Friday, February 28, 2020

COVID-19 - In the face of a global pandemic

Some two months after the first cases of the coronavirus, now officially named COVID-19, it seems that man may well be facing a global pandemic.

Pandemic "is inevitable"

President Trump has downplayed the risk saying that "Nothing's inevitable." But experts have contradicted the US president. Tom Frieden, a former CDC Director, told CNN, "It is inevitable there will be a pandemic" but that it was not clear whether it would be mild or severe. Whilst it spreads easily, there was an "enormous amount we don't know," Friedman said.

This is the crux of the matter. There are mixed messages coming from health experts, politicians and organisations. Frieden says that it "appears to be spread before people become symptomatic." The key phrase here is 'appears to be'. Indeed there is not enough known about this particular virus.

Unclear risks

One key reason scientists outside China are in the dark is that information has not been forthcoming from China. Indeed there are serious doubts about the veracity of official Chinese public health data which has made it nearly impossible to draw firm conclusions about the scope and scale of the epidemic. COVID-19 infection rates, mortality, recovery, methods of transmission, incubation periods, and even screening methods have all been thrown into doubt [SCMP].

This outbreak could have been a major turning point in Beijing's quest to assume a leadership role in world affairs. Instead, a lack of transparency has poisoned the well of global goodwill and rekindled concerns about China's control and manipulation of information, its influence over the World Health Organisation and its reliability in a crisis.

Whilst information concerning the virus has not been entirely transparent, China's draconian crackdown of imposing strict quarantine zones, shutting down industry, transport, schools and public events does seem to suggest it might be more serious than one might be led to believe by authorities.

Taking measures

Many countries across Europe imposing strict measures to counter the spread of the virus. Switzerland today, for example, has banned any public events exceeding 1,000 people [Guardian].

There is a general consensus that the virus spreads readily, and perhaps more so than seasonal flu. But it is not clear - at least as far as official information is concerned - what the death rate is and whether those dying are only in high risk groups, such as the very young, elderly and those with immunity disorders.

"We've seen deaths of doctors in their thirties and forties," Frieden says, highlighting the concern that otherwise healthy individuals can succumb to the virus.

Growing numbers

Measuring the numbers of those infected is fraught with problems. Without proactive testing, one cannot determine the true picture. In Britain for example, there were 19 confirmed cases as of 28th February [BBC]. Yet there are undoubtedly many people who have not been tested and who do have the virus.

Sanjay Gupta, CNN's Chief medical correspondent has said that testing for the virus in the US was "inadequate." Meanwhile the WHO has warned of a "pandemic potential."

Frieden doesn't see a pandemic as devastating as the 1918 Spanish flu which killed some 50 million globally. But talking to CNN's Christiane Amanpour he said what was currently being observed was the "Calm before the storm" and that it would "Get worse before it gets better."

Information and disinformation

There are many people who have dismissed the potential risks of COVID-19, suggesting it was no more a concern than seasonal flu.

However, one has to remember that while it is correct to say influenza kills thousands every year there are stark differences between seasonal flu and COVID-19. Epidemiologically speaking COVID-19 appears to spread more readily. Some studies suggest the overall death rate of COVID-19 is 2.3%, although the rate is much higher amongst the elderly [Cidrap]. Of course one has to temper this with the uncertainty of information coming out of China.

In another study based on the cruise ship that was overrun with the virus in Japan it was found that COVID-19 had an R-naught number of 2.28, an epidemiological measure of how many people one infected person might infect.

The International Journal of Infectious Diseases published a report which looked at the 355 passengers who contracted the virus on the ship. Researchers calculated an R0 of 2.28, similar to other R0 modeling published in the past several weeks.

Place this value aside the median R0 value for the 1918 pandemic which has been estimated at 1.80 and it is clear that COVID-19 has a far greater potential to infect millions of people. Seasonal flu meanwhile has an R0 of 1.28 [NCBI / CNBC].

Another issue that is ignored when comparing seasonal flu to COVID-19 is that there are currently ways of fighting seasonal flu. Firstly, there is an annual vaccination scheme in place in many countries. Secondly there are antiviral drugs that are known to be effective in fighting influenza.

Carefully choosing her words Dr Margaret Harris of the World Health Organisation held back from alarmist predictions but nonetheless said governments needed to be proactive. She also pointed to the concerns over this being a new disease.

"We didn't know this virus existed before December,"  Dr Margaret Harris told CNN, "but we have science on our side."

However, most medical experts say any vaccine could be up to 18 months away.

Unclear information

One of the biggest issues facing the public is the lack of clear information coming from government and official sources. Indeed, there are mixed messages which have only helped fuel opinions that the COVID-19 concern amounts to hype and unnecessary panic.

"It's going to disappear. One day it's like a miracle, it will disappear," Trump told attendees at an African American History Month reception in the White House Cabinet Room.

Trump's comments after Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, had warned of an epidemic. "We expect we will see community spread in this country. It's not so much a question of if this will happen anymore but rather more a question of exactly when this will happen and how many people in this country will have severe illness. … Disruption to everyday life might be severe," she said Tuesday.

President Donald Trump contradicted Messonnier in a press conference from the White Housing briefing room Wednesday, telling reporters, "I don't think it's inevitable. It probably will. It possibly will. It could be at a very small level or it could be at a larger level." [CNN]

Meanwhile, across the pond in the UK messages concerning the coronavirus have been just as confused. Earlier this week the prime minister's official spokesman said, "We will be led by the advice from public health and medical experts and will take steps which they feel are required to best protect the British public."

The risk to individuals "remains low" and 99% of those tested in the UK had come back negative, the spokesman added. "We are well prepared for UK cases, we are using tried and tested procedures to prevent further spread and the NHS is extremely well prepared and used to managing infections."

Taking action

However, while many countries across Europe were putting bans in place on events exceeding gatherings of 1,000 people [Guardian] there seemed to be no clear contingency to implement similar measures.

Indeed, local schools and health centres across the UK took their own unilateral decision to shut on Thursday 27th February after local heads determined there might be a risk after some pupils and visitors were identified as having returned from northern Italy where there has been a recent spike in cases.

While the health secretary Matt Hancock said the decision should be one for individual institutions, the former health secretary Jeremy Hunt told Sky News that people should prepare for schools to close down to stop the spread of COVID-19. The public might have to brace for "social and economic trade-offs," he said, and cautioned the NHS will not function "business-as-normal" if a pandemic breaks out [Sky News].

Shutting down large gatherings should certainly be considered, especially if a recently leaked UK government report is to be believed

The government document, which was leaked to The Sun newspaper, said "the reasonable worst case" was for four fifths of the country to succumb to the virus.

The document by the National Security Communications Team warned, "The current planning assumption is that 2-3% of symptomatic cases will result in a ­fatality." This could mean as many as 500,000 Britons could die [Independent].

Recession fears

While there is uncertainty concerning how governments react to a possible pandemic, stock markets are already reacting negatively. Businesses have already made their own decisions to shut down. Concerts have been cancelled, Disney resorts in Asia have shut down and hotels have closed their doors to visitors.

Meanwhile, a slowdown in exports from China and the knockon effects to businesses around the world has hit the markets hard. In the last two weeks US stocks have taken a major hit with trillions of dollars being wiped off the value of shares.

Yesterday, share prices were on track for the worst week since the global financial crisis in 2008 as virus-related disruptions to international travel and supply chains fueled fears of recession in the United States and the Euro zone [BBC].  

Ratings agency Moody's said a coronavirus pandemic would trigger global and US recessions in the first half of the year [Reuters / Guardian].  

For some countries, such an economic downturn could be disastrous. Britain in particular, faces a great deal of uncertainty as it negotiates its trading position with the European Union having formally left the block in January.

Should Boris Johnson follow through on the threat to fall back on WTO rules if it fails to secure a deal on its own terms by June, the country could face economic collapse if a global recession takes hold.

Last September the global accountancy firm KPMG warned a no-deal Brexit would have a significant short-term economic impact on the UK, plunging the country into recession, causing a rise in unemployment and prompting an estimated 6% slide in house prices. Meanwhile, KPMG said that crashing out of the EU without a deal would likely last for a year and lead to a 1.5% contraction in the UK's economy. A 10% decline in the pound's exchange rate in this scenario would also push up inflation to above the Bank of England's 2% target, potentially forcing the central bank to lower its key interest rate to near zero [FT].  

Couple this with a global recession, and Britain could face a very bleak future indeed.  

Growing racism, hysteria and prejudice

Another bleak concern is the growing prejudice and outright racism being shown towards Chinese people around the world because of the coronavirus.

While it is true to say that COVID-19 originated in China and likely may have come from bats [Guardian / Bloomberg], it is not true to suggest that it is Chinese people's fault. Chinese people are no more likely to have the virus than anyone else. Yet many Chinese people, and even people who look oriental, have been targeted with racial abuse.

In Southampton and surrounding areas in the south of England there have been a number of cases recorded. Dr Michael Ng, who is chair of the Chinese Association of Southampton, which has around 200 members, told the Guardian that hostility against the Chinese community was at the worst level he had known since he arrived in the UK 24 years ago. "It's quite scary when you are walking, as a student, to have people shouting at you, throwing stones at you and you are on your own," he said. "I have a lot of PhD students from China who when they come here they like to wear masks because it seems to be something quite common in China because of air pollution and other things but now they won't wear masks. It's because of the threat of being abused, of being called a virus." [Guardian]

It's not just Britain either. In New York City, a man assaults a woman wearing a face mask, calling her a "diseased b****." While on a Los Angeles subway, a man proclaims Chinese people are filthy and says "every disease has ever came from China [sic]." [CNN]

These are not isolated cases. Neither is it the only form of prejudice. Chinese restaurants have also seen a sharp decline in business wary customers stay away. At Yin Ji Chang Fen, a restaurant in Manhattan's Chinatown, business has dropped 30% to 40% since the first cases of coronavirus were reported near the start of the year.

"If you listen to all the different news reports, people are scared," says Debbie Chen who runs a restaurant in Houston. "There may be some hints of xenophobia. ... But at the same time, I think that for some people, it might just be ignorance, fear, and there may be people putting things out without thinking about how it impacts working people." [USA Today]

The xenophobia displayed by many could indeed be labelled the pathogen of prejudice as one publication described the phenomenon [Economist].

Sadly the situation may get a lot worse before it gets better. If, as some fear, the threat from COVID-19 is greater than is being publicly disseminated, there will, in the weeks and months to come many repercussions.

"Zombie apocalypse!"

Shutdowns of businesses, industry, transport networks and schools may become commonplace. Health services and hospitals may well become overwhelmed as they attempt to deal with the increased number of patients. A rising death toll may precipitate panic amongst the general population which could well precipitate social disorder. In Italy one has already seen panic buying with shops and supermarkets being emptied. And some in Britain are already stockpiling [Guardian].

Kim Geun-woo, a 28-year-old resident of Daegu, South Korea's fourth largest city, told Reuters, "It's like someone dropped a bomb in the middle of the city. It looks like a zombie apocalypse." [Reuters]  

Whilst the description of a 'zombie apocalypse' is perhaps going a little far, the situation is certainly beginning to look like a Hollywood disaster movie.

tvnewswatch, London, UK