Who knows some one who has had Covid? Who has lost a friend or family member?

What happened

Richard Horton, the editor of the Lancet, “The Covid-19 Catastrophe What’s gone wrong and what is to stop it happening”. This is a useful history, it dates the first person identified to a patient in Wuhan on 30th December 2020. A PCR test confirmed a new type of corona virus. The local health authorities released a health alert and reported to the WHO. The wet markets, thought to be the source of the virus, a Zoonotic transfer possibly via pangolins to humans was shut.

The WHO set up an incident management team. Chinese scientists released genome sequence on 12th January. 30th January the WHO declared a Public Health Emergency of International Concern.

And then we watched. Korea was next the disease began with a religious gathering. A quick response in East Asia, China has quarantine and stay at home order.

The naming: known officially as “severe acute respiratory syndrome coronavirus 2” or by its abbreviation, SARS-CoV-2. We commonly refer to COVID-19 and the 19 is not the year but the number of the virus.

We quickly learn it spreads rapidly between humans, mainly via the respiratory tract through droplets and fomites.7 It presents through a wide range of symptoms, primarily but not restricted to fever, cough and difficulty breathing. As time passes, the range of symptoms identified with COVID-19 increases.

Next is the Diamond Princess a cruise ship where it is contained and Northern Italy! Numbers rise in Italy in May and June.

Then we have the global pandemic – in the US initially in the North West

Waves of the epidemic first April May. We are in the second major way and numbers are worse than they have ever been.

I can’t do this justice in 10 minutes so in summary with certain countries highlighted.

What makes Covid unique

1. Many people have no symptoms for the first four to five days after acquiring the disease, but may infect others during this time. A key concept here is that infectiousness is measured by the reproduction rate. This is the number of new infections one individual transmits. If each person infects more than one other person, the epidemic will continue to grow. If it falls below one, the epidemic will shrink.
2. It is has a relatively low case fatality rate.
3. There are long term health consequences.
4. The most at risk are the elderly and those with comorbidities. Example case fatality rate by age 30 -39 South Korea 0.11% Italy 0.3 aged 80 + South Korea 13% and Italy 20.2 per cent.

Where are we with the numbers?

Over 82 million infections worldwide and the daily numbers are increasing slowly. 1.8 million deaths globally. Worst affected countries US over 21 million infections still climbing, 361 thousand deaths. India over 10 million, Brazil nearly 8 million, Russia over 3 million UK and France nearly 3 million. South Africa over a million but 16th in the list. Canada 631 466 cases and 16 403 deaths but rising.

What numbers should we look at number of cases noting these are predictors of hospitalisations and deaths to quote a British Scientist these are baked in. These data need to be treated with care. Hospitalisations are pretty accurate and ultimately the death data, especially if you can also look at excess deaths, but do this with care.

At the moment the situation is dire. In the UK yesterday we had the highest number of cases yet: just over 62 500, there were 1 042. Canada’s highest case count was on the 3rd January 16 141 yesterday half this 8 082 and deaths your highest was still in July 251 but in January it has risen to 218. Baked in! The USA 253 145 cases 3 855 deaths. In South Africa a new lock down. Illogicality.

The response

Basic public health responses. First there was no proven treatment the key was to flatten the curve. This was to ensure the health system can continue to deliver care: hospitals, nurses and doctors, availability of ICU beds and respirators. The way in which to flatten the curve is by slowing down the transmission of COVID-19. On a non-pharmaceutical basis this is done by sanitising, respiratory hygiene (applying accepted protocols when coughing and sneezing), applying physical distancing measures and wearing a mask. Mask wearing protects both the wearer and others. In addition, testing and tracing those infected and isolating is a basic and effective public health response.

UK full lockdown, from Sunday for the third time. Allowed out for essential shopping and once a day for exercise. Allowed out for essential work. So railways running or emergency timetable, millions on state supported furlough. The buffoon did not say how long, the legislation allows it to 31st March.

The medical response has been much developed, case fatality rates are falling, but serious Covid is not easily treated. Some drugs help and more are being developed.

The rapid scientific progress is our way out. This will be through vaccines. So in the UK we have Pfizer/BioNtech which has been rolled out and this was joined by the Oxford/Astra Zeneca. So far 1.3 million vaccinated. More shots to be approved. But Pfizer needs -70C storage. But the Buffon called Boris and his government are proposing to delay the second dose. The way it works here is there is an order in which people will get vaccines: over 80s and care home workers, over 70s and health care workers and clinically vulnerable, over 65s. I can expect vaccination in late March or early April. Real issue of access elsewhere and reports of delay in France.

What is the outlook

Health: new treatments in development and vaccine will role out, this as a medical issue should be under control by September.

Economic: V shaped best case, U shape second best. K shape realistic. But actually who knows dead sectors, cruise ships, airline industry

Educational: delays in schooling

Social:

Psychological:

What we should do

Personally stay sane, probably don’t do what I am doing ‘Dry January’. Family if you have reach out if you don’t. There will be many people alone and also there needs to be central clearing and co-ordination of support. Don’t entertain conspiracy theorist (a small cohort of KW yoga teachers).

We need to set up research to answer key questions. Hold our leaderships accountable. Provide evidence.

The numbers: https://coronavirus.jhu.edu/map.html
Excess Deaths: https://www.economist.com/graphic-detail/2020/07/15/tracking-covid-19-excess-deaths-across-countries
Projections: https://covid19.healthdata.org/global?view=total-deaths&tab=trend
Other useful sites: https://ourworldindata.org/mortality-risk-covid