“The price of peace [from coronavirus] is eternal vigilance” to paraphrase Leonard Henry Courtney, 1st Baron Courtney (1832-1918) – at least until we have an effective vaccine.

The coronavirus is very different from the influenza virus, but it behaves very similarly. Most influenza pandemics have come in wave patterns, with a peak usually followed by a second wave around 6 months later.

On Monday June 8, Tom Whipple, the Times of London's science editor, published an article that aptly summarises what many countries are facing in this coronavirus pandemic.

“The virus has no interest in your moral intent. It does not care if you are meeting people because you are angry about racism, because you are honouring VE Day with a conga line… It cares only that you meet people,” he wrote.

And that is the risk we face as lockdowns are relaxed all over the world, allowing more people meet… more than scientists would like.

Lack of vigilance will risk repeating what Iran is currently experiencing, and the London Times headline (June 7) says it all: “Iran swamped by a second wave after lockdown eased to save jobs. With its economy ailing, Tehran has been forced to attempt a return to normality — and seen a drastic spike in infections.”

A hundred scientists had this to say in a letter in the Times Higher Education (June 5): “There is a very high probability that relaxation of lockdown, coupled with a potential breakdown in public trust, will bring us back into a situation where the outbreak is once again out of control.”

Tom Whipple gives a simple analogy: “Coronavirus is not beaten, it is suppressed. Like pushing a ball underwater, we can hold it there — but release the pressure and, these scientists believe, it will bounce right back.”

Whipple is quite correct to express his concern. In the UK, less than 10 per cent have been exposed to the virus and R0, the rate at which the virus reproduces, is hovering is close to 1, the critical value above which viral infections increase exponentially.

The situation in Malta is different. Because social distancing and other public health measures have been very effective, with a very small proportion (much smaller than the UK’s) of the population having been exposed to the virus, Malta’s R0 is currently less than 0.5. We also have the advantage of a tried and tested testing system with thousands of swabs taken daily, both in the community as well as for all patients admitted to our hospital. This is then backed by an extensive contact tracing exercise to identify anyone coming into contact with any positive individual and thus preventing further spread through quarantine measures.

An aerial view of the Nossa Senhora Aparecida cemetery in Manaus, Brazil, where COVID-19 victims are buried daily. Photo: AFP

Some colleagues in Italy and the US have suggested that the virus might be weakening, but geneticists studying the virus’s mutations are sceptical and cannot see why this should be the case. Others have speculated that ordinary coronaviruses that cause the common cold may have bestowed protection to a significant amount of the population – perhaps. It is also possible that the virus is less virulent in higher temperatures and higher UV indices as occurs in summer - maybe. And certainly people are more out in the open anyway in summer where viruses are less easily caught.

It has also been mooted that large population numbers may have been exposed and are to some degree immune despite negative antibody tests, since antibody levels appear to wane swiftly with this virus - possibly. However, these are all speculations, not backed by solid science and lives cannot be risked on speculation.

Whatever these conjectures, what we know for sure is that social distancing works. Two studies published simultaneously last Monday suggested that lockdowns prevented catastrophic outbreaks in many countries. Lockdowns may have prevented 60 million infections in the US and 285 million in China. Lives saved are estimated at 3.1 million in 11 European countries, including 500,000 in the UK alone. Lockdowns dropped infection rates overall by 82 per cent, well below epidemic levels. Clearly, aggressive actions, while causing massive economic disruptions and job losses, were effective in preventing exponential viral spread.

Lockdowns also bought time for social adaptation, slowing the spread and allowing healthcare systems to prepare and stock on needed equipment and research labs to perhaps approach the development of a vaccine.

However, this implies that only small fractions of populations have been exposed and have immunity, even in countries with a large number of reported infections. It has been estimated that less than 10 per cent of the populations of France, Spain and Sweden have developed antibodies against the virus with at least short term immunity. “We’re very far from herd immunity. Unfortunately, this offers ample opportunity for large outbreaks if the public does not continue to follow social measures and Public Health advice. The risk of a second wave happening if all interventions and precautions are abandoned is very real.” This advice was echoed locally by James Degaetano, the President of the Malta College of Pathologists. 

For all of these reasons, we must remain alert until - hopefully - a vaccine becomes available. Until then, social distancing, masks, hand washing etc are our best hope of avoiding or dampening a second wave as we go into winter and we are all indoors and schools are in full swing. We need to maintain our efficient contact tracing whereby a single isolated outbreak is rapidly identified and nullified. In Whipple’s words, “Every day Britain’s outlook is more promising”, as is Malta’s, but please take care and continue to use the customary precautions.

Heed the words of our infectious disease prevention experts: “Malta has no guarantee that a secondary wave of COVID-19 will not place”.

Victor Grech is a consultant paediatrician (Cardiology) at Mater Dei Hospital. Michael Borg is head of infection control at Mater Dei Hospital.