By The Washington Post · Liz Sly, Simon Denyer, Ruth Eglash
Japan, Israel, Lebanon and Hong Kong are among dozens of places reporting record numbers of new cases in recent days, many weeks after they had crushed the curve of infections, reopened their economies and moved on.
And in some countries that had brought numbers down, notably in Europe, the reopening of borders, bars and nightclubs is being blamed for a small but noticeable increase in cases.
In Belgium and Spain, the number of daily infections has surpassed levels not seen since early May, prompting authorities to reimpose some recently lifted restrictions.
"I'm afraid you are starting to see in some places the signs of a second wave of the pandemic," British Prime Minister Boris Johnson said Tuesday, referring to Europe, as he sought to justify reimposing quarantine measures on travelers from Spain. Britain also is seeing more cases.
The United States, Brazil and India are still fueling the bulk of the pandemic's growth, accounting for nearly two-thirds of the new cases reported globally over the past week. Many other countries, including in Africa, Latin America and the Middle East, have not yet reached a peak in infections, officials at the World Health Organization say.
Most places experiencing new waves of coronavirus cases still lag far behind the United States, Brazil and some other parts of the world in per capita rates of infection. Japan, for instance, has only around 230 infections per 1 million people, compared with more than 13,000 infections per 1 million people in the United States.
But since the beginning of July, the number of new cases in Japan has climbed by more than 60%, a growth rate equivalent to the United States', alarming a country that had trumpeted the "Japanese model" for containing the virus.
"We now have got an epicenter developing within Japan. Unless we stop it with a full force as a nation, I worry that we might go the same way as New York or Milan," said Tatsuhiko Kodama, a professor at the University of Tokyo who is leading a research project on the virus.
In Australia and some other places such as Hong Kong and Israel, all of which had appeared to defeat the virus, infections are growing twice as quickly as in the United States, or even faster, suggesting there is no end in sight to the virus's spread. A million new infections are now being reported every four days worldwide, pushing the total to well over 16 million cases.
Infectious-disease specialists say that references to a "second wave" are not helpful, given that almost nowhere in the world has entirely banished the virus. Rather, they say, we can expect to see waves of growth and contraction as authorities relax and tighten containment measures.
The July resurgence in countries that had boasted of success has meanwhile confounded hopes that summer would bring some respite, at least to countries in the Northern Hemisphere that seemed to have managed their coronavirus outbreaks well.
Some of the countries where the case numbers are rising or raging are in the Southern Hemisphere, now experiencing midwinter, such as Brazil and Australia. But the new increases are also afflicting regions that had been bracing for a fall wave, predicted as people spend more time crowded together indoors and lower humidity facilitates the transmission of the virus, said Tim Spector, a professor of genetic epidemiology at King's College in London. His team published a paper last week on how colder conditions affect the transmission of the novel coronavirus and the severity of covid-19, the illness the virus causes.
A worrying question now, Spector said, is how much worse the coronavirus spread will become when winter does arrive in the Northern Hemisphere.
"Everyone was predicting that as summer came, the United States, for example, would be fine, that they could get cases low before the winter struck. That's not happening," he said. "It's a reasonable assumption that when winter comes, the frequency and doses of virus people are infected with will be greater and severity will increase again."
Overwhelmingly, governments and scientists attribute the resurgences to the relaxation of social distancing measures, the resumption of tourism and the reopening of nightclubs, bars and restaurants, where crowded conditions create optimal conditions for the coronavirus to spread.
"When people mix, the virus moves," said Mike Ryan, the executive director of the World Health Organization's emergency program, at a virtual news briefing Monday.
The good news, he said, is that many of the new outbreaks have been pinpointed, which helps the task of controlling them with isolation, testing and contact tracing. In Spain, outbreaks have been traced to migrant agricultural workers in the province of Aragon and to the reopening of nightclubs in Barcelona.
But they also underscore the challenge of maintaining the vigilance required to keep the virus in check for months on end, experts say.
"If we think of this pandemic as a fire, there are embers everywhere. You relax your vigilance and it takes off again," said W. Ian Lipkin, a professor of epidemiology at the Mailman School of Public Health at Columbia University.
People are growing tired of the pandemic's impact on their lives, he said. "There's a lot of pent-up economic anxiety and social anxiety, and this is lasting longer than anticipated," Lipkin said.
In Japan, record numbers of infections over the past week have been blamed on Tokyo's hostess clubs. Yet the government and the public alike are resisting calls by health professionals for new restrictions that might further damage the economy.
Some countries are battling far greater economic problems than Japan and face even tougher choices about curtailing economic activity to control the virus. One of those is tiny Lebanon, which won plaudits for containing the coronavirus with a swift and strict lockdown early on but has seen its case count more than double in the past month - to 4,021 as of Wednesday, according to Health Ministry figures.
Lebanon also is confronting an economic collapse that began well before the pandemic and has accelerated despite the lifting of the restrictions in early June. The government on Tuesday reimposed a staggered lockdown that will shut down the country over the next two weekends and close the bars and nightclubs that had reopened, in some instances to huge crowds.
Firass Abiad, who heads the coronavirus response at Lebanon's biggest government hospital, the Rafik Hariri University Hospital, captured the country's dilemma in a tweet.
"As we stare into either a health or an economic abyss, or both, what options do we have?" he asked.
There may be places in the world where increased testing explains some of the jump in numbers, experts say. The Israeli government points to the higher number of tests now being conducted to explain a huge second wave of infections that has given the country one of the highest surges in cases in the world, said Nadav Eyal, a journalist with Israel's Reshet News.
But the greater availability of tests cannot explain the overall numbers, hospitalizations and deaths, Lipkin said. Cases are rising, he reiterated, because people are letting their guard down.
"We didn't think we would see people relax as much as they have," he said. "There's a whole series of things we should have anticipated, could have anticipated and accounted for. But the majority of these increases are of our own making."
- - -
Denyer reported from Tokyo and Eglash from Jerusalem.