- March 22, 2020
Each day new information about the coronavirus outbreak is added to the already overwhelming avalanche of information that is being shared around the globe. We each have to work out what’s important to know, amidst the public health and economic advice; what’s interesting to know or piques our curiosity, such as Placido Domingo has contracted the virus, and Angela Merkel is in quarantine and what’s vital.
The vital information relates to everyone’s immediate safety and listening to the Government’s daily briefings is a good place to start for each person to find out how to keep themselves and their family protected. https://www.gov.uk/coronavirus
Sifting through the information, the following questions are also useful at a population level:
HOW PREPARED WERE WE FOR THIS PANDEMIC? AND HOW PREPARED ARE WE FOR THE FUTURE?
Epidemiologists have been warning about a new pandemic for the last 10-15 years, and 5 years ago in 2015, Bill Gates clearly warned that we had more to fear from a global viral outbreak than we do from other threats such as nuclear war. He set out very clearly what governments could be doing to prepare for a future pandemic, which involved strengthening health systems such as health facilities and testing equipment, and basically planning ahead to ensure the resources and expertise could be called upon at short notice, particularly in underdeveloped regions. The UK has had a series of Pandemic Preparedness strategies in recent years, and as recently as October 2019 examined contingencies and plans required for a major flu pandemic.
The impact of both the virus and our response to it has been shocking in its seeming suddenness. It raises questions as to whether we are prepared for the next stage of this pandemic, will there be future waves, a second or third wave of the outbreak? What are governments doing to prepare more fully?
China’s approach has apparently worked in tackling the virus decisively through immediate isolation and quarantine and reducing the numbers to manageable levels. China is not complacent and is building additional isolation units and more ventilators to cope with future demand. It is focussed on preventing large outbreaks in the future. The same goes for other Asian countries such as Singapore and South Korea which have promoted rapid testing, tracking and isolation of cases and quarantine of close contacts for 14 days.
Part of the problem across the UK, USA and Europe is that milder cases are not being tested or officially diagnosed, leaving these countries more exposed to a prolonged outbreak. The fatality rate of Covid 19 is about ten times higher than seasonal flu and both the numbers of cases and deaths are rising across these areas.
Testing, treatments and vaccines alongside clear public health guidance, are all part of the arsenal for short and long term preparation.
WILL TESTING BE SIGNIFICANTLY INCREASED IN THE UK TO COUNT ALL THOSE INFECTED?
The World Health Organisation has called for more testing and they have given a message to all countries to test, test, test.
We need to know the numbers of those infected and where they are. We currently have no idea how many asymptomatic people there are with the virus. The more people that do currently have it and show no symptoms, then the better it is, as it would mean that the rate of symptomatic cases and both mortality and case fatality rates would be lower than currently calculated.
The UK have promised to step up its response. Testing is variable across the country, but new testing facilities are being rolled out across the country to speed up the process.
PCR is the most commonly used test for diagnosing Covid 19. It stands for polymerase chain reaction and detects viral agents in a specimen. It is done using a nose or throat swab and it has a very high level of accuracy. However it has a relatively long turnaround time. Currently in the UK, these tests are done in specific labs, and smaller labs are sending away specimens and can wait up to 6 days for the results. Another option being rolled out is smaller, less expensive devices that can be used by smaller hospitals to carry out a higher volume of tests UK wide.
The Secretary of State for Health, Matt Hancock has said that the UK is planning to buy millions of antibody tests, which are currently being developed by Public Health England. This would revolutionise the testing further, by not only identifying those with the infection, but all those who have developed antibodies to the infection, giving us a much better handle on who has contracted the virus, whether they were asymptomatic or not. It is thought that if someone has contracted Covid 19 that they will build up an immunity against the virus. This new test is expected to arrive within weeks.
In the meantime, the PCR test is being rolled out further with the new faster testing equipment. Both are welcome developments and we will see how comprehensively these are rolled out.
WHAT THERAPEUTICS ARE BEING USED TO PREVENT DEATHS AND AID RECOVERY?
What scientists are looking at is drugs that inhibit the virus. Some diseases have both drugs and vaccines to tackle them. Some diseases only have drugs and no vaccines. The fastest and probably most pragmatic approach is to repurpose drugs that are effective for other diseases.
There are some antiviral drugs already in use to treat other conditions that have been researched to treat Covid 19. One drug is called Remdesivir – originally developed to treat Ebola which has shown some promise. There are also anti-virals that treat malaria and HIV that are also showing positive responses. Many doctors are highlighting the importance of trialling these drugs or combination of drugs as quickly as is feasible in order to save as many lives as possible.
HOW FAR HAS THE RACE FOR A VACCINE REACHED?
Vaccines are the best weapon we have against Covid 19 and pandemics in general. The first step was understanding the genetic make-up of the virus – this was identified early on just two weeks after the first cases were reported to the WHO. Developing vaccines is the next stage, and then they need to be analysed and tested and regulated. Making vaccines can take ten years or longer between the development stage, testing and mass manufacturing. The more closely a vaccine mimics the disease, the better immunity it will provide. There are many candidate vaccines ready to be tested and the timescales are being condensed to create a safe vaccine by 2021. With many scientists working both in collaboration and in competition across the globe, the estimate is that we will have a vaccine available for the public in 12 to 18 months, and then governments will need to decide who gets it first.
In the meantime, social distancing and self-isolation are the tools we have to keep the virus at bay for as long as possible.
Keep tough! As my mum would say!
Orig. Immunos v. Pathos