The other day, while typing up patients’ records, a box kept appearing on my screen. It contained a list of questions to ask about travel history, or any contact with known cases of coronavirus – the new respiratory pathogen currently causing worldwide consternation. GP computer systems are slick at this sort of thing: the word “fever” automatically launches a sepsis screening tool. The coronavirus pop-up hasn’t returned since; I suspect it is in development and was being trialled. But it illustrates the preparation going on throughout the health system to meet this potential new challenge.
At time of writing, the UK has eight confirmed cases of the virus, known as Covid-19. All appear to have acquired the infection while abroad; the first instances of domestic person-to-person transmission will be a highly unwelcome development. The eight patients are being cared for within the UK’s network of high consequence infectious disease (HCID) units. But with limited numbers of these specialist isolation beds, the Department of Health has now designated Arrowe Park hospital in Wirral and Kents Hill Park conference centre in Milton Keynes as additional facilities. In declaring Covid-19 a “serious and imminent threat to public health”, Health Secretary Matt Hancock has given authorities the power to forcibly isolate people infected with the virus.
That is the present strategy: rapid detection and immediate quarantine of any case. This approach might be successful; two past epidemics of comparable coronaviruses – Sars and Mers – were snuffed out in affected countries by sustained, rigorous detection and isolation practice.
If this fails and Covid-19 starts spreading, we will have quite a job on our hands. The last pandemic we faced – swine flu, in 2009 – proved relatively benign, with lower infectivity than is estimated for Covid-19 and a mortality rate of just 0.02 per cent. Data from China, where there are now almost 40,000 cases, suggests Covid-19 has a death rate of around 2 per cent. By the end of its pandemic, swine flu was reckoned to have infected a fifth of the global population; if Covid-19 does similarly, it could result in hundreds of thousands of deaths and several million hospital admissions.
Swine flu’s biggest impact was population panic – I recall an unprecedented volume of contact from people with any degree of viral symptoms, which overwhelmed capacity. Fear over Covid-19 is already noticeable; working at my local hospital last week, I saw people wearing face masks in the A&E waiting room – something I had never before encountered. Combine swine flu-levels of population panic with a virus capable of causing millions of hospitalisations, overlaid on an NHS devastated by a decade of Tory austerity, and you get an idea of the scale of the potential challenge.
Chinese authorities initially attempted to suppress news of Covid-19, with police taking action against doctors who tried to raise the alarm in Wuhan, the city at the epicentre. One of these doctors, 38-year-old ophthalmologist Li Wenliang, tragically died from the infection on 7 February. China is now pursuing aggressive quarantine practice. Other countries where cases have been imported are, by and large, ones with well-organised and well-resourced health systems, which appear to be managing to arrest the coronavirus’s spread. The big fear is if it gets into countries too poor to have systematic health-care provision. The more areas of epidemic activity there are around the globe, the more difficult it becomes for unaffected countries to prevent subsequent ingress.
Novel respiratory pathogens arise in countries where there is close proximity between animals – coronaviruses tend to originate in bats and snakes – and overcrowded human populations. But in our era of global travel and interconnectedness, they are everyone’s problem. Yet another reason to address the immoral income and health care inequality between different populations of human beings in our world.
This article appears in the 12 Feb 2020 issue of the New Statesman, Power without purpose