COVID-19: Newly modelled projections, overseas travel advice

The Eastern Mediterranean Region is the focus of most concern for the World Health Organisation today, as it reiterated the need to enhance surveillance and response activities in relation to the outbreak of COVID-19 there.

The number of new cases in China is reportedly declining due to early and aggressive containment measures. Global numbers as at 3rd March: 90,870 cases, of which 1,922 in the previous 24 hours, almost all of which from outside of China.

UK cases and detection

As of 4th March, a total of 16,659 people have been tested in the UK, of 85 were positive (some of which have since recovered). The UK is one of the first countries outside of China to have a prototype specific laboratory test for this new disease.

After SARS in 2003, Public Health England developed a series of diagnostic tests to detect any member of the family of coronaviruses. These have been used for several years, and were able to detect the first UK case of Middle East respiratory syndrome (MERS) in 2012.

Travel advice (Source: Foreign & Commonwealth Office)

As at 4th March, the FCO is advising against all travel to Hubei Province, and against all but essential travel to the rest of mainland China. If you’re in China and able to leave, you are advised to do so.

The FCO is also advising against all travel to the city of Daegu and all but essential travel to the city Cheongdo, in South Korea.

It is also advising against all but essential travel to 10 small towns in the Lombardy region and 1 in the Veneto region of Italy.

The FCO is not advising against travel to any other country or territory as a result of coronavirus risks.

Modelled projections for COVID-19 (Source: AIR Worldwide)

Current observations suggest that a high proportion of infected individuals with the novel coronavirus, COVID-19, develop very mild and nonspecific symptoms. Therefore, they may not seek medical care and may not be counted in the published figures. Moderately symptomatic individuals usually experience fever, fatigue, and dry cough and may ask for medical care.

The current estimate of people who have developed severe symptoms ranges between 8% and 20%; these severe symptoms include pneumonia, shortness of breath and, in more complicated cases, acute respiratory distress syndrome, arrhythmia, and shock. Intensive care unit admission has been higher among people over 60 years of age with pre-existing comorbidities.

There is high uncertainty around the fatality of the disease; however, it is estimated that COVID-19 has a higher case fatality rate compared to seasonal flu (~0.1-0.4%) and a lower CFR compared to the 2003 SARS outbreak (~5.0%-10.0%). The current estimation for the average CFR ranges between 0.5% and 4%.

According to China Center for Disease Control among more than 72,000 patient records, with 86% of cases between 30 to 79 years old, current estimation for CFR ranges between 0.5% and 4%. CFR is estimated to be more than 5% for individuals with pre-existing conditions such as cardiovascular disease, diabetes, chronic respiratory conditions, hypertension, and cancer, and more than 8% for people older than 70 years old.

Currently there is no specific treatment available for this disease other than supportive care. There are some antivirals and other treatments currently being used to treat patients. So far, fatality is most common in older patients, with more than 80% of deaths occurring in people over 60 years of age, more than 40% of whom have one or more pre-existing known co-morbidities, including cardiovascular disease, diabetes, and malignancies. It is also important to note that people who are more than 60 years old are generally at higher risk for any type of pneumonia and not just COVID-19 pneumonia. For these reasons, an overall increase in cases of the virus does not imply a commensurate increase in fatalities.

Senior scientist at AIR Worldwide, Dr. Narges Dorratoltaj said: “In countries with robust healthcare systems, any imported cases would most likely be contained with few or no transmissions to additional people -- provided that cases are rapidly identified, and appropriate infection control protocols are followed. However, the current increase in the number of cases in some countries outside of China shows that there has been silent transmission that started in clusters and expanded to communities before health officials were able to contain them completely.”

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