For nearly two months after the first coronavirus cases were identified in central China, the UK’s own reported infections stayed low. But now things are starting to change.
On March 10, the Department of Health and Social Care announced the sixth Covid-19 death in the UK. There are now 373 confirmed cases in the UK – with new cases over the last few days being added at a rate of around 50 per day. And as the numbers keep going up, the UK government is preparing to move to the next phase of its plan to tackle the outbreak.
The government’s plan to deal with the outbreak – outlined in a document published on March 3 – splits into four chunks. Right now, we’re still in the first phase: containment.
This means trying to catch cases as early as possible and trace all contact with infected people to avoid the spread of disease. But the UK is already edging towards the end of containment. On March 4, an uptick in the number of infections prompted England’s chief medical officer, Chris Whitty, to say it’s likely we’ll soon have to move on to the next stage, ‘delay’. In a worst-case scenario, he told a press conference, up to 80 per cent of the country would be infected with the virus.
Andrew Freedman, reader in infectious diseases at Cardiff University, cautions that it’s hard to say with any certainty what could follow. “At one stage I was quite optimistic that we might be able to contain it and we wouldn’t have a big problem, but that’s looking less likely now.”
If containment doesn’t work and we do move on to delay, the country will be focused on slowing the spread of Covid-19 and pushing it away from the winter season in order to limit the impact on already overstretched healthcare services. At the same time, delay could buy more time for research and development of effective treatments or even a vaccine. “What we really need to do if we get to the delay phase is to reduce the spike in the number of people getting it,” explains Sarah Jarvis, a GP and clinical director the healthcare advice website Patient. “A relatively flat peak could make a huge difference because it will reduce the pressure at any one time on healthcare services. And it’s also going to mean that the people providing those services are less likely to be off sick.”
At first, delay might not look so different to what came before. Some measures from the containment phase are likely to continue, such as isolating early infections. But it could also include ‘social distancing strategies’ such as the closures of schools, encouraging home working and the cancelling of large gatherings. The Royal College of Physicians has already postponed its annual meeting in April until next January so that doctors can concentrate on looking after Covid-19 patients.
It remains to be seen whether the draconian measures in China — where whole populations have been put in quarantine — and the newly announced lockdowns in Italy could be on the cards for the UK. But Jarvis doesn’t think the benefits will outweigh the social costs. “The genie is now well and truly out of the bottle, so I think there is very little to be gained from quarantining whole communities.” However, a new mathematical modelling study published in the journal Science suggests Wuhan’s travel bans reduced Covid-19 cases from there to other countries by 77 per cent until mid-February. China reported its lowest number of new infections in a single day since January on March 7, which does indicate the country’s extreme response slowed the virus’s spread.
As well as looking to other countries, we can also learn from previous outbreaks. Swine flu (a strain of the H1N1 influenza virus) reached the UK in April 2009. The containment phase involved self-isolation and antivirals prescribed for suspected cases. Once a pandemic was declared in mid-June, there was talk of extending the school holidays to reduce the spread of the virus. But cases began to decline sharply within a few weeks and the proposal was rejected. Infections rose again in September but to much lower levels than expected.
Swine flu turned out to be a much milder illness than first thought but it could have easily been a different story. The contingency plans developed then have provided a useful starting point to develop a response plan to Covid-19, says biological anthropologist Jennifer Cole at Royal Holloway University in Surrey. It should mean a strategy is in place to help hospitals cope with extra capacity based on the ‘reasonable worst-case scenario’ that Whitty announced.
“It’s the equivalent of if you’re expecting a flood and you build the defences to be ten metres high, the flood at the moment is less than ten metres,” Cole says. “That’s not likely to change, so although we’re moving away from the contain phase, the planning assumptions have been made with that eventuality in mind.”
But it’s tricky drawing direct parallels between flu viruses and the coronavirus that causes Covid-19, points out Heidi Larson, professor of anthropology, risk and decision science, at London School of Hygiene and Tropical Medicine. “We’re in a different situation now because H1N1 was not a new virus. That was one we had experience of because of a devastating epidemic from 100 years ago [the 1918 Spanish flu].”
A new influenza vaccine is manufactured every single year so it wasn’t hard to make one for swine flu (it was introduced in October 2009). Although Covid-19 is genetically closely related to the SARS virus, there’s never been a vaccine successfully deployed for any type of coronavirus before. Even if scientists do manage to make one for Covid-19, it will need to go through clinical trials, so won’t be available any time soon.
The newness of this pathogen also means the situation is vulnerable to misinformation, so much so that WHO has declared the phenomenon an ‘infodemic’. On social media trustworthy sources are easily drowned out by rumours about bat soup, bioweapons and bleach. Cole is fighting this misinformation overload by moderating the coronavirus Reddit forum. “One of the things Reddit forums show is what concerns people have and what information they most need. That can actually be very useful for official agencies to know what they need to be providing to the public.”
Widespread panic and rash speculations aren’t going to help if we move into the delay phase. In the meantime, the obvious advice remains relevant: wash your hands more; and use the ‘catch it, bin it, kill it’ strategy for coughs and sneezes to help reduce the peak of the infection. But it might be a good idea to start making contingency plans at the community level. This could involve volunteering to do childcare if your kid’s school is closed or offering to get groceries for your elderly neighbour who is likely to be more vulnerable to the coronavirus.
Ultimately Cole believes the more action we take, the less helpless we feel. But that doesn’t mean stockpiling hand sanitiser and toilet paper. “The most useful thing you can do now is to ask yourself what part you can play in slowing the spread. It’s about making sure you’re part of the response, not just sitting there waiting to be a victim.”
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