“A matter of time” was the verdict of England’s chief medical officer, Chris Whitty, last week on the potential spread of the coronavirus across the UK. Sure enough, last Friday news broke that the latest patient diagnosed with Covid-19 in England is the first to catch it in the UK. There are now confirmed cases of the virus in more than 50 countries and it has resulted in at least 2,800 deaths.
With fears that Covid-19 could infect two-thirds of the world’s population if its spread is not controlled, talk of a pandemic is inevitable. The government’s response here is focused on trying to slow transmission of the virus to lessen its health and economic impacts.
Covid-19 is much less deadly than other similar zoonotic viruses that have transferred from animals to humans; the death rate of Covid-19 is estimated to be 1%-2%, whereas Sars had one of more than 10%. However, the virus appears much more infectious than Sars, and consequently has already resulted in a higher number of deaths worldwide.
This is where the challenge comes: slowing its spread depends on taking disruptive action, particularly in light of the fact that not all carriers will experience easily identifiable symptoms. After the virus took hold in Hubei province, the Chinese government took drastic measures to try to stop its spread across the rest of China, imposing strict quarantine measures, shutting down whole cities and transport networks. More than half a billion people have had severe restrictions imposed on their movement; in Hubei province, residents are forbidden from leaving their apartments without prior permission and many community officials are buying and delivering food and medicines for citizens under quarantine. In some areas of China, local government is offering financial rewards for citizens who tell on those who have failed to report their own travel to infected areas, or who turn in those who have a fever.
Few countries would impose restrictions this draconian: in liberal democracies governments have to rely far more on changes in individual behaviour to slow the virus’s march. Hence the emphasis in the UK is on self-isolation for those who have travelled to affected areas, and clear public health advice aimed at improving individual hygiene. It is hoped that this will prevent transmission and protect those who are more vulnerable to severe and potentially fatal symptoms.
Employer decisions will also be critical. People are more likely to follow official advice to self-isolate at home if they are entitled to sick pay, even if they are showing no symptoms of disease. Last Wednesday the health secretary, Matt Hancock, told employers that any staff asked to self-isolate are entitled to take sick leave. However, employment experts have said that employers are not necessarily legally bound by this, so some of this will come down to individual business decisions. With suggestions that schools might need to close for up to two months if the virus infects large numbers of people, the government will also need to issue advice for what employers should do about parents whose children need to remain at home. It may need to make emergency support available to prevent small businesses collapsing. It will certainly need a medium-term plan for responding to the economic consequences of a pandemic; amid concerns about a global recession, global stockmarkets lost £3.9tn in value last week.
Health officials have warned that there have been serious issues in the response so far. GPs have reported that public health advice has been unclear: patients who have travelled back from at-risk countries have not been given information about what to do if they develop symptoms on arrival at airports; local health authorities have been refusing to suspend online GP booking services, resulting in patients presenting at surgeries with symptoms and potentially putting other patients at risk; and the NHS’s 111 telephone line has been giving the wrong advice to visit a GP. Meanwhile, two senior NHS leaders have told the Observer that the NHS would struggle to cope with a major outbreak of Covid-19 as a result of a lack of high-dependency beds and specialist respiratory wards. While the long-term health risk of contracting the virus appears to be low, it could have profound knock-on impacts on people’s health as a result of cancelled operations and clinics. School closures could significantly reduce medical staff availability. Any pandemic would inevitably place huge pressures on the health service, but a decade of underfunding has left it vulnerable, understaffed and stretched beyond capacity.
More broadly, there has been a complete failure of leadership on the part of the government. At a time when public panic could spread, people need reassurance that there are plans in place to deal with a pandemic. But as the alarming headlines and media reports increase, ministers have delayed appearing on key national news programmes that reach a wide public audience, and it took Boris Johnson days after the first British cases emerged to give a statement to the BBC. It echoes his failure to visit flood-hit areas of the country in recent weeks.
The reaction of the government, of individuals and employers will determine how quickly the virus spreads, and therefore its long-term impact on the health and economic wellbeing of the nation. We should also not lose sight of the fact that experts have long warned that a pandemic of this sort would eventually happen without tougher worldwide measures to minimise the risk of zoonotic viruses being transmitted to humans. After this outbreak is over, there needs to be stronger global action to reduce the risk of these outbreaks in the first place.
