On the Spread of Novel Coronavirus

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It is hard to escape the fact that Covid-19, aka Novel Coronavirus, is back in the news today.
 
I remember that when news of the virus in Hubei province first broke, I was surprised that there was talk of testing and quarantining those travelling in and out of China when there should have been a total ban on all such travel and especially by plane as soon as they were aware of the outbreak. Although the CRISPR technology offers hope for the future, there is currently no cure for any virus. It would take at least a year to develop a vaccine and in the meantime, the only effective, preventative measures are to isolate the infected to prevent transmission. This means quarantining infected individuals and areas to protect the health of the wider population and regardless of how inconvenient or costly this might be.

 

I believed that authorities around the world have been playing down the risk and that China was late in applying quarantine restrictions because they are more worried about short term economic damage than the health of the population. The WHO were also critical of this at the time.

 

On several occasions the BBC news presented someone, who appeared to be representing business interests in Hong Kong, as an authority on the subject. He insisted that the quarantine measures should end because the virus was not serious and was in any case spreading so therefore the quarantine was ineffective. At the time, it was not possible to make a comparison with what the rate of transmission might have been without quarantine measures and so his argument lacked any scientific validity.

 

The BBC along with other media in the UK continued to reassure the public by playing down the threat, giving the mortality rate as 1% although a quick calculation using the actual figures (then 1,060 deaths from 33,600 infections) showed that it was 3%. They described the virus as being no worse than flu with most victims suffering only minor illness. Besides, it was only older people with an existing pre-condition (i.e. the fact they were older) who were likely to die from the virus. Even so, in actuality younger people had also died from the virus including health workers and the doctor who had first identified the virus. So it was evident that a protracted exposure to the illness was also a factor in mortality.

 

On 13th February, news services reported that the virus had stabilised according to the WHO. This conflicted with alarming (BBC) reports Hubei had seen a record 242 deaths and 14,800 new infections on the previous day whereas the previous highs were 103 deaths and 3,800 infections in a single day (official Chinese statistics). This disparity in reports was then explained as being the result of China changing the time at which infections were being recorded.

 

There being no apparent serious threat and amidst further concerns about an adverse effect on the economy, to some extent coronavirus then faded from (UK) news to be superseded by reports about the damage caused by severe weather and the suffering caused by the resultant floods. There were however occasional reports of planes returning Britons from areas infected by the coronavirus and also reports of the plight of Britons quarantined on the Diamond Princess cruise ship at Yokohama with calls for them to be similarly returned to the UK as has happened this week.

 

Late last night, reports of the coronavirus began to appear once again in the BBC breaking news ‘tickertape’ at the foot of the screen. Firstly, four of the cruise ship evacuees who were flown to Britain on Saturday (after allegedly being tested for the virus) had tested positive for coronavirus, bringing the total number of cases in the UK to 13.

 

This was followed by reports that the number of infections in South Korea had doubled within a 24 hour period putting the country on ‘high alert’, that a 6th person had died as a result of the spread of the virus in north Italy and that the entire border of Iraq has been closed following an outbreak there.

 

Despite BBC news being occupied with these stories today and the word ‘pandemic’ being used as a potential outcome, their correspondent has continued to emphasise that 4 out of 5 infected people will experience only minor symptoms and that it is the elderly who are most at risk. Finally, this afternoon, the BBC’s Simon McCoy asked an expert why there is so much concern about the spread of the virus if the effects are being described as mild. The reply, “because we know so little about the virus” is correct.

 

The method of transmission of the new coronavirus is not yet fully understood. There are various accounts, many of which are based on experience of previous strains of the virus. The rapid spread suggests airborne transmission and because close contact with infected people is a factor, there is advice to wear face masks and dispose of used tissues safely. However, there are recent cases where there has been no known contact with an infected person and the virus has been found to remain active in the body fluids of those who have been treated and cleared of the illness. There are conflicting reports as to whether the virus can be transmitted by touching infected surfaces.

 

The public are advised to wash their hands regularly (especially before and after touching the face) and to disinfect surfaces. These are sensible precautions but are unlikely to achieve more than to delay an outbreak according to health authorities. They also transfer some responsibility for transmission to the public. An increase in cases in Japan has raised concerns about rapid transmission by what appears to be multiple methods. Even so, a BBC Asian correspondent described the future of summer Olympics due to be held in Tokyo in July as being of, “even greater concern”.

 

It is now predicted that the virus will spread to every continent and that it is only a matter of time before it is classed as a full pandemic. As for the ‘quarantine vs economic damage’ arguments, the global fears about the virus are now having a severe impact with markets ‘falling’, stocks ‘plummeting’ and oil ‘slumping’ according to reports. Meanwhile, China reports that the virus has spread much more slowly in those regions where strict quarantine controls were quickly applied.

 

The figures at the time of writing are:

 

Total cases: 79,744 cases (51,828 active and 27,916 closed)

Total deaths: 2,629

Recovered: 25,287

 

The live update on these figures (with a breakdown by country) can be found at Worldometers.

 
 
Update (10.03.20):
 

It is now thought that the Coronavirus outbreak will peak in the UK in about 2 months time. It is hoped that this can be delayed until June when warmer weather may ameliorate the effects of the disease and the longer period involved will enable health services to better cope with the influx of new cases.

One thing we could learn from the outbreak is that a virus that has a lower mortality rate and in most people presents milder symptoms than SARS (say) can actually be more deadly if it is taken less seriously because it can then spread more quickly and further afield. Because the number of fatalities is the product of the number of infections and the mortality rate, a high number of infections is as deadly as a high mortality rate.

According to the World Health Organisation (WHO), a total of 8,098 people worldwide became sick with SARS in 32 countries during the 2003 outbreak. Of these, 774 died. The current statistics for Coronavirus (10.03.20) are that there have been 115,695 infections across 155 countries of whom 4,085 have died. Since 2003, there have periodically been further, less serious, outbreaks of SARS yet despite continuing research, there is still no effective vaccine.

In the coming month or two, it is highly likely that we will need to adapt to increasing restrictions on our behaviour and other measures that will be implemented to control the spread and mitigate the effects of Coronavirus. As we come to terms with these, we should also treat them as a dress rehearsal. As an expert on infectious diseases from Oxford university, speaking on BBC news today has pointed out, outbreaks of deadly and potentially pandemic diseases that were comparatively rare in the 20th century, have increased in frequency in the last 20 years and are now a feature of the 21st century.

Like the severe weather, floods and forest fires, deadly and pandemic diseases are something we are now likely to experience on a more regular basis.

 
Links:

1. ‘Rapid Spread of Coronavirus’, BBC World News

2. Effect on economy, Sky News

3. Global spread,  New Scientist

4. Advice and reports,   World Health Organisation

5. Coronavirus at  Wikipedia

 

 

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