Malawi is experiencing a new epidemic altogether

Dr Titus Dival

Malawian epidemiologist Dr Titus Divala answers some questions on COVID-19 wave that has hit the Southern African country.

1. Is Malawi going through a 2nd wave of coronavirus?

No we are not, it is way more than a second wave. I think what we are experiencing is a fresh epidemic altogether. We indeed had a complete cycle of infections, hospitalisations and deaths started building up in May 2020, peaked at the end of July 2020 and subsided at the end of August 2020, and one would lightly consider what we have now a regular second wave, but that would be an understatement. Indeed we expected and correctly predicted that a second wave would occur from December 2020, but what we are seeing now should properly be called the rebirth of COVID-19, its just like a new virus is amidst us and it is brutal.

2. So, if not a 2nd wave, what are we experiencing? 

The kind of second wave of viral infections we expected is one that is slower and less painful than what we are seeing first because with time, viruses develop changes that usually weaken them, secondly, people infected in the first wave are often immune by the time a second wave comes.

However, with the new COVID-19, the fresh round of infections are spreading much faster than before. In the first wave we had a long period before seeing large numbers of hospitalisations, this time, we have seen hospitalisations jumping from 19 to 70 in just seven days. It took very long to start seeing large numbers of deaths in the last wave, and the highest we recorded in a single day was 9  on 01 August 2020.

But this time it has just been a few weeks and we have already started seeing 10 in 24 hours. We have also seen people who were infected in the first wave getting sick again. So summing up, I think calling this a second wave is a serious understatement, this is a new epidemic, an epidemic within epidemic. 

3. Why is the new epidemic fast and more deadly? 

Evidence from South Africa shows that the virus has changed so much and the changes have given it advantage that suit its survival. It can now spread faster than before. The spread is much faster because everyone who is infected has a much higher concentration of the virus than what was happening in the first wave.

Having high concentration means that when talking, singing, breathing one releases amounts of virus large enough to start the disease in the people standing less than 2m close to them especially if they are not wearing face coverings or in a closed room.

It is also worth noting based on epidemiological principles that the large numbers of cases could just be because with experience, we are doing a much better job of detecting it than we did in first wave.

Even with that in mind, the large numbers and rapid rise in hospitalisations and deaths does weigh more towards a more virulent epidemic than we had before. All this remains part of ongoing investigations, but I would simply say, until contrary evidence comes forward, the new version of coronavirus is way more dangerous than one we had before.

4. Should Malawians brace themselves for hard times due to the virus?

A quick answer is YES. This new version of coronavirus is giving me sleepless nights, because it is much more transmissible (faster transmission) than the first one, it does require much more adherence to prevention measures than before.

Considering that route of transmission and size of viral particles have not changed, prevention measures remain the same (limit movements, wear mask, watch your distance, and wash hands regularly) but reducing transmission will need much more effort than we needed in the first wave. From my experience, advocating for prevention measures is very unpopular, and adhering is hardly achieved on our streets. 

5. How long might the 2nd wave be here for? 

The bulk of our first wave was three months long (June, July, August 2020) and I suspect that this one will also last that long or shorter, if people are either vaccinated or become religiously adherent to prevention measures. As you and me can imagine, vaccines are unlikely to be in Malawi tomorrow or the day after, so we really need to take care or we will perish.

6. What would be your words to Malawians as we face this monster? 

Fellow Malawians, we who made it through the initial round of infections, can also make it this time if we do our part. First, we must all limit our movements to essential activities only. Second, if we have to leave our household to do those essential activities, we must wear masks, watch our distance to ensure observance of 2 meters, and wash hands regularly. COVID-19 does not affect everyone the same way, the good thing is that we know some groups of people in our society whose risk of dying from it is higher than others. 

7. Who is the highest at risk?

These are individuals aged at least 60, or those with heart or lung disease, hypertension, or diabetes, cancer or HIV, or other chronic illness. These groups of people need to be supported by relatives, workmates, communities, employers or government to live and observe all the prevention measures carefully.

Preferably, they should limit contact with all people who are frequently mobile. All these measures apply to the at-risk individuals, their care givers, and anyone living with them. This may be the single intervention that can save them, as we wait for vaccines to reach Malawi, something that may not happen soon.