Introduction

The COVID-19 pandemic has been a challenge to the world for 10 months and has had the same devastating effect on each country it has occurred in. The pandemic has presented an overwhelming challenge to health systems across the world and in South Africa alike – and has seen health facilities being overburdened and drastic measures being taken to ensure the safety of both patients and health workers alike.

Countries such as Spain and Italy have been hardest hit and seen their health systems stretched to capacity in their first wave and have begun to see the same with the resurgence of the virus in many communities. This has also been the case for countries such as South Korea and China who had initially controlled the spread of infection but now struggle with a second wave.

Amid a resurgence of COVID-19 in some countries, several different vaccine trials have begun within others. The race to find a vaccine that successfully inoculates individuals against COVID-19 has seen significant progress since its’ initiation, with the Oxford COVID-19 trial (ChAdOx1 nCOV19) for example being tested in multiple countries, including South Africa and Brazil.

This article will critically examine the resurgence of COVID-19 within other countries, the impact from the first wave of the pandemic within these countries, as well as possible underlying factors, before examining the possibility of a second wave within South Africa. It will also explore the progress being made with vaccine trials across the world and the likelihood of the distribution of a successful vaccine.

 

Understanding the resurgence of COVID-19

South Korea

South Korea has been seen as a success story in how it has managed and effectively curbed the spread of the COVID-19 pandemic without needing to take drastic measures such as closing businesses and restricting the movement of its’ citizens (Oh, Lee, Schwarz, Ratcliffe, Markuns, Hirschhorn, 2020).

The South Korean government and health officials created a management strategy based on three specific principles. The first, ‘detection’, saw the country create hundreds of innovative screening facilities and clinics, and the inclusion of the private sector ensured that there was never a shortage of testing kits.

The second principle, ‘containment’, ensured all individuals who had tested positive were properly isolated and quarantine facilities were adequately equipped to prevent the further spread of the virus. This principle also ensured that contact tracing was done in a thorough and time-sensitive manner and hundreds of intelligence officers were deployed to fulfill this task.

The last principle, ‘treatment’, saw the health system in the country effectively manage and contain the spread while ensuring that all patients were given the necessary attention and treatment; while treatment facilities were built and additional health workers were deployed in high infection areas to curb the spread and effectively manage the outbreak (Oh et al, 2020).

This quick and decisive response from South Korea resulted in all necessary resources being mobilised and the spread of the disease was minimised as far as possible – with the country only reporting just over 11000 cases in June 2020 (Ulucak, 2020). With the first wave of the virus having been effectively managed, a resurgence has now seen South Korea reconsider implementation strategies as new cases begin to spread at a quicker rate (Alam & Sajid, 2020). As of September 18th, 2020, 1000 new cases have been reported in the past five days (Alam & Sajid, 2020) and the total number of cases has gone up to over 23000.

The resurgence has largely been attributed to cluster outbreaks within a given area of major metropolitan areas and could spread nationwide if not contained successfully. This increase in infections could be largely attributed to factors such as the reopening of nightclubs and the easing of travel restrictions. Alam & Sajid (2020) reported that the recurrence of the virus within major metropolitan areas occurred within several heavily crowded areas and venues, with one such venue being a church.

The surge in infections could also have been due to a significant number of individuals being unknowing carriers of the virus and their interaction with other individuals in an enclosed area could have led to the outbreak of the virus (Lockerd Maragakis, 2020). It is fears of a nationwide outbreak that has led the South Korean government to consider imposing stricter social distancing measures such as a reinstatement of the ban on social gatherings and travel. The bio-surveillance model being used by South Korea to battle the pandemic, however, has allowed for the government to implement the same measures and strategy to curb the spread of this resurgence and the efficient system used for contact tracing has ensured all cluster outbreaks are heavily monitored and controlled (Punj, 2020).

 

Spain

The first COVID-19 case occurred in Spain at the end of January and has since pushed the limits of a very fragile healthcare system. Cases rose at an extremely rapid rate and saw the country’s government impose a nationwide lockdown to prevent the virus from spreading as far as possible. Despite this, Spain was one of the hardest-hit countries within Europe and saw a significant number of deaths within a short amount of time as over 4000 deaths had been recorded by March 2020 (Hedgecoe, 2020).

A large portion of the infected population included health workers and the elderly and as such has also seen a high death rate and daily infection rate. As of August 2020, 19000 elderly people have died from COVID-19 and as of June 2020, over 50 000 health workers have become infected with at least 600 having died from the virus. The reason for this could be attributed to factors such as a lack of resources within health facilities to effectively manage the outbreak and a lack of understanding on the part of the general public around the severity of the COVID-19 pandemic which meant a decreased adherence to protective measures such as wearing a mask in public and avoiding social gatherings (Fotheringham, 2020).

By May, restrictions in Spain had begun to ease and life returned to relative normalcy as the number of cases and deaths had decreased substantially and the healthcare system within Spain was able to effectively manage the number of positive cases being admitted. By August, however, cases surged once again as the country began to see the number of positive cases being admitted rise significantly with over 3000 cases being recorded daily, 20 times higher than when wave one had plateaued in June (Badcock, 2020).

A key difference in the number of positive cases being recorded in this wave was that the majority were the younger demographic within the population (Badcock, 2020). It has also seen a higher number of asymptomatic cases being reported. This has led to only 3% of all cases requiring hospital admission. Certain regions within Spain have also become hot spots for infection and some of these regions also lack the necessary resources and have ill-adapted health facilities to cope with the continuing rise in infections should the rate of hospitalization increase (Badcock, 2020).

Despite the rise in infection, the characteristics of the spread of the virus have been different this time around as the severity of the symptoms have been significantly lower in this wave due to the part of the population that was affected (Badcock, 2020). This also allows for the Spanish government to effectively manage and control the rate of spread and ensure the adequate availability of the necessary resources.

 

The United States of America

The United States of America (USA) has been one of the worst affected by the COVID-19 pandemic and at present has the highest number of cases (over 7 million recorded cases) and deaths (over 200 000 deaths) in the world (Worldometer, 2020). The management of the pandemic by the government has raised a number of questions into the effective management of resources and the communication that was received by its’ government.

Since the virus reached its’ shores in January, the USA has been divided on how the pandemic has been handled and received by the public (Nature, 2020). Some states such as New York and California were harder hit and as such implemented stricter measures around social distancing and introduced a mandatory lockdown for all non-essential workers. Despite this, the health system became overwhelmed due to the consistent surge in cases and a lack of resources such as ventilators and personal protective equipment to cope with the pandemic.

The USA has had several resurgences of the virus and has seen it affect different populations with each resurgence. With the easing of more stringent regulations across the country and as normal life begins to resume, COVID-19 cases continue to surge as it reaches new populations and areas within the USA (Hawkins, 2020).

According to Hawkins (2020), the USA is not actually experiencing a second wave as the number of cases in the USA simply plateaued but never actually reclined successfully enough for the first wave to be considered as over. The surge in cases could be seen as more of a surge in new infection rather than as a result of frequent testing. Currently, the death rate within the USA is lower than expected, however, several different hospitals within the USA have reached capacity within their intensive care units (Hawkins, 2020).

Should these resurgences not be adequately managed and controlled and stricter measures implemented to ensure that the spread of the virus is curbed, this could lead to a second wave for the USA, which as demonstrated by both Spain and South Korea, could be a very different pandemic to cope with than the first wave.

 

What South Africa is doing to prevent a second wave

South Africa’s first COVID-19 case happened much later than a number of countries, but it was one of the quickest to implement stringent measures to ensure the safety of its’ population and curb the spread of infection amongst its’ general population. The Presidency and National Department of Health have both been praised for the efforts made in trying to retain the infection as far as possible and approaching the easing of the restrictions associated with lockdown using a phased and staged method supported by advisories from the National Command Council and from other experts in the field (Harding, 2020).

With infections having decreased and the peak of the COVID-19 beginning to ease, a number of more stringent measures have been decreased such as extending the period for which alcohol can be on sale and the easing of restrictions on event capacities. The South African presidency has however cautioned that South African citizens still need to be vigilant and ensure that they are still adhering to social distancing measures and using personal protective equipment when going out in public in order to ensure that there is not a resurgence of infections.

With the economy beginning to resume normal activity and international travel to a number of countries being permitted, there are concerns of a second wave of the COVID-19 pandemic. The preparedness of government entities and bodies is key in ensuring that this is not the case and the necessary action has been taken to ensure that there is not a rise in the rate of infection.

One of the measures taken by the government has been the creation of a smartphone application that allows for the geolocation of COVID-19 clusters and also informs an individual if they have come into contact with an individual who has tested positive for the COVID-19 virus. The application sends an exposure alert to individuals who have been exposed to the virus and is just one of the offerings available from the South African government and their digital range of services.

Another contingency plan in effect is the extension of the State of Disaster to allow sufficient time for all health facilities and infrastructure to be adequately prepared should a second wave happen. The continued curfew and closure of social gathering spots such as nightclubs and public events also minimises the spread of infection as far as possible.

 

A critical look at the vaccine trials currently happening across the globe

Presently there are a number of different vaccine trials taking place globally in an effort to inoculate the global population against the COVID-19 pandemic. The testing and approval of a vaccine is a long and technical process aimed at maximising the benefits it poses to the general public in the protection it offers against a particular virus or disease and minimises the possibility of any risk or side effects.

With the urgency of the current pandemic, this process has been expedited to provide a vaccine as soon as possible. This task has been undertaken by a number of different pharmaceutical companies and countries and these trials have a number of different branches across the world.

One such trial is the ChaDoX1 Ncov-19 (Oxford-AstroZeneca) which is currently in its’ third phase of testing. The vaccine component comprises of ChAdOx1, a weakened and non-replicating version of a common cold virus (Clinical Trials, 2020). This vaccine expresses a spike protein component of the COVID-19 virus which allows for the body to develop an immune response to this protein component. This then prevents the same spike protein found in the COVID-19 virus from entering human cells thereby preventing the virus from incubating in the individual and making them ill (Clinical Trials, 2020).

At present this vaccine trial is being tested across the globe and is also being tested in South Africa across a number of different sites within the country (Clinical Trials, 2020). Due to a medical event that occurred within a participant of the ChAdOx1 trial, the testing of the vaccine was temporarily halted within the country while it is reviewed by safety and protocol scientists in the United Kingdom (University of the Witwatersrand, 2020).

Moderna, which is a pharmaceutical company in America is currently in the human phase of their vaccine trial which until thus far has yielded promising results. Moderna is currently only conducting trials within the United States of America and is largely being funded by the government (Corum, Wee & Zimmer, 2020).

The Moderna vaccine harnesses the messenger ribonucleic acid (mRNA) within the body to create viral protein cells. These protein cells then control and determine how a virus is able to interact with the human body. Currently, Moderna has released their protocol and guidelines for determining the safety and effectiveness of their vaccine which includes a waiting period for symptoms of COVID-19 to present themselves within a significant number of trial participants and then wait for the significant number of participants to appear vaccinated before reaching a definitive conclusion on the success rate of the vaccine (Corum et al, 2020).

A collaboration between German BioNTech (a biotechnology company), pharmaceutical giant Pfizer, and Chinese pharmaceutical company Fosun Pharma has resulted in a vaccine that also harnesses mRNA and is administered in two doses instead of one (Corum et al, 2020). The vaccine began initial trials in May and two versions were trialled in phases one and two of the trial process. These stages within the vaccine trial process are used to determine the safety and effectiveness of the vaccine as well as any potential.

Both versions of the vaccine were found to produce antibodies against the COVID-19 virus as well as immunity cells that produce an effective response to the virus (Corum et al, 2020). Researchers found that one version of the vaccine had a significantly lower number of side effects and was moved forward to phase three of the trial process. Results determining the success of the vaccine will be available as early as October 2020.

Novavax, a company based in the United States of America, has created a vaccine based on the insertion of protein particles into microscopic particles (Corum et al, 2020). Trials for this vaccine began in May and the trial has been invested in by the Coalition for Epidemic Preparedness Innovations (CEPI).

A phase-2 trial has been launched in South Africa and a blinded-placebo controlled methodology is being used to determine the safety and efficacy of the vaccine (Corum et al, 2020). Should the vaccine pass all necessary phases, this vaccine could be rolled out in 2021 and a partnership with a pharmaceutical manufacturing company in India could potentially mean the mass roll-out of the vaccine.

 

Conclusion

The COVID-19 pandemic has caused devastation across the globe and continues to spread at an alarming rate. The resurgence of the virus in certain countries and the change in the patterns of infection and spread from the first wave is an indication of the ever-changing nature of the disease and how it continues to impact on the general public.

While some countries such as South Korea have been able to effectively manage and control the spread of disease, the resurgence of a second wave has presented new challenges that see the disease spreading faster than the country is able to cope. In the case of countries like Spain where the first wave of the pandemic brought the health system to its’ knees, the second wave has been easier to manage due to the demographic that is affected within the population which has resulted in a less severe impact than the first wave.

The United States of America has also shown how while the virus has never actually decreased substantially or plateaued, infections consistently occur and continue to do within new population groups and spread faster than it did previously. This then begs the question as to what the second wave of the virus could hold for South Africa should it occur.

The only absolute answer to the prevention of resurgence is vaccination. As illustrated a large number of COVID-19 vaccine trials are underway and are producing promising results. The next phase will be the distribution of these vaccines across the globe. With more developed countries such as the USA and China have already placed orders in bulk, the assistance of organizations like CEPI will ensure the people of Africa will also have the opportunity to be vaccinated and do their part in making the COVID-19 a relic of the past.

 

References

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