SARS-CoV-2 COVID-19 update 1

Rookwood, Going Postal
Virus VIH
KanijomanLicence CC BY 2.0

They say a week is a long time in politics, and an identical maxim could be applied to the field of commentary concerning emerging diseases. Not only has 2019-nCoV been renamed SARS-CoV-2, with a payload disease called COVID-19, but the news cycle seems to have been infected with an extremely virulent strain of hyperbole, interspersed with the pustulating boils of panic, fear and warnings that the structural supports holding the heavens aloft are about to structurally fail. Now that Brexit has been accomplished, at least in the most modest of terms, the UK media has rolled their bandwagons onto the pitch of an Armageddon style plague. Even some politicians are strutting their SJW credentials by self-isolating. Pity they all couldn’t follow suit. Permanently.

The UK media is not the only player trying to manipulate what is going on. Channel 4 did a half-hour special on Valentine’s evening just to set the mood. YouTube has taken to including links to the WHO (World Health Organisation) in many videos discussing the coronavirus, irrespective of the medical qualifications of the contributor. As part of the kickback against “Fake news”, there seems to be a concerted effort to direct the narrative away from facts, evidence and indeed truth. I wouldn’t mind so much but my irony filter blew a fuse when warning messages were displayed on Russia Today videos, informing me that the programme was sponsored by Russia. In the pursuit of controlling the agenda, according to Event201 (The mysterious and coincidental World Economic Forum Coronovirus “planning” exercise last December), it is essential that governments and new media take responsibility, shutting down the Internet if necessary to prevent the spread of any “uncomfortable truths”.

At the time of writing the last article, we didn’t have any “home grown” cases. All eyes are now on the London conurbation of Brighton, where a health centre has closed and a GP as well as an A&E consultant have now tested positive. There are reports of enforced quarantine, which seems strange as we are not profiling travellers. The genie is now out of the bottle for the UK, and we will see over the coming weeks and months what the true mortality and infection statistics are. China, having been caught out by the severity of the illness, has been forced not only to adjust their statistics, but to abandon sample testing for the virus due to sheer weight of numbers. They are currently relying on x-rays or image scanning to detect abnormalities in the lungs, as they focus on the most critical casualties. No doubt this will distort the figure further, as other illnesses may present with similar tissue damage. The system is clearly under intense pressure in China, and they are taking harsh measures to try and contain an already bolted horse. Some of the scenes coming out from this proud and independent nation could be torn from the pages of a history book covering the black death, and the sense of fear is palpable. In these troubling times, it is essential we bear the immortal words of Lance Corporal Jack Jones in mind – “Don’t panic”. For panic and irrational decisions can be more fatal than the outbreak itself.

A number of new facts have emerged over the past few weeks, some comforting and some less so. The good news is that case zero (the first identified case) seems to have been in the beginning of December 2019, which suggests the disease is not as fatal as first thought. At the time of writing, we are looking at 66,887 cases with a fatality rate (I assume those include pre-morbid complications) of 2.23%, or 1,523 victims. In my last article I used the figures of R0 (2.04), an incubation of period of 3 days, a mortality rate of 2.6%, and 10% developing fatal complications. It looks as if the overall mortality rate is lower than I suggested, which is good. The bad news is the infectious period, worse case, is up to 24-28 days. It is very difficult to extrapolate if this is [infectious-isolation/cured-infectious] or just [infectious-isolation/cured]. The anecdotal evidence suggests that the virus has an average incubation period of 5 days, yet this extremely high figure, which ever way you cut it, will push the R0 figure much higher. The evidence also suggests that up to 15% develop complications. So to summarise, while the elderly and infirm currently seem more susceptible, it is less fatal overall, but more infectious. To put this in perspective, seasonal flu (with complications) will hit a 1% mortality rate, which funnily enough is the figure the BBC currently use for SARS-CoV-2. To put this in perspective, the percentage of deaths attributed to both pneumonia and influenza currently runs at 6.9% in the US, but remains below the epidemic threshold according to [1]. Considering pneumonia kills in disease scenarios from chickenpox to HIV, I cannot stress this enough, it is the secondary infection or pre-existing condition that kills, generally not the primary illness in these circumstances. If current reported figures are accurate, the majority of SARS-CoV-2 sufferers will survive a very nasty bug. If they have a pre-existing medical condition, e.g. diabetes, hypertension or a lung condition, the prognosis is not so good. If you have a high number of ACE2 receptors, this seems to suggest a higher mortality rate. Be this down to genetics, race or smoking, this is the gateway through which SARS-CoV-2 attacks the body. It would be interesting to see a breakdown by these parameters, but there are some indications that men, women and different races will be affected very differently [2].

Now to switch from cold hard statistics to emergency planning mode. I make no apologies for adopting a “Titanic” stance on this, women and children first. It is disturbing that a baby was born with SARS-CoV-2, and it is currently undetermined if the virus was in the placental fluid of the mother or not. This suggests that pregnant women need to take extra precautions, especially as the infant mortality rate has not been clearly established yet. While newborns generally have incredibly strong immune systems, any infection that can cross the placental barrier or into a mother’s milk is very serious. Again, there are not sufficiently accurate statistics available yet to determine the age, gender and racial spread with any confidence, so in these circumstances prevention is far better than cure. Oxygen shortage in babies is a well documented cause of brain damage, so the secondary complications of SARS-CoV-2, (ARDS) have the potential to contribute to this, especially when the lungs are underdeveloped. The chances of an abnormal miscarriage are high, based on previous SARS studies.

Outside of the disease itself, we are beginning to see the impact on society as the Zeitgeist runs with this panic. Chinese industry is already at an extended New Year break of 16 days beyond normal, and the government resumption of work on the 17th of February may be extended. Shortages and price gouging of face masks continues worldwide, as people grasp at any security they can find against nature. Fuelled by some seriously profane propaganda on Twitter et al, people are being driven to panic. Scenes of people dropping dead in the street abound, despite the fact if you are that ill with a virus, you would feel so wretched not be out and about in the current circumstances. That said, the Chinese are very strong on the whole concept of “face”. They may feel they have to carry on regardless, which would explain the welding shut of apartment doors in certain regions to prevent the occupants leaving. So on that basis, I would suggest that the ongoing impact on China as nation will be catastrophic, and it will take considerable time for everything to level out, especially as the political ramifications reach further upwards. It used to be said if America sneezes, the UK catches a cold. Today, with global defence, technology and consumer sectors highly dependent on China, the scenario is very different.

Furthermore, apart from the virus, we have another Eastern devil in our midst. Just In Time delivery and production systems, originally developed in Japan for the automotive sector, are the mainstay of UK business. Behind your local Tesco, Aldi or Sainsbury there is no huge warehouse. At most, you will have 24 or 48 hours stock on board, all delivered from a centralised warehouse. JIT, like this accursed virus, has permeated every part of the supply chain. The whole Amazon concept is built on this, and it already shows. Fancy 500 3M Disposable Respirator Face Masks? £4,600. For that price, I would expect Amazon Prime, but there is a dearth of any sensible offering there, which suggest supply chain shortages. Ironically, what nation makes the worlds face masks? No prizes for guessing the winner. Expect major supply chain and service disruption in the UK and potentially globally as this virus takes deeper hold, irrespective of morbidity. With an extended incubation/infection period, expect individuals and employers to be very proactive in isolating potential cases, with a domino effect on efficiency. The government less so, as I will explain.

Government has two modes, business as usual and crisis. I said in my last article that I would hope that long before that point, our government would put in place strict isolation and civil contingency measures. They have failed in the former abysmally. 10 weeks from case zero, we have no regulated regime at airports and ports for checking symptomatic patients irrespective of where they are from, other than self declaration or observation of aircrew. Far from banning flights from China or other infected regions, we have chosen the path of complacency. Sadly, viruses have no regard for organisational stupidity, although rationality is an effective weapon as the enlightenment showed. My guess is the government is currently waiting to see just what happens, and it will not be until something goes badly wrong, this outbreak will be taken seriously and the government will then jump to crisis mode. We might just be looking at a bad flu season, but I shudder at the potential human cost when we only have 6,000 ICU beds available. Even if we argue that we have 10 times that amount of oxygen available at the bedside, if this outbreak hits critical mass, we only have sufficient infrastructure resource for a fraction of the population. Provided SARS-CoV-2 stays in the 10-15% complications bracket with a low RO, and adequate isolation is enforced, we have an excellent chance of surviving this relatively unscathed. These assumptions are being placed under considerable pressure though, as I predict other hotspots will soon emerge. The South East and large cities will take a major hit from incidents like this, being a major transport hub and people living in very close proximity. The widespread use of HVAC (Heating Ventilation and Air Conditioning) will also contribute to the spread.

That doom and gloom outlook is tempered with the fact we have a new media that will unwittingly drive people towards panic and isolation, which is a different scenario from infection entirely. My estimate is we will suffer infrastructure instability before we reach that medical crisis point as the Facebook and Twitter generation posts cases and rumours, causing a major ripple effect. Think of the 3 day week or the industrial action in the ’70’s as comparible scenarios, although with more technology in use, the impact will be somewhat different. Keep an eye out for black swan events, especially driven by panic or assumption e.g. mass walkouts due to lack of PPE (Personal Protection Equipment). People will be more stressed out than usual, so I suspect there will be a significant psychological payload as well, potentially spilling over into unrest if the situation deteriorates significantly. It seems a strange coincidence to me, but the narrative seems to be one of continually conditioning the public for the sight of armed police and NBC (Nuclear, Biological, Chemical) clad operatives on our streets. The Skripal affair certainly had enough of those. The majority of the public will not see this as precautionary, and no matter how insistent the government is, a “no smoke without fire” mentality will exaberate the stress and panic levels further.

As an inveterate Monty Python fan, I unapologetically suggest the following. Nobody expects the Spanish inquisition, even less an incarnation of the Spanish flu. A classic haemorrhagic fever, symptoms included coughing up blood and bleeding from the ears. No such incidences of these symptoms have been so far documented in medical journals of this outbreak. As Gloria Gaynor sang, we will survive. From the information gleaned so far, yes, I am concerned, but there are far nastier scenarios out there which we are nowhere near. For the more cynical amongst us, I can see enforced vaccinations being the next step coming out of this crisis. Already, students are being refused entry to university for not having up to date MMR shots. My money is on a mandatory vaccination law being passed in the UK soon. Which should send chills up the spine of any sane individual, even more so than any fever SARS-CoV-2 might produce. The outcome of this outbreak, irrespective of any human cost, will be more centralised control. When we have an NGO called ID2020 pushing for a global ID, in bed with Microsoft and the vaccine industry, in the year of a potential global epidemic, something doesn’t quite add up.

My advice? As copied from Dr. John Campbell:

1. Stay home when possible, avoid planes, buses, trains, queues, busy areas.
2. No visitors, avoid close contact with symptomatic people or potential carriers, don’t share cups.
3. No handshakes, kisses, hugs. Don’t kiss babies. All outside surfaces, money.
4. Gloves and meticulous hand hygiene, don’t touch eyes, nose mouth.
5. Wash hands, warm water and soap or hand sanitizers.
6. Catch it – bin it – kill it.
7. Coughs and sneezes spread diseases.
8. Faecal contamination, meticulous hand and surface hygiene.
9. Wear a quality medical mask or N95.
10. Wrap around glasses.
11. Avoid hospitals, limited visiting.
12. Good nutrition, vitamin D.
13. Keep warm, sleep, family life.
14. Thoroughly cook meat and eggs.
15. Avoid public spaces and wear a mask at home if you start to feel ill with fever.

For those that want a daily, level-headed commentary on the latest status of the bug, I would recommend Dr. John Campbell [3] and MedCram [4] to the house. For latest stats, see the the John Hopkins University GIS map, partners in Event201. [5]. If you enjoy statistics, there is an excellent XLS spreadsheet for analysis of the outbreak [7]


[1] Contagion live
[2] ACE2 receptors genetic study
[3] Dr. John Campbell
[4] MedCram
[5] JHU COVID-19 outbreak map
[7] COVID-19 analysis tool by andology

© Rookwood 2020

The Goodnight Vienna Audio file