We’ve always been able to rely on politicians to create a crisis out of a challenge, but with the coronavirus outbreak they have excelled themselves.
I understand that they are trying to do the right thing for their people, and like all of us they’ve been hit with a tsunami of miss-information about Covid-19, but even after 40 years working in Public Health, recent events have left me (almost) speechless.
In the early stages of an outbreak of a novel virus we need to be cautious, as this may be the next ‘Spanish Flu’, (which according to a report in last weeks National Geographic probably originated in China and not Spain – so somebody got an ‘F’ in geography back in 1918), but by January 2020 we had a good indication that Covid-2019 was more like seasonal flu than the zombie apocalypse. So this makes some recent decisions intriguing.
One example was the Diamond Princess – shutting 2000 passengers and crew on a cruise ship with known coronavirus cases on board – what could possibly go wrong?
Another was not allowing the Westerdam to dock in Thailand, resulting in it being re-routed to Cambodia, where the airport did not have the necessary flight connections, so they were all bussed back to Thailand, whilst at the same time two cruise ships happily docked in Phuket.
I’m now watching the case of the hotel in Tenerife with interest – what’s the end game here – to ensure everyone has a good dose before they’re flown home?
I think as operators it’s time we all started to consider the real risk and balance those against the very real damage we are doing to the economy and people’s livelihoods. A good model comes from UK health and safety legislation that says it is the duty of an employer to ensure, as far as is reasonably practicable, the health, safety and welfare of their employee’s. The legal definition of what constitutes ‘reasonably practical’ includes the level of the risk, the economic costs and the current state of technology. We now know that the risks are similar to influenza, the economic impacts look to be significant, and the technology needed for effective control is simple hand washing and effective use of sanitizers. So why are we still inflicting massive self harm on our businesses and on the global economy?
Are we all just reacting to sensation media reporting and fake news?
So here’s 6 common myths about Covid-19 and my predictions for the next 6 weeks to try and help to restore some balance:
Myth 1: The case fatality rate is 2%
The often quoted figure of a 2% case fatality rate (CFR) is based on details from Wuhan, but with the overloading of the local hospitals and the reluctance to report an illness for fear of being taken to a crowded quarantine facility with no medical staff, only the most serious cases are being reported. But a death from pneumonia is going to be thoroughly investigated – so this reduces reported case numbers and increases fatality reports.
If we look at just the cases amongst medical workers in Hubei Province, which should be a little more accurate, we see a fatality rate of 0.2%. Then if we look at cases outside of China, the fatality rate is 0.18%, which is similar to seasonal flu. (As a comparison Dengue is 26% and H5N1 Bird Flu was 60%). Iran appears to have a CFR of 3%, but with many cases being in remote villages with limited testing facilities, the true number of cases can never be known, but again the serious ones will be investigated more thoroughly, so this inflates the fatality rate.
https://smw.ch/article/doi/smw.2020.20203
https://www.who.int/influenza/human_animal_interface/EN_GIP_20130604CumulativeNumberH5N1cases.pdf
Myth 2 – Masks protect the wearer
Surgical masks are worn to protect patients from medical staff who may have a mild infection that could be serious for a sick patient. If medical staff are treating a person with a serious infectious disease, they will wear a full respirator and eye protection, plus a bio-hazard suit – not ideal wear for a trip to the shops.
Re-using masks may also add to the risk due to possible contamination of the masks and additional hand contact with your face – so if you decide to wear a mask, wash hands after touching your mask.
WHO Guidance: “Wearing medical masks when not indicated may cause unnecessary cost, procurement burden and create a false sense of security that can lead to neglecting other essential measures such as hand hygiene practices. Furthermore, using a mask incorrectly may hamper its effectiveness to reduce the risk of transmission”.
Myth 3 – It is spread by air-conditioning systems
There are several reports in the press that HVAC systems may spread the virus, and this has been linked to the spread on the Diamond Princess cruise ship. Most AC systems are self-contained and do not recirculate air from other parts of the building. Fully centralized HVAC systems with a central plant-room do recirculate some air to save on energy, but the long distance of the trunking, the fans and the dust filters should be enough to prevent a significant risk from any droplets. But if travelling in a car with potentially infected people, it may be a good idea to switch your AC from recirculation to bring in fresh air.
Myth 4 – The incubation period is over 14 days
In most cases it’s very difficult to be sure when a person was infected, so all incubation periods are an estimate. The 14 day recommendation for quarantine was based on data from the SARS epidemic in 2002/3, and estimates for Covid-19 range from 2 to 24 days. Cases where it appears to be over 14 days are probably due to the patient being infected at a later date than was estimated during the investigation, or due to inadequate testing that failed to identify the case until long after the initial exposure. In addition some people have no or very mild symptoms, so the onset date for the disease is not easy to estimate.
https://www.medpagetoday.com/infectiousdisease/generalinfectiousdisease/84963
Myth 5 – A person can become infected again
The media loves to create sensational reports that suggest we’re all doomed, and the single case of one person who tested positive, then tested negative, then was found later to be positive is probably not a case of re-infection, it’s more likely to be a case of a failed test method for the negative test.
Myth 6 – Singapore, Korea and Japan have a major problem
From a Covid-19 viewpoint, here are two types of Countries. Those that have cases and have effective screening and testing so they report their numbers, and those that have cases but they have ineffective screening and testing so nobody knows. You are likely to be safer in a country like Singapore that has effective screening, testing, quarantine and medical facilities than anywhere where they still believe they have zero cases.
Covid-19 has also been in the community within Wuhan since November (first confirmed case reported in The Lancet was 1 December), and the airport screening and controls were not put in place until January, so it will still be spreading globally even if China, Korea and Japan completely sealed their borders tomorrow.
https://www.medrxiv.org/content/10.1101/2020.01.23.20018549v1.full.pdf
My 6 predictions for the next 6 weeks:
- In 6 weeks time every country in the world with the possible exception of North Korea (due to media control) and Armenia (because nobody knows where it is) will have reported cases of Covid-19
- Governments will have finally realized that banning travel is causing massive damage to the economy for minimal benefit
- We will all be bored of wearing masks, much to the relief of the medical staff who’ve been unable to source masks since we all went for the Dr Kildare look (showing my age there)
- The business that will survive the crisis will have implemented highly visible hygiene measures to reassure customers and staff
- Business that failed to adapt to the reality that Covid-19 is here to stay will be posting profits warnings
- The WHO will still have not declared a Pandemic