In December 2019, an outbreak of mysterious pneumonia hit Wuhan, China. It was linked back to the Huanan Seafood Wholesale Market, a wet food market. The disease would spread rapidly throughout China, and the rest of the world. It was soon designated COVID-19.
Coronavirus is an enveloped, positive single-strand RNA virus. It belongs to the orthocoronavirinae subfamily, and to the genus beta-coronavirus, with other variations like SARS-CoV. It should be noted that ‘coronavirus’ is an umbrella term covering all many subtypes of this virus, most of which would cause nothing more harmful than a common cold. It is believed that COVID-19 was passed to humans from a single isolated animal source in the Wuhan wet food market, making it the third zoonotic coronavirus.
Symptoms include fever, a dry cough, loss of smell or taste, and fatigue. They may also include gastrointestinal symptoms, a runny nose, musculoskeletal aches, and a variety of less common symptoms. In general, COVID-19 has been found to be a mild disease in the young and healthy, and a highly dangerous one in the elderly or those with comorbidities. With increased age comes increased risk of severe symptoms, of hospitalisation, and of death. Likewise, comorbidities such as having asthma, being obese, or having diabetes, are all closely linked to worse outcomes.
COVID-19’s infection fatality rate was assessed by the World Health Organisation to be 0.27% (corrected 0.23%), after the examining of 61 different studies, with 74 different estimates, looking at infection fatality rates from 0% to 1.63%.
With the world being more interconnected than ever, COVID spread rapidly across Europe during the spring of 2020, with a second wave falling in the autumn of 2020.
COVID is perhaps most interesting – especially in the context of interviews – as a public health quandary. Faced with a novel disease without clear treatment options, countries would attempt a variety of (sometimes unorthodox) methods to counter it. These methods included lockdowns (in some countries like France, Spain and Italy these were heavily policed), the mandating of mask-wearing, shutting of shops and restaurants, the creation of extra hospital space, and the rushing through of final year medical students.
In spring 2020, the UK rapidly found that it lacked the PPE needed to protect its healthcare staff, and that it lacked the bed space (notably in ICUs) to deal with an escalating infection rate and increasing hospitalisations. Boris Johnson’s pleas to, ‘stay at home, protect the NHS, save lives,’ were backed by a national lockdown. There would be further lockdowns, using tiered systems, initiated throughout 2020. Lockdowns undoubtedly saved lives, and provided time for the NHS to prepare itself. However, that time was arguably used hugely ineffectively. The UK failed to implement an accurate or useful test-and-trace contact tracing program, making it incredibly hard to pinpoint outbreaks. There was both a lack of testing capacity and a failure to implement a system that would quickly contact those that may have been exposed.
When one looks at countries that have ‘succeeded,’ they have been hugely reliant on clear public health campaigns, with clear and coherent messaging throughout, backed by quick and accurate contact tracing. Singapore, Vietnam, New Zealand and Vietnam are good examples. It should be noted that whilst hugely unpopular with many of the public, lockdowns are shown by New Zealand in particular to work without damaging the economy as badly as an ongoing battle with the disease. In order to work like this, the lockdown seemingly must be swift and (relatively) absolute, to bring infections down to as close to zero as possible.
The concept of herd immunity entered the public lexicon in a way it never had previously, with some believing that letting the virus pass through the population was the only way to proceed. Normally herd immunity would be brought about through the use of a vaccine. That race to develop a vaccine was billed as one of the most important technological challenges of the 20th century, and saw record investment and mobilisation of scientists and pharma companies.
What is COVID-19?
COVID-19 is the term given to the disease caused by SARS-CoV-2 – not to the virus that causes it. SARS-CoV-2 is the subtype of coronavirus that causes COVID-19. It is a zoonotic virus, meaning that it is transmissible from animals to humans. Coronavirus is an enveloped, positive single-strand RNA virus. Coronavirus is an umbrella term covering all many subtypes of this virus, most of which would cause nothing more harmful than a common cold.
What caused COVID-19?
The simple answer to this question is that we do not know. The outbreak began in Wuhan, China. Coronaviruses are common in cattle, camels, bats and pangolins, amongst other animals. It is unclear exactly how the disease first spread to humans. Current theories centre on either a wet food market (a large market selling fresh seafood and fresh meat) in Wuhan, or the disease having spread from pangolins or bats. The idea that the disease was released from a lab in Wuhan is largely discredited by the scientific community.
What is a zoonotic virus?
A zoonotic virus is one that is able to transfer from animals to humans. It may also be known as a zoonose. Zoonotic disease may be bacterial, viral, parasitic or fungal. Zoonotic diseases are hugely common, with scientists estimating that more than 60% of infectious diseases in people can be spread from animals, with 75% of every new infectious disease in humans being transmitted from animals. Zoonotic diseases may spread through either direct or indirect contact.
What are the risks of rushing to develop a vaccine?
Vaccine development happens in phases. Phase 1 involves giving the vaccine to a small number of volunteers to assess its safety, check the dosage, and confirm that it generates an immune response. Phase 2 involves giving the vaccine to 100s of volunteers to further check its safety profile. Phase 3 involves giving the vaccine to thousands of volunteers, both to further check its safety, and to investigate its effectiveness against a similar group of people who receive a placebo. Each of these phases were carefully followed for the production of vaccines (although some doubts remain about China and Russia’s processes) for COVID-19, meaning that there are no risks involved with the vaccine having been ‘rushed’ – in fact it was developed quickly due to international collaboration and huge amounts of investment.
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Do you think that the UK dealt well with coronavirus?
No. I believe that the UK failed to develop a proper plan at the very outset of the pandemic, or to then stick to a plan throughout it. The government failed to realise the disease’s true severity, and the ease with which it might be transmitted into the country. There was a lack of clear public health messaging and announcements, alongside mixed signals and mixed messages from many government figures, who often failed to take responsibility for their own actions. Additionally, the UK failed to have prepared well for this type of pandemic (expecting influenza to be the next pandemic) and failed to rely on its civil service and health service as much as it ought to have done, instead using private contractors for work like the test and trace system.
What countries dealt well with COVID-19?
Taiwan, New Zealand, Singapore and Vietnam are held up as examples of countries that dealt especially well with the pandemic. Taiwan used an efficient contact tracing system, and their response was largely informed by the previous SARS epidemic. New Zealand imposed strong travel restrictions early during the course of COVID, and attempted an elimination strategy, rather than a reduction strategy. Singapore, like Taiwan, used a system of aggressive contact tracing and testing also informed by the SARS epidemic of 2003. A contact tracing app that was taken up by citizens, alongside the use of new technology – including robots – helped as well. Vietnam acted early to bring in border restrictions, as well as introducing health checks alongside closing its border with China in January 2020. This was backed by a very efficient contact tracing system.
What lessons should the NHS learn from the COVID-19 outbreak?
If we were to face another similar pandemic, there are multiple lessons that we should have learnt, reflected on, and be able to implement. Firstly, the UK should have acted with greater urgency at the start of the outbreak. We should have developed a plan at the outset (or before it) that was understood by all and that was adhered to throughout. Any lockdown should have been stringent immediately, and therefore able to extend for less time. The test and trace system should have been far better run and organised, by the government itself rather than outsourced to private contractors. Over summer months when the virus was weakened, huge amounts of effort should have been dedicated to a near-total elimination strategy, improved contact tracing, and preparation for winter.
What area of the population is most at risk from COVID-19?
The at risk are divided by the NHS into two groups – clinically extremely vulnerable and clinically vulnerable. The first category is the highest and includes those having chemo or antibody treatments, those with blood or bone marrow cancer, those with a severe lung condition, those having radiotherapy, those taking immunosuppressants like steroids, those with a heart condition, the pregnant, those that have had an organ transplant, or those with another form of disease that may cause immunosuppression. Those that fall into the second group include those over the age of 70, those with a less severe condition affecting the heart or lungs, the obese, those with a liver disease, or anyone with another form of disease that increases one’s risk of infection.
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Are lockdowns to be condoned as a way of dealing with a disease like this?
It appears that lockdowns might have to form part of a country’s response to a pandemic in certain situations. However, we must draw a distinction between lockdown and social distancing. A total lockdown appears to be not only hugely negative for the economy but also damaging to the mental health of the population. Therefore, lockdowns must only be condoned as a short, stringent measure that allows for a dramatic reduction in caseload, to such an extent that a contact tracing program may take over as the main weapon against disease. Social distancing may remain in some shape or form, however.
What would you say to the Prime Minister, if you could, to try and persuade them to prepare better for a future pandemic? What might you change?
I would emphasise that pandemic planning is important to maintain, simply because a pandemic will catch us unaware. Therefore, it is easy to understand the temptation to reduce funding for pandemic planning, with so many other issues facing the country at any one time – and a pandemic seemingly nowhere on the horizon. However, after the vast economic damage done by COVID-19 – not to mention the bereavements, damage to mental health, and lingering effects of the disease for many, it should be clear to a politician – like the Prime Minister – that pandemic planning is worth the funding. I would highlight the examples of countries like Taiwan and Singapore that planned effectively, having learnt from SARS, and fared far better than the UK. I would stress that we must have adequate PPE, adequate and clear plans in place, and that public health messaging should be concise and follow the plan from the outset.
When answering a question on COVID, make sure not to let your personal opinion get in the way. You may agree entirely with the government’s handling of the issue, or disagree with it strongly- the important aspect is to weigh up both sides of the debate and approach it from a public health standpoint rather than a political one. As a future doctor, your responsibility is to consider what health interventions will have the greatest positive impact on the greatest number of people.
It will likely be brought up by your interviewer. If not, it should be mentioned as soon as you are asked about recent healthcare news or trends. Likewise, mention it if public health is brought up in conversation. Neglecting to mention it when asked about either of these topics would seem like an oversight.
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