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INTRODUCTION
Many countries have seen a two-wave pattern in reported cases of coronavirus disease-19
during the 2020 pandemic, with a first wave during spring followed by the current second wave
in late summer and autumn. Empirical data show that the characteristics of the effects of the
virus do vary between the two periods. Differences in age range and severity of the disease have
been reported, although the comparative characteristics of the two waves still remain largely
unknown. Those characteristics are compared in this study using data from two equal periods

of 3 and a half months. The first period, between 15th March and 30th June, corresponding to

the entire first wave, and the second, between 1st July and 15th October, corresponding to part
of the second wave, still present at the time of writing this article. Two hundred and four
patients were hospitalized during the first period, and 264 during the second period. Patients in
the second wave were younger and the duration of hospitalization and case fatality rate were
lower than those in the first wave. In the second wave, there were more children, and pregnant
and post-partum women. The most frequent signs and symptoms in both waves were fever,
dyspnea, pneumonia, and cough, and the most relevant comorbidities were cardiovascular
diseases, type 2 diabetes mellitus, and chronic neurological diseases. Patients from the second
wave more frequently presented renal and gastrointestinal symptoms, were more often treated
with non-invasive mechanical ventilation and corticoids, and less often with invasive
mechanical ventilation, conventional oxygen therapy and anticoagulants. Several differences in
mortality risk factors were also observed. These results might help to understand the
characteristics of the second wave and the behaviour and danger of SARS-CoV-2 in the
Mediterranean area and in Western Europe. Further studies are needed to confirm our findings.

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FIRST AND SECOND WAVE OF CORONAVIRUS

Coronavirus disease-19 (COVID-19), produced by the severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2), has become a global pandemic, giving rise to a serious health
threat globally. Several countries have seen a two-wave pattern of reported cases, with a first
wave in spring and a second in late summer and autumn.
In Spain, the first wave of COVID-19 began in early March 2020, although some isolated cases
had been reported in February. As a consequence of the first outbreak, the Spanish Government
introduced a series of strict prevention measures, including home confinement, which lasted

from 13th March to 4th May, followed by a three-month period of progressively increasing
social interaction, work and commercial activity. As of July, life in the country had returned
to relative normality, except for the mandatory wearing of a face mask and maintaining a safe
social distance. Unfortunately, the number of cases of patients with COVID-19 began to
increase towards the end of August and a month later it once again presented numbers similar
to those in April. This forced the Government to reintroduce serious restrictive measures,
including local and regional lockdowns, closures of bars, restaurants, cultural and sports
activities, and a general curfew after 10 pm. The number of cases in Spain has continued to grow
since then, with some ups and downs, and at the time of writing this article it seems that it is
beginning to stabilize.

The second wave of COVID-19 had been predicted months earlier and had already occurred in
other countries. The vast majority of Western European countries are currently suffering the
consequences of this second wave and are taking similar restrictive measures. However,
empirical data would suggest that this second wave differs from the first in such factors as age
range and severity of the disease. Indeed, it has been suggested that this second wave in
Europe might be linked to the appearance of a new variant of the SARS-CoV-2, termed
20A.EU1, which appears to have originated in Spain, from where it then spread to the rest of
Europe through tourists who had spent their summer holidays in that area.

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The similarities and differences between the characteristics of the two waves remain largely
unknown. Population comparison is difficult because the technological and logistical capacity
of the countries in detection and diagnosis of asymptomatic patients and those with mild
symptoms has improved greatly in the six months since spring, and it is assumed that the
incidence of infection in the early months of the pandemic was much higher than had been
reported. However, a more accurate comparison of the two waves is feasible through the study
of the hospitalized patients for whom disease was confirmed by reverse transcription-
polymerase chain reaction (RT-PCR) and severe symptoms.

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PRECAUTIONS TO BE TAKEN
1. Protect yourself and those around you:
Get vaccinated as soon as it’s your turn and follow local guidance on vaccination. Keep
physical distance of at least 1 meter from others, even if they don’t appear to be sick. Avoid
crowds and close contact. Wear a properly fitted mask when physical distancing is not possible
and in poorly ventilated settings. Clean your hands frequently with alcohol-based hand rub
or soap and water. Cover your mouth and nose with a bent elbow or tissue when you cough
or sneeze. Dispose of used tissues immediately and clean hands regularly. If you develop
symptoms or test positive for COVID-19, self-isolate until you recover.
2. Wear a mask properly:
Make sure your mask covers your nose, mouth and chin. Clean your hands before you put your
mask on, before and after you take it off, and after you touch it at any time. When you take off
your mask, store it in a clean plastic bag, and every day either wash it if it’s a fabric mask or
dispose of it in a trash bin if it’s a medical mask. Don’t use masks with valves.

3. Make your environment safer:

The risks of getting COVID-19 are higher in crowded and inadequately ventilated spaces where
infected people spend long periods of time together in close proximity. Outbreaks have been
reported in places where people have gather, often in crowded indoor settings and where they
talk loudly, shout, breathe heavily or sing such as restaurants, choir practices, fitness classes,
nightclubs, offices and places of worship
To make your environment as safe as possible:
Avoid the 3Cs: spaces that are closed, crowded or involve close contact. Meet people outside.
Outdoor gatherings are safer than indoor ones, particularly if indoor spaces are small and
without outdoor air coming in. If you can’t avoid crowded or indoor settings, take these
precautions:
Open a window to increase the amount of natural ventilation when indoors.
Wear a mask (see above for more details).

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4. Keep good hygiene:

Regularly and thoroughly clean your hands with either an alcohol-based hand rub or soap and
water. This eliminates germs that may be on your hands, including viruses.
Cover your mouth and nose with your bent elbow or a tissue when you cough or sneeze.
Dispose of the used tissue immediately into a closed bin and wash your hands.
Clean and disinfect surfaces frequently, especially those which are regularly touched, such as
door handles, faucets and phone screens.

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5. What to do if you feel unwell:

If you have a fever, cough and difficulty breathing, seek medical attention immediately. Call by
telephone first and follow the directions of your local health authority.
Know the full range of symptoms of COVID-19. The most common symptoms of COVID-
19 are fever, dry cough, tiredness and loss of taste or smell. Less common symptoms include
aches and pains, headache, sore throat, red or irritated eyes, diarrhea, a skin rash or
discoloration of fingers or toes.
Stay home and self-isolate for 10 days from symptom onset, plus three days after symptoms cease.
Call your health care provider or hotline for advice. Have someone bring you supplies. If you
need to leave your house or have someone near you, wear a properly fitted mask to avoid
infecting others.
Keep up to date on the latest information from trusted sources, such as WHO or your local
and national health authorities. Local and national authorities and public health units are best
placed to advise on what people in your area should be doing to protect themselves.

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VACCINATION
A vaccine is a biological preparation that provides active acquired immunity to a particular
infectious disease. A vaccine typically contains an agent that resembles a disease-causing
microorganism and is often made from weakened or killed forms of the microbe, its toxins, or
one of its surface proteins.

Benefits of Being Vaccinated for COVID-19.

Feeling some anxiety about receiving any new vaccine is understandable. However, while the
COVID-19 vaccine was created and approved more quickly than the average vaccine, safety
and testing precautions were not sacrificed to achieve effective results.

COVID-19 is a highly infectious and, in some cases, highly dangerous disease. Some
populations, including the elderly and persons with underlying medical conditions (i.e.,
comorbidities) are at greater risk for severe symptoms and even death. Natural immunity
combined with vaccine-induced immunity appears to be the most effective means of
safeguarding against COVID-19.

Advantages of Vaccination

Protection against COVID-19: The best means of staying healthy is to avoid infection
by the SARS-CoV-2 virus. If, however, you do become infected, vaccination appears to limit
the risk of developing severe or even fatal symptoms. This is because the currently available
vaccine primes your immunological system for producing antibodies without causing you to get
sick. If you do become infected, your body is prepared to fight the disease. Vaccination
typically results in fewer or milder symptoms when you’re ill (or no symptoms at all).
Protection for your family and friends: By getting the COVID-19 vaccine, you also
lessen the chance of spreading the COVID-19 pathogen to family members, friends, or other
people with whom you have contact.
High rates of effectiveness. All FDA-approved medications are clinically tested before
release to the public. The Pfizer-BioNTech vaccine has been shown to be 94-95 percent

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effective within two weeks of full inoculation against the original strand of the COVID-19 virus.
Vaccines also show high numbers of efficacy protecting people from serious illness from
COVID -19 variants.
As with any vaccination, some side effects have been recorded. These include soreness at the
injection site, headaches, chills, fever, and fatigue. In the great majority of cases, these post-
inoculation symptoms will disappear quickly. They are also far less severe than the most serious
COVID-19 symptoms.

Vaccination and Public Health Safety Measures

The availability of vaccines does not decrease the need for safety measures to help beat the
COVID-19 pandemic. Even after inoculation, you should:
Practice good personal hygiene, including frequent hand washing wear a face mask in public
practice social distancing avoid prolonged contact with crowds, indoors or out. The ultimate
defeat of COVID-19 requires every tool available: vaccination, natural immunity, and effective
public health measures.

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RESULT
During the study period, 468 patients with SARS-Co-V2 infection, confirmed by RT-
PCR, were admitted to the hospital. The first wave peaked at the end of March and was followed
by a progressive decrease with very few patients being admitted in May and June. The number
of cases fluctuated upward from mid-July until a sharp increase in mid-October. The number
of patients admitted was 204 in the first wave and 264 in the second one. Those in the second
wave were significantly younger. A noteworthy feature of the second wave was the high number
of children between 0 and 9 years of age, 12 of them being babies under 1 year. The second wave
caused a significantly higher number of admissions to Gynecology, Pediatrics and Emergency
Departments and fewer to Internal Medicine and ICU. The duration of hospitalization was
significantly shorter in the second wave. A total of 49 deaths occurred during the first wave
and 35 during the second wave, so the case fatality rate decreased from 24.0% to 13.2%. The
patients who died were significantly older than the survivors and those who died in the
second wave were older than those in the first wave.

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CONCLUSION
The results of the present study show that hospitalized patients in the second wave were younger,
required fewer days of hospitalization, had lower mortality rates and treatments were more
effective and less intensive. Although the majority of symptoms were similar in both periods,
the higher incidence of gastrointestinal symptoms in the second wave stands out as a difference.
Comorbidities were similar, but there were differences between those associated with mortality,
highlighting the importance of chronic neurological diseases in this second wave. An important
difference was the high incidence of babies, children and pregnant and post-partum women
admitted but, in general, these cases were not serious and were resolved promptly and
successfully. These results might help to understand the characteristics of this second wave and
the behavior and danger of SARS-CoV-2 in the Mediterranean area and in Western Europe
generally.
Future prospects are difficult to predict. We think that COVID-19 will not disappear in the
short or medium term. New variants of the virus may appear, the vaccination process can
predictably last all year 2021 or more, until a sufficiently high percentage of the population is
protected, and the maintenance of strict lockdowns for very long periods is difficult to bear from
the economic, social and psychological points of view. Currently, the whole world is in the
middle of the second or perhaps the third wave, so take the precautions over covid and get
vaccination as soon as possible.

Get vaccine and keep your world safe.

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PHOTOS

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