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Making sense of the coronavirus.

By NICK O’HEAR.

COVID-19 CAN be a very nasty illness. A friend of mine died from it two weeks ago. Possibly her lungs were not strong; she used to smoke and had suffered from lung cancer. It is still a shock.

Seasonal flu is also a nasty illness. Each year an average of 17,000 people die in England from flu (28,303 in the bad year of 2014/15). This compares to total deaths in the UK from the coronavirus of 17,000 at the time of writing and rising. This puts coronavirus on a par with a bad seasonal flu.

But the coronavirus gets far more attention than seasonal flu. In the U.S., tragically many small children die of it – typically 150. As far as I know we never hear of this. Two weeks ago, the sad death of a 5-year-old is broadcast on every news item for more than a day. This grim graphic from CDC (Centers for Disease Control and Prevention USA) puts seasonal flu into focus.

I hadn’t realised how bad flu can be. The CDC states:

Flu Complications

Most people who get flu will recover in a few days to less than two weeks, but some people will develop complications (such as pneumonia) as a result of flu, some of which can be life-threatening and result in death.

Sinus and ear infections are examples of moderate complications from flu, while pneumonia is a serious flu complication that can result from either influenza virus infection alone or from co-infection of flu virus and bacteria. Other possible serious complications triggered by flu can include inflammation of the heart (myocarditis), brain (encephalitis) or muscle (myositis, rhabdomyolysis) tissues, and multi-organ failure (for example, respiratory and kidney failure). Flu virus infection of the respiratory tract can trigger an extreme inflammatory response in the body and can lead to sepsis, the body’s life-threatening response to infection. Flu also can make chronic medical problems worse. For example, people with asthma may experience asthma attacks while they have flu, and people with chronic heart disease may experience a worsening of this condition triggered by flu.

Nevertheless, coronavirus differs from seasonal flu because there is no vaccine and because of the demands it puts on the NHS.

Reading the newspapers last weekend you would think that the UK has coped very badly and is in utter chaos. The Sunday Times headline illustrates this; “Coronavirus: 38 days when Britain sleepwalked into disaster”. In fact, the U.K. is doing about as well (or as badly) as most other European counties. There have been to date 17,000 hospital deaths or 240 deaths per million of the population.  This is about the same as in the Netherlands and less than in France, Spain or Italy. Belgium is particularly badly hit with 503 deaths per million while Germany has done remarkably well with only 58.

In the Netherlands where I live, social distancing and working from home mirror the UK but we are allowed to travel and to enjoy our parks, for example to sunbathe. Lockdown was implemented in the Netherlands a few days earlier than in the UK but the results seem very similar; 240 deaths per million in the UK vs 220 in the Netherlands. This demonstrates to me that the UK could be more relaxed on travel and the use of parks and beaches.

The timing when the coronavirus hit obviously has an influence on the current situation, however it is worth noting that the number of cases of Corona in the UK and Germany are similar 125,000 and 148,000 respectively. The reasons given for Germany having such remarkably low fatalities are threefold. Firstly, the average age of coronavirus patients is lower in Germany and their survival rate is higher (it was brought into Germany by skiers), secondly, the Germans are doing more rigorous testing and tracing and thirdly, hospitalization and entry to intensive care and ventilation is earlier.

Of these three I would imagine that the excellent hospital care is the key to reducing fatalities. Other European countries should expand intensive care, buy ventilators and of course do more testing.

Or should they? This depends on what will bring this epidemic to an end. Will it die out in the summer as seasonal flu tends to? Will we have a vaccine in time to stop a second wave? Can we achieve herd immunity?

Concerning a vaccine, there seems little chance of getting the population vaccinated this year and, given that it may not be developed in the UK, we won’t be first in the queue. Sometime next year is the best we can realistically hope for.

If the virus does not automatically expire in the summer, we have to contemplate a second wave of infections. Worrying news from Japan makes this all too real. But it doesn’t end there, there is nothing to stop successive waves until we reach herd immunity.

To understand the concept, let us say that one person infects 3 people, they go on to infect 9 then 27, 91 and so on.  Gradually as the number of people who have had the virus and are immune increases, a single person can only infect 2 people then 1. Herd immunity occurs when a single person infects, on average, less than one person and the infection flattens and dies out. This means that most of the population will get the infection; the exact number depends on the initial rate of infection. This takes time; months to a year or more. The more we do to reduce the rate of infection by lockdown, the longer it takes. Social isolation reduces the infection rate (the R value) from about 2.5 to possibly 1.5. This slows the spread of the disease as illustrated below

Eventually though most of the population will be infected and we can take our punishment in one big catastrophe or a series of smaller disasters. It is difficult to get a good grip on this because we don’t know enough about the virus. We don’t even know if everybody exposed to it will get it. Assuming that we are all equally susceptible to getting coronavirus and that the virus will not die out, the table below gives the total number of infections for the UK vs the R value. This also assumes that recovered people will not become re-infected i.e. that immunity lasts longer than the virus.

To quantify herd immunity properly, we need to know how many people have had the virus and how long immunity lasts. If many people have had the virus (but with mild symptoms) the death rate is lower and herd immunity easier to contemplate. If individual immunity lasts less than a year then allowing the virus to spread rapidly might be a good approach.

What is the effect on the economy and are we trashing it? You often hear that you can’t put a price on life but that is exactly what the National Institute for Health and Care Excellence (NICE) has to do. They value a year of good quality life at about £25,000 and this is what they are prepared to spend to extend life by a year. We don’t know how many lives are possibly saved by the lockdown measures. Because most of the lives saved are in the older category, we can estimate that each life saved gains 10 years. This may be generous. The more difficult part is assessing how many people would have died. You read figures from 0.01% to 3%, but because we don’t know how many people have had coronavirus, and we can’t yet relate the number of deaths to the number of infections. Nevertheless, we can construct a table that gives a budget based on these inputs.

 

The Chancellor, Rishi Sunak , has given a stimulus package of £30 billion and interest free loans of £330 billion. He promises more. The burden and costs fall heavily on businesses. There is a lot of suffering and anxiety bearing on people who are running out of money and on their families. With one lockdown we could also lose 10% of our GDP this year (£200 billion) or it could be more. We could possibly contemplate a second lockdown but surely no more. This expense and suffering is to save the lives of people mostly my age (65+).

It seems that the government’s underlying strategy is to get to the summer and hope that the virus dies out of its own accord.

Let us pray they are right.


Nick O’Hear is chairman of Tension Technology International, Ltd., based in Schoonhoven, The Netherlands.

 

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