The Coronavirus Pandemic – Dr Tim Ubhi
22nd April 2020
The Coronavirus Pandemic – Dr Tim Ubhi
Today (22nd April 2020) is day 154 since the first case of Coronavirus (Covid -19) was detected in the first patient in China. The exact date is thought to be the 17th November 2019 although the Chinese quote December 8th. The 17th November was therefore day zero, the day the world changed.The scientific evidence suggests that there was a jump across species from bats to humans around this time. At day Day 56 (12th January 2020) the WHO announce the detection of a new respiratory virus in the Wuhan region of China. The first UK transmitted case was confirmed on the 28th February 2020 (Day 102) and on Day 113 (11th March 2020) the WHO classified this as a pandemic. The UK government implemented a lockdown on 23rd March 2020 (day 125) and we are now 30 days into lockdown. Initial estimates from Imperial college suggested that 500,000 people could die from coronavirus in the UK but this was revised to 20,000 on the 30th March because of the perceived impact of the lockdown. The official number of deaths today (22nd April 2020) is 18,100 but this is probably an underestimate because of the omission of the deaths from care homes and the delay in reporting deaths. We are therefore more than likely well over 20,000 deaths already. Over 100 of those deaths were NHS frontline staff.
What do we know about this virus? In truth we know very little. We know that it is an RNA virus and that it affects the respiratory system in patients causing a severe pneumonia that results in death in 1-2% of overall cases. However, children do not appear to be significantly affected whilst 14% of those over 80 years of age will die.
There is no effective treatment that has been identified and the problem is that the governments around the world are having to play a big and very risky propaganda game to try and keep their populations under control whilst accepting a significant number of deaths. There is also a balance between turning the country “off” to control the transmission of the virus and the economic consequences both nationally and individually. We have already seen scenes of unrest in Italy where unemployment begins to have an impact on social order. I fear we will see this happening in the UK before long. People need to provide for their families.
So, is there a way out? Do we accept a certain number of deaths and relax the regulations? Is a vaccine likely to be developed and will it be effective? Is there a role for more widespread testing as in Germany? These are very difficult questions. I hope there is an effective vaccine produced but I’m not sure it’s possible. Look at the common cold which although being a relatively mild infection, works at the interface of the respiratory system with the body in the same way as coronavirus does. The difference with coronavirus is that it causes a very high level of inflammation which reduces the function of the lungs causing a fall in oxygen levels and eventually death in some patients. Even if we were to produce antibodies to the virus we might not be able to stop the strong inflammatory response. Only time will tell. We are hoping and praying that our very clever scientists can find a way around this.
What is certain is that the world will change. We will have coronavirus for a long time to come and we are going to have to adapt if we want to survive. This is a horrible virus that kills by stealth.
The NHS workers on the frontline are vulnerable. There is not enough personal protective equipment to go around and this has to change, quickly! Although we are seeing a flattening of the curve, we are in our summer season. Imagine what is going to happen in winter when we also have seasonal flu to deal with. That is going to be an even bigger problem and may raise the death rate well beyond our current projections. I suspect it will. Remember too that some of these NHS staff who are being asked to put their lives at risk have not had a pay rise rise for over 9 years. Indeed they have effectively had at least a 10% pay cut. Time to put a stop to that Mr Johnson & Mr Hancock, if you really appreciate us now is the time to show it.
The German approach of testing and tracing contacts appears to be the right one. This is what the WHO recommended right at the beginning. We need to implement this as soon as possible and upscale our testing. We need to outsmart this virus, it is highly infectious and will have a huge impact in populations with high density, i.e. the inner cities. This is where the poorest in our society are likely to live and I fear that this will have a bigger impact on them than the wealthy. It is a story that has been repeated over time.
We are desperately looking at treatment combinations to see if anything will make a difference. Studies are ongoing to see if anything will kill this virus. A few teams (US based mainly) have suggested hydroxychloroquine, azithromycin and zinc as a potential treatment combination but there is no good evidence yet. The other problem is that if we get evidence that a particular drug helps it is likely to sell out very quickly because the whole world will want it.
There is likely to be a relaxation of lockdown in June but I suspect it will not last for long, if we are to beat this virus it will be as an international community. Ironic really, anyone remember something called Brexit?
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