#Coronavirus - Going viral 

Where do you want to be if there is a coronavirus (COVID-19) breakout? Well, preferably on an Outer Hebridean island, with a well-stocked larder, plenty of turf for the fire and a pile of books. But more realistically, writes Catherine Feore, assuming that most of us are unable to abscond from work or family commitments, what sort of country would you like to be living in? 

Let’s narrow it down by looking at where you don’t want to be. You don’t want to be somewhere where sycophancy or authoritarianism leads to a lack of transparency and public trust. So, you need a robust democracy with proper checks and balances, including independent health professionals and media. In addition, you need politicians who listen to experts and are willing to make unpopular decisions to serve more important ends. 

Poverty and the associated precarity of workers who might be unable to take time off could also lead to under-reporting, so economic support for the weakest is not only an act of solidarity, but also an act of universal self-interest. Even if you aren’t vulnerable, the economic knock-on effects will be heavy. 

Universal and free or affordable health care are critical; no one should fear coming forward - hopefully via phone or online initially. Singapore made the decision to pay for the cost of hospitalization irrespective of where the patient is from. Moreover, it needs to be a country that recognizes that they will also need to provide a palliative for the economic pain that will be one of the side-effects of this epidemic – the self-employed and small businesses are particularly vulnerable. 

Equally, you will want to be somewhere where people assume their individual responsibilities. Over the last week, there has been much discussion about hand-washing. It is amazing how this simple and affordable act can be so effective. The virus has a thin lipid (fat) layer, so soap or washing-up liquid and some vigorous scrubbing can make the virus inactive. Dry your hands using paper towels, rather than a dryer. Incidentally, if you don’t already, you should try to make this the habit of a lifetime. Other simple measures include sneezing into a handkerchief or elbow, self-isolating if you think you are unwell or vulnerable and generally keeping a little more distance from your fellow human beings than you might be used to. 

Finally, you want to be in a country that has thought long and hard about the challenges that a pandemic presents and that has held many simulations to enhance preparedness.  

These elements narrow your choice down to somewhere in Europe and the more open societies in Asia.  

I am writing this at a turning point (9 March). Over the weekend Italy declared sweeping restrictions to mitigate the spread of Coronavirus, the entire country is now under lockdown; there is growing concern about under-reporting in certain countries, particularly the US and Turkey; and if you were in any doubts that we are in crisis territory, international markets plunged to depths last seen during the financial crisis in 2008 over the weekend.   

It is moments like these when you discover that those much-maligned experts and faceless bureaucrats have been quietly modeling and preparing for this day for some time.  The European Centre for Disease Prevention and Control (ECDC) is an EU agency dedicated to strengthening Europe’s response to infectious disease.  

The ECDC works with international organizations, in particular, the World Health Organization and EU countries, to identify, assess and communicate information on current and emerging threats to human health, hosting an Early Warning and Response System (EWRS).  

The ECDC carries out its risk assessment and then advises the Health Security Committee, which brings together health expertise from every EU member state. National authorities inform the ECDC about what measures they are taking. The ECDC is not the only agency involved. The EU has also mobilized other agencies, including the European Medicines Agency (EMA) and the European Union Aviation Safety Agency (EASA). 

The EU is working across Directorates and pulling out all the stops, to take as integrated an approach as possible, working closely with the EU’s health ministers. There are no easy choices and the more stringent the measures to contain or deter the spread of the infection, the harder the hit to the economy.  

The list of EU actions is very long indeed, but to give you an idea it has included funding through an EU Healthy Gateways to improve capacities at entry points, such as ports; measures to help laboratory preparedness: €114 million to support the WHO; €15 million for rapid diagnosis and surveillance in Africa; €90 million to the EU’s Innovative Medicines Initiative to support urgently needed research on diagnostics, therapeutics and prevention; €3 million to repatriate EU citizens from Wuhan, China; the examination of joint procurement of protective equipment; and, support to find a vaccine. 

In the EU, health services and public health are primarily the responsibility of national governments, but as this coronavirus epidemic has illustrated, the EU is there to support, complement and supplement national action; in doing so it pools resources and expertise. 

UPDATE 13 March: THE EU HAS ANNOUNCED FURTHER SUPPORT AND MEASURES, INCLUDING A PROPOSAL TO DIRECT EUR 37 BILLION UNDER COHESION POLICY TO FIGHT AGAINST THE CORONAVIRUS, ASWELL AS LOOSENING OF STATE AID, REGULATORY, BANK CAPITAL AND GROWTH AND STABILITY PACT RULES. 

Known knowns, known unknowns, unknown unknowns 

Scientists are data-crunching as I write, but at this moment China’s quarantine, social distancing, and isolation of infected populations appear to show that an epidemic can be contained.  Data shows us that young people and those under 50 are very resilient. However, there are many areas where there is uncertainty. 

For those saying that COVID is just like annual influenza (I have a certain orange person in mind) the case fatality rate (CFR) is estimated at about 0.3 - 1% which is much higher than for a moderate influenza season, which is usually of the order of 0.1% CFR. This figure is likely to fluctuate with wider testing and more positive, but non-fatal, results. Nevertheless, fatality does appear to be much higher than for influenza. COVID-19 is also infectious for around 10 days, which is much longer than typical influenza placing a heavier burden on healthcare systems. While influenza’s transmission is reduced in the warmer summer months, we don’t yet know if this will reduce the transmission of this virus.  

Studies already seem to show that COVID-19 can be transmitted one to two days before the onset of symptoms, this is problematic as it means that the virus is passed on before the need to quarantine or self-isolate may be recognized. As many people have a mild or asymptomatic response to the virus they could unknowingly be spreading the virus, this means that wider quarantines like those in Italy may be applied more widely.  

Measures can help to flatten the epidemic’s curve, which means slowing down the spread of the disease while the health services can scale up making it more manageable and while a vaccine is developed, though it is estimated that this could take from a year to 18 months. In the meantime, beware of wacky alternative treatments – rinsing your mouth with saline solution, drinking elderberry syrup or chewing on raw garlic just won’t cut it! 

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