Coronavirus: are we at the beginning of a major pandemic?

The origin of the current coronavirus epidemic has been linked to illegally traded wildlife at Wuhan’s ‘wet’ seafood market, which sells live animals including bats, rabbits and marmots. However, the exact source of the outbreak has not been identified, although it has been suggested that pangolins, one of the most trafficked animals in the world and sometimes consumed in China, may have been an intermediary.

The basic reproductive number for the illness is estimated at 2.2, meaning that on average each sufferer will infect more than two other people.  The viruses’s potential to spread while the patient is asymptomatic is very worrying as its mean the incubation period is five days. When symptoms do appear they include fever, cough, and shortness of breath leading (in some cases) to acute respiratory distress and bilateral pneumonia. Men who have or do smoke, or suffer from underlying chronic condition appear to be most susceptible.

At the time of writing, coronavirus has killed 813 people, with all but two victims in mainland China: one death occurred in the Philippines and another in Hong Kong. So far, the 2019-nCoV coronavirus epidemic has affected 24 countries. According to a cruise ship spokesperson, confirmed cases on a cruise ship in Japan rose by six to 70, making the vessel the biggest centre of infection outside of China. 

Reported cases in China alone have now climbed to 37 198, less than two months after the virus surfaced in late December in Wuhan. The Government there has sent more than 11 900 medical workers to Hubei province to fight the epidemic and built new hospitals with quite extraordinary celerity.

Over eight months, the 2002-2003 outbreak of severe acute respiratory syndrome, or SARS, killed 774 people and badly afflicted almost 8100 others in 26 countries. Mainland China accounted for about 45% of SARS deaths.

The World Health Organization has warned of a chronic shortage of gowns, masks, gloves and other protective equipment in the fight against the spreading epidemic.

A British man on board a cruise ship has been diagnosed with the coronavirus and is now hospitalised. Another patient has tested positive for coronavirus in England, bringing the total number of UK cases to eight, the chief medical officer has said. In Europe, five Britons, including a nine-year-old child, who were staying in a chalet at a French ski resort, have been diagnosed with coronavirus. They tested positive after sharing lodgings with a man who is believed to have contracted the disease in Singapore, said France’s health ministry. Singapore has just confirmed seven new cases, pushing its total to 40.

Anyone returning in the past fortnight from the Far East who has symptoms like a cough, fever, or shortness of breath should stay indoors and call the NHS 111 service. The Department of Health said they should do so ‘even if symptoms are mild’, adding: ‘In addition to China, a number of countries higher risk, including Singapore, a major stopover location for flights to Australia, have been identified because of the volume of air travel from affected areas, understanding of other travel routes and number of reported cases.’

The situation seems to be deteriorating rather rapidly. Are we on at the start of a major pandemic? What further steps should the authorities in the UK and elsewhere be taking?

Comments (25) Add yours ↓
  1. Roger Kirby Professor of Urology

    Coronavirus poses a “serious and imminent threat” in the UK, the government has declared as it moved to forcibly quaratine victims.

    The Department of Health has introduced new powers which will allow it to forcibly quarantine people with the virus, send them to isolation and force them not to leave if they pose a threat to public health.

    February 10, 2020 Reply
  2. Nicola Stingelin Ethicist

    Many experts have long said that zoonotic disease & how we interact we animals is a ticking time bomb – quite possibly an area of neglected public health. Thanks for reminding us of this.

    I appreciate of course that coronavirus deserves to be taken seriously and should not be trivialized (particularly for population segments rendered vulnerable by health or life situation bad fortune).

    For me the coronavirus situation gives me important food-for-thought to reflect again on the powers we grant the State – and the powers we want and need our public health agencies to hold to override our hard won liberties by imposing compulsory quarantine.

    In spite of political turmoil, police shortages and NHS woes, I feel that I am in pretty good hands in trusting those taking these decisions in the UK – a post Brexit reason-to-be- happy – or am I naïve?

    However parallel to the facts and concerns so lucidly and importantly expressed in this blog, and to my reflection added above, I cannot help but also feel sad that the attention and resources being given to coronavirus are not matched regarding public health scandals such as homeless on our own streets.

    Arriving back home late yesterday evening after speaking at an RSM event, and popping-in to the Sainsbury’s Express to biblically buy milk and a bottle of red wine – and a box of chocolates to leave by the sleeping bag of one on my homeless friends sleeping outside the shop – does make we wonder what kind of a world we are living in.

    Am I being a bit bleak; am I a bit odd to feel rather confused?

    February 11, 2020 Reply
  3. Roger Kirby Professor of Urology

    The number of British cases of coronavirus has doubled to eight – with two healthcare workers among those testing positive – while a GP surgery in Brighton was closed yesteray amid fears of the infection spreading.
    Brighton’s County Oak medical centre yesterday posted a warning notice on its door telling patients it was “closed due to operational difficulties”.
    According to reports, one of those infected was a GP, who was at work for one day but did not see any patients. Workers wearing protective suits were pictured cleaning the surgery and pharmacy yesterday afternoon.
    Yesterday became the deadliest day for the virus – the death toll has now risen above 1,000, and more than 40,000 people have tested positive in China.

    February 11, 2020 Reply
  4. Eric J Webb Retired GP

    Worldwide – on WHO figures:

    Malaria – circa 450,000 deaths / year
    ‘Flu’ – circa 80,000 deaths 2017-18
    TB – 1.5 million deaths in 2018 (including 250,000 with HIV)
    HIV – 770,000 deaths in 2018
    RTAs – 1.25 million deaths / year

    Let’s keep a sense of proportion shall we!

    February 11, 2020 Reply
    • nicola stingelin Ethicist

      Tks for reminding us of this important perspective

      February 12, 2020 Reply
  5. Roger Kirby Professor of Urology

    Situation in the UK:
    Eight patients in England have tested positive for coronavirus. Chief Medical Officer for England Professor Chris Whitty, has shared a statement. If more cases are confirmed in the UK, it will be announced as soon as possible by the Chief Medical Officer of the affected country.

    Based on the World Health Organization’s declaration that this is a public health emergency of international concern, the UK Chief Medical Officers have raised the risk to the public from low to moderate. This permits the government to plan for all eventualities. The risk to individuals remains low.

    Based on the scientific advice of SAGE the UK Chief Medical Officers are advising anyone who has travelled to the UK from mainland China, Thailand, Japan, Republic of Korea, Hong Kong, Taiwan, Singapore, Malaysia or Macau in the last 14 days and is experiencing cough or fever or shortness of breath, to stay indoors and call NHS 111, even if symptoms are mild.

    These areas have been identified because of the volume of air travel from affected areas, understanding of other travel routes and number of reported cases. This list will be kept under review. Our advice for travellers from Wuhan and Hubei Province remains unchanged from the below.

    The Secretary of State for Health and Social Care, Matt Hancock, has announced strengthened legal powers to bolster public health protections against coronavirus. The regulations have been put in place to reduce the risk of further human-to-human transmission in this country by keeping individuals in isolation where public health professionals believe there is a reasonable risk an individual may have the virus.

    As of 11 February, a total of 1,358 people have been tested, of which 1,350 were confirmed negative and 8 positive.

    The DoH has been working in close collaboration with international colleagues and the World Health Organization to monitor the situation in China and around the world.

    February 11, 2020 Reply
  6. Roger Kirby Professor of Urology

    Two prisoners at HMP Bullingdon in Oxfordshire are being tested for infection, with both reportedly in isolation while Public Health England conduct tests.
    The virus – now officially called Covid-19 – has so far killed 1,068 people in China according to the World Health Organisation (WHO), with 43,000 people in the country infected.
    An additional 358 instances of the virus have been confirmed in 24 other countries outside of mainland China, with the only deaths confirmed in Hong Kong and the Philippines.
    Speaking in an update, WHO chief Tedros Adhanom Ghebreyesus said any vaccine would be at least 18 months away.

    February 12, 2020 Reply
  7. Patricia GP

    Thank you for your interesting blog and for raising your concerns about a new pandemic. Predicting the extent and lethality of the 2019-nCov outbreak, which originated in China as you highlighted, still proves challenging at present. The rapid spread of information online including via social media has, on one hand, allowed us to follow emerging cases in real-time. On the other hand, it can lead to difficulties differentiating reliable sources of information from fake news, leaving the public and experts at times confused and overwhelmed.
    Public Health England has been quick and efficient in providing us with clear advice, which is updated on a regular basis- this holds for the general population, as well as health care professionals who deal with symptomatic and/or concerned patients. As a researcher and health care professional, I am impressed by how quick the viral sequence was published, and new scientific data/tests developed and shared across the globe. However, many questions about the virus remain at present e.g. duration of incubation period, how long viral shedding persists, and true case and fatality rate etc. To predict outbreak dynamics, and to tailor preventative measures in a socioeconomic way, we require these answers soon. In the meantime, public health authorities need to guide the public and healthcare professionals on next steps. They have the difficult task not to frighten the population, whilst not underreacting and putting lives at risk. Whilst it remains crucial to try and halt the virus’ spread, we need to simultaneously continue to prepare ourselves to cope with the virus.

    February 12, 2020 Reply
  8. John Ashton Former lecturer and Professor of Public Health

    At the moment, while COVID 19 has become a pandemic and been declared a Global Public Health Emergency by the WHO, it still has the characteristics of an outbreak here in the UK. As such, the efforts at the moment are in containment by identifying those people who may have been exposed to the virus and ensuring that they either self-isolate or are formally quarantined under new powers taken by the government this week. This measure has all the appearance of having been taken in the hoof and highlights the fact that we haven’t had a comprehensive review of Public Health legislation with a Public Health Act since 1936.

    Recent cases in Brighton relating to a Dr who had been skiing in France and come in contact with a so-called ‘super spreader’ who had come to the same resort from Singapore illustrates the naivety of a focus principally on people flying from China to Heathrow. There are many ways of travelling to the U.K. that might bring infection and Port Health must be strong in all land, sea and airports. This week the Port Health community has drawn attention to the cuts in budgets and understaffing that has affected them too.

    Whilst we undoubtedly have some of the strongest laboratory and clinical services in the world these are only one part of a robust, resilient and effective service. Since 2013, with the creation of Public Health England, the central public health function has been protected at the expense of the local and regional system where budgets have been cut by 30%, staffing levels dramatically reduced and the position of Directors of Public Health reduced to that of second tier Officer with no automatic access to Chief Executives or leaders of council, and prevented from having active relationships with the media. This is something that is essential now when there is rumour and anxiety bordering on panic brought about by, for example, sending travellers to be quarantined at Arrowe Park hospital in the Wirral at very short notice, with no public preparation, and then the bringing in of a quarantine order in the same way.
    To avoid rumour, trusted local voices of the local public health director, medical director and other clinicians should be played in freely.

    Similarly, at the national level there is confusion as to who is the public face of the response. Several ministers have appeared courting the limelight (a dangerous hostage to fortune, remember Edwina Currie!). The new CMO Chris Whitty is not well known yet, but should be fronting up alongside the prime minister supported by the prime minister not accounting to him. PHE is almost invisible.

    Each day brings new insights:

    The closure of the health centre in Brighton should alert everybody to have business continuity plans in the public and private sectors . Each family should have a domestic plan.

    If the outbreak is not contained then the public will be the main weapon against the epidemic. It will not be possible to hospitalise our way out of it

    The public must be treated as adults and not as children. There needs to be open and transparent information from trusted voices and faces. The time is short.

    We are not a totalitarian country but, at the moment, we are behaving paternalistically and this is in the verge of totalitarianism. It won’t work in the age of the internet and social media, as is being shown in China.

    February 13, 2020 Reply
  9. Roger Kirby Professor of Urology

    Some 242 deaths from the new coronavirus were recorded in the Chinese province of Hubei on Wednesday – the deadliest day of the outbreak.
    There was also a huge increase in the number of cases, with 14,840 people diagnosed with Covid-19.
    Hubei has started using a broader definition to diagnose people – which accounts for most of the rise in cases.
    China sacked two top officials in Hubei province hours after the new figures were revealed.
    Until Wednesday’s increases, the number of people with the virus in Hubei, where the outbreak emerged, was stabilising.
    But the new cases and deaths in the province have pushed the national death toll above 1,350 – with almost 60,000 infections in total.

    February 13, 2020 Reply
  10. Mike Kirby Professor

    BMA is providing useful advice and a contact number for queries

    BMA advisers are on hand to answer any questions you have and are available on 0300 123 1233 and support@bma.org.uk
    For NHS 111 a process has been established whereby when a patient calls the service seeking further information about the virus, they will receive a pre-recorded message.
    – If the patient has any concerns, they will be put through directly to PHE helpline to help make decisions.
    – If the patient is unwell or has recently visited affected areas, they will be triaged to an NHS clinician.
    – Hospitals in England were asked a week ago to put in place an NHS 111 pod – a facility, preferably outside the emergency department and very close to the entrance. This is a dedicated room/space with a direct line to NHS 111. Patients who suspect they have symptoms of the virus are directed to the pod and will be put through to NHS 111 where they will discuss their symptoms with a clinician. The majority will be advised to return home, but those that need testing will be provided with further instructions via 111.
    Hospitals are being asked to identify a separate space, outside an Emergency Department, where testing can take place. The only patients being tested in emergency departments are those who are very ill. This will be rolled out across the system.

    A home diagnostic swab testing service will be rolled out very soon, rather than patients presenting to emergency departments.

    All this sounds very sensible

    February 13, 2020 Reply
  11. Roger Kirby Professor of Urology

    A ninth case of coronavirus has been confirmed in the UK as warnings the disease is likely to spread further in the country and international agencies warn of global complacency. Believed to have been the first case of a carrier being detected in London, the patient has since been taken to a specialist centre at Guy’s and St Thomas’.
    Officials confirmed the ninth victim of the virus – which has been named Covid-19 by the World Health Organisation (WHO) – contracted the pneumonia-like illness in China. Officials are now working to identify those the patient had contact with. It comes after Professor Paul Cosford of Public Health England told the BBC more cases of coronavirus in the UK are “highly likely”.

    February 13, 2020 Reply
  12. Roger Kirby Professor of Urology

    China didn’t release key genetic data on the coronavirus until about two weeks after it emerged that a new SARS-like illness may be sickening people, highlighting the need for outbreak detection systems to incorporate modern scientific tools.

    Insufficient attention was paid to the information doctors had gathered about the genetic sequence of the novel coronavirus, scientists said in a commentary paper in the Lancet medical journal Tuesday. The authors, who include two members of the World Health Organization’s emergency committee, said this wasn’t the result of a cover-up or deliberate delay, but rather the absence of mechanisms to inform outbreak warning systems.

    February 13, 2020 Reply
  13. Roger Kirby Professor of Urology

    There are now a total of 64,441 suspected and confirmed cases of COVID-19, worldwide.
    Of these cases, 63,859 are in mainland China. There have been 1,383 deaths from COVID-19.
    The figures have been collated by Johns Hopkins University’s Center for Systems Science and Engineering.
    Adam Kamradt-Scott, an infectious diseases expert at the University of Sydney, said the figures show drastic measures implemented by China to stop the spread of the coronavirus “appear to have been too little, too late”.

    February 14, 2020 Reply
  14. Roger Kirby Professor of Urology

    Chinese officials have given figures for health workers infected with the new coronavirus, amid concerns about shortages of protective equipment.
    Six health workers have died and 1,716 have been infected since the outbreak, they said.
    The death a week ago of Doctor Li Wenliang, who tried to warn authorities early on about the virus, provoked a burst of public anger and grief.

    February 14, 2020 Reply
  15. Roger Kirby Professor of Urology

    A Chinese tourist has died in France, marking the first death in Europe from the disease caused by the coronavirus, France’s health ministry said.
    There were 2,641 new confirmed infections in China, the National Health Commission said in a statement Saturday, bringing the total to almost 66,500. In Wuhan, the Chinese city where the coronavirus outbreak is centered, authorities further tightened the already-strict quarantine on residents.
    The State Department will evacuate American citizens and their families on board the Diamond Princess cruise ship, the largest infection cluster outside China and which is being quarantined in Japan.
    The virus is showing no signs of abating outside of China too. Japan, Thailand and Malaysia on Saturday confirmed new cases.

    February 15, 2020 Reply
  16. Roger Kirby Professor of Urology

    China has threatened to punish anyone who returns to Beijing without entering quarantine for 14 days, as authorities stepped up efforts to stop the spread of coronavirus. The new measure was announced in the capital’s state-run newspaper after the death toll rose to nearly 1,400 and the number of confirmed cases approached 65,000.
    However, it remains unclear how the regulation will be enforced or whether it applies to foreigners and people not normally resident in Beijing. Authorities also revealed that 1,760 healthcare workers had been diagnosed with coronavirus and six had died since the start of the outbreak.
    It came as the virus spread to Africa for the first time, with Egypt confirming yesterday the case of a foreigner who has been put into isolation in hospital.

    February 15, 2020 Reply
  17. Roger Kirby Professor of Urology

    China has reported a drop in new coronavirus cases for the third day in a row, as it became clear the country’s leadership was aware of the outbreak’s potential before the dangers were made public.

    There were 2,009 new cases in mainland China on Saturday, bringing its total to 68,500, according to the country’s National Health Commission.

    The fatality rate remained stable at 142 deaths.

    The figures have emerged after a 80-year-old Chinese tourist in Paris became the first person to die from the virus in Europe.

    February 17, 2020 Reply
  18. Roger Kirby Professor of Urology

    An interesting blog on quarantine: https://blogs.bmj.com/bmj/2020/02/17/coronavirus-and-the-ethics-of-quarantine-why-information-matters/?utm_source=twitter&utm_medium=social&utm_term=hootsuite&utm_content=sme&utm_campaign=usage

    February 17, 2020 Reply
  19. Roger Kirby Professor of Urology

    Legal blog questioning new regulations:

    https://ukhumanrightsblog.com/2020/02/13/corona-vires-has-the-government-exceeded-its-powers/#more-139789

    February 17, 2020 Reply
    • Nicola Stingelin Ethicist

      Thanks Roger
      This link provides an important insight.
      It connects to the points made above that all of us involved in medicine/the medical sciences might be advised to take the coronavirus as motivation to (re)consider the status quo globally and nationally regarding the powers we grant out government in health emergencies to forceably put temporarily aside basic liberties in order to protect public interests.

      February 22, 2020 Reply
  20. Roger Kirby Professor of Urology

    The head of the World Health Organization (WHO) has expressed concern at the number of coronavirus cases with no clear link to China or other confirmed cases.
    Dr Tedros Adhanom Ghebreyesus’s comments follow Iran’s announcement of two more deaths, bringing the total there to four.
    The window of opportunity to contain the virus was “narrowing”, he said.
    Iranian health officials said the virus may already be in “all Iran’s cities”.
    Outside China 1,152 cases of the virus have been confirmed in 26 countries and there have now been eight deaths.
    They include two deaths in South Korea, which has the biggest cluster of confirmed cases apart from China and a cruise ship quarantined in Japan.
    Italy on Friday announced 16 more cases and its health minister said schools and offices would be closed and sports events cancelled in the affected regions.
    China has so far reported 75,567 cases including 2,239 deaths

    February 21, 2020 Reply
  21. Roger Kirby Professor of Urology

    A coronavirus patient initially discharged after recovering in southwestern Sichuan province’s Chengdu city has been readmitted after testing positive during a quarantine period at home, the city’s public health clinical center said on Friday.

    The patient tested positive during a check-up 10 days after being discharged, the center said in a statement. Similar cases have been reported in other regions.

    February 22, 2020 Reply
  22. Roger Kirby Professor of Urology

    Italy has introduced “extraordinary measures” to tackle the spread of the biggest outbreak of the new coronavirus in Europe.
    Prime Minister Giuseppe Conte announced the emergency plan late as the number of cases rose to more than 100.
    The measures were imposed after two Italian citizens were confirmed to have died from the virus.
    A dozen towns in the northern regions of Lombardy and Veneto have been effectively quarantined under the plan.
    Around 50,000 people from towns in two northern regions have been asked to stay at home by authorities.

    February 23, 2020 Reply
  23. Roger Kirby Professor of Urology

    The Chinese Center for Disease Control and Prevention released clinical details on the first 72,314 patients diagnosed through February 11. The report shows that COVID-19 killed 2.3 percent of patients, meaning it is currently 23 times more fatal than the seasonal flu. Severe disease and deaths were reported in every age group including children.

    February 24, 2020 Reply

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