COVID-19 in the UK: Expert Q&A

Peter Russell

February 14, 2020

A confirmed case of COVID-19 (coronavirus) was seen in London this week.

The woman, who had travelled from China, 'self-presented' at the A&E department of University Hospital Lewisham last Sunday.

Much media attention was focused on the role played by public transport in virus transmission, including the London underground, buses and taxis.

Robin Thompson, PhD, junior research fellow in mathematical epidemiology at the University of Oxford, said: "In general, if a virus arrives in a dense population, or at a transport hub, the potential for transmission is higher. A key factor determining the risk of sustained transmission is the number of cases [contacts] that an infectious host has, and this can be higher if the initially infected host or hosts are in a well-connected location."

However, he told Medscape News UK that in this week's case in London, which involved a woman travelling to hospital in an Uber taxi, she "was isolated very quickly" and that "the risk to any other individual is still very low".

Among other developments in the past few days:

  • Sir Simon Stevens, NHS England chief executive, warned that many more people may be forced to self-isolate as part of efforts to stop the virus spreading

  • The coronavirus outbreak in Wuhan could peak in mid-to-late-February, a preliminary analysis by the London School of Hygiene and Tropical Medicine said

  • The Church of England said parishioners with coughs and sneezes should receive only the bread and not share the wine at Holy Communion

  • The British Dental Association warned that a shortage of face masks sparked by the coronavirus outbreak posed an imminent risk of disruption to UK dental services

Q&A

We asked Michael Head, PhD, senior research fellow in global health at the University of Southampton for his assessment of the threat posed by COVID-19 to the UK, and how long it might continue.

Dr Head: There is one theory that it might replicate flu – it might die out at the end of what we normally see as the flu season.

Alongside that there is containment and isolation that's going on in China and internationally, and the pick up of patients as early as possible here in the UK.

I think that the end-of-February estimate is plausible. But obviously there's still so many unknowns, that we can't say for sure.

I think the summer estimates are more the worst case scenario, and we hope we don't get to that – but it could happen.

There seems to be much we don't know about this virus

The number crunching is difficult. 

There are a couple of things that in the grand scheme of things are a little bit reassuring: there's not a huge amount of person-to-person spread outside China. That in itself is reassuring, and is one reason why a late February peak might be reasonable.

Also, the fact that children seem to be reasonably sub-clinical, or asymptomatic. There's not many children being hospitalised for serious illness, for example. Perhaps their immune system is doing rather well at countering it when it first invades the body.

Often in, for example, swine flu, children remain conduits of spread. There were peaks in cases being reported during term times.

Because children don't seem to be so badly affected with coronavirus, that's obviously another reassuring variable here which gives us a little bit of confidence that this can be contained before it does go pandemic.

How much could the public transport system be responsible for spreading COVID-19?

It's a credible concern, [but] the available data is a bit thin on that precise point.

We know that flights are a conduit for international spread because it’s quite easy to track passengers. We know who gets on and off a flight, and where they go.

If you're on public transport in the centre of London, you don't know who's on that, or who you caught your infection from. It might have been from the person on the train, but you don't know that.

So, the data is a little bit difficult to disentangle to say that outbreaks are definitely spread by hanging around on London buses or London tubes. There's people mixing in the same place, so it's likely to have some impact but the data that I've seen from looking at papers from years gone by suggests that slightly longer distance travel, when you're in a contained space for a longer period of time, like long-distance trains, or flights, seem to be more of a conduit for spread than a London tube stop, where you might only be on the train for a few minutes.

How do you predict the future of COVID-19 in the UK?

For my best guess, I would go with the London School of Hygiene and Tropical Medicine who reckon it will peak at the end of February.

There will be a little bit of spread within the UK, but not a huge amount. 

I don't think we will have sustained, endemic spread within the UK.

Why do you think that?

I think a multitude of factors, together.

The fact that we are on high alert, and seem to be picking up cases pretty early.

The NHS has [an excellent record] previously with SARS, and with the odd Ebola cases that have come to the UK.

So, we as a country are experienced with handling that sort of thing.

The fact that children don’t seem to be spreading it like wildfire is a good thing, and the fact there doesn't seem to be a huge amount of person-to-person transmission outside of China.

I think for those reasons I'd be cautiously optimistic that it shouldn't have too great an impact here in the UK.

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