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?