I simply cannot believe I haven’t found five minutes to jot down a much belated blog post regarding this global coronavirus pandemic. I could find an excuse:

• I was busy sorting out emergency units across South Africa, as part of the national medical preparedness strategy
• I was hanging up laundry or washing dishes or discussing ingredients for family supper – as part of our strict national lockdown

These seem rather feeble – so let’s ignore…..

In a quarter of a century of emergency medicine, I have NEVER seen such an unprecedented sharing of global information regarding a single disease. There are news items, posts, articles, forums, journal publications – every information channel across the globe is providing or peddling COVID-19 data or commentary. Thus to make this blog relevant – we would have to cut through the chatter – and focus on the facts. I thought it might be useful for readers to separate the sensible from some of the fake news – it will at least make for a short blog post.

In the last fading seconds of 2019 – the World Health Organisation (WHO) was alerted to a group of patients with pneumonia in Wuhan in China. The cause was soon established to be a new (or novel) coronavirus, most likely contracted from a live animal market (a subject for a powerful conversation in a subsequent blog perhaps). The illness was named COVID-19 and the actual infectious agent – the virus – was ultimately named SARS-CoV-2. Under the microscope the viral particles have little protein halos or crowns – hence the “corona” in the name. The coronaviruses have been with us for quite some time and typically cause a mild, self-limiting disease called the common cold. You get a fever, a cough, feel fatigued, get a bit snotty, maybe have sore muscles or a sore throat. You soldier on regardless, or take it easy for a bit (with your grandmother’s recipe for chicken soup or ginger tea perhaps) and you recover completely in a week or two.

Occasionally though, a coronavirus can cause quite severe disease and people can die. In 2003, it was SARS (severe acute respiratory syndrome); a virus that probably jumped across to humans from bats. In 2012, it was MERS (middle east respiratory syndrome), another coronavirus probably from camels that time, that caused a severe outbreak. They caused less than a thousand deaths though. Now we have SARS-CoV-2 and at the time of writing, some 3 million cases globally, with over 200 000 deaths. The stats are showstoppers – with over a million cases in America alone and thousands dying in just New York City; while other countries like Italy and Spain and Iran have also seen devastating rates of complicated infections and deaths. And this narrative is ongoing.

Some context is perhaps possible if one compares to other global or regional infectious disease outbreaks and the situation at the time in terms of available medical resources and treatment options. No antibiotics and less sophisticated healthcare in the mid-fourteenth century and a simple bacterium (killed by an ordinary antibiotic today) caused the Black Death or plague pandemic and wiped out hundreds of millions of people. The Spanish ‘flu pandemic may have killed as many as 50 million people at the end of the First World War – and today we have an effective ‘flu vaccine against all common strains of that virus. Ebola virus (that scary viral haemorrhagic fever discovered in the jungles of the DR Congo in 1976) killed just over 11 000 in west Africa in the 2014 outbreak. And now we have a vaccine too.

You could source just about any information required from Dr “pick your favourite internet search engine”….but today I will simply attempt to de-clutter that space and just look at some essentials via a Q&A:

“Will I die from COVID-19 ?”

Some people will die, yes, from complications of this viral disease. This is similar to many other common viral infections and tragic in human terms but expected in medical terms. The death rate varies dramatically in different countries mostly due to varying degrees of effective testing and positive case tracing. Some countries report death rates in excess of 6% due to COVID-19 while others are less than 1%. Given that over 80% of patients are either asymptomatic or have very mild infections and wouldn’t ordinarily seek healthcare for it at all – we are clearly missing thousands of cases in our analysis. It is clear though, especially from countries like Italy, that elderly patients do a lot worse, especially if they have an underlying medical condition like cardiovascular disease. It would seem that children fare relatively better – why is not obvious, although something to do with their ability to mount effective immune responses to common viruses is logical. They can spread it easily enough though hence the logic behind certain school closures.

Is there treatment for COVID-19 ?

A cure per se is not yet available. Neither is an effective vaccine. Thus treatment, for those few that develop a severe form or complicated illness, remains supportive. This will typically entail oxygen therapy and various forms of respiratory (or breathing) support. It would seem that many of the patients who do badly or die suffer from a particular inflammatory reaction in their lungs, thereby leading to many attempted medical therapies being directed towards dampening these reactions. All sorts of drugs (that we use for other purposes usually) have been tried, or are busy being tested. These include anti-retroviral agents used to fight HIV; antibiotics such as azithromycin; even certain antimalarial drugs like chloroquine. It is usually a “side action” or associated mechanism that is thought to potentially have some benefit for the COVID-19 patient. To date though, NOTHING is proven to offer any material benefit beyond supportive management. Are we likely to see a vaccine ? Probably within a year or so, yes. In order to get one, we first need access to people who have recovered from the illness and have developed effective antibodies (immune system protection) to this specific coronavirus. Thereafter we can follow the complicated process of vaccine development, safety and efficacy trialling and ultimately distribution.

Will herd immunity save us ?

The term or notion of herd immunity has bounced around the blog pages and been thoroughly confused. Very briefly – it is a concept describing how a group of people or population will not get a certain disease as they have either been vaccinated against it or had it before – either situation thereby given them immune protection. If they can’t get the disease, they can’t spread the disease, the unprotected or vulnerable are safe from the disease and bingo – herd immunity. Given that a single COVID-19 positive patient can spread their sickness to 2-3 people (compare about 18 for another virus like measles) – we’d need about 70% of the population to have had the disease (as there is NO vaccine yet) before it becomes relevant. Thus most of our “herd” would need to get sick first – so this simply isn’t a protective strategy.

How do I keep myself and my family safe ?

For now, without a vaccine, it is about education and prevention. The education part will deal with some of the fears and anxieties by putting the nature of the infection into context. You should recognise that there are vulnerable groups of people who should be afforded greater protection, but see also that younger, otherwise healthy people are at much lower risk. Furthermore, most of these patients will have an asymptomatic or mild infection and recover completely.

The prevention part is about avoiding viral transmission and being socially considerate by reducing your ability to spread infection to others. It would seem that this virus is predominantly spread in large respiratory droplets (like those you can’t quite see that you cough or sneeze out that someone else could breathe in) or on contaminated surfaces where those droplets have landed. And they typically land within a few metres of you. Thus social distancing (and in extreme situations – government mandated lockdown) keeps the risk down. Wearing a mask – this mostly helps prevent you coughing or sneezing viral particles out and making someone else ill. Healthcare workers wear different sorts of masks to prevent them breathing in viral particles that are still in the air. Wearing gloves – no use really if you wash your hands properly and frequently. And the clean hands thing is probably the most important message of all. Clean hands can’t transmit the virus to your face when you talk or eat. Clean hands don’t transfer anything to other surfaces or people. Soap and water / alcohol hand sanitiser – whatever you can afford or get your hands on! #cleanhandsforthewin