Dr Freya Jephcott is a research fellow at Cambridge University where she combines anthropology and epidemiology to improve our understanding of responses to disease outbreaks of unknown origin. Here, she addresses some of the most frequently asked questions about coronavirus.
UPDATE: This article was first published on 11 March – and on 16 March, the government updated its advice for pregnant women. You can read more about it here.
When will coronavirus likely peak?
What an epidemic ends up looking like is determined as much by the behaviours of the population it’s spreading in as the causative agent itself, which in this case is SARS-CoV2, the virus which causes COVID-19.
We are currently working to slow the epidemic as much as possible, in part, to limit the strain we put on our health systems but also to try and avoid a situation where a large chunk of the working population are simultaneously stuck at home or hospital, sick or looking after a sick loved one, which could disrupt supply chains and other critical services. Typically, when we slow the spread of a virus during an epidemic we flatten what we call the ‘epidemic curve’, which is that wobbly shape you get on a graph when you plot the number of new cases over time. This means the epidemic ends up having a lower, later peak and often results in a lower total number of cases.
When the virus peaks, for us here in the UK or for the global population, will be determined by the actions we collectively undertake over the coming months. It is important to remember that whilst this virus spreads very quickly, the epidemic, and therefore the epidemic response, will unfold over months, maybe even years, not weeks or days. Whilst I can’t give you an exact date for the peak, nobody can at this point in time, I can tell you, however, that I think it is unlikely to be within the next few weeks so we need to be preparing for a long game. I feel that I should also mention that epidemics often have multiple peaks and there is a good chance that we will experience resurgences of cases after an initial peak.
Should pregnant women or those trying to conceive be especially concerned about coronavirus?
This question is well outside of my area of expertise so I’m going to quote directly from the Royal College of Obstetricians and Gynaecologists website, which at present says that, ‘Pregnant women do not appear to be more susceptible to the consequences of coronavirus than the general population.’ Significantly, it does go on to note that 'As this is a new virus, how it may affect you is not yet clear. It is expected the large majority of pregnant women will experience only mild or moderate cold/flu like symptoms.' I would recommend checking their website regularly as we are likely to learn significantly more about the clinical course of the virus over the coming months and they are one of the groups most likely to aggregate and communicate the findings. Regardless of whether you are pregnant or not though, doing simple things like washing your hands regularly and well (20 seconds with soap and water) is likely to reduce your risk of contracting the virus.
Will coronavirus come back every year like flu?
We just don’t know enough at this point to say, but it is something that a number of prominent public health figures are seriously considering.
There are a few questions that need to be answered before we can get a good sense of the likelihood of this happening. These questions include: how long do people remain immune to SARS-CoV2 once they’ve recovered? Do we get any kind of immunological cross-protection from any of the more common coronaviruses found in humans? Is there a natural seasonality to the virus, as with some of the other coronaviruses in humans, where we tend to see higher numbers of cases in the cooler winter months?
A couple of the viruses responsible for the common cold are endemic coronavirus of humans, but there have also been coronaviruses that made the jump into humans that didn’t persist such as SARS-CoV, which was responsible for relatively short, sharp epidemic back in 2002. It would be very sad to see a new virus join the list of endemic diseases of humans, but whilst we wait for answers on that we must do what can to slow spread of the virus during this initial epidemic stage in order to safeguard our health systems and protect the health of the more vulnerable members of communities.
Should people who wear contact lenses avoid wearing them and revert to glasses in case of germs?
Interesting question. Logically it follows that if you wear glasses rather than contacts you’ll touch your eyes less, which in turn would reduce your risk of infecting yourself with the virus. The glasses themselves might even partially shield your eyes from respiratory droplets (what we think is mostly spreading the virus). That said, in practice I really don’t know how much difference it would make.
We’ve still got a lot to learn about how this virus spreads. We know that respiratory droplets (released through coughing, sneezing and sometimes just talking or breathing) have an important role to play in spreading the virus. We also know that touching our mouths, noses and eyes, especially with unwashed hands, increases our risk of contracting certain respiratory viruses. What we don’t know yet - and honestly, we may never know - is how often SARS-CoV2 infections result from people touching their eyes. In truth, it might not be that much.
I’m sorry I don’t have a clear answer for you, but if it isn’t too much hassle and if you live in an area that’s seeing a lot of COVID-19 transmission, then maybe give it a go. Who knows, one day it might be shown to be an effective protective strategy?
How deadly is coronavirus?
Most estimates put the case fatality ratio (CFR) of COVID-19 – that is the proportion of infections that are likely to result in death - between 0.5% - 4%, with most experts leaning towards the lower side of the range. With COVID-19 there is a very strong skew towards severe illness in older people and people with particular underlying medical conditions, with some estimates putting the CFR for people over 80 years of age at over 14% and the CFR for people under 40 at around 0.2%.
Just because you don’t belong to a high risk group, however, doesn’t mean that you’re not at risk of getting very sick. It also doesn’t mean that you don’t have an important role to play in slowing the spread of the virus. Washing your hands well and often, as well as following the current guidance coming from local health authorities around things like social distancing (e.g. working from home where possible) is not only about protecting yourself from contracting the virus but also about protecting the people around you.
Is coronavirus man-made?
No, it is not man-made. Well, at least, not in a ‘grown in a lab’ kind of a way.
I assume this question is in reference to some rumours circulating online and published in some parts of the American press recently involving a research laboratory in Wuhan and sometimes incorporating some spurious claims about the genetic code of the virus.
I think in part people jump on these conspiracy theories about outbreaks being man-made whenever we have large outbreaks (e.g. Ebola, HIV etc) because a lot of people don’t understand how precarious our situation already is in terms of vulnerability to emerging diseases.
Few people working in global health are likely to be surprised by the current outbreak, so much as frustrated that we weren’t better prepared for it given what we already knew about viral emergence. Since the late 1980s it has been clear that we are living in an era of emerging infectious diseases. This is because so many features of modern life (e.g. escalating environmental degradation, high-density animal farming, increasingly large and mobile populations etc.) are known to promote the emergence and spread of infectious diseases, especially viral zoonoses (viruses that, at least initially, are spread to humans by animals). That it happened to be a coronavirus this time isn’t especially surprising either. As a group of viruses they do seem to be particularly predisposed to what we call ‘zoonotic spillover’, essentially, making the jump from animal populations into human ones. In fact, two of the viruses responsible for the common cold are coronaviruses and back in 2002 we had a large epidemic caused by a coronavirus called SARS suddenly making the jump from an animal population (probably civets) into humans.
As Laurence Fishburne’s character in the film Contagion points out, ‘Someone doesn't have to weaponise the bird flu. The birds are doing that.’ The same is more or less true of coronaviruses, though I would note that we’re not helping the situation by not addressing those larger human drivers of disease emergence I mentioned above.
Can an individual do anything to strengthen their immune system if they're worried about coronavirus?
I don’t know of anything you can do to boost your immune system against COVID-19 in particular. That said, there are a few pieces of general advice when it comes to maintaining a strong immune system: best as you can, stay fit and healthy; don’t smoke; make sure that you’re up to date with your routine vaccinations; and if the seasonal flu vaccine is available in your area right now and recommended for general use (some places prioritise flu vaccine for people belonging to particularly vulnerable groups), I’d recommend getting it too. Whilst the flu vaccine won’t protect you against COVID-19 directly there are a number of indirect benefits in terms of fighting COVID-19, including avoiding a nasty co-infection, lessening the chances of being mistaken for a COVID-19 case when you happen to just be down with the flu, and generally reducing the chances of your making demands on a health system when its busy fighting an epidemic.
This advice was up-to-date as it was published on 11 March, 2020 at 3pm.
Read more: Coronavirus: Will I Have To Cancel My Summer Wedding?