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Covid-19 in the UK: An intelligence assessment

Posted on 14th March 2020 at 10:05am

Philip Ingram, MBE, shares this Covid-19 intelligence assessment, with particular reference to the UK’s approach to public health during this emergency.

One of the worst things a Prime Minister has to admit to his country is that: “Many more families are going to lose loved ones before their time,” as Boris Johnson was forced to say in his press conference about what the UK was going to do about the Covid-19 pandemic. 

He, together with the country’s chief scientist and the Chief Medical Officer for England and Wales, who had consulted and obtained agreement with the Chief Medical Officers of Scotland and Northern Ireland, explained the current position with the Covid-19 pandemic and what the Government’s response would be.

The general feeling after the briefing was it was considered, informative, measured and frightening all at the same time. However, this hasn’t stopped the armchair scientific and medical experts such as Nigel Farage and Piers Morgan from berating the response because it doesn’t match, or go further than, the responses of some other countries. Comments from influencers like Morgan, such as: “The Government seems to be avoiding draconian ‘shutdown’ action now because we will all get too bored with it,” display a shocking naivety which, from a journalist, is at the least unhelpful and is certainly unprofessional. Maybe now is the time to do a proper intelligence assessment of what we know.

The thing to realise about intelligence assessments – as intelligence is very often blamed after the fact for not seeing things that were not there at the time of writing – is that they are an assessment at a snapshot of time. As the situation develops and more information, or ‘unknowns’ come to be known, then an intelligence assessment is likely to change. No enemy on the battlefield follows your plan because it is in your intelligence assessment, no terrorist is caught because you have assessed how small the threat is, no virus will do exactly what you predict.

What is a virus?

The microbiological society describes a virus as the smallest of all microbes. With some, they are so small that 500 million could fit on to the head of a pin. They are unique, because they are only alive and able to multiply inside the cells of other living things. The cell they multiply in is called the host cell. 

A virus is made up of a core of genetic material, either DNA or RNA, surrounded by a protective coat called a capsid, which is made up of protein. Sometimes the capsid is surrounded by an additional spikey coat, called the envelope.

Under a process called Lysis, virus particles burst out of the host cell into the extracellular space, resulting in the death of the host cell. It is this that causes the damage to the host organism, and the symptoms experienced when many cells are killed. Once the virus has escaped from the host cell it is ready to enter a new cell and multiply.

An organism, if exposed to the virus or a similar version, may have a degree of immunity as it has the genetic pattern to develop antibodies to fight the viruses and restrict their spread. The danger is when a novel virus is discovered, as organisms will have no pre prepared defences.

The next question has to be, what is Coronavirus and what is Covid-19?  

According to the Centre for Disease Control and Prevention in the US (CDC), coronavirus is the name of a family of viruses that were first identified in the 1960s. They are named for the crown-like spikes on their surface (envelope) and there are four main sub-groupings known as alpha, beta, gamma, and delta.

People around the world commonly become infected with some human coronaviruses and in recent years it has been identified that coronaviruses that infect animals can evolve and jump the species gap to humans. Three recent examples of this are: severe acute respiratory syndrome, or SARS (SARS-CoV-1); Middle East Respiratory Syndrome, or MERS – which were both identified as beta viruses; and now we have coronavirus disease 19, or Covid-19, which has been designated as a novel coronavirus, ie it doesn’t fit into any already known category and therefore any immunity to other types of coronavirus that is present in a species can be bypassed by this strain. The name of the virus that causes COVID-19, the disease, is Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2).

Comment: Much is already known about coronaviruses, about their protein makeup, their genetic coding, their transmission, their strengths and their weaknesses, there has been over 50 years research into them already and SARS and MERS have given recent impetus to the scientific community.  SARS-COV-2 is closely related to SARS-COV-1 which emerged in 2002. Therefore, the scientific fight against Covid-19 disease is not from a standing start, it is from a position of many years research.

Where did Covid-19 come from?

Here conspiracy theories abound, as the reality is the origin of SARS-CoV-2 is only a scientific assessment. However, based on over 50 years research into coronaviruses and that the international scientific community is quick at checking and commenting on all of the relevant works and studies in the scientific community, their current assessment is probably accurate; it is certainly extensively peer reviewed.

The World Health Organisation (WHO) situation report of January 21, 2020 said that on December 31, 2019, the WHO China office heard the first reports of a previously unknown virus behind a number of pneumonia cases in Wuhan, a city in Eastern China.

On January 11 and 12, 2020, WHO received further detailed information from the National Health Commission China that the outbreak is associated with exposures in one seafood market in Wuhan City.

In February Nature Magazine reported that: “Chinese scientists suggested, on the basis of genetic analyses, the prime suspect was the scaly ant eating pangolin. However, it then went on to say that scientists have since examined that data and believe that although the animal is still a contender, the mystery is far from solved.

Other animals that are known as host of various coronavirus strains are bats and they, like the pangolin, were sold live in the Wuhan market. MERS and SARS were originally coronaviruses hosted on bats, so it is now thought that they are the most likely contender.

Apportionment of its source is made slightly more conspiratorial by the fact that Wuhan is the site of China’s only facility designated at Biosafety Level 4 (BSL-4) and is known as the Wuhan Centre for Disease Control (WHCDC). It was constructed in 2004 following the SARS emergency, to conduct research into countering such viruses. Level 4 facilities are designed to stop the escape of even the smallest particles, so accidental escape is highly unlikely. Despite sensational speculation in some press circles, there is no evidence in the scientific community that the COVID-19 disease is a result of WHCDC activity.

Comment: Coronavirus species jumps have been identified in the past, bats were identified as the source of the SARS coronavirus and, given the initial reporting in the city of Wuhan and the focus around the seafood market, it is highly likely that the ground zero for the COVID-19 disease is Wuhan and the seafood market. However, it is possible that the exact source will never be identified and therefore likely that sensationalised speculation will continue. 

How dangerous is Covid-19?

Covid-19 is a new illness and as such, no one will have any inherent immunity to the virus that causes. An understanding of how the disease develops in humans is just being observed. This lack of inherent immunity means that the herd immunity principles that restrict the spread of known viruses and the peak of their impact in numbers, does not exist.

The main symptoms of Covid-19 are a cough, a high temperature and, in severe cases, shortness of breath.

According to NHS England, because Covid-19 is a new illness, exactly how it is spread from person to person is not fully understood. However, the WHO says: “The disease can spread from person to person through small droplets from the nose or mouth, which are spread when a person with Covid-19 coughs or exhales. These droplets land on objects and surfaces around the person. Other people then catch Covid-19 by touching these objects or surfaces, then touching their eyes, nose or mouth. People can also catch Covid-19 if they breathe in droplets from a person with COVID-19 who coughs out or exhales droplets.”

It continues: “Illness due to Covid-19 infection is generally mild, especially for children and young adults. However, it can cause serious illness: about one in every five people who catch it need hospital care. While we are still learning about how COVID-19 affects people, older persons and persons with pre-existing medical conditions (such as high blood pressure, heart disease, lung disease, cancer or diabetes) appear to develop serious illness more often than others.”

The UK Government says: “A minority of people who get Covid-19 will develop complications severe enough to require hospital care, most often pneumonia. In a small proportion of these, the illness may be severe enough to lead to death.” The Prime Minister, Boris Johnson, confirmed this in his statement of March 12, 2020.

On January 30, 2020, the WHO declared the outbreak of Covid-19 to be a ‘Public Health Emergency of International Concern’ (PHEIC). On March 11, 2020 the WHO formally declared Covid-19 as a pandemic. A pandemic is a new disease for which people do not have immunity that spreads around the world beyond expectations.

Exact death rates expressed as a percentage of infections is impossible to accurately state at this time as many who contract the disease will have very mild symptoms, are unlikely to be tested and therefore formally diagnosed and recorded as having it, but could still transmit it to others.

Comment: Covid-19 is extremely dangerous to certain parts of the community, but will have little impact on most sufferers. However, as there is no herd immunity, there is very real potential for the most vulnerable to require hospitalisation all at the same time, overwhelming medical facilities. Anyone with the disease, even with very mild symptoms, can transmit it.

Much has yet to be learned about this disease and its impact but the “So What?” is that it is critical to take measures to reduce the number of severe cases and spread them over as long a time period as possible, to ensure medical facilities and staff are not overwhelmed. Those measure must be taken by all potential sufferers to have the best outcome.

People should take statistics in the press with an understanding of the reality that they are likely wrong and an over exaggeration of the risk if taken in isolation. 

What can, and is, being done about it? 

Every county seems to be taking a slightly different approach to dealing with the Covid-19 pandemic, which is fuelling political opportunism, sensational headlines preying on the very real fears of the population, and in turn, causing anxiety in the financial markets, wiping billions of their value. One thing is clear, it will pass.

The UK has very robust, tried and tested processes and procedures for dealing with pandemics. This is nothing new and the WHO has been talking about the threat from a ‘disease X ‘scenario for some years. Understanding of the spread and measures to deal with it for theoretical diseases have been modelled and exercised frequently and the Government has a series of plans to deal with these incidents ready to go.

On March 3, 2020 the Government published its Coronavirus (COVID-19) action plan based on its experience in dealing with other infectious diseases and its influenza pandemic preparedness work. The UK Government and devolved administrations, including the health and social care system, have planned extensively over the years for an event like this. The UK is therefore well prepared to respond in a way that offers substantial protection to the public.

The plan confirms that: “The majority of people with Covid-19 have recovered without the need for any specific treatment, and it is expected that the vast majority of cases will best be managed at home.”

The planning principles for the UK and devolved administrations used are:

  • Undertake dynamic risk assessments of potential health and other impacts, using the best available scientific advice and evidence to inform decision making.
  • Minimise the potential health impact by slowing spread in the UK and overseas, and reducing infection, illness and death.
  • Minimise the potential impact on society and the UK and global economy, including key public services.
  • Maintain trust and confidence amongst the organisations and people who provide key public services, and those who use them.
  • Ensure dignified treatment of all affected, including those who die.
  • Be active global players – working with the WHO, the Global Health Security Initiative (GHSI), the European Centre for Disease Prevention and Control (ECDC), and neighbouring countries, in supporting international efforts to detect the emergence of a pandemic and early assessment of the virus by sharing scientific information.
  • Ensure that the agencies responsible for tackling the outbreak are properly resourced to do so, that they have the people, equipment and medicines they need, and that any necessary changes to legislation are taken forward as quickly as possible.
  • Be guided by the evidence, and regularly review research and development needs, in collaboration with research partners, to enhance our pandemic preparedness and response.

The key is that they are evidence-based, balanced, well planned and frequently modelled and lead to four phases:

  • Contain: Detect early cases, follow up close contacts, and prevent the disease taking hold in this country for as long as is reasonably possible
  • Delay: Slow the spread in this country, if it does take hold, lowering the peak impact and pushing it away from the winter season
  • Research: Better understand the virus and the actions that will lessen its effect on the UK population; innovate responses including diagnostics, drugs and vaccines; use the evidence to inform the development of the most effective models of care
  • Mitigate: Provide the best care possible for people who become ill, support hospitals to maintain essential services and ensure ongoing support for people ill in the community to minimise the overall impact of the disease on society, public services and on the economy.

The aim across the board is to delay the onset of rapid cross infection throughout the population and spread the peak and most severe cases out over a longer time period, enabling current and surge medical capabilities to deal with the effects of the Covid-19 disease on those most affected.

However, a plan is only as good as those who adhere to it and the government advice needs the general public to follow that advice if there is a hope of the plan succeeding. Social distancing, seeking advice from the 111 website and handwashing are all examples of what the general public needs to do to keep the government plan on track and to save as many of the most vulnerable and severe cases as possible.

CommentThe measures being outlined to deal with the Covid-19 epidemic are considered, modelled, progressive, well planned and thought through by every expert in the field. They are not made up ‘on the hoof’ and are designed to minimise the impact on sufferers, society, business and life in general. The measures do require a greater public understanding and co-operation, and this is one time when sensationalism and speculation is unhelpful at best, but more likely deadly. 

Why are other governments taking different actions?

Other governments may take different actions as they have different cultural norms, different scientists with differing opinions, they are likely to be at a different stage of the pandemic and all healthcare systems and social care system likely differ, so strain and breaking points won’t be the same between countries.

A final consideration is there is a possibility of different political considerations in decision-making. For example, France’s closing of schools and universities puts additional strain on adults, some of them key to the emergency response processes. The banning of groups of 100 or more again could (and I emphasise ‘could’, as I don’t believe this question has been asked), make it easier for President Macron to control anti-government sentiment, such as the yellow vest protests which, with greater pandemic spread, could flare up further. In Ireland, the pressure from the closure will force the political parties to agree a new government more quickly.

Unfortunately in this world one has to consider political actions as part of disaster consequence management.

AssessmentThe current COVID-19 pandemic is a serious situation that will likely result in a number of deaths, that number will be a very small percentage of those who catch the disease as most people will recover, many without ever being formally diagnosed.

Critical to keeping the death toll to the lowest numbers possible is flattening out the peak number of severe cases at any one time in order to reduce the burden on medical facilities and personnel.

Current understanding of how pandemics spread is good, current planning for dealing with pandemics has been scrutinised by some of the best brains in the country and are generally well thought through. They rely on evidence-based assessments and have been modelled extensively.

COVID-19 will disrupt normal activities for a period of time and then society will recover. However, as ever, the success of any plan requires the support and co-operation of all involved, and in a pandemic scenario that means the general population. Recovery time for society will depend on cooperation and sticking to a well-tested plan.

MERS, SARS and COVID-19 are just the latest in a series of viral infections, there will likely be more in the future and many will have a smaller impact, but the potential remains for some with an even greater impact on society. Assessment Ends.

The best advice remains that on the front cover of Douglas Adam famous book, The Hitchikers’ Guide to the Galaxy, which says: “Don’t Panic.”  The current continuously updated statistics for the pandemic can be followed here.

This blog was written by Philip Ingram MBE a former senior Military Intelligence officer and specialist in CBRNE. He grew up in a family immersed in disease identification and control as his late father, Brian, ran a laboratory at the local hospital and his biomedical science journals were Philip’s youthful reading. He is always available for comment through the contact us page at his website. You can listen to this blog through his PODCAST site by clicking here

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