David A. Andelman COVID-19 spikes in South Africa, Melbourne offer America clues ahead of winter 2020

Will the U.S., which has so far failed repeatedly to get ahead of COVID-19's spread, start paying attention in time?
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A resident of Epping Gardens Aged Care Facility is taken away in a ambulance in Melbourne, Australia, on July 28. The state of Victoria recorded 532 new cases of the coronavirus and six more deaths on July 27, making it the worst day of the pandemic.Darrian Traynor / Getty Images
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By David A. Andelman, executive director of The RedLines Project

Earlier this month, Africa passed the 1 million mark for the number of recorded cases of COVID-19. Australia has imposed its second lockdown in Melbourne as cases spiked in key urban areas.

Besides the obvious humanitarian concerns, why should the U.S. be troubled by these events? Because the Southern Hemisphere is deep into its winter season, and the virus's progress in colder continents could be a precursor of horrors to come as America and the Northern Hemisphere head toward their first full fall and winter since this coronavirus was discovered.

For the moment, a search of government statements issued by officials in the United States suggests that little attention is being directed south. This is a mistake.

Sadly, for the moment, a search of government statements issued by officials in the United States suggests that little attention is being directed south. This is a mistake.

South Africa is having a particularly tough time. The further down the African continent we go, the colder the weather. Sure enough, South Africa, which passed the 500,000 mark of confirmed coronavirus cases on Aug. 1, has registered more than half the cases on the entire African continent, despite its population making up barely 5 percent of the continent's total.

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The spread is due to a combination of factors, including poverty, crowded living conditions and poor health care options. But one reason for this spread could also be the weather. Low temperatures in Johannesburg average around 36 degrees in mid-summer, while north in Lagos, Nigeria, average temperatures do not usually drop below 72 degrees.

Australia's main population centers, meanwhile, are roughly on the same latitude as South Africa, as that country also moves into the heart of its winter season. Worryingly, Australia's second largest city, Melbourne, locked down for a second time in early July for six weeks, though officials warned that could well be extended. Nighttime temperatures have dropped to the low 40s — its average throughout August.

We can't say for sure that these data points are related, but we should certainly be trying to determine if they are.

This all may feel quite removed from the immediate challenges facing American officials. But the global community is far more concerned.

"The whole international community and WHO has been nervous," Linfa Wang, director of the program in emerging infectious diseases at the Duke-NUS Medical School in Singapore told Bloomberg. "We always said the world will be watching very closely what happens in New Zealand and Australia in the Southern Hemisphere."

There are any number of reasons the coronavirus could be spreading more rapidly in cold weather, but without hard data, scientists are treading gingerly. For one thing, research suggests respiratory viruses seem to transmit more readily and droplets carrying them remain more viable in the winter's cold weather and lower humidity.

A study by University of Sydney researchers published in the journal Transboundary and Emerging Diseases pointed out "an association between lower humidity and an increase in locally acquired positive cases. Researchers discovered a 1 percent decrease in humidity could increase the number of COVID-19 cases by 6 percent."

"COVID-19 is likely to be a seasonal disease that recurs in periods of lower humidity," study lead Michael Ward said in a press release. "We need to be thinking if it's winter time, it could be COVID-19 time."

There are also a host of behavioral differences between the seasons that could contribute to spikes. Quite simply, the tendency of more people clustering in enclosed spaces to keep warm during the winter months inevitably facilitates the spread of the coronavirus.

"Certain viruses like influenza tend to have a seasonality," Jennifer Nuzzo, senior scholar at the Johns Hopkins Center for Health Security, told me in an interview. "Some people think it's humidity. Some people think it's temperature. Some people think it's behavioral, and which of those is most important is not known. Also, do they all matter? That's also not known. So one concern is potentially that if we are indoors more often and more likely to cough on each other — as a result, we could see more in-household transmission."

Indeed, some research suggests that extreme social distancing and other control measures may be necessary through 2022 as COVID-19 ebbs and flows with the seasons.

"We projected that recurrent wintertime outbreaks of SARS-CoV-2 will probably occur after the initial, most severe pandemic wave," Harvard T.H. Chan School of Public Health researchers Stephen Kissler and Christine Tedijanto and their associates wrote in the journal Science. "Absent other interventions, a key metric for the success of social distancing is whether critical care capacities are exceeded. To avoid this, prolonged or intermittent social distancing may be necessary into 2022."

But, the researchers added, "a resurgence in contagion could be possible as late as 2024."

While we don’t have as much research on COVID-19 as we’d like, scientists do have plenty of studies that examine the behavior of viruses like the Spanish flu.

While we don't have as much research on COVID-19 as we'd like, scientists do have plenty of studies that examine the behavior of viruses like the Spanish flu — an influenza strain that was responsible for a lethal pandemic a century ago. At the time, there was no vaccine treatment, nor for that matter as assiduous monitoring of the spread, but it is believed that as many as 500 million people — a third of the world's population at the time — were infected and between 20 million and 50 million died in the course of three waves of the virus.

The deadliest, second wave arrived in Africa beginning in August 1918 as soldiers and laborers returning from World War I in Europe rapidly spread the disease, which swept from the seaports into the continent's interior during the winter season. Then, as now, South Africa itself was one of the five most-impacted impacted nations, with some 5 percent of the country's population dying.

This year, there has also been some concern that under-testing and under-reporting of seasonal influenza in the Southern Hemisphere may affect our preparedness as the U.S. potentially battles two viruses simultaneously. (The U.S. and Europe look at Southern Hemisphere numbers for clues as to the potential intensity of the next seasonal flu cycle further north.)

World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus said his researchers have seen a "dramatic decrease" in influenza testing in 2020, including a 62 percent decrease in the number of specimens shipped to WHO labs. As Johns Hopkins senior analyst and research associate Matthew Shearer wrote in July, this suggests "it is critical that public health and healthcare systems develop plans now for a variety of scenarios."

On July 12, South Africa President Cyril Ramaphosa declared, "The storm is upon us," the Financial Times reported. Even then, South Africa's confirmed cases had passed those recorded in Italy or Germany and were trending upward.

In the deeply impacted Soweto township outside Johannesburg, Thabo Nko, a local undertaker, told the Economist he was doing 20 burials a week, 10 times his normal total. With the nearest cemeteries full, he was burying people 30 miles away.

Africa needs more help if it's going to slow the spread of COVID-19 and influenza across the continent. But the problems in the Southern Hemisphere do not exist in a vacuum. The developed nations could learn a lot from the experiences of the developing nations as summer turns to fall, then quickly to winter.

But will the U.S., which has so far failed repeatedly to get ahead of COVID-19's spread, start paying attention in time?

Related:

CORRECTION: (Aug. 17, 2020, 5:00 p.m. ET) An earlier version of this article misstated average temperatures in Johannesburg for June and July. Thirty-six degrees is the average low for those months, not the average nighttime temperature.