There is a scene in the 2017 film Darkest Hour where, deep in his Whitehall bunker, Gary Oldman’s Churchill and his war cabinet await, despondently, an inevitable German invasion. This moment recurred to me following reports last Thursday (20 February) of the first cases of the new coronavirus in Italy. At the time of writing, there have been 229 confirmed Italian cases and seven deaths (making Italy the most infected country outside of Asia). The virus is here in Europe and spreading fast; the UK waits.
A pandemic is defined as an infectious disease that is transmitted within all continents on earth. The coronavirus has now infected many tens of thousands of people across the globe. Asia, Europe and the Middle East are all reporting transmission. Cases have been reported in the US, Australia and beyond. The World Health Organisation will likely declare a pandemic soon.
The Darkest Hour analogy is somewhat unfair to my colleagues in clinical infectious diseases units across the UK. Most have been working intensely as they deal with thousands of potential coronavirus infections. People who arrive at a clinic reporting symptoms (such as coughs, shortness of breath and fevers) compatible with the disease, combined with a credible risk of having contracted it (eg travel to China or another high-risk country, or contact with an infected person) will have a mucus sample taken and sent for a diagnostic test.
[See also: Coronavirus and the geopolitics of disease]
Ideally, they should not mingle with other patients and should attend an isolation pod, which are increasingly present at many hospitals. Better still, they should isolate themselves at home and call 111 to alert the authorities to visit them there. Health officials are learning to work dressed in personal protective equipment with respirator masks. Once a mucus sample has been obtained, it is sent for testing. The test involves detecting viral genetic material, RNA, using special reagents to convert it to DNA, that, in turn, can be amplified using another set of reagents in the so-called Polymerase Chain reaction (PCR). The DNA can bind a fluorescent dye, allowing visualisation on a screen.
At present, only a few labs are accredited to do the tests (in Scotland, for example, there is one each in Glasgow and Edinburgh). If positive, the sample is sent to the Public Health England lab in Colindale for confirmation. Nearly 7,000 tests have been performed in the UK so far, with just 13 positive as of Monday night, including the passengers finally allowed to end their ordeal on the Diamond Princess cruise liner, where the virus spread widely among quarantined passengers off the coast of Japan.
The Italian situation is alarming. It means that a health system, not significantly divergent from the UK’s, failed to spot multiple cases before the first diagnoses were made. Many infected people must have already travelled around Italy, and further afield, with their viruses too.
The virus, unlike its predecessor, the 2003-04 Sars coronavirus, is transmitted by asymptomatic people. We cannot isolate and quarantine such cases, nor stop them from transmitting the disease. It seems inevitable that the virus will have entered other European countries, including the UK, already.
An early epidemiological model, from scientists at Imperial College London, estimated that up to 60 per cent of the population of the UK (66.4 million) could become infected within the first year of transmission. We still know little about how many infected people become seriously ill. As many as 90 per cent may suffer only mild symptoms or nothing at all. But even this would leave six per cent of the UK’s population, around four million people, suffering a serious illness.
If estimates of a 2 per cent fatality rate among sick people translate here, then we might expect 80,000 coronavirus-related deaths in the UK over the next 12 months. This adds substantially to the 500,000 or so deaths each year from all causes and is far beyond the death rate of seasonal flu outbreaks we like to console ourselves with when trying to contextualise the disease.
It is possible, too, that matters won’t be this severe. Warmer weather and sunshine could slow the virus’s spread. Although several anti-viral drugs tested in China have failed, others are still being trialled, with remdesivir, an antiviral drug first invented for Ebola, still holding anti-coronavirus promise. At least one fast-track experimental vaccine has entered human trials, but we will have to wait a year or more even if it proves effective. As of early Tuesday morning (25 February), there are no reports of the coronavirus spreading in the UK. But with the Italian epidemic intensifying, we must use every minute to prepare for its arrival here.