Covid-19: keep calm and make a plan

While some of the Press produce shouty headlines for fun and profit and others affect armchair insouciance, the truth lies somewhere in between: no, it’s not going to kill us all; no, it’s not just flu; no, it’s not going away.

This week’s Spectator adopts the postprandially relaxed position. Martin Vander Weyer reassures us https://www.spectator.co.uk/2020/02/coronavirus-is-a-chance-to-buy-cheaper-but-it-comes-with-a-health-warning/ that the recent stockmarket reverses (btw, in percentage terms nothing remotely like the Dow’s one-day drop in 1987 https://edition.cnn.com/2013/05/31/us/dow-jones-industrial-average-fast-facts/index.html ) may offer buying opportunities, particularly in pharma firms seeking a vaccine for Covid-19, though (chuckle) investors should ‘wash hands and don a face mask’ before placing their bets. Well yes, I think the frail, twisted state of the world’s financial system is currently much more of a real and present danger to shareholders and pensioners; but we’ll come back to vaccines in a moment.

The Speccie’s Ross Clark https://www.spectator.co.uk/2020/02/the-most-dangerous-thing-about-coronavirus-is-the-hysteria/ also seeks to allay our ‘hysteria’ about coronavirus, but his downplaying doesn’t quite work for me. Like so many, he makes the comparison with influenza in the winter of 2017-18, quoting the Office for National Statistics’ figure of 50,000 fatalities, but must have missed the British Medical Journal’s comment (referencing Public Health England’s study): ‘the ONS seem to have exaggerated the risk to the public by in the region of 150 times.’ https://www.bmj.com/content/361/bmj.k2795/rr-6 . The fatality rate from seasonal flu is something like one in a thousand; The Guardian (28 February) says Covid-19 is ‘ten times more deadly.’ https://www.theguardian.com/world/2020/feb/28/coronavirus-truth-myths-flu-covid-19-face-masks . Clark tells us that SARS (9.6% fatalities https://www.businessinsider.com/china-wuhan-coronavirus-compared-to-sars-2020-1?r=US&IR=T ) and H5N1 (60% death rate https://www.who.int/influenza/human_animal_interface/avian_influenza/h5n1_research/faqs/en/ ) ‘hardly justify’ being called epidemics, let alone pandemics; and ‘If China had not taken such dramatic steps to stop the [Covid-19] disease, we wouldn’t be half as worried.’ Au contraire, the Chinese should have acted earlier and faster and they are certainly not overreacting now; the dropped match that might have been doused quickly at the start has become a blaze requiring all available appliances.

Covid-19 is much less fatal than SARS, but has a similarly high level of transmission from person to person. The threshold contagion rate for an epidemic is R1, i.e. on average each person passes the disease on to one more; MERS https://www.who.int/news-room/fact-sheets/detail/middle-east-respiratory-syndrome-coronavirus-(mers-cov) and the highly deadly H5N1 https://www.cdc.gov/flu/avianflu/h5n1-people.htm were below this rate, but SARS was in the region of R2-R3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4558759/ and Covid-19 is now thought to be similarly infective https://www.theatlantic.com/science/archive/2020/01/how-fast-and-far-will-new-coronavirus-spread/605632/ , though earlier estimated at R4 https://www.medrxiv.org/content/10.1101/2020.01.27.20018952v1.

What makes the latest coronavirus more dangerous is that it seems to have a longer incubation period https://www.health.harvard.edu/blog/as-coronavirus-spreads-many-questions-and-some-answers-2020022719004#q2 than SARS’ 2-7 days https://www.cdc.gov/sars/about/faq.html , so there is a greater chance that it will slip through basic screening measures at airports etc. It also vastly expands the network of possible contacts before and after a case of infection, so containment becomes exponentially more difficult. The UK’s twentieth case, appearing in Surrey on Friday, is the first to have occurred here through secondary or tertiary transmission but given a prolonged pre-symptom period the trail can easily go cold. https://news.sky.com/story/first-case-of-coronavirus-confirmed-in-wales-and-two-more-in-england-11945201

Paradoxically, a quick and deadly disease is less of a threat, since it can be spotted early and eliminates its host fast before it can find many new ones; Covid-19 may go on to claim lots more victims overall because it kills a small percentage of a much larger number. Interviewed by The Atlantic magazine, Harvard epidemiology professor Marc Lipsitch opines, ‘I think the likely outcome is that it will ultimately not be containable,’ so rather than an epidemic or pandemic it will be endemic: a new regular seasonal illness like colds and flu, but one for which – as with other coronaviruses - there may be no long-lasting immunity, and which is more fatal than flu. https://www.theatlantic.com/health/archive/2020/02/covid-vaccine/607000

In the same Atlantic article, the CEO of the Coalition for Epidemic Preparedness points out that even though a vaccine may be developed by Spring or summer this year, testing for safety and effectiveness may mean it is not publicly available until 12 – 18 months from now.

Meanwhile, we can begin to analyse and quantify the risk factors of Covid-19, based on cases identified so far. Worldometer https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/ combines information from two authoritative sources to estimate the likelihood of dying if infected, according to age, sex and pre-existing medical conditions. The initial indications are:

1.  Below age 50, the risk of death is 0.4% or less; after that, it goes from 1.3% to above 10% at age 80

2. Men are significantly more vulnerable than women, BUT most cases so far are Chinese and in China, men are much more likely to be smokers (as this study confirms https://jech.bmj.com/content/71/2/154 )

3. In descending order, the following conditions significantly increase mortality risk: cardiovascular disease; diabetes; chronic respiratory disease; hypertension; cancer.

On the basis of the above, we can begin thinking about public and individual strategies to cope with the challenge of Covid-19.

First, timing: we need a plan to get through the next 18 months to two years, by which time a vaccine may become available. During this time, we all need to be extra-cautious, not only to evade the virus personally but to avoid spreading it to others. Perhaps all public places – e.g. schools, shops, offices, places of worship and mass entertainment – should have wall-mounted hand sanitisers as is standard in hospital wards. We need to wash hands frequently. Masks, says the government’s advice to transport workers https://www.gov.uk/government/publications/covid-19-guidance-for-staff-in-the-transport-sector/covid-19-guidance-for-staff-in-the-transport-sector , ‘do not provide protection from respiratory viruses [but should] be worn by symptomatic passengers to reduce the risk of transmitting the infection to other people.’ One reader suggested shopping off-peak if possible; others may have more ideas to offer.

Then, focus: the elderly and infirm are clearly much more at risk. Maybe the NHS Secretary could authorise doctors and pharmacies to allow the old and weak to stockpile essential medicines so that if there is a local outbreak they can self-isolate in order to avoid contracting the disease; and their carers and visitors need to be much more scrupulous in hygiene precautions (think of sheltered accommodation and nursing homes.) There may need to be safer arrangements for them to access GP and hospital services. Those who still work may be permitted to do more at home. Health advice and initiatives may increase their stress on reducing smoking, excess body weight (dieting can beat diabetes in some cases), blood pressure etc. How about preparing varied food packs and menus to make it simpler for the vulnerable to have adequate and appropriate nutrition to endure a viral siege? (We need a new Lord Woolton and Marguerite Patten!)

Any more ideas?