In Europe, the long-predicted second wave of the coronavirus pandemic . Several countries are reporting more daily covid-19 cases than they did during the first wave in March, though the higher numbers may be due to more people being tested.
鈥淚n some member states, the situation is now even worse than in the peak during March,鈥� said Stella Kyriakides, the European Union鈥檚 commissioner for health and food safety, on 24 September. 鈥淭his is a real cause for concern.鈥�
Spain, the Czech Republic, France and the Netherlands are reporting higher numbers of daily confirmed cases per million people than in March, with聽. 聽The UK and Portugal have the next highest infection rates, but haven鈥檛 yet exceeded peak rates.
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However, during the first wave, testing was mostly limited to those in hospitals, meaning many cases were missed. Antibody surveys, which estimate the proportion of people who have had the virus, show that the actual number of cases at the time was much higher than official figures suggest.
鈥淭here is undoubtedly more testing being done now than in February and March,鈥� says Martin Hibberd at the London School of Hygiene & Tropical Medicine. 鈥淭he numbers are difficult to compare.鈥�
The figures should serve as a wake-up call, said Hans Kluge, the World Health Organization鈥檚聽regional director for Europe,聽. 鈥淎lthough these numbers reflect more comprehensive testing, it also shows alarming rates of transmission across the region.鈥�
鈥淥bviously, if you don鈥檛 search, you don鈥檛 find,鈥� says Giulia Giordano at the University of Trento in Italy. 鈥淗owever, this does not necessarily mean that now we are discovering more infection cases because we are testing more. The cases may really be more.鈥�
One indicator of how many cases are being missed is what proportion of tests come back positive, she says. This proportion is rising in most European countries, but isn鈥檛 yet as high as in March.
In Spain, for instance, a third of tests were positive in March. By June, this had fallen to 1 in 100, but has now risen to 1 in 10. In the UK, it is up to 2 in 100.
If actual case numbers aren鈥檛 yet as high as they were in March, this would help explain why the number of hospitalisations and deaths has remained low even as case numbers have soared. Spain is reporting , compared with 18 during the peak of the first wave.
Another reason could be that younger people returning to work and education are the ones being infected while older, more vulnerable people continue to shield. 鈥淲e do not yet know how impactful the current set of measures will be in reducing SARS-CoV-2 transmission to vulnerable groups,鈥� says Hibberd. 鈥淗owever, with case numbers still rapidly rising, it seems unlikely that they will be sufficient to prevent later increases in hospitalisations and deaths.鈥�
Death rates also lag several weeks behind infections. However, the number of deaths among those infected 鈥� the infection fatality rate 鈥� is expected to be lower during the second wave. 鈥淭his would mean we won鈥檛 see the same impact even if cases did soar,鈥� says Jason Oke at the University of Oxford.
There are many reasons for this. Medical staff have more experience with the disease, for instance, and treatments such as dexamethasone have been shown to reduce the death rate.
The rising case numbers indicate either that people aren鈥檛 following the measures meant to prevent the spread of the coronavirus or that those measures are insufficient, the . The population is still highly vulnerable, it noted, as antibody surveys suggest that less than 15 per cent of people in the EU and the UK have immunity.
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