The Covid-19 pandemic shows no sign of slowing, with over 40 million cases worldwide and over 1.12 million deaths. Many countries in Europe and the MENA region that appeared to have avoided the worst of the pandemic or, to have successfully brought the virus under control, have seen cases rise sharply since the end of August. This has been described in many media outlets as the “second wave” of Covid-19.

To explore how different countries have responded to the rise in cases, Forward Thinking and the Order of Malta organised a meeting of the Doctor-to-Doctor initiative on the 19th of October. Health experts from Germany, Italy, Jordan, Lebanon, Saudi Arabia, Sweden, Turkey and the WHO were brought together to explore questions that included –

  • Why have some countries experienced a milder “second wave” than others? What factors have driven the rise of cases in some countries?
  • Why has the death toll appeared to have been lower in the second wave?
  • How are lessons from the first wave of Covid-19 being applied to the second? Is this having a noticeable impact?
  • How has understanding on treatments continued to develop?
  • How has understanding of the virus itself continued to develop?

The term second wave was debated extensively by participants. Some, particularly in Europe, felt it accurately described the situation in their country. However, in the MENA region it was more contested, as some countries felt they were only now entering a phase of exponential growth in cases, having previously prevented community transmission in the first half of the year.

A great deal has been learned about how to treat the virus. Mechanical ventilation should be a tool of last resort and corticosteroids are highly effectively for very ill patients. However, more is to be discovered, as demonstrated by the WHO study indicating that remdesivir has limited impact on Covid-19.

With the nature of the virus itself, there are debates as to whether has begun to mutate in a manner that suggests it is becoming attenuated to humans. Those who reject the idea that the virus has changed significantly, argue that the reduced death rate witnessed in some parts of the world, could instead come from the virus hitting a younger population and a reduced viral load in new infections (as a result of social distancing policies).

While there are several promising vaccines in development, no one can be certain of their efficacy. It was recommended that governments therefore back as many options as possible, rather than invest too heavily in a single vaccine which may prove ineffective. However, even when a vaccine is discovered, it may be several years until it is widely available. In the absence of a vaccine or highly effective treatment, the best tools to contain the virus remain social distancing, wearing masks, washing hands and trying to ensure effective ventilation of crowded enclosed spaces.