How come children aren't becoming ill? And are there any long-term health implications? So much about coronavirus is still unknowable – but that hasn't stopped us blindly googling for answers. To provide some clarity, Grazia has asked an expert, Dr Freya Jephcott, a research fellow at Cambridge University where she combines anthropology and epidemiology to improve our understanding of responses to disease outbreaks of unknown origin, to address some of our biggest concerns...
How likely is it that young healthy people will die?
Not very likely is the short answer. It is surprisingly difficult to gauge how deadly an outbreak will be early on in an epidemic, especially if a lot of cases are mild or asymptomatic (not showing signs of illness) as is the case with SARS-CoV2 (the virus that causes COVID-19). Most estimates coming out at present suggest that if you heap all age groups together, somewhere between 0.5% and 4% of people who contract the virus will end up dying from it. It’s important to note, however, that not everyone in the UK will end up contracting the virus.
From what we’ve seen of COVID-19 so far, and from what we know of other coronaviruses that affect humans (there are actually quite a few), it tends to be elderly people and people with underlying health conditions that develop severe illness. So whilst some young and otherwise healthy people may end up getting very ill and even dying, the vast majority of serious cases will be amongst the elderly and the already ill. Just because young people are unlikely to die, though, doesn’t mean they don’t get infected and haven’t got an important role to play in fighting the spread of the disease.
Why has it spread so much in Italy and why have there been so many deaths?
Early on in the epidemic, countries in Europe were directing a lot of their resources towards detecting and isolating introduced cases of COVID-19. In practice, this means focusing on identifying cases among people who had recently travelled to areas know to have a lot of cases, such as the Hubei province in China. Unfortunately, no surveillance system is perfect and inevitably an occasional case will be missed and the virus can start to spread unnoticed in the new country. As only the first case is likely to have travelled in an area known to have cases and COVID-19 can look a lot like common illnesses such as the common cold, the virus can spread quite far in a new country before finally being detected. At this stage containment can be very difficult and It looks like something along these lines happened in Italy. It’s possible, maybe even likely, that there has been unrecognised spread of COVID-19 within other countries that just hasn’t been detected yet.
The seemingly higher proportion of deaths in Italy could be down to it having an older population than most other parts of Europe. Older people tend to develop a more severe form of the disease and are therefore at greater risk of dying. The apparently high death rate could also be a quirk of COVID-19 surveillance systems. Milder cases of illness tend not to be picked up by our surveillance systems as easily as moderate or severe cases, because if someone is more obviously ill they are more likely to get tested, especially if they are being treated at a healthcare facility. This means that during outbreak responses we tend to significantly undercount the number mild cases, which can have the effect of making a disease seem more deadly than it actually is.
Are there any after affects or long-term implications?
It’s still too early to say for sure. It appears that most people who contract COVID-19, especially if they only had a mild form of the illness, recover without any long-term effects. With more severe illness, the risk of long-term health effects is likely to increase.
Are asthma sufferers at greater risk?
This is outside of my area of expertise and it’s possible that there isn’t a definitive answer to this just yet. Right now the NHS website suggests that people with asthma are at greater risk of developing severe COVID-19, so a cautious approach is warranted here.
Why aren't babies getting it if they're just as vulnerable?
We know that babies can get infected by SARS2-CoV as at least two newborn babies tested positive for it in China. Whilst I don’t recall hearing about severe illness in either of them, there probably haven’t been enough cases detected in infants yet to say how vulnerable they are to severe disease.
Is it safe to be commuting, especially in London?
It’s hard to give one-off advice with such a rapidly developing situation. The best thing to do is to regularly check the gov.uk website for the most up to date guidance. At the time of writing this there wasn’t anything on there to suggest that you should be especially concerned about commuting in London.
That said, there are things you can, and should, be doing to help protect yourself such as regularly washing your hands with soap and water or, if soap and water aren’t readily available because you’re currently commuting to work for instance, clean your hands with one of those alcohol-based hand gels (ideally, one with at least 60% alcohol content).
Is it true that children can have it without showing serious symptoms?
There is strong evidence to suggest that most of the severe illness occurs in people over the age of 60 and that children in particular tend to experience relatively mild symptoms. That said, there is a lot we still don’t know about this virus and children with particular underlying medical conditions could be at increased risk of severe illness. Furthermore, it may turn out that even though children tend not to get very ill, they still have a significant role to play in spreading the virus so it’s important that we do get complacent.
What is the tipping point likely to be before we all self-isolate?
There are lots of different strategies that can be employed to help limit the spread of respiratory illnesses like COVID-19, ranging from people just washing their hands more often to the shutting down of entire cities as happened in Wuhan.
When talking about what disease control measures could or should be enacted in the UK in the future, it is not only going to be a question of what will be effective, but also what is proportionate and what is actually viable within a particular population. What I mean is, whilst the shutting down of Wuhan and instructing all of its residents to self-isolate was seemingly quite effective in slowing the spread of disease at the start of the epidemic, the same measures might not make much impact in a situation where there is already lots of transmission outside of the city, which is often the case later on in epidemics. Furthermore, those kinds of extreme measures might not even be logistically or culturally possible in a different population.
The UK government’s COVID-19 current action plan focuses a lot on trying to ensure the continuation of normal life in the UK and on making sure that the health system would be able to cope with an increase in the numbers of people with respiratory illnesses requiring care. There is mention of what we call ‘social distancing measures’ but this could be anything from asking people who can work from home to do so or the temporary shutting down of some kindergartens and schools to slow transmission. If there were areas where people were asked to self-isolate in larger numbers, as in Wuhan – and I don’t think that this is likely to happen – then it would probably make more sense early on in the epidemic when the spread of the virus is still concentrated to particular areas.
1In terms of experiencing the illness oneself, how is it different to normal flu?
The symptoms of COVID-19 are very similar to those of far more common respiratory illnesses such as seasonal influenza and the common cold. The most commonly reported symptoms are fever and a cough, however, there is considerable variability in severity person-to-person. As a rule, younger and otherwise healthy people seem to experience quite a mild form of the disease. A WHO spokesperson suggested that for most people it will be much more like the common cold than flu. For an estimated 15 – 20% of people infected, however, the virus will cause a more severe form of respiratory illness requiring hospital treatment. Elderly people and people with particular underlying health conditions are particularly susceptible to this more severe form of the disease. As time goes on and we learn more about the disease we’ll have a better sense of the likely trajectories of illness in different groups of people.
If you were advising someone to buy one thing to protect themselves from the spread of coronavirus, what would it be and why?
Soap or a good alcohol-based hand sanitizer (with at least 60% alcohol). Washing your hands regularly and well (as in, for 20 seconds with soap and water) has been shown to reduce the spread of infectious diseases such as influenza, and there is good reason to believe it will help limit the spread of COVID-19.
How quickly can you do a test? Is the result immediate?
The laboratory tests used for confirming COVID-19 cases in the UK at present do not give an immediate result. Exactly how long it will take from having a sample taken (typically a nose and a throat swab) to getting the test results will depend on a number of things, including how far away the nearest laboratory with testing capacity is. I have heard of some people getting test results within six hours, but this is probably on the quicker side of things.
I live with a person who is particularly vulnerable. What can I do to help protect him?
Only your housemate and the medical professionals managing their care will really be able to answer this. That said, it’s a good idea to adopt rigorous hygiene practices such as washing your hands regularly with soap and water and generally keeping the shared surfaces and objects clean.
This advice was up-to-date as it was published on 9 March, 2020 at 2pm.
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