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Third Wave Coming: How We’re Getting Smarter About COVID-19

Masks for all ages
Masks for all ages

PARIS — With much of the world trying to minimize the impact of a COVID-19 second wave, governments are again forced to make impossible choices between relaxing restrictions to avoid total economic implosion or staying shut down to limit death tolls. Even countries typically mentioned as pandemic role models, like South Korea, are seeing a resurgence of cases.

But perhaps the grimmest news of the second wave is that many experts say we're bound for a third wave.

We know little about how things will play out, especially as hopeful results continue to arrive from several major vaccine efforts. But the logistical challenge of deploying a global vaccination effort means there's a real risk of a third wave arriving well before the virus is defeated. Others say that the next surge would be better characterized as a second installment of a drawn-out second wave.

Either way, the West is unlikely to go into crippling lockdowns again given the depth of economic damage caused by previous efforts to contain infections. What we do have is nine months of gained experience of grappling with the pandemic, and from that, governments have learned important lessons and fashioned new tools for minimizing the impact of the crisis in the months ahead. Here's a look at some of the progress that's been made:

Better knowledge of the virus

Treatments Three major vaccines have been developed and moved into final approval phase, with the UK set to deploy this month. But as we wait, the medical community has been testing and repurposing existing drugs and studying their effect on health, mortality and length of hospitalizations. Some show promise:

• A recent WHO worldwide study (conducted on 11,266 adult patients, across 500 hospitals in more than 30 different countries) reported that the steroid dexamethasone, used as a last resort among the most serious cases requiring oxygen, reduced mortality rates by up to one-third.

President Trump's hospitalization, in the United States, shed light on an experimental treatment using a combination of two synthesized "monoclonal" antibodies to boost the natural immune response of patients. U.S. officials have granted emergency authorization for the treatment — though the WHO remains unsure about the method.

• According to CNN, 14-year-old Anika Chebrolu from Texas could help deliver another potential COVID-19 treatment. Using in-silico methodology, she developed a lead molecule that can selectively bind to the spike protein that the SARS-CoV-2 virus uses to attach to human cells, infect them and replicate.

• Health professionals and authorities around the world have learned just how crucial timely diagnoses and treatments are. We now know that it's critical to act fast in symptomatic cases, while asymptomatic or only lightly affected patients can quarantine at home.

Viral load - One question researchers have sought to explain is why hospitals and ICU admissions dropped drastically over the summer. The going theory now is that when people receive lower doses of the virus, largely due to social distancing and wearing a mask in public spaces, their bodies are able to fight it and develop immunity more quickly. And the smaller the viral dose people carry, the less infectious they are. The hypothesis is backed by several studies, according to the The Washington Post, but more research is needed to confirm it, especially about how the viral load may impact the severity of the infection.

Masking up in Frankfurt — Photo: 7C0

Prevention is the best cure, but how?

The right tracking - The faster a cluster can be identified, the better the chances of containing the spread. Countries like South Korea have been praised for their streamlined responses to new cases, made possible through extensive contact tracing systems using both manual and digital methods. Many countries have tried to copy that approach, launching smartphone apps that rely on Bluetooth and geolocation to identify and notify people who might have become infected.

• In Germany, the Corona-Warn-App has been downloaded approximately 22 million times but only around 60% of users who have tested positive for Corona upload their findings onto the app, meaning that the people they have come into contact with aren't duly informed of the risk.

• In Finland, an app launched at the start of September became one of Europe's most popular with 1 million downloads in the first 24 hours, as reported by AP. It now has 5.5 million users and counting.

• Across the EU, three out of the 23 member states with a contact-tracing app have switched on cross-border interoperability: Germany's Corona-Warn-App, the Republic of Ireland's COVID-19 tracker, and Italy's Immuni app. Any user traveling from and to these countries can now receive exposure notifications through their national app, without downloading the local one.

Up to the test - Several countries have carried out massive testing campaigns. But the results of the standard PCR tests take up to 4-5 days to arrive, limiting their ability to prevent infected people spreading the virus further. Several labs worldwide have developed antigen tests that work just like the PCR-tests but produce results much more quickly (15 to 30 minutes).

• In the United States, Abbot Laboratories, the only one manufacturing rapid tests, received emergency authorization in August to put them on the market. At the end of September, Trump announced a plan to distribute 150 million of them.

• The WHO and the Bill & Melinda Gates Foundation have partnered to reach volume guarantee agreements with Abbott and SD Biosensor to make 120 million antigen rapid diagnostic tests available to low- and middle-income countries.

On air - Unlike during the first wave, we now know that the virus can be airborne and thus ventilation of potentially infected places is key, with new studies suggesting that the virus can survive in the air for as long as eight minutes. This summer, the WHO issued new recommendations regarding ventilation in public spaces.

Germany will reportedly invest 500 million euros to help schools, offices, museums, entertainment halls, and other public buildings upgrade their ventilation systems.

Buenos Aires province will ban using air conditioning in hospitality venues around primary tourist spots during seasonal holidays, El Tribuno reports.

• In Spain, the Ministry of Education and Employment of the Junta de Extremadura issued clarifications to educational centers in preparation for winter, advising for a "balance" between ventilation to minimize the spread, "adequate" air conditioning to keep a decent temperature, and "adequate" clothing for pupils to stay warm.

Finding new indicators

Back in April, studies pointed out that traces of ribonucleic acid (RNA) of COVID-19 could be found in wastewater. The information was at first explored as a potential new source of contamination but it is now used for wastewater-based epidemiology (WBE), a powerful tool to trace the circulation of a virus in a community and estimate its prevalence and geographic distribution. It is particularly useful to monitor asymptomatic infections, which often slip under the radar of clinical surveillance. Wastewater analysis can help locate potential clusters by detecting the virus from 24 hours up to six days before the first symptoms appear.

• In Madrid, Spain, the regional government implemented a method for collecting samples along the city's 15,000-kilometer sanitation network. The action helped the city predict hospitalization rates several days in advance, La Vanguardia reports.

• In late July, maritime-firefighters from the dedicated COMETE unit in Marseille, France predicted an outbreak that only became clinically measurable in early August. The unit recently started collecting more targeted samples in nursing homes to test the residents' environment without exposing them.

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Geopolitics

Why This Sudan Coup Is Different

The military has seized control in one of Africa's largest countries, which until recently had made significant progress towards transitioning to democracy after years of strongman rule. But the people, and international community, may not be willing to turn back.

Smoke rises Monday over the Sudanese capital of Khartoum

Xinhua via ZUMA
David E. Kiwuwa

This week the head of Sudan's Sovereign Council, General Abdel Fattah El Burhan, declared the dissolution of the transitional council, which has been in place since the overthrow of former president Omar el-Bashir in 2019. He also disbanded all the structures that had been set up as part of the transitional roadmap, and decreed a state of emergency.

In essence, he staged a palace coup against the transitional authority he chaired.


The general's actions, which included the arrest of Prime Minister Abdalla Hamdok, are a culmination of a long period of tension between the civilian and military wings of the council.

A popular uprising may be inevitable

The tensions were punctuated by an alleged attempted coup only weeks earlier. The days leading to the palace coup were marked by street protests for and against the military. Does this mark the end of the transition as envisaged by the protest movement?

Their ability to confront counter revolutionary forces cannot be underestimated.

The popular uprising against Bashir's government was led by the Sudan Professional Association. It ushered in the political transitional union of civilians and the military establishment. The interim arrangement was to lead to a return to civilian rule.

But this cohabitation was tenuous from the start, given the oversized role of the military in the transition. Moreover, the military appeared to be reluctant to see the civilian leadership as an equal partner in shepherding through the transition.

Nevertheless, until recently there had been progress towards creating the institutional architecture for the transition. Despite the challenges and notable tension between the signatories to the accord, it was never evident that the dysfunction was so great as to herald the collapse of the transitional authority.

For now, the transition might be disrupted and in fact temporarily upended. But the lesson from Sudan is never to count the masses out of the equation. Their ability to mobilize and confront counter revolutionary forces cannot be underestimated.

Power sharing

The transitional pact itself had been anchored by eight arduously negotiated protocols. These included regional autonomy, integration of the national army, revenue sharing and repatriation of internal refugees. There was also an agreement to share out positions in national political institutions, such as the legislative and executive branch.

Progress towards these goals was at different stages of implementation. More substantive progress was expected to follow after the end of the transition. This was due in 2022 when the chair of the sovereignty council handed over to a civilian leader. This military intervention is clearly self-serving and an opportunistic power grab.

A promised to civilian rule in July 2023 through national elections.

In November, the rotational chairmanship of the transitional council was to be passed from the military to the civilian wing of the council. That meant the military would cede strong leverage to the civilians. Instead, with the coup afoot, Burhan has announced both a dissolution of the council as well as the dismissal of provincial governors. He has unilaterally promised return to civilian rule in July 2023 through national elections.

Prior to this, the military had been systematically challenging the pre-eminence of the civilian authority. It undermined them and publicly berated them for governmental failures and weaknesses. For the last few months there has been a deliberate attempt to sharply criticize the civilian council as riddled with divisions, incompetent and undermining state stability.

File photo shows Sudan's Prime Minister Abdalla Hamdok in August 2020

Mohamed Khidir/Xinhua via ZUMA

Generals in suits

Since the revolution against Bashir's government, the military have fancied themselves as generals in suits. They have continued to wield enough power to almost run a parallel government in tension with the prime minister. This was evident when the military continued to have the say on security and foreign affairs.

For their part, civilian officials concentrated on rejuvenating the economy and mobilizing international support for the transitional council.

This didn't stop the military from accusing the civilian leadership of failing to resuscitate the country's ailing economy. True, the economy has continued to struggle from high inflation, low industrial output and dwindling foreign direct investment. As in all economies, conditions have been exacerbated by the effects of COVID-19.

Sudan's weakened economy is, however, not sufficient reason for the military intervention. Clearly this is merely an excuse.

Demands of the revolution

The success or failure of this coup will rest on a number of factors.

First is the ability of the military to use force. This includes potential violent confrontation with the counter-coup forces. This will dictate the capacity of the military to change the terms of the transition.

Second is whether the military can harness popular public support in the same way that the Guinean or Egyptian militaries did. This appears to be a tall order, given that popular support appears to be far less forthcoming.

The international community's appetite for military coups is wearing thin.

Third, the ability of the Sudanese masses to mobilize against military authorities cannot be overlooked. Massive nationwide street protests and defiance campaigns underpinned by underground organizational capabilities brought down governments in 1964, 1985 and 2019. They could once again present a stern test to the military.

Finally, the international community's appetite for military coups is wearing thin. The ability of the military to overcome pressure from regional and international actors to return to the status quo could be decisive, given the international support needed to prop up the crippled economy.

The Sudanese population may have been growing frustrated with its civilian authority's ability to deliver on the demands of the revolution. But it is also true that another coup to reinstate military rule is not something the protesters believe would address the challenges they were facing.

Sudan has needed and will require compromise and principled political goodwill to realise a difficult transition. This will entail setbacks but undoubtedly military intervention in whatever guise is monumentally counterproductive to the aspirations of the protest movement.

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David E. Kiwuwa is Associate Professor of International Studies at University of Nottingham

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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