Moving from pandemic 'delay' to increasing 'mitigation' phase
Many people are asking the following questions:
- We have had previous scares over potential pandemics, but have we learned from these experiences?
- What is the similarity of COVID-19 to SARS and flu viruses?
- Is the response to COVID-19 proportionate and appropriate?
- What causes a pandemic?
- Will we see multiple waves of the illness?
Being fore-warned is allowing us to lay down contingency plans
Quick summary of some viral jargon
Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is the name given to the 2019 novel coronavirus. COVID-19 is actually the name given to the disease associated with this virus. SARS-CoV-2 is a new strain of coronavirus that has not been previously identified in humans.
While the viruses that cause both COVID-19 and seasonal influenza are transmitted from person-to-person and may cause similar symptoms, the two viruses are very different and do not behave in the same way. The European Centre for Disease Prevention and Control (ECDC) estimates that between 15,000 and 75,000 people die prematurely due to causes associated with seasonal influenza each year in the EU, the UK, Norway, Iceland and Liechtenstein. This is approximately 1 in every 1,000 people who are infected. By comparison, the current estimated mortality rate for COVID-19 is 20-30 per 1,000 people.
No prior immunity
Despite the relatively low mortality rate for seasonal influenza, many people die from the disease due to the large number of people who contract it each year. The concern about COVID-19 is that, unlike influenza, there is no vaccine and no specific treatment for the disease yet. It also appears to be as transmissible as influenza if not more so. As it is a new virus, nobody has prior immunity which in theory means that the entire human population is potentially susceptible to COVID-19 infection.
Recent history of pandemics
As Prof David Mabey from The London School of Hygiene and Tropical Medicine informed us ten years ago in his article, Big flap about a bit of flu: "We shouldn’t forget that this is not the first time a spectre of devastating pandemic has grabbed headlines and altered government policy: in 1976 the highly hypothetical suggestion of a ‘Swine Flu’ outbreak drove the American administration to initiate a population-wide vaccination campaign. Ultimately there was no pandemic – just a lot of people with Guillain-Barre secondary to the vaccine. The current panic [bird flu] should therefore be considered with that note of caution in mind."
This pandemic was predicted
Big flap about a bit of flu is useful as it sets out to describe the origin of influenza pandemics, global situations with respect to viruses (in this case H5N1), and what we can do to reduce morbidity and mortality if and when a pandemic hits. It is against this backdrop that we can view the latest threat and be grateful for the research largely conducted in the UK that has helped to inform global policy on managing pandemics.
Prof Mabey predicted that this pandemic was going to happen, he said, "These data suggest that ‘adaptive mutation’ may be bringing the virus closer to efficient human transmissibility... and many authorities now think another pandemic is inevitable".
He went onto say, "But this time it’s different. On the negative side, increased air travel will spread the virus more quickly, and modern medicine has created a larger population of vulnerable people (transplant recipients, chemotherapy patients etc). But against this we have better hygiene and nutrition, improved diagnostics and supportive management as well as drugs against influenza. Furthermore, we have been warned in advance and can intervene early – provided we support Asian surveillance and healthcare systems".
Based on the evidence, China was also forecast to be the likely source of a new mutant, "History suggests that these reassortment events most probably occur in South-East Asia or China".
What pandemic mitigation measures that can be taken?
Every day we keep hearing increasingly draconian methods for taking social distancing seriously. A group of US physicians have come together to make their own suggestions for preventing the spread of the virus and 'flattening the curve'. See KevinMD
In summary:
- Proactive school closings save more lives than reactive school closings. Your schools should close now … before infections are present. Closed schools do not mean playdates for children – this counteracts the social distancing the school closures are meant to create in the first place.
- 6 feet: The COVID-19 virus spreads through droplets. They can move 6 feet before gravity brings them to earth. Stay 6 feet away from people if you need to go outside.
- Meticulous hand washing: Wash thoroughly and wash often. Alcohol-based hand sanitizer works well if your hands are otherwise clean.
- Do not touch your face. This is hard. This is a learned skill: Practice often.
- Clean doorknobs, toilets, cellphones, countertops, refrigerator handles, and so on many times each day. The virus could live on certain surfaces for 4-72 hours.
- If you can work from home, work from home.
- No tournaments, no sports events, no soccer, baseball, dance, volleyball, softball, gymnastics, concerts, martial arts, etc. We don’t care how much they claim they will clean the equipment.
- Cancel vacation travel. We know you planned this for a long time. You will be saving many lives by doing so … perhaps someone you know.
- Cancel weddings/ bar/bat mitzvahs, birthday parties, and so on. Help other people live so they can celebrate future events too.
- If you are over 60 years old, you should stay home. You should only go out if there is a critical need.
- If you have parents/grandparents in a nursing home, you should consider moving them home for now.
- Do not congregate in a restaurant, bar, etc. Again, you will save the lives of people you will never meet.
- If you feel sick, stay home. It doesn’t matter if you don’t feel too sick. Going to work will put countless other people at risk of suffering or dying.
- Cancel all business travel. Your life and the lives of others are more important.
- Expect supply chain issues: Work with your doctor to try to get a three month supply of medication.
- Many grocery stores have order ahead options with either pick up or delivery. There are online grocery delivery services available in many areas. Wash your hands thoroughly after unpacking groceries.
Returning to Prof Mabey's prophetic words, "Being fore-warned is allowing us to lay down contingency plans in advance, and the use of effective drugs [when available] coupled with public health measures should enable us to significantly limit morbidity and mortality".
