di Devi Sridhar
On 23 January, the central government of China imposed a lockdown in Wuhan and other cities in Hubai province that affected 57 million people. Even with these measures, the coronavirus started spreading to other countries – Singapore, Hong Kong, South Korea and beyond. However, something unexpected happened and the exponential rise in these countries started to flatten. As I write, China has managed to keep its confirmed cases under 90,000 with daily new cases coming down.
The Chinese response also had the consequence of buying other countries time. The UK has now had eight weeks to track the outbreak, and to learn about the virus. What we can now say for certain is that the UK has decided to chart its own course. Unfortunately, no certainty can attach to the wisdom of this – indeed, one needs to ask whether the UK approach is akin to gambling with the health of the population.
We know that the virus spreads through droplets expressed through coughs and sneezes, and through hands. We know that symptoms start with a high fever, followed by a dry cough and a few days later some individuals start having breathing difficulties and require hospital treatment or even intensive care.
We know that mortality rates rise with patients’ age and pre-existing conditions such as cardiovascular disease, hypertension and diabetes, and that children have been largely spared the severe symptoms. We know that this is not like seasonal flu (with a death rate of 0.1%), but that Covid-19 results in around 5-10% of confirmed cases requiring intensive care and a death rate estimated at up to 2-3%.
In terms of response, other countries have provided good examples of how to effectively manage the outbreak. We do not yet have a vaccine and potential antiviral treatments are still in clinical trial but we have other effective, non-pharmacological interventions.
From South Korea, we have learnt that basic public health measures, such as extensive testing, can help measure the size of the problem, establish where the confirmed cases are, how transmission chains are occurring and, therefore, how to break them. From Singapore and China, we have learnt that contact tracing is essential, whether in the household, or within the community. This helps us to understand who could have been exposed and ensure that all are informed so that they immediately self-isolate.
From Taiwan and China, we learnt that early social distancing measures, such as banning large gatherings, restricting movement, working from home and essentially “shutting down” society for a time can reduce transmission and buy time for health services to ensure capacity is there for those needing medical support.
From Hong Kong, we have learnt the importance of individual behavioural change through extensive hand and environmental hygiene, restricting movement and crowds, 14-day quarantines for those arriving from mainland China and widespread awareness of key information. And we wait to see whether the Italian approach of large-scale social distancing will pay off.
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