06 October 2020

Coronavirus in Romania: summer plateau, autumn records

Almost three months have passed since I wrote my previous update about the coronavirus in Romania, and the situation has not improved since. It did not take long for the number of daily cases to surpass 1000 – two weeks instead of one as I was expecting. Since then, the weekly average has never gone below 1000, with occasional daily dips only during weekends, when fewer tests are processed. As in late spring, we were stuck on a new plateau; the number of infections has remained relatively stable in the 1150 to 1250 range for almost two months, into the first weeks of September.

The beginning of September has brought a series of relaxation measures that were reflected in new increases later in the month. On September 1st indoor restaurants were allowed to reopen for the first time since the initial declaration of an emergency situation in March – two weeks later, the weekly average number of cases surpassed 1300 for the first time.

Then on September 14th the new school year started with mostly in-person classes – again two weeks later, on September 30th, Romania reported over 2000 new daily cases for the first time. There are already numerous reports of clusters linked to schools – these were promptly closed, and students returned to online learning. While I can understand that many parents and children prefer to attend classes in person, I cannot help but think it was a very unwise decision for containing the pandemic. It would have made more sense to suspend the entire school year in the hopes of getting the disease under better control by this time next year.

We also held local elections on the 27th, but for now it is too early to tell what impact this event had on disease spread. My own electoral ward has distributed face masks and disposable gloves to all voters, and they did not allow more than five people at a time to enter the premises, so the impact should be relatively low.

Surprisingly, Romania seems to have managed to keep exponential growth somewhat in check so far. I personally worry though that our testing capacity is strained – the number of daily tests has not been scaled up to match the increase in reported positive cases – so we run the risk of not identifying and isolating more infected people, which could then spread the disease further.

Looking outside of Romania’s borders, the ongoing situation in many parts of Europe looks increasingly bleak. There are rapid increases in Spain, France, and the UK – where they recently discovered an Excel reporting mistake that forced them to revise case numbers up – in short, the autumn wave has arrived. In Poland as well cases have gone up considerably in recent days, quickly surpassing 2000 per day – they were under 1000 as recently as September 24th – I am not familiar with their local particularities, maybe they also opened schools for the new year.

Daily new confirmed COVID-19 cases October 2020 Europe
Daily new confirmed COVID-19 cases in October 2020 (Europe)

Consequently, both Madrid and Paris are set to reintroduce stricter measures, and Israel has gone back into full lockdown mid-September. Some attributed the rapid increases to laxer measures and premature relaxation, as detailed in the below Twitter thread comparing the evolution in Madrid and New York – although New York has uncovered its own disease clusters in recent days.

I partially agree with this assessment. From what I gather, mask wearing was not compulsory in France and other countries for many months, whereas here in Romania it feels commonplace. Compared to the early days of the pandemic, I now rarely see someone without masks on the subway or in stores; I even had a haircut while wearing a mask. This is unfortunately impossible to demand in restaurants and bars, where people go to consume food and drinks. There is certainly an element of unpredictability and ‘luck’ in how this disease spreads through clusters and super-spreaders, but having restaurants and bars open for business seems an unnecessary risk.

As some have pointed out, the situation may not be so dire, because testing in the first wave was more limited, causing many infections with lighter symptoms to go unreported. The number of deaths so far seem to support this hypothesis, as it is still well below the March highs in Spain, Italy and France – but there are other factors to consider here: better treatment strategies could have improves the survival rate, while overcrowding hospitals and infections among older people following these surges could lead to more deaths in coming weeks.

In other relevant news, the race to deliver COVID-19 vaccines is picking up the pace. Russia was the first to approve one in August, followed by China. The Russian vaccine has been tested on only about 80 people, so it is far from proving its effectiveness or safety for mass inoculation – it should be noted that case numbers are rising again in Russia. The Chinese variant faces a similar issue: as the authorities have reported low case numbers for months, there are few subjects available to test a vaccine on. Several Western pharmaceutical companies have entered Phase 3 trials, meaning on large scales to test the level of protection offered by the vaccine candidate and to uncover possible side-effects. The AstraZeneca trial has already been suspended for a couple of days to investigate health problems in two test subjects, and there are similar reports about the Moderna and Pfizer trials. The Johnson & Johnson vaccine seems the most promising, as it works with a single dose and has less restrictive storage requirements.

Other research are focusing on understanding the effects the virus has on the human immune system – one particular interesting find is how it deactivates interferons in some people, leading to severe forms of disease – and on more effective treatments – here steroids have shown some positive results for patients in critical condition. There is increasing chatter on Twitter about aerosol transmission, including a long FAQ on how to best avoid infection. I found this conversation somewhat amusing, as I wrote about these measures as far back as May on my blog, linking to experts warning about the critical role of indoor gatherings and of clusters in spreading this disease.

Daily new confirmed COVID-19 cases October 2020 world
Daily new confirmed COVID-19 cases in October 2020 (world)

The biggest story was certainly that President Trump tested positive for coronavirus and was quickly hospitalized. In absence of clear statements, many have speculated that his condition was severe, based on the medication administered to him. I remain skeptical that he will change his attitude towards the virus and start promoting more active measures to combat the pandemic. It will certainly be interesting to follow how his illness will affect the upcoming presidential election less than one month away…

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