Are We Heading for a Coronavirus Pandemic?

The coronavirus outbreak looks set-in for the long haul, with strong holds now in Northern Italy (currently at over 400 cases and 12 deaths) and Iran amongst others, and new cases cropping up in the news feed in a seemingly endless stream. Officials and health authorities are doing their best to try and limit the spread with travel restrictions, postponement of large events such as sports matches that would bring large numbers of people together, and school closures, but might it be too little too late?

Even with authorities trying to put measure in place, it requires the cooperation of the public too to abide by those rules rather than put themselves ahead of others. The situation in Italy is testament to this. Despite quarantining towns in Northern Italy where cases of coronaviruses had been confirmed, a group of individuals from Bergamo, just outside the locked-down area, persisted in travelling to Sicily where they kicked off another outbreak of disease. If you are in a high-risk area, stay put and self-quarantine!

Consideration had been given to closing Italy’s borders with neighboring countries, but cases have now been identified in these countries, suggesting such a measure is now too late.

Re-infection or uncleared infection?

According to reports from Osaka's prefectural government, a woman in Japan has been confirmed as a coronavirus case for a second time, weeks after apparently having recovered. This is the first time such a phenomenon has been reported but it raises questions for many.

Prof Paul Hunter, Professor in Medicine, University of East Anglia, commented “There is so much we do not know about this case to give a properly informed opinion. Did the woman test negative after her last positive and if so, how many tests were negative before her initial discharge? Does she have any underlying illness or is she on any treatment that could affect her immune system?”

With so many unknowns, what are the most likely explanations? Prof Hunter continued “So there are two possibilities:

1. This is indeed a relapse of the illness – This was seen is SARS but in someone who was being treated with steroids. It is possible that the illness could be biphasic as suggested by Dr Tierno though this is unlikely to be common based on current information.

2. She has a prolonged excretion of virus from her initial infection and tests were either not done or were not done sufficiently well or enough to confirm clearance. It does appear that swabs for the virus are not 100% reliable. In this case it is even possible that the recent sore throat maybe unrelated. COVID-19 tends to cause upper respiratory tract symptoms rather less frequently than did SARS.

I would caution against reading too much into this report given the lack of information. However, the report reinforces the fact that we have to investigate all such findings really thoroughly and report such information if we are to make the best decisions based on sound scientific evidence. At this time, I would council against changing management guidelines based on this case but we do need to always keep them under review.”

To facemask or not to facemask, that is the question!

With images of facemask-clad people all over the news, Jo public can be forgiven for assuming that this is therefore the answer to arming themselves against infection with coronavirus. Not so! As anyone who has worked in infectious disease containment conditions well knows, for effective disease prevention, a mask must

-          Be of sufficiently tight weave or density to prevent pathogens entering through the mask itself

-          Fit the face tightly so no air at all can escape or enter around the edge of the mask, even when you are moving or talking

-          Not be affected by moisture which otherwise significantly diminishes any protection offered

Dr Stephen Griffin, Associate Professor Section of Infection & Immunity, University of Leeds, said “Standard facemasks provide relatively little protection from respiratory aerosols – they can stop larger droplets and some studies have estimated an approx. 5-fold protection versus no barrier alone. Also, once they are worn for a time, they become moistened and protection diminishes further. Exhaled droplets also reduce in size quickly by evaporation, and of course virus particles are far smaller than the fiber mesh in these sorts of masks.” For anyone with facial hair, this too is a big no when it comes to the use of facemasks as it prevents an effective seal from forming.

So, is there any point to wearing a facemask? Dr Griffin continued “However, wearing a mask can reduce the propensity for people to touch their faces, which happens many more times a day than we all realize and is a major source of infection without proper hand hygiene. They are also useful for people that are themselves symptomatic in stopping coughs and sneezes, primarily by encouraging good “etiquette”, i.e. catch it, bin it, kill it…”

Are there any mask that do offer good protection? “There are higher specification masks that contain filters and, when properly fitted and sealed, provide significantly better protection. However, these aren’t as easy to come by and are obviously more expensive” concluded Dr Griffin.

Another aspect not considered by facemask wearers, is the vulnerability of the eyes as a route of infection. Given these considerations, the masks being used by the general public have very little to offer and can give a false sense of security. The best advice remains the same as for seasonal flu, if you are having to mix with people, carry out regular and thorough handwashing, be conscious of not touching your face and eyes, and use disposable tissues to cover your mouth when coughing or sneezing.