COVID-19 – CMO Update and Overview – 5th Edition

Date of data extraction: March 24, 2020.

Given the fast-changing situation, this overview is being updated approximately on a weekly basis.

New If you read the previous edition, new/amended content can be quickly found via the small green box markers.

Much is still unknown about the 2019 novel coronavirus (SARS-CoV-2). This document, created by Achim Regenauer, Chief Medical Officer PartnerRe, is intended only as a general overview. Opinions expressed are those of the author. Over the coming weeks and months, a much clearer picture of this virus and its impact is likely to emerge. We hope you find this information useful.

 


Terminology

  1. The virus: SARS-CoV-2 (similar usage to the term “HIV virus”)
  2. The disease: COVID-19 (similar usage to the term “AIDS”)

New Updated personal assessment of the author

As of March 11, the WHO has labelled the COVID-19 outbreak a pandemic. In the meantime the focus has shifted from China to Europe, the US and other parts of the northern hemisphere.

In most countries, the doubling time of reported infections is in the range of only 2 to 5 days. Limited testing capabilities, reporting lags of more than a week and undetected mild/asymptomatic cases (potentially more than one third) mean that actual case numbers are likely to be far higher than reported.

It is hoped that applied non-pharmaceutical measures, as now mostly being implemented in Western Europe, will decelerate transmission and prevent the breakdown of healthcare systems given limited intensive care resources and ventilators. It will be approximately two weeks before we know how successful these measures have been. The first very tentative data from Italy is encouraging.

Even stronger non-pharmaceutical measures (containment plus digital monitoring of quarantine measures and tracking of individuals), as taken for example by China, Singapore, Taiwan and South Korea, have already yielded positive results. It is unclear, however, what will happen in these countries, nor indeed in any country imposing control measures, once the measures are relaxed.

It is remarkable that so much knowledge about this new virus has been gained in such a short period of time. Advances in diagnostic testing are also progressing well, with a promising outlook of imminent deeper insights into the virus’ epidemiology.

As to further development, the spread of SARS-CoV-2 is fast and similar to the spread of annual influenza. So might this disease also be, or become, seasonal? Could it subside (northern hemisphere) during the coming spring and summer seasons due to higher temperatures, higher humidity, increased UV light exposure and less time spent indoors? Experts1 remain skeptical about this as much remains unknown about the virus.

Another important unknown is whether patients who have recovered from COVID-19 will develop a lifelong immunity or only a partial, time-limited immunity. This question has enormous implications for a future vaccine.

It is too early to determine the full impact on national healthcare systems, economies and societies. It is likely that the virus will be evident during winter 2020/21, and that by then there may be an effective vaccination and therapies.

The virus’ mortality, expressed by the Case Fatality Rate (CFR)*, is reported with wide ranges, but may come down to less than 1% in the majority of countries with a robust healthcare system. Risk assessment currently still lacks reliable screening tests, challenging modelling due to the ongoing presumably high number of undetected asymptomatic cases.

A major concern is that SARS-CoV-2 has now spread to developing countries where testing is rare, such as Africa, which is in close trading contact with China and the Middle East, and physically close to Iran.

If the lockdown situation in China continues for considerably longer, a disruption to the global pharmaceutical supply chain may become an issue given China’s key role in pharmaceutical production; many chemicals used in the making of new medicines come from China.


*CFR: Case Fatality Rate.
The ratio of deaths to the total number of people diagnosed with the disease over a certain time period.

Where it all started

Novel zoonotic coronavirus SARS-CoV-2 was first identified during an outbreak of pneumonia in Wuhan City, Hubei Province, China in November 2019. On January 9, 2020, the WHO announced that this is a new strain of coronavirus not previously identified in humans. The virus is now rapidly spreading in Europe, Asia and North America, with first cases in many countries in Africa, the Middle East and Latin America. On March 11, the WHO declared this to be a pandemic.

New Epidemiologic situation

New infection numbers currently lag reality by approximately 8 to 10 days due to incubation and reporting times. The genuine current situation is therefore likely to be higher than the reported infection number doubling times of 2 to 5 days.

Since December 31, 20192 – and as of March 24, 2020 – 381,000 confirmed cases of COVID-19 (according to the applied case definition in the impacted countries) have been reported globally. The table below lists the countries most affected, respectively most tested, for SARS-CoV-2 infections3.

CountryConfirmed casesDeathsCase Fatality Ratio*
China81,5533,2814.0%
Italy63,9276,0779.5%
USA46,3975931.2%
Spain35,1362,3116.6%
Germany29,0561230.4%
Iran24,8111,9347.8%
France20,1288624.2%

*: For more information and discussion points relating to the CFR, see section ‘How lethal is COVID-19?’

What are coronaviruses?

Coronaviruses are a large family of viruses.

  • Some cause illness in humans (e.g. the common cold, Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS)).
  • Others are common to different animal species including camels, cattle, cats and bats.
  • Rarely, animal coronaviruses can infect humans and then spread between humans, such as with:
    • SARS 2002/3. Note, it took over a year to halt the spread of this virus. Any ongoing transmission is mostly secondary in the hospital setting.
    • MERS 2012. Note, despite rigorous control measures, isolated outbreaks of MERS-CoV are still occurring. Again, any ongoing transmission is mostly secondary in the hospital setting.
    • SARS-CoV-2. A new strain of coronavirus not previously identified in humans (the topic of this overview). In contrast to SARS and MERS, the mean transmission is occurring via close person-to-person contact, a factor more likely to initiate a pandemic, as has now occurred.

Transmission and the likelihoods of infection and falling ill

  • As humans have not previously been confronted with SARS-CoV-2, there is no natural (cross) protection from the immune system.
  • The transmission of SARS-CoV-2 is different to influenza and SARS; evidence is growing that the virus replicates efficiently in the upper respiratory tract (throat) and causes a slower onset of symptoms in contrast to SARS-CoV-1. Of added concern, the virus concentration in throat swabs is highest before symptoms have manifested. Infected individuals therefore produce a large quantity of virus in the upper respiratory tract during a prodrome period, but during this time they feel well, are mobile and carry on usual activities, contributing to an easier spread of infection. These findings4 complicate screening and containment measures.
  • Person-to-person transmission through direct and close (about 1.5-2.0 meters) contact via aerosols is the most common transmission mode for SARS-CoV-2. The median duration of viral shedding can be up to 20 days. Epidemiological records from China suggest that up to 85%5 of human-to-human transmission has occurred in family clusters6.
  • An indication of the risk of infection from social contact is given by the secondary attack rate, defined as the probability that an infection occurs among susceptible people within a specific group (e.g. household or close colleagues).
    • According to initial reports, the secondary attack rate of SARS-CoV-2 is estimated to be between 1% and 5%, and even as high as 35%, though supporting studies remains scarce7 and include only small sample numbers.
  • Based on R0 estimates of 2-3 (see R0 definition in section, ‘The pandemic potential’), mathematical models suggest that 50–60%8 of the global population will eventually be infected, in part due to a lack of awareness.
  • New The role of asymptomatic carriers in transmitting infection is still not understood9 – pre-symptomatic infectiousness (i.e. during incubation period) therefore remains a concern. It is now assumed that infected individuals begin to transmit SARS-CoV-2 one day before the onset of COVID-19 symptoms10. A first report from Shenzen in China estimated that 23%11 of transmissions may have originated from pre-symptomatic infections.
  • New SARS-CoV-2 has been detected with virus RNA along multiple routes of transmission12, but questions remain regarding the respective implications of varying forms of transmission:
    • The primary route is via coughing or sneezing: in one study, viable SARS-CoV-2 virus was detected in aerosols in largely stable amounts for 3 hours13,14 after aerosolization, although the heavier droplets containing the virus as produced from coughing and sneezing are likely to fall out of the air faster.
    • Contact/objects. There are some preliminary indications15 that object contamination, e.g. of door handles, toilets and sinks, may play a minor role. On a positive note, the virus was successfully decontaminated (no longer detectable) after routine cleaning. In terms of how long it remains viable on surfaces, no viable virus was detected after 4 hours on copper, 24 hours on cardboard, and 72 hours on plastic and stainless steel16. At over 30°C, the survival duration of SARS-CoV-2 is shortened17. However, it should be stressed that all these findings relate to laboratory-based investigations which do not correspond fully to real-world conditions.
    • Blood. Although coronaviruses usually infect the upper or lower respiratory tract, viral shedding in plasma or serum is common. There is therefore still a theoretical risk of transmission of coronaviruses through the transfusion of labile blood products.
  • The incubation period is currently assumed to be approximately 5-6 days, but there are some outliers, including rare claims of up to 27 days.
  • New Not everybody infected with SARS-CoV-2 will fall ill. Three studies from different settings (the cruise ship outbreak, returnees and a contact-based case search) reported manifestation index values (the percentage of infected persons who became ill with symptoms) of 51%18, 69%19 and 81%20 respectively.
  • New There are also reports21 of recovered COVID-19 patients with resolved chest findings, no ongoing symptoms and no subsequent contact with infected persons, but who showed repeated positive RT-PCR (see definition in section, ‘How is the virus detected?’) test results for up to 7 days22 after hospital discharge or discontinuation of quarantine. The findings suggest that recovered patients can retain virus particles in their body for a while, though most are likely to be no longer infectious.

Pandemic course

For risk monitoring, epidemiologists primarily use R0 – the reproduction number – as the parameter to describe the transmission potential of an infectious disease outbreak. This parameter is dependent on factors including the infectivity, susceptibility of the population and population density.

  • R0=1: the number of cases is stable, the disease is endemic
  • R0 >1: the number of cases is increasing, it will eventually become an epidemic
  • R0 <1: the number of cases is decreasing
  • SARS had a R0 of <1 to 2.75. Seasonal influenza has an R0 of 2 to 3
  • New SARS-CoV-2: An accurate R0 is difficult to assess, as this parameter depends upon a number of criteria, which may also vary by country. Most experts, however, agree on an R0 of approximately 2.323, which is higher than SARS. The forthcoming summer season (northern hemisphere) may see a reduction in the R0 value due to less favorable environmental conditions and a first basic immunity of parts of the population, but it is expected to stay above 1.0. However, even this is heavily debated, as the seasonality of the virus remains unknown.
  • Determining the spectrum of clinical manifestations24 of SARS-CoV-2 infections is perhaps the most urgent research priority, because it determines the strength of public health response required. Currently, data is only available from China (see section, ‘How morbid is COVID-19?’).
    • If the seriousness of infection is similar to seasonal influenza, especially during milder seasons, mitigation measures can be tuned accordingly.
    • If the seriousness of infection is similar to the 1918/19 Spanish influenza, and therefore at the upper end of severity scales in influenza pandemic planning, the same responses would be warranted for SARS-COV-2 as for the most severe influenza pandemics.

Who is at risk?

  • The most instructive statistics have been disclosed by the Chinese Center for Disease Control and Prevention (China CDC)25: SARS-CoV-2 mostly affected the age range of 30 to 79 years (87%), 1% are aged 9 years or younger, 1% are aged 10 to 19 years, and 3% are aged 80 years and older.
  • In the meantime, there is growing evidence26 that infection rates in young children in fact are not lower than the population average, but are only lower for symptomatic COVID-19 disease. Children may therefore often act as asymptomatic transmitters.
  • Older people and those with chronic underlying diseases such as heart and lung conditions and cancer, are at particular risk27. The health of the immune system plays a key role here, as it declines with age (and smoking status). Patients with cancer or autoimmune conditions are usually treated with immunosuppressive drugs, putting them at further risk.
  • Other risk groups are health care workers and close contacts, e.g. family members, coming into contact with infected persons.

Transmission is fairly high and certainly easier than for SARS. The vast majority suffer a mild, if not an asymptomatic course of the disease.

Transmission via asymptomatic infected individuals and favored by an unusually long incubation period is likely. 

Transmission of e.g. measles or varicella is more than 5 to 10 times higher28.

Genomics – insights and differences compared to past pandemics

  • Genome sequencing29 of SARS-CoV-2 completed on January 29 suggests that the virus originated from a single source within a very short time period and was rapidly detected.
  • As with all viruses, SARS-CoV-2 mutates constantly and does not have the same capability as human cells to correct these ‘errors’. However, from over 500 genetic sequences30, it is known that there have only been a few mutations31, approximately two mutations per month, which is much lower than the mutation rate of the influenza virus. All analyzed samples are closely related with only a few mutations relative to a common ancestor, originating in Wuhan, China32.
  • Genome sequencing will have more to give, as it will be extremely important for the development of diagnostics, therapies and vaccines. To date, over 500 patents have been issued for vaccines and therapeutic agents, such as antibodies, cytokines and nucleic acids, which could help to prevent or treat SARS-CoV-2 infections33.
  • Scientific communication is now faster than during past pandemics34 as scientists share more information using preprints via biomedical preprint servers or Twitter or Slack. This will expedite knowledge exchange and transfer.

Statistical modelling

All model projections should be viewed with some reservation as they are based on as-yet uncertain assumptions. The specific case definitions and clinical criteria for diagnostic evaluation also differ by country. Furthermore, data on asymptomatic infections are essential in modelling the risk posed by SARS-CoV-235, but are mostly unknown.

What are the symptoms and development over time?

  • Unfortunately, the clinical picture is unspecific and offers a wide spectrum of clinical severity, which complicates timely detection. Furthermore, no clinical criteria and biomarkers are available to help differentiate individuals more likely to progress to severe illness.
  • Pneumonia appears to be the most frequent manifestation of infection, characterized primarily by fever, cough, dyspnea and bilateral infiltrates on chest imaging. Headache, sputum production and diarrhea are less common.
  • However, patients can present with a spectrum of disease ranging from mild respiratory illnesses, particularly in younger adults or children, to severe disease (including respiratory failure, septic shock or other organ failure requiring intensive care).
  • Patients usually seek medical care on day 2-4 after the onset36 of symptoms because this is when they develop shortness of breath and early pneumonia. For those who suffer from a severe form, day 7 is mostly critical. After day 1137, most patients who survive are on their way to recovery.
  • The majority of patients who recovered from COVID-19 pneumonia38 showed the greatest severity of lung disease on CT scans at approximately 10 days after the initial onset of symptoms. Chest CT scan signs of improvement began at approximately 14 days after the initial onset of symptoms.

How is the virus detected?

  • Currently via a combined viral nose and throat swab and a 5ml serum tube.
  • The assays in current use require designing small pieces of DNA that match sections of the viral genome obtained from the swab. However, there are still uncertainties around the kinetics39 of SARS-CoV-2 viral shedding, so the timing of the test may affect the result. The WHO has appointed SARS-COV-2 referral laboratories for testing – capabilities remain limited due to the required sophisticated technologies.
  • These diagnostic tests are based on a genome-based standard technology known as reverse-transcriptase polymerase chain reaction, or RT-PCR. Results are at best available in about 4 hours. To date, none of these tests have been standardized39.
  • Another significant hindrance for wide-scale screening is the cost – currently up to USD 250 to run per individual, depending on procedures and the volume of tests that a laboratory performs.
  • The problem with RT-PCR is that it can pick up viral genetic material only if there’s a lot of it. Early in an infection, before someone starts to feel really sick, there’s often not enough RNA material for such tests (the amount of virus produced by the body can change throughout the course of the illness). It can therefore deliver false negative results. Using this test as a screening tool for asymptomatic people is therefore less useful.
  • New With regard to the rapidly evolving outbreak, healthcare systems need in the short term to be able to carry out high-volume testing with the capability to reliably detect the virus during the incubation period. This may be imminent. The next step for monitoring the spread of the virus will follow a different, more convenient and significantly more effective diagnostic40 approach: a blood test that within minutes rather than hours identifies antibodies against the SARS-CoV-2 virus. Antibodies against SARS-CoV-2 begin to form within a week of infection22. Antibody tests are known as ‘serologic’ tests.
  • New Health authorities could also use serologic tests to investigate the immune status of the population (so-called ‘serosurveys’). The results could influence important decisions by public health measures, such as the reopening of public institutions. By testing healthcare workers, clinics could specifically assign doctors and nurses with positive antibody tests to care for patients with COVID-19. Such tests could also be used to identify convalescent individuals whose blood serum would be suitable for the treatment of an active infection.
  • New Many research41 groups are working on developing serologic tests, which still require validation with well characterized sera (blood samples from infected individuals) in order to be reliable for general use in medicine and epidemiological investigations. A first serologic test has just been published by US researchers42.

New Testing for the SARS-CoV-2 genome remains complex and confined to special laboratories, although in many countries testing capacity has been ramped up. Unfortunately the test is fairly expensive and does not reliably detect the virus during its incubation period.

A high number of unrecorded cases therefore remains likely as there are as yet no large epidemiologic studies.

New Blood tests detecting SARS-CoV-2 antibodies (serologic tests) are to be expected within weeks for clinical application. These will make screening more effective and also shed more light on COVID-19’s epidemiology.

How morbid is COVID-19?

  • New There are a potentially large number of asymptomatic or only minor symptomatic individuals whose infection is not being detected – this has a clear impact on the statistics. One indication of these ‘missing numbers’ is given in a report43 that states that 18% of the Diamond Princess cruise ship passengers who tested positive for SARS-CoV-2 showed no symptoms during or after the quarantine period44. Other virologists are assuming that up to 33% remain asymptomatic without a general feeling of illness10.
  • Diverse patterns of COVID-19 infection will be reported by country over the next few months, reflecting differences45 in age structure, monitoring, healthcare-seeking behavior and varied environmental factors.
  • There seem to be 3 major patterns of the clinical course of the infection:
    • 81% have mild cold46 symptoms or mild pneumonia47, allowing a higher chain of transmission through populations.
    • 14% are severe cases.
    • 5% are critical cases needing intensive care unit (ICU) treatment due to complications such as acute respiratory distress syndrome (ARDS), acute respiratory injury, septic shock and acute renal injury. There are first reports48 that more than two-thirds of critically ill patients require invasive breathing support. This could strain hospital critical care resources.
  • New The report, “WHO-China Joint Mission on Coronavirus Disease 2019”, states that on average (median) the disease course is 2 weeks for mild cases and 3-6 weeks for severe cases.
  • There is still a scarcity49 of data for the clinical course of COVID-19. First reports from outside China are expected soon, initially from South Korea and Italy. Reports regarding associated long-term complications are logically not yet available.

Publications on the clinical course pattern of SARS-CoV-2 infection are currently only known from China, South Korea and Italy. The healthcare systems in these countries are, however, too varied to form a reasonable understanding of the exact proportions of asymptomatic to mild, severe and critical cases. It will be at least another month before clinical studies shed more light on the course of COVID-19.

How lethal is COVID-19?

New The mortality of infectious agents in an epidemic is usually expressed as a case fatality rate (CFR), being the ratio of deaths to the total number of people diagnosed with the disease over a certain time period. A problem arises here, as many cases are mild or asymptomatic, and are therefore not diagnosed. Once serologic tests are available during the later phases of this pandemic, these individuals will become part of the CFR denominator. Until this time, the CFR is only an estimate and is likely to change over time. Current CFR estimates are as follows:

  • New Italy has a high CFR of approximately 9.5 %. Contributory factors include the fact that Italy currently tests all suspicious causes of death for SARS-CoV-2, thus increasing the CFR numerator. In addition, Italy has an older population.
  • The CFR of COVID-19 in China currently ranges from 2.9% in Hubei province to 0.4% in other Chinese provinces50.
    • Most of those who have died are older; e.g. those aged 70 to 79 years had a CFR of 8%, and those aged 80 years and older had a CFR of 14.8%.
    • CFR is elevated among those with preexisting comorbid conditions—10.5% for cardiovascular disease, 7.3% for diabetes, 6.3% for chronic respiratory disease, 6.0% for hypertension and 5.6% for cancer.
    • CFR is 0.9%, i.e. much lower, for those without a preexisting health condition51.
    • No deaths have been reported among mild and severe cases.
    • Outside of the Hubai province52 the CFR in China is lower, although based on limited data, likely no higher than 1% to 2%, although this will depend on accurate detection of those with mild disease.

To compare these CFR values with previous pandemics:

  • A normal flu season has a CFR of 0.1%.
  • Previous major influenza pandemics, e.g. 1957 and 1968, had CFRs of 0.8-1.2%. Spanish flu had a CFR of 2.0%.
  • SARS had a CFR of 9-10%, MERS had a CFR of 36% – both coronavirus epidemics had lower transmissibility but higher mortality than COVID-19.

In view of significant under-recording of cases, the lethality of COVID-19 is lower than published and reliable estimations remain difficult to make.

New The CFR also varies considerably between countries, ranging from 0.1% to around 10%. It is heavily dependent on patient age, associated comorbidities, the availability of isolation facilities, intensive care units and ventilators, and on the general ‘surge capacity’ of the healthcare system. However, despite these variations, it can be assumed that the CFR of COVID-19 in countries with robust healthcare systems lies between 0.7% and 1%.

Historically, the CFR and transmissibility develop inversely: there seems to be an adaption of the virus to the host that makes transmission easier and more effective (contagious), but that results in less deaths – Spanish flu, however, was the exception.

How will the infection be treated?

  • No specific treatments are available for COVID-19. The mainstay of management is therefore optimized supportive care to relieve symptoms and support organ function in more severe illness.
  • There are no specific antivirals available, but China is currently running more than 80 clinical trials on potential treatments for COVID-1953.
  • New The fastest approach to finding an effective antiviral is to test existing drugs used for other infections, such as Chloroquine (Malaria), Arbidol (Influenza), Remdesivir (SARS, Ebola), Favipiravir (Ebola) and Oseltamivir (Influenza). If any one of these proves efficacious against COVID-19, a fast-track regulatory approval can be expected. The WHO recently launched a mega-trial across multiple countries called SOLIDARITY. The trial will investigate the impact on the mortality of critically ill COVID-19 patients of the four most promising antiviral treatments (Remdesivir, Chloroquine, lopinavir and Ritonavir with/without interferon-beta). The first results will be announced as soon as next month54.
  • New Remdesivir is considered the most likely to be effective. This drug inserts a missense mutation into the genome sequence of the SARS-CoV-2 virus. This mutation is said to interrupt the reproduction of the virus. Large international trials of this drug are underway.
  • New Antivirals typically need to be given very early on in an infection as they are most effective before large-scale viral replication begins. For COVID-19, this is a considerable challenge in terms of preventing spread, as there are so many asymptomatic and mild cases. It is likely that the first clinical applications of antivirals will be administered to critically ill patients as a last resort, and whereby knowledge on efficacy and side effects will also be gained.

No vaccine is currently available for COVID-19, but many research groups55, supported by new technologies, are working on this. More than 11 vaccine candidates56 are in development and a phase 1 study of an mRNA vaccine developed by the US National Institutes of Health (NIH) is expected to begin very soon. Successes are likely to be reported, but it is realistic to expect that first applications, even if approval processes by authorities are accelerated, will not be available within the next 12 to 18 months.

How can I protect myself?

General measures for prevention of viral respiratory infections if there is a concern of contracting COVID-19 include:

  • Handwashing for at least 20 seconds. An alcohol-based hand sanitizer may be used if soap is unavailable.
  • Individuals should avoid touching their eyes, nose and mouth with unwashed hands.
  • Limit travelling to areas impacted by COVID-19 and avoid contact with sick people, in particular those with a cough.
  • Try to avoid close (<1.8 m) contact with persons suspected of having the virus.
  • A face mask can protect against contracting a coronavirus if it is a N95 respirator mask (currently sold out) but this is only recommended for health care personnel and those living with an individual with confirmed COVID-19.

The risk of contracting a seasonal flu or influenza virus remains higher than for SARS-CoV-2.

Handwashing, no handshaking and general preventive measures (in particular social distancing) are key.

New Efficacy of non-pharmaceutical interventions57,58

As there is currently no vaccine (pharmaceutical intervention) for COVID-19, the best way to prevent widespread infection is for the population to avoid exposure to the virus (non-pharmaceutical intervention). Unfortunately, even international health authorities are not currently coordinating risk-commensurate measures, partly perhaps as there is no hard data from epidemiological studies or international recommendations that corroborate more drastic measures.

Many governments – e.g. in Asia and Europe (e.g. Italy, France, Spain, Germany and Austria) – are now implementing measures such as school closures, restricted social gathering, limiting population movement and quarantining of hot spots at the scale of cities or regions. This is mainly encouraged by the success of consistent, severe non-pharmaceutical measures as taken in China, South Korea, Taiwan and Singapore. Less severe strategies – such as home isolation of suspected cases, home quarantine of those living in the same household as suspected cases and social distancing of the elderly and others at most risk of developing a severe form of the disease – are less promising and at best a means of intervention in case of a secondary outbreak.

The more stringent non-pharmaceutical interventions now being widely implemented should slow or even stop the spread of COVID-19 to avoid a rapid and steep peak in COVID-19 cases in favor of slower growth to relieve the pressure on hospitals, healthcare workers, intensive care units and ventilators.

The experience from China and South Korea has shown that suppression is possible for a fairly short time period. However, it remains to be seen if it is possible long term to maintain this suppression and to manage the associated social and economic costs.

Positive signs of how well equipped we are to handle a pandemic

Given the many advances made since previous pandemics, societies are now far better equipped to handle even a severe pandemic. For example:

  • The SARS-CoV-2 genome was decoded within two weeks of the virus’ identification and a diagnostic test59 was developed.
  • We can expect much more progress from genomics (see section on genomics above).
  • Highly stringent containment measures, as implemented in China, South Korea, Singapore and Taiwan, appear to have been effective.
  • The vast majority of COVID-19 cases are mild.
  • Science, global and national health authorities can now more easily communicate with the public and exchange timely data, experience and information via the internet.
  • Vaccine prototypes are already being tested.
  • Numerous antiviral drugs, efficacy of drugs approved for other virus diseases, and vaccine candidates are underway.

 


 

Contributor

Dr. Achim Regenauer, Chief Medical Officer, PartnerRe

Editor: Dr. Sara Thomas, PartnerRe.

This article is for general information, education and discussion purposes only. It does not constitute legal or professional advice of PartnerRe or its affiliates.

References

1https://api-nationalgeographic-com.cdn.ampproject.org/c/s/api.nationalgeographic.com/distribution/public/amp/science/2020/02/what-happens-to-coronavirus-covid-19-in-warmer-spring-temperatures;  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365403/
2https://www.ecdc.europa.eu/en/geographical-distribution-2019-ncov-cases; https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200309-sitrep-49-covid-19.pdf?sfvrsn=70dabe61_4
3John Hopkins University, 24 March, 8.00 am.
4https://www.jwatch.org/na50961/2020/02/21/spread-sars-cov-2-infection; https://www.tagesspiegel.de/wissen/warum-covid-19-ansteckender-ist-als-sars-enorme-mengen-virus-im-oberen-rachenbereich/25588526.html; https://jamanetwork.com/journals/jama/fullarticle/2761890
5https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30633-4/fulltext
6https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30673-5/fulltext; and https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)30566-3.pdf
7https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf
8Lancet. 2020; 395: 689-697
9https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30673-5/fulltext
10Podcast, Professor Drosten, 18 March. Charité University Hospital Berlin.
11https://cmmid.github.io/topics/covid19/control-measures/pre-symptomatic-transmission.html
12https://www.medscape.com/viewarticle/925575#vp_2 and https://jamanetwork.com/journals/jama/fullarticle/2762997
13https://www.medrxiv.org/content/10.1101/2020.03.09.20033217v1.full.pdf
14https://www.jwatch.org/fw116458/2020/03/17/how-long-does-coronavirus-survive-air-and-surfaces?query=pfwTOC&jwd=000020109420&jspc=IM
15https://jamanetwork.com/journals/jama/fullarticle/2762692
16https://www.medscape.com/viewarticle/926929
17https://www.medrxiv.org/content/10.1101/2020.03.09.20033217v1.full.pdf
18https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180
19https://www.ijidonline.com/article/S1201-9712(20)30139-9/pdf
20https://www.medrxiv.org/content/10.1101/2020.03.03.20028423v2
21https://jamanetwork.com/journals/jama/fullarticle/2762452
22Podcast, Professor Drosten, 17 March. Charité University Hospital Berlin.
23E.g. https://jamanetwork.com/journals/jama/fullarticle/2762510
24https://eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.6.2000110
25https://jamanetwork.com/journals/jama/fullarticle/2762130
26https://www.medrxiv.org/content/10.1101/2020.03.03.20028423v1
27https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-symptom-progression-11-03-2020.pdf?utm_source=share&utm_medium=ios_app&utm_name=iossmf; https://www.medscape.com/viewarticle/926698; and https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext
28https://theconversation.com/r0-how-scientists-quantify-the-intensity-of-an-outbreak-like-coronavirus-and-its-pandemic-potential-130777
29https://www.nextbigfuture.com/2020/02/coronavirus-is-bat-coronavirus-with-sars-receptor-and-likely-joined-in-a-lab.html
30https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30673-5/fulltext
31https://www.aerzteblatt.de/archiv/36927/SARS-Virus-Nur-geringe-Neigung-zur-Mutation
32https://www.gisaid.org/epiflu-applications/next-sars-cov2-app/
33https://www.sciencedaily.com/releases/2020/03/200312101037.htm
34https://www.sciencemag.org/news/2020/02/completely-new-culture-doing-research-coronavirus-outbreak-changes-how-scientists
35Not expanded upon here as this is not the expertise of the author.
36https://www.bmj.com/content/368/bmj.m606?utm_source=twitter&utm_medium=social&utm_term=hootsuite&utm_content=sme&utm_campaign=usage
37https://www.ucsf.edu/news/2020/02/416671/how-new-coronavirus-spreads-and-progresses-and-why-one-test-may-not-be-enough
38https://pubs.rsna.org/doi/10.1148/radiol.2020200370
39https://www.nature.com/articles/d41587-020-00002-2
40https://www.the-scientist.com/news-opinion/how-sars-cov-2-tests-work-and-whats-next-in-covid-19-diagnostics-67210
41https://globalbiodefense.com/headlines/singapore-first-to-test-out-covid-19-serological-assay-in-outbreak-contact-tracing
42https://www.medrxiv.org/content/10.1101/2020.03.17.20037713v1
43https://www.bloomberg.com/news/articles/2020-03-14/a-fifth-of-virus-cruise-cases-asymptomatic-study-says
44Another study reported a 51% manifestation index, see reference 18.
45https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-symptom-progression-11-03-2020.pdf?utm_source=share&utm_medium=ios_app&utm_name=iossmf
46https://www.jwatch.org/fw116437/2020/03/10/covid-19-can-look-common-cold-researchers-say
47https://jamanetwork.com/journals/jama/fullarticle/2762130
48https://www.bloomberg.com/news/articles/2020-02-23/coronavirus-patients-long-ventilator-stays-strain-hospitals
49https://www.ncbi.nlm.nih.gov/books/NBK554776/
50https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30673-5/fulltext
51Epidemiological characteristics of new coronavirus pneumonia. Chinese Journal of Epidemiology, 2020,41 (2020-02-17).
52https://jamanetwork.com/journals/jama/fullarticle/2762130
53https://www.nature.com/articles/d41586-020-00444-3
54https://www.sciencemag.org/news/2020/03/who-launches-global-megatrial-four-most-promising-coronavirus-treatments
55https://www.pharmaceutical-technology.com/analysis/coronavirus-mers-cov-drugs/; and
https://www.nih.gov/news-events/news-releases/nih-clinical-trial-investigational-vaccine-covid-19-begins
56https://jamanetwork.com/journals/jama/fullarticle/2762510
57https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/news–wuhan-coronavirus/
58https://www.sciencemediacentre.org/expert-reaction-to-mrc-centre-for-global-infectious-disease-analysis-report-9-impact-of-non-pharmaceutical-interventions-npis-to-reduce-covid-19-mortality-and-healthcare-demand/
59https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/laboratory-guidance

Additional sources (selection)

https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://www.ecdc.europa.eu/en/current-risk-assessment-novel-coronavirus-situation
https://theconversation.com/r0-how-scientists-quantify-the-intensity-of-an-outbreak-like-coronavirus-and-its-pandemic-potential-130777
https://jamanetwork.com/journals/jama/pages/coronavirus-alert
https://www.bmj.com/coronavirus
https://www.sueddeutsche.de/gesundheit/coronavirus-forschung-uebertragung-covid-19-1.4788734
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30374-3/fulltext
https://www.ecdc.europa.eu/en/geographical-distribution-2019-ncov-cases
https://link.springer.com/article/10.1007%2Fs00330-020-06748-2
https://multimedia.scmp.com/infographics/news/china/article/3047038/wuhan-virus/index.html

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