Explainer: Coronavirus – what we know now

In response to the global Coronavirus outbreak, expert Dr Jeremy Rossman, a Virologist at the University of Kent’s School of Biosciences, has provided an explainer.

What is the situation?

  • On 11 March, the World Health Organisation declared COVID-19 a pandemic.
  • As of 19 March 2020, there are over 237,000 confirmed cases in over 177 countries, with almost 1000 deaths.
  • In the past 24 hours alone, there were over 18,000 new cases.
  • The number of cases worldwide is doubling every 5 days.
  • In the UK there are over 3,300 cases and 144 deaths, though the number of cases is doubling every three days.

Where is this happening?

  • At present the pandemic is concentrated in Europe.
  • Italy has over 41,000 cases, Spain over 17,000, Germany over 14,000 and France over 9,000.
  • Countries throughout Europe have closed schools, offices, public spaces and placed restrictions on travel and gatherings.
  • Over 100 million people are on lock down in the region.

How many people have Coronavirus in the UK?

  • The case numbers may be far greater than these numbers suggest.
  • First, many countries (including the UK) are only testing the people most at risk of serious disease; meaning that we do not know the actual number of cases nor where in the country most of the cases are.
  • The UK has only run 26,000 tests and with many people requiring multiple tests, the number of tested individuals is far lower.
  • Other countries are testing at even lower rates. France has only run 12,000 tests. However, most countries are rapidly scaling up their testing capacity as Public Health England is currently doing.
  • A recent study in Science found that in China 86% of the cases of COVID-19 were never identified. If these numbers are accurate that would mean that there are actually over 19,000 cases in the UK and nearly 1.7 million cases globally.

What happens if you have coronavirus?

  • Current estimates are that the virus causes severe pneumonia that requires hospital care in 7-15% of the cases (not adjusted based on the Science report data) and has a case-fatality rate of 2%.
  • For comparison, the 1918 Spanish flu pandemic is estimated to have had a 2.5% case-fatality rate.

What is being done?

  • Many efforts are being undertaken globally to prevent the spread of the virus; however, much of the effort is focused on delaying the spread of the virus or flatting the curve so that we don’t have a peak of infections and overwhelm the NHS.
  • However, recent modelling studies have shown that this will not prevent overburdening the NHS and is not a viable strategy on its own.
  • This supports the stance of the WHO that significantly more testing is required. The WHO Director-General has said “The most effective way to prevent infections and save lives is breaking the chains of transmission. And to do that, you must test and isolate. You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don’t know who is infected.”
  • However, there are stories of hope in this pandemic.
  • China, which has had over 80,000 cases, only had 34 new cases on 18 March and most of the cases in the past week were imported from other countries.
  • South Korea, which has over 8,500 cases and was recently seeing nearly 1,000 new cases a day, only had 152 cases on 18 March.
  • The ability of two of the hardest hit countries to bring their outbreaks under control gives hope for the ability to contain this pandemic.
  • However, their approach has followed the WHO guidelines of preparing, testing, isolating and delaying the spread. South Korea, which has a smaller population than the UK, has performed over 210,000 tests.

Is there hope of a cure/vaccine?

  • There is also hope in that multiple clinical trials are currently underway to test novel therapeutics against COVID-19 and several vaccines have been developed (including one starting clinical trials in Oxford), though it is unlikely that a vaccine will be available for public use earlier than 12 months from now.

What have we learnt of coronavirus so far?

  • We have learned much about the virus recently.
  • The virus causes lower respiratory track illness, including: fever, cough and difficulty breathing. Typically, the disease is very mild, though occasionally life-threatening pneumonia can develop.
  • The virus is spread through respiratory secretions (e.g. being within 6 feet of someone coughing for 10 minutes or longer) or direct contact (e.g. touching a surface that someone had coughed on). People are most infectious early on in the disease when they have typically mild symptoms and might not even know they are infectious.
  • We see that children can be infected by the virus, though they seem to have very mild infections and don’t seem to pass the virus on very effectively. However, children with any pre-existing health conditions may also be at a greater risk of disease.
  • The virus can survive on metal or plastic surfaces for 72 hours and on paper/cardboard for 24 hours but can be easily killed by disinfectant solutions (including most hand sanitisers) and by hand washing (for at least 20 seconds with soap and warm water).

What comes next?

  • Within the UK we are likely to see cases continuing to rise for several weeks and people should be prepared for social distancing measures to persist after this.

Dr Jeremy Rossman is a leading voice on the biosciences of viruses and has been sought after for insights since the beginning of the coronavirus outbreak. Jeremy is Honorary Senior Lecturer in Virology at Kent’s School of Biosciences.

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