How lucky we have been in having among our ANVIL Associates Greg Atkins, former professor of Virology at Trinity College Dublin, who offered, just before Covid-19 appeared at the end of 2019, to give us a talk on his specialism. He entitled his talk “The Danger Posed by Emerging Virus Infections.” This week, on the 10th of June 2020, backed up by his UTube video, https://www.youtube.com/watch?v=19RdLqBMoK4 Greg updated ANVIL and lead us in a discussion of his subject on ZOOM.
So here for myself and anyone interested is my attempt to summarise where we are now as a result of the barrage of media news we have had and what Greg has had to say on the subject.
- This SARS-Cov-2 virus which causes the disease Covid-19 is spreading rapidly through a world population of unparallel size (7.8 billion) and density. This is made possible by the unprecedented opportunities there now are for international air travel. Covid-19 has become a pandemic, and it has yet to run its course, particularly in the poorer areas of the world where the devastation it will cause if a vaccine is not found rapidly, will be truly catastrophic. It will certainly not be the last pandemic. International co-operation is vital to deal with these as they arise. Unsurprisingly this could have been done better with Covid-19.
- By the time it reached us the Chinese had told us much about how virulent it was and who would be most at high risk from it. The SARS-Cov 1 2004 epidemic with its very high mortality rate (one in ten) was seen as a warning.
- We know Covid-19 is a touch and aerosol infection. Highly infectious in confined spaces, it is hardly infectious out of doors, except for uncovered face coughing and sneezing. Infected rails, seats and smooth objects are also infectious. Soap and water effectively breaks down its encasing corona and kills it. Currently there is no vaccine or curative medication available. One may be by December 2020 if we are lucky. Current work at Oxford and Imperial College looks quite promising and 82 others around the world are also trying. More facts have emerged since China.
4 Children under 10 and young people under 25 if infected usually show no symptoms, though a small minority are mildly ill for about a week. No child under ten has died. (A statistically insignificant number have been very ill) The very small number in the 10-25 age range who have died have been obese or have had other serious conditions. No infected child is known to have passed COVID-19 on to an adult. The infection rate then climbs. The largest observational study to date finds that the risk of death increases in the over 50s, as does being male, being obese, or having underlying heart, lung, liver or kidney disease. Other risk factors are dementia, Alzheimer, and BAME descent. Groups with more than one of these conditions are at increased risk.
5 How contagious Covid-19 is and what Its effects are vary enormously. Take Group X, an uncertain but large percentage of the population who are infected but have no symptoms. (Estimates vary between 40-80%. Two large studies are currently ongoing which might give more meaningful results) Can Group X members infect others? We just do not know. It is assumed some might. The following are all infectious. Take Group Y. These show mild or very mild symptoms. Group Z. These are a subgroup of Y who develop a serious illness but recover completely.Then take Group F. They are a much smaller subgroup of Z who have a very unpleasant life-threatening illness, (Fever, coughing, breathlessness, diarrhoea) require hospital ICU treatment or ventilation and about half of them die and many of this group who survive do so seriously or permanently weakened. (A cheap, available arthritis drug has just been found to bring down the death rate for the severely ill by 15-20%) We have now reached the point where 40,000 to 60,000 have died in the UK.
6 Initial estimates from scientific bodies of what the total numbers of Group F and deaths could be if the virus spread widely throughout society, varied hugely. (both 250,000 and 20,000 were estimated by different scientists) These figures and what happened in Italy resulted in the fear that the numbers of seriously ill Covid-19 patients could completely overwhelm the NHS (and the care homes) and the policy of lock-down was introduced. Track, trace and Isolate (TTI) was initially deemed unnecessary and the necessary tracers, trackers and PPE were anyway, we now know, simply not available. The whole economy , education, the law, travel, tourism, manufacture etc. has ground to a halt and the NHS has become Corvid-19 focused to the detriment of its normal treatment of cancer, heart and non-covid illnesses. The economy (GDP) will be down by 20% this year. An enormous increase in poverty and unemployment is now predicted for the whole UK. Will Hutton writing in the Guardian says of the problems facing the economy “Part of the explanation (for its failure) is the structure of the UK economy. It’s not that retailing, leisure, hospitality, business services are not economically valid activities. But in Britain they have become vastly outsized, built on unsustainable consumer spending flowing from the rise in property prices. There needs to be a rebalancing and a new generation of firms whose foundations are less intertwined with the fortunes of house price-dependent consumption.”Now after three months of lock down, deaths and Corvid-19, hospital admissions have reduced to 151 today, and a TTI system has been introduced with the intention of isolating outbreaks. Tests are now “available for everyone who thinks they are infected.” Social distancing needs to soon stand at one metre if the economy is to have a chance of restarting. Non-essential shops will open next week. Currently the“Hospitality”sector is confined to serving take-away meals which is unsustainable.
Today total confirmed deaths from Covid in the UK are 41,747 but the “excess death rate” has topped 60,000. With 295,828 confirmed cases a 0.7% death rate for those tested positive “is our best guess” (Atkins). The problem is that currently there is no way of knowing what proportion of the total population of 66.6 million are susceptible to being infected. What is known is deaths are concentrated amongst the over sixties (particularly amongst the 70 plus demographic) with the conditions listed. “88 out of 100 deaths are over 65” Guardian. This appears to be because the immune system weakens with age. Very few fatalities have occurred outside that demographic. “2 out of 100 deaths are under 50”
“26 out of every 100 deaths are BAME” It is also the case that security guards, taxi drivers and bus drivers and the most unskilled and poorly paid die much more often than professionals. Not surprisingly poor health and poverty go together.
62% of deaths under 85 are of men, regardless of social background. A fact little commented on.
(Live Science: Though nobody can yet explain the oddity, It’s possible that the sex hormones estrogen and testosterone play a role, according to previous research on respiratory illnesses. Or perhaps it’s because the X chromosome (which women have two of, but men have only one) has a larger number of immune-related genes, giving women a more robust immune system to fight off the coronavirus. Maybe the virus is hiding in the testes, which has abundant expression of ACE2 receptors, the portal that allows SARS-CoV-2 into cells.)
Reflections on the way ahead
Certainly 60,000 often very painful, isolated and unexpected deaths is a deep cause for sadness and continuing fear across the country. Nevertheless, given this general picture of the incidence and spread of Covid-19, can we afford to continue to apply social distancing to schools and children (and students at colleges and universities) when we now know that they are only at risk of a mild infection and that as far as schools go there is apparently no confirmed evidence of pupils being a risk to their teachers or parents (unless parents and teachers are ill or obese) as far as we can see? As MD reports in Private Eye on July 2nd “Healthy under 45s are at much less personal risk of harm, even at 1Meter, and schoolchildren are at tiny personal risk.. The risks to them of not going to school are far greater.” So, what to do?
Perhaps we have now reached the point when the NHS is no longer in danger of being overwhelmed and it is now time to open the entire education sector from nurseries to universities. Why? Because the health, educational, economic and social costs of not doing so are, for the children and students concerned, simply far greater than the risks to the health and lives of a quite small minority who are vulnerable. Perhaps we have now reached the point when we should open the whole economy to “normal” functioning for the same reasons.
It seems to me that now we need to recognise, as was not at first emphasised, that the threat of serious illness or death from Covid-19 is confined to quite a distinct high-risk group. Those of mature age who are also suffering from the listed underlying health conditions.
What of the risk of a second outbreak of serious infections if the ending of lock-down social distancing seems to trigger one? Should this lead to the re-introduction of lock-down policies if the second outbreak is confined to the same distinct high-risk group, bearing in mind the huge cost of doing so in economic and human terms?
This is where a good up and running track, trace and isolate system is needed to identify hot spots. An alternative to another general lock-down perhaps could be the registering and supporting financially those who seek and then accept a medical diagnosis that they are at serious risk from the virus and agree to live under “safe” conditions and self-isolating until a vaccine is available. Though supporting the desperately poor and those without means so they do not return to dangerous work may seem expensive and needing sensitivity in how it should be introduced, such a policy rather than broad lock-downs might help keep the economic recovery upon which everything else appears to depend, on track. (Note the final comment below that a face covering when outside the home now seems the best way to reduce the impact of infection from those who show no symptoms) What do you think?
John Baxter 17-6-2020 added to 24-6
Comments from three medically qualified friends.
A good summary of the position but I think opening the economy BEFORE a properly functioning test and trace system is running would be reckless. But that’s only my opinion (though I think a lot of others would share it). SP (Dr)
Interesting. Thank you! And yes I completely agree that a second lockdown would be catastrophic economically and unnecessary for the NHS (a doctor in London, Birmingham or Manchester might think differently however!). My only quibble would be that those who are high risk could equally choose to not self-isolate and take their chances, following the “rather live well for a short time than poorly in isolation for longer” approach. I guess this would depend on the best estimate of vaccine availability at the time. RG (Dr)
On the basis of what I know about viruses I find it difficult to believe that infected children will not pass their infection to adults, however mild their own symptoms might be. SD (Dr)
24/6/2020 Greg Atkins sent me a paper by Monica Gandhi, Professor of Medicine, University of California, San Francisco. which points out that about half of all infected people are without symptoms yet can transmit SARS-CoV-2 as easily as those with symptoms. This means that universal mask wearing when outside of the house and around others is the best tool to limit transmission. So wearing a mask and practicing social distancing can prevent asymptomatic spread and help reduce the harm from this dangerous virus until we get a vaccine.