key: cord-0707300-5ov8npkh authors: Hafeez, Sara; Din, Misbahud; Zia, Fatima; Ali, Muhammad; Shinwari, Zabta Khan title: Emerging concerns regarding COVID‐19; second wave and new variant date: 2021-04-14 journal: J Med Virol DOI: 10.1002/jmv.26979 sha: 4313a3307f92f3a0576325b53f908cfaf08047f9 doc_id: 707300 cord_uid: 5ov8npkh nan To the Editor, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which emerged in December 2019 has been the cause of tremendous panic around the globe for the past whole year. The virus has spread to over 200 countries, claiming up to 2 million lives globally (data till February 9, 2021). During the current health crisis when the scientific community is battling hard to contain the first wave of coronavirus disease-19 , the globe has been hit recently by a second wave. 1 Historically, pandemics have occurred from time to time, infectious diseases have had a profound and lasting impact on global societies, shaping their politics, economy, and civilizations. 2 Researchers refer to the Spanish flu pandemic to understand and control the COVID-19 pandemic. Even though the coronavirus is from a different family of viruses than the influenza virus, they are significantly similar as both silently attacked the world and the societal as well as the political response to both pandemics is closely alike. 3 Historical records of the 1918 influenza pandemic and unpredictability of the second wave have caused distress among people as the first wave of that outbreak (Spanish flu) proved to be relatively mild as compared to its second wave which was much worse. 4 Among the coronaviruses, at the beginning of 21st century, severe acute respiratory syndrome (SARS) that emerged in 2002-2003 was recognized as a global public health threat. A decade after the SARS outbreak, another even more severe respiratory disease emerged in 2012 that is known as the Middle East respiratory syndrome (MERS). 5 Both the SARS and MERS epidemics affected human health significantly and some aspects of these pathogens could be compared to SARS-CoV-2 as they share many similarities but obvious differences exist as well. 6 Both SARS and MERS affected humans differently even though they are related to the novel coronavirus. COVID-19 shows distinct epidemiological, pathogenetic, and clinical features as compared to SARS and MERS, so it is difficult to predict the COVID-19 situation from the data available on the novel coronavirus has a fatality rate of 2.3%, which is much lower than that of SARS which was 9.5% and even lower than that of MERS with a fatality rate of 34.4%. Hence, it is estimated that COVID-19 spreads more easily than MERS and SARS even if it is not as fatal. 7 The second wave of the COVID-19 has been experienced by many countries and governments have started confinement measures to limit the spread of infection. People are tired of following the precautionary actions against COVID-19 and frustrated due to lockdown for months, canceled activities, stress, and economic challenges. All these factors are contributing to the apogee of COVID-19. 8 The current global COVID-19 situation is represented in Figure 1 . Researchers have urged that for herd immunity to work, approximately 60%-70% of the population has to be immune against COVID-19. 9 In comparison, immunity to other seasonal coronaviruses is usually transitory. Limited COVID-19 re-infection cases have been reported, which means people are not immune to this virus for long enough to develop herd immunity. 10 Research suggests that strict measures like social distancing and self-isolation help in suppressing the spread of COVID-19 but allowing it to spread to gain herd immunity in a population does not control the transmission or infection rate. 11 Countries around the world have prevented the spread of coronavirus by restricting travel and social activities. 12 The relaxation of precautionary measures like restricted outings, avoidance of gatherings, self-isolation and lockdowns have resulted in the quick escalation of COVID-19 cases across Europe, therefore governments have started to limit social activities again to counter the second wave of COVID-19. 13 The most effective way to fight the spread of COVID-19 to date is to prevent it by following the suggested precautionary measures to prevent it that includes hand hygiene, social distancing and quarantine and increased testing to reduce secondary cases. 14 Australia fought the pandemic most effectively by following strict lockdown rules for a longer period during the start of the pandemic. However, the prevention wasn't without consequences and Australian society and economy have been adversely affected. 15 As the several regions of the world are clearly in the grip of the second wave of COVID-19, strict lockdown cannot be imposed as travel restrictions are being lifted and governments in different countries want to resume their economies, however, no mass vaccination is in sight yet, some supportive and pharmacological treatments such as remdesivir, dexamethasone, and convalescent plasma can help reduce the severity of infection in serious patients of COVID-19 to decrease the case fatality ratio in the world. 16 Moreover, measures to protect public health must be kept in mind: social distancing, hygiene, and the rigorous use of face masks in public areas should be strictly followed. Another challenge that the world is facing along with the second wave of COVID-19 is that viruses constantly get modified through a mutation that could lead to the birth of new variants of a virus over time. 17 The year 2021 is expected to be the one where humanity gets rid found in December 2020 in South Africa and P1 identified in Brazil in January 2021. None of these variants have proved to be more fatal than their respective parent virus. However, the transmission capability of some of these variants may be enhanced due to spike protein alterations such as the N501Y mutation which is the part of the virus that attaches to human cell receptor ACE2, which are also major targets for vaccines. Another mutation of concern is E484K, which also affects the spike The authors declare that they do not have any conflict of interests. Sara Hafeez and Misbahud din: Initial draft preparation and study design. 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