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.
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.
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.