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Until a vaccine, all our strategies must protect NHS and vulnerable

Connor Bamford



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NHS doctors working on the front line

NHS doctors working on the front line

AFP via Getty Images

NHS doctors working on the front line

The Covid-19 pandemic caused by the virus SARS-CoV-2 has already claimed the lives of 207 people in Northern Ireland, with over 2,600 confirmed cases across the region.

Covid-19 threatens to claim more lives in the near future. To date, over the last five months, more than 167,000 have died worldwide.

Although most people remain with only mild symptoms, Covid-19 can be a devastating illness, particularly in the elderly or those with certain underlying health conditions.

Without a safe and effective vaccine that can be scaled up rapidly there is little hope of controlling SARS-CoV-2.

We can only hope to slow its spread, avoiding overwhelming our already-strained health service, through public health measures such as lockdown, social distancing and isolation.

While we should all take solace in the fact that this approach is working, it may not be enough. There is a concern that we can all look too closely at the numbers of cases and confirmed Covid-19 deaths. This is especially true considering that we are not currently testing widely and so risk not being representative.

Furthermore, Covid-19 does not just affect infected people, and the disruption it is causing can have deadly knock-on consequences via poverty and disrupted health care.

Looking at what everybody is dying from may give us a clearer picture, and in Northern Ireland all-cause mortality shows a rapid peak towards the end of March, which plateaus similar to what we see for Covid-19-specific fatalities.

Studying the official figures, the Northern Ireland Covid-19 epidemic began in earnest in the first week of March and initially grew rapidly.

Then came lockdown and people's movements and connections dwindled quickly, and therefore so has the virus. Over the next weeks we saw something dramatic happen - the trajectory changed.

No longer was SARS-CoV-2 spreading as fast, doubling every three to four days. Now the virus could spread only as half as fast, doubling every eight days.

It may even be more impressive than that as we are more intensively sampling people at most risk, such as front line workers, and thus could be over-estimating the prevalence.

Some quick calculations, comparing confirmed cases now with predicted cases extrapolated from early March's growth rate, suggests that lockdown has likely prevented over 80% of the cases, which could translate into hundreds of lives, lives that would have been lost if people did not abide by social distancing when they did.

Given its rapid spread, every day of lockdown equates to an ever-increasing number of lives saved.

While the public is evidently asking where is the peak, it is clear that we are in its midst only we have flattened it, which transforms it into a depressing, plateaued march of fatalities we are experiencing.

If our strategy is working to limit the peak, how then do we get out of this situation and brace ourselves for inevitable future epidemics or waves of Covid-19?

As SARS-CoV-2 is still very much 'out there' in the community, our next steps may rely in part on keeping a very close eye on the virus as it moves between people in the community.

However, this approach is much harder than it appears.

The vast majority of people infected with SARS-CoV-2 may only have 'cold-like' symptoms.

Those mild cases are capable of spreading the virus to unsuspecting people around them. Worryingly, we even know now that SARS-CoV-2 can be passed on before you feel any symptoms.

In the weeks to come we should expect more deaths in line with the dozens a day we are seeing currently as long as social distancing is maintained.

However, the situation in the care sector may result in more as it is clear that it was not as well protected as it should have been.

As we are not testing in the community then we can only hope those people making it into the hospital paint a representative picture of that situation, if appearing a week slower than we would like.

The post-lockdown situation might therefore require changing how and who we test, moving the testing closer to where the virus is in the community to keep a hold on it. Another strategy could be radically altering the tracking of the virus through the use of apps that monitor Covid-19‑like symptoms, where they occurred and nearby whom, which would facilitate quick isolation.

All our strategies must first of all serve to protect the healthcare system and those who are most vulnerable in the community.

Dr Connor Bamford is a virologist based at Queen's University

Belfast Telegraph