Experts warn that seasonal flu would place more stress on health systems stretched by pandemic
A second wave of virus infection could be breaking over Europe and the situation could turn grim in the coming months, as the northern hemisphere approaches the winter months.
For instance, in Britain, more than 3,000 new cases were reported in 24 hours for the second day in a row last Saturday. France also chalked up 10,000 new infections on Saturday, close to the peak of its first wave in April.
Other countries facing a resurgence include Spain, which became the first Western European nation to record more than 500,000 cases since the start of the outbreak.
Experts in Singapore cautioned that this could be a worrying uptrend.
Professor Paul Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection, said that though it is unclear if the increased numbers are due to more testing or more cases, it is likely the number of cases will go up with the colder months.
Respiratory viruses thrive in the winter as, among other reasons, people are more likely to gather in crowded indoor environments, facilitating transmission, Prof Tambyah told The Straits Times.
Associate Professor Alex Cook, vice-dean of research at the National University of Singapore’s (NUS) Saw Swee Hock School of Public Health, said seasonal influenza is often more prevalent in the winter months, and if Covid-19 and the flu co-circulate, it would place additional stress on already burdened healthcare systems.
However, Prof Cook remained cautiously optimistic that the measures used to prevent Covid-19 would also protect against other respiratory viruses.
“Evidence is also emerging from the southern hemisphere – which has already experienced their first winter of influenza and Covid-19 simultaneously – that their influenza epidemics this winter were much smaller than usual because of the Covid-19 safety measures. So, if safe distancing can be kept up, it might prevent this double epidemic.”
Influenza vaccination coverage rates might also increase as people are more aware of the need to protect themselves, Prof Cook said. “It’s really important for those at higher risk of flu to get a vaccine shot this year, especially elders.”
Professor Teo Yik Ying, dean of the NUS’ Saw Swee Hock School of Public Health, said, however, that with the symptoms of Covid-19 and influenza being similar, people may be confused as to whether they have the flu or Covid-19.
The usual processes of contact tracing and quarantine might be confounded if people think they simply have the flu and do not come forward early enough, when they in fact have Covid-19, Prof Teo said. “This behaviour can certainly and unwittingly seed additional community clusters.”
But Europe’s fate would really depend on whether governments and the people make the commitment to control the situation, monitor and enforce measures so as to drive down community transmissions, he said, noting: “I do not believe that Covid-19 will necessarily take off during winter months, since we saw how China and South Korea were able to successfully control large-scale community spread even during their winter months of February and March.”
“However, stamping out new Covid-19 cases would require measures to curb interactions between people, which regrettably appears to be lacking presently in many European countries,” he said. Countries that fail to do so might see larger outbreaks this time, he cautioned.
Professor Dale Fisher, a senior consultant in the division of infectious diseases at the National University Hospital, added that it would be useful for countries approaching winter to have strategic plans to engage the community in how they should approach and modify behaviour in the colder months.
A worsening of the Europe situation bodes ill for Singapore as well in various aspects, experts said.
It is unlikely that the Government will allow travel to countries with uncontrolled community spread, Prof Fisher said.
Prof Teo said this would open the door to more imported cases, and run the risk of worsening the fragile local situation especially when Singapore’s current Covid-19 outlook is optimistic and positive.
“Even if there are green lane arrangements established for business and essential travel, we will need to continue our quarantine measures for any incoming travellers from these countries, in designated government facilities rather than home quarantine.”
Prof Tambyah said good data will be critical as well as the rolling out of novel diagnostics, treatments and vaccines to indicate the level of immunity needed to protect a community.
“Countries may be forced to innovate and consider measures such as ‘immunity passports’ or less than perfect rapid diagnostic tests at entry points as a prolonged ban on travel is not likely to be sustained forever,” he noted.