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Coronavirus and Northern Ireland: The facts about 'Public Enemy Number One'

Dr Connor Bamford


There is a real likelihood of the virus, also known as SARS-CoV-2, showing up here. Good personal hygiene - not heading to your GP or A&E - is the key to fighting it, says Dr Connor Bamford

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The UK has nine confirmed cases of the coronavirus and Northern Ireland is told to expect cases

The UK has nine confirmed cases of the coronavirus and Northern Ireland is told to expect cases

AP

The UK has nine confirmed cases of the coronavirus and Northern Ireland is told to expect cases

As the number of confirmed infections breaches 40,000, leaving behind 1,000 deaths in its wake, the novel coronavirus has been branded "Public Enemy Number One" by the World Health Organisation and more of a threat than terrorism.

The virus, which originated in China in late 2019, is now called severe acute respiratory syndrome - coronavirus-2, or SARS-CoV-2 (previously it was known as 2019-nCoV) and has since spread to 25 countries across Asia, Europe and North America.

The UK has now identified nine cases and is currently fighting to contain further spread within its borders. Northern Ireland has been told to expect cases.

So, what is the new virus and the disease it causes, how bad will it get and what can you do to protect yourself?

SARS-CoV-2 is a never-before-seen infection in people that can cause a severe lung infection called pneumonia that can be fatal in around 1% of infections. It is worthwhile to bear in mind that other microbes can cause pneumonia, which we have a vaccine for, but they will not work against SARS-CoV-2 pneumonia.

Unfortunately, there is no vaccine against SARS-CoV-2, nor antiviral medicines to cure it. With an incubation period from a few days to a week or so, very likely everybody is susceptible to SARS-CoV-2 infection.

However, a spectrum of disease has been noted, which ranges from mild flu-like symptoms, such as aches, fever and coughing, right up to more serious signs, like difficulty breathing, leading ultimately to respiratory failure.

It is thought that, actually, most infections could be mild. Those with more serious outcomes were more likely to be older and have pre-existing medical conditions, such as heart disease, or diabetes.

SARS-CoV-2 is a kind of virus called a "coronavirus", named after its crown-like shape when observed using a powerful electron microscope.

The new coronavirus would be the seventh coronavirus known to infect humans; four of the others being innocuous agents of the common cold, while the final two, similarly, have caused deadly lung infections and they are called SARS-CoV and MERS-CoV.

You may remember SARS-CoV, which, as you might have guessed, is close cousin of SARS-CoV-2, as being responsible for an outbreak in 2003 in southern China that gripped the world as it infected 8,000 people, killing 10% of those infected before being eradicated.

MERS-CoV is actually a virus that causes the common cold in camels, but continues to jump species into people in the Middle East, killing around one-third of those.

Experts have estimated that, on average, each infected person could spread it to two or three others

Very likely all human coronaviruses - including SARS-CoV-2 - started out in non-human animals, such as bats, before making their way into people.

Although the animal origin for SARS-CoV-2 is currently unknown, the outbreak began at a live-animal market that housed numerous exotic animal species for human consumption.

What is most concerning about SARS-CoV-2 is its ability to spread between people. This is perhaps most evident in the rapidity and magnitude with which the numbers of cases have grown since its discovery in late 2019.

Experts have estimated that, on average, each infected person could spread it to two or three others, although this is only an average and, as recent cases in the UK have demonstrated, some infected people under certain circumstances may facilitate the spread to a value which is higher than the average.

In a similar manner, many people likely fail to pass the virus on to anybody. As SARS-CoV-2 infects your lungs, it can be transmitted through the respiratory route, not too dissimilar from the way that colds and the flu do.

However, there are myriad ways that an infection can spread this way, which include by coughs and sneezes, or by accidentally bringing the virus to your nose or mouth from contaminated surfaces.

It appears that most spreading of SARS-CoV-2 takes place in settings of prolonged close contact, such as within living spaces, and the current guidelines place the most risk at a distance of less than two metres for 15 minutes.

Vaccination is our greatest defence against virus infections. Take measles or influenza, for example. The measles virus has all but been eliminated from the UK, due to the extraordinarily safe and effective MMR jab, while every year the flu vaccine saves countless lives from a death caused by influenza.

However, there is no vaccine against SARS-CoV-2 yet, in part because of its novelty. Scientists simply have not had enough time to produce a safe and effective immunisation yet.

Unfortunately, there is only supportive care for infections with SARS-CoV-2, which will effectively manage your symptoms, supplying you with oxygen if you can't breathe, while we wait for the virus to take its course and for your body's own defences to kick in naturally.

Given the lack of vaccination, it is prevention of spread of infection that is our only real defence against this virus

However, spurred on by the threat of this new coronavirus and supported by funders across the globe, researchers worldwide are searching for treatments and vaccines against SARS-CoV-2, but this will likely take many months - if not more than year - to come to fruition.

You may thus ask how can you protect yourself and your family? Given the lack of vaccination, it is prevention of spread of infection that is our only real defence against this virus. This strategy can take place at a national level and at a personal level.

Nationally, through rapid diagnosis, contact-tracing and isolation with treatment of infected individuals, or quarantine of any suspected cases, the UK and other countries are able to effectively shut down spread of infection.

At an individual level, you can practice good hygiene measures, such as covering your mouth when coughing and sneezing, and by thoroughly washing your hands regularly.

It is not recommended that you use masks to protect yourself against SARS-CoV-2. While very rare, if you do have symptoms of SARS-CoV-2 infection, and have been to - or been in contact with anyone who has recently travelled to - the affected regions in Asia, then alert your healthcare provider, who will advise you on how to proceed.

It is not advised that you attend your GP, or accident and emergency, directly, in order not to pass the virus on.

Given the time of year and similar signs, it is more likely that flu-like symptoms are caused by common cold, or influenza, viruses, rather than SARS-CoV-2.

It is concerning that the number of confirmed infections and deaths from SARS-CoV-2 continues to grow around the world, with significant spread outside China, including in the UK, and there is an ever-real likelihood of cases popping up locally in Northern Ireland. However, there are signs that the situation isn't just as bad as it might seem.

For example, the vast majority of infections are currently located in just one province of China; there might be a slowing-down of new confirmed cases reported from China; and that, as the UK has demonstrated this week, we have extraordinary capacity to find, treat and contain this virus and protect our communities.

Dr Connor Bamford is a virologist at the Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast

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