Caused by the novel coronavirus SARS-CoV-2, there is so much that we do not know yet about the virus causing this pandemic – despite its rampant path worldwide since it was first detected last year in the city of Wuhan, in Hubei Province in China. As of April, at least 135 out of the world’s 195 countries had infected cases, with all countries expected to have many cases of COVID-19 by the end of 2020.

Delayed information

The novel coronavirus infection has spread internationally so rapidly that health agencies worldwide have largely been caught unprepared. As the first cases of COVID-19 arose in Wuhan in mid-November 2019, this is especially concerning because the Chinese government did not publicly concede until 21 January that person-to-person transmission of the novel coronavirus had occurred.

Furthermore, Chinese doctors who raised the alarm in late December were reprimanded. It is the extremest of folly for any government to attempt to conceal the spread of such a serious infection, as it will eventually become known to the world’s health authorities. A global outbreak that by March numbered over 150,000 cases is especially difficult to hide.

The World Health Organisation (WHO) office in China was informed of cases of pneumonia with unknown causes on 31 December 2019. By 20 January 2020, 282 cases of the novel coronavirus had been reported from China, along with Japan, the Republic of Korea and Thailand. WHO declared this coronavirus outbreak a Public Health Emergency of International Concern (PHEIC) on 30 January. By that time, there had been over 7,800 COVID-19 cases reported worldwide, with over 200 deaths, in 20 countries.

It wasn’t until 11 March that the WHO declared the spread of SARS-CoV-2 to be a global pandemic, something that the world’s health officials had long known by then. By that date, there had been over 118,000 confirmed cases, with over 3,100 deaths in 113 countries.

Community spread

There is now ongoing community spread of the virus, which will result in many thousands more cases. Community spread occurs when those who are infected and contagious continue to interact with people who are previously uninfected. It may not be known by those who then become ill how or who they interacted with passed the infection along to them. The ability of COVID-19 to spread infection is enhanced through its persistence on environmental surfaces, spread through exhalation in the air, and a long incubation period of 5-11 days.

Fatality rate

Another concern for nations where COVID-19 is now spreading has been the death rates observed among the elderly. It has caused increasing death rates in every older age category (50s, 60s, 70s and 80+ years) with a CFR of ~15% in those 80 years or over. However, deaths are also increasing among younger age groups.

Pre-existing medical conditions, including cardiovascular disease, diabetes, respiratory illness, hypertension and cancer all increase the risk of death from COVID-19 infections. Overall, men (4.7% death rate) have a greatly increased death rate than women (2.8%) – reasons unknown. In the absence of preventive measures, such as social distancing in the absence of viable antiviral protection, there could well be a winnowing of those living in care homes and nursing facilities worldwide.

Vaccines and antivirals

Recent evidence has been presented that this coronavirus is at least composed of two slightly different genetic types now circulating with the current pandemic – characterized as an ‘L’ and ‘S’ type. The original coronavirus is the L (ancestral) type, while the S type that evolved from it is now more prevalent in worldwide circulation. Further, the L type is more aggressive, causing a more serious infection.

If these findings are accurate, then perhaps they could prove useful to novel coronavirus vaccine development – the best method to prevent viral (and bacterial) infections. Knowing this, it may be disconcerting to learn that, at least in the US, normal vaccine development time from concept to approved product is 15-20 years. Such safeguards include years of safety and efficacy testing in the laboratory and animal experimentation prior to a candidate vaccine being tested in human volunteers. Nevertheless,expedited vaccine development for SARS-CoV-2 is underway.

Another method to prevent viral infections is the use of antiviral medication during the time a viral disease is circulating within a population. This may be particularly useful for those unable to be vaccinated. However, there are currently no effective antiviral compounds available to treat COVID-19 disease. Expedited antiviral trials are being conducted worldwide with various antiviral compounds, including protease inhibitors and the broad-spectrum antiviral Remdesivir.

The full impact

The harsh reality is that no government can be fully prepared for the effects of a worldwide pandemic. In the US many local city and county health offices have lost thousands of frontline health worker jobs since the 2008 recession. Estimates have calculated a loss of 50,000 public health posts with a commensurate shortage of healthcare industry workers. This personnel shortage has an immediate impact upon a nation’s capacity to respond to a pandemic, and to promptly recover from its effects. Other countries, including the UK, have suffered similar healthcare cuts and shortages.

A recent academic paper from the UK described a recent transition from a primarily medical to a multidisciplinary public health specialist workforce as unprecedented, and could serve as a model for other countries to develop public health workforce capacity. Only time will tell how the UK will weather the COVID-19 storm. Given the varying national responses being implemented to this worldwide pandemic, a good case study of each nation’s pandemic effectiveness is now underway. It is the hope of all world governments that the lessons we continue to learn, and there will be many – about SARS-CoV-2 virus and COVID-19 disease, and the development of vaccines and antivirals, will be effective in mitigating this pandemicwand future outbreaks.

“The WHO has been assessing this pandemic around the clock and we are deeply concerned by both the alarming levels of spread and severity, and by the alarming levels of inaction… We cannot say this loudly enough, or clearly enough: all countries can still change the course of this pandemic.”

WHO DIRECTOR DR. TEDROS GHEBREYESUS, 11 MARCH 2020