6 August 2020

Discussion

What we know

• this is a novel disease and it will take time for its full impact to be known
• it can be spread by people with no apparent systems
• some people will die as a result of infection
• others will suffer persistent complications that can be debilitating
• spread can be controlled by a combination of physical distancing and face coverings

The disease

The first thing to say is that the SARS-CoV-2 virus is novel. We have not seen anything quite like this before and we need to be very cautious with it.

One of the most difficult aspects of this virus is that it can be spread by apparently healthy people who are showing no signs whatsoever of being affected by it - "asymptomatic spread". An early chinese study suggests that around 80 per cent of people who are infected will show nosigns of the disease. Many of the precautionary measures taken at the start of the outbreak, such as temperature checks and symptom screening, have not stopped the rapid spread of this virus. On the other hand, countries that have been ultra-cautious, such as New Zealand, have come out well.

Professor Charles Swanson of the Francis Crick Institute told a recent BBC Panorama programme that infected people can spread the virus for 2-3 days before they show any symptoms themselves.

Another "novel" feature of the virus is that damaging blood clots can be produced as our immune system fights off the virus. We will discuss the effect of this later in this article.

Some confusion has arisen because of the international definition of the "mild" form of the disease. If you have the "mild" disease, then you do not end up in hospital. Many people infected have reported extremely uncomfortable symptoms and would object to the label of a "mild" disease.

One thing that has improved since the start of the outbreak is that the chance of dying in hospital in the UK with the disease is now lower than the frightening 15 per cent [Case Fatality Rate] sen during the early days. This is because of considerable improvements in treatment. (Obviously, this will only hold as long as the hospitals do not become overloaded.) However, recent figures confirm that the disease is [still more lethal]https://www.medrxiv.org/content/10.1101/2020.08.06.20169722v1) than 'flu.

With a lot of attention on the number of people dying, it is easy to miss the discrepancy between those who have tested "positive" and those who are subsequently described as "recovered" (and, as far as recorded deaths are concerned, no one in England is considered to have recovered). Obfuscated by the number of tests ordered privately instead of being reported to, and tracked, by the NHS, these statistics are also clouded by the length of time that people suffer from the disease (often weeks). When cases are growing rapidly, it is difficult to see patterns in this.

But it is now clear that there are dangers to this disease other than the one that shoves us beyond "the final curtain". Even when applying cruel irony, we cannot pretend that this is like pneumonia, "the old people's friend" Young people are affected, too. Only not so obviously.

"Long-haul" or "Long" CoVid

Now that infections have been around for several months there are reports that "[up to half a million Britons are suffering the effects of "long Covid"[(https://www.telegraph.co.uk/politics/2020/08/05/mps-hear-aftereffects-coronavirus-can-linger-months-cause-lasting/)" with those affected reporting lingering symptoms consistent with increasing incidence of internal damage.

Data from the Covid Symptom Study app, (downloaded more than three million times), suggested in July that a "significant number" of people report symptoms for a month after infection. Over one in 2https://twitter.com/danjlevy/status/12629459366128517130 suffrerers report symptoms for longer than that, says genetic epidemiologist Prof Tim Spector.

We have scientific confirmation that SARS-CoV-2 is infecting "privilege" immune sites, including the central nervous system30221-0/fulltext), bone marrow, reproductive system, and all the major organs

Post-infection complications include brain damage, heart arrhythmias, shortness of breath, intense fatigue, diabetes and other serious conditions. Damage to the nervous system can occur even in people with mild cases of the disease.

Reported symptoms in other studies include nausea, chest tightness, severe headaches, "brain fog" and limb pains. Recurring symptoms can last for weeks - and even months - after their diagnosis. Prof Paul Garner from the Liverpool School of Tropical Medicine is an epidemiologist who has been studying his own post-Covid19 long-haul journey since he first fell ill on 19 March. He describes his condition now as "being like Chronic Fatigue Syndrome (CFS) or ME".

Elsewhere, complications are listed as brain damage, heart arrhythmias, shortness of breath, intense fatigue, diabetes and other serious conditions that could be short-lived or persist long-term – we simply don’t know yet.

Studies show that younger people (30 - 50 age group) have a significantly higher chance of strokesfollowing infection. In another study, one in five young adults under 34 were not back to their usual health three weeks after testing positive.

One of the more disturbing research papers has just been published in The Lancet30228-5/fulltext) revealing possible disruption to micro-structural and functional brain integrity in the recovery stages of COVID-19 in 55 per cent of COVID-19 patients, with no significant difference between severe and non-severe cases. This suggests long-term consequences of SARS-CoV-2 infection.

A recent article in The Atlantic sums up the situation. "Most have never been admitted to an ICU or gone on a ventilator, so their cases technically count as “mild"... their lives have nonetheless been flattened by relentless and rolling waves of symptoms that make it hard to concentrate, exercise, or perform simple physical tasks. Most are young. Most were previously fit and healthy".

Dr Mick Hart, the doctor who treated Prime Minister Boris Alexander Johnson at St Thomas's Hospital in London has said "Coronavirus is our generation’s polio". (In previous generations, poliomyelitis left some victims disabled for life).

Conclusion

This is not the 'flu. This is a serious and sometimes life-threatening disease. Everyone should avoid the possibility of becoming infected, and to ensure that they don't infect others.

Comments are welcome, but you will have to log into our site to leave them here.

What we know about the virus

The spread of SARS-CoV-2

Staying safe

What we still don't know about the virus

Back to policy statement

Further results of our "desk research" into the current coronavirus outbreak will be published here.