The news that we have been anticipating has now been reported: COVID-19 is officially a pandemic. In practice, this adds little to what we know: the coronavirus is now found in over a hundred countries, undergoing community transmission in several. Over the last week, the good news that cases of COVID-19 are reducing in China was tempered by the reports of increasing cases across Europe. There are now around 3,000 cases each in Germany, France and Spain. More established epidemics are reported in South Korea and Iran – with around 8,000 and 10,000 cases respectively – and over 15,000 infected in Italy. Countries are responding to the outbreak as they deem necessary; appropriate to the stage of the epidemic, and the possible economic and social consequences if interventions are performed too early or late.
Balancing such considerations in an emerging situation is clearly fraught with difficulty. What is clear is that limiting the peak incidence of those patients requiring hospital admission is of paramount importance. If the rise of the outbreaks can be slowed sufficiently to allow severe cases to find a bed in hospital, then lives will undoubtedly be saved. It should be remembered that even if hospitals are able to house the considerable number of severe coronavirus patients, hospital staff still need to treat other severely affected patients – those that have suffered heart attacks or been involved in road traffic accidents. In the overstretching of hospital services, COVID-19 could cause fatalities in not just those who are infected with the coronavirus.
Early efforts to thwart the rise of the coronavirus have now started in several European countries: large social gatherings are prohibited, schools are closed, and working from home is advocated. Nothing like the wide-spread quarantining now present in Italy has so far been duplicated in other European centres, however. People are increasingly fearful of the developing situation: shops have been depleted of everyday items from toilet rolls to rice and pasta. In these uncertain times, rumours can thrive and gain traction. In fact, the bizarre claim that cocaine could cure COVID-19 was recently rebuffed by the French Government which was responding to false news spread on social media. Reliable guidance from governments and health authorities will be needed over the next few days and weeks to limit the transmission of the virus. Such advice will certainly continue to involve the need for increased personal hygiene, but also to decrease social contact: both the well and sick staying more at home.
In slowing the epidemics, countries are likely to also prolong the time that these social restrictions will be necessary. The only hope is that the summer in the Northern Hemisphere will either reduce the number of those infected, or at least reduce those severely affected. This is simply not known at present. Some might point to the fact that warmer Hong Kong and Singapore have not had sustained transmission of COVID-19 as evidence for the beneficial effects of the hotter temperatures. However, the situation is clouded by the fact that these countries also underwent social measures to limit the spread of the virus. The sunnier climes may not have been responsible for the lack of a large epidemic.
In these concerning times of increasing case numbers, it is important to remember that every person that recovers will prove to be a barrier for further epidemics of COVID-19. This is because the antibodies that we develop in response to the virus will most probably protect us against further COVID-19 infections. The larger the number of people infected, the larger will be our collective immunity (the so called ‘herd immunity’) that will both slow and reduce the virus if it comes back in the winter. We are not entirely sure how many people have already been infected with the coronavirus, and therefore how many now have immunity. In general, only those with symptoms have been tested but as some have very few symptoms following infection with the coronavirus, the actual number of patients may be much higher. Only when a test is developed that can measure the presence of COVID-19 antibodies, will we know for sure how many have been infected and how many now have immunity. It is hoped that even if another epidemic comes back in the winter, it will be much less severe than those presently experienced across the globe. As a vaccine may be available in early 2021, COVID-19 is likely to be a significant trial - but also a temporary one.