance our ability to contain new outbreaks.
“If we can’t do that successfully,” Duchin said, “we’ll have to go back to social distancing.”
But, as the South Korean example shows, just one person with an undetected infection could jumpstart the virus’s spread. This has been a difficult task even with the most diligent testing-and-tracing regimen. And the US certainly does not have that as of yet.
The real solution to the coronavirus, and the best hope for an eventual end to these lockdowns, would be effective treatments or vaccines. Otherwise, we’re left with blunter instruments.
“Without a vaccine or antiviral drugs,” Duchin said, our best hopes are social distancing, widespread testing, and contact tracing. That is a herculean task for understaffed and overwhelmed public health agencies.
“We have to be able to identify almost all the cases,” he said. “Even a few cases, if unrecognized, will spark an outbreak that will spiral out of control.”
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