The Covid-19 Outbreak - Update 10th March 2020
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The Covid-19
Outbreak
- Update
10th March 2020
As of 09.03.2020 there have been 111 753
case of Covid-19 infection reported with
3888 deaths. The comparable figures in last
week’s update (on 02.03.2020) were 89 856
and 3069.
There are now reported cases in 111 countries and
Dr Mark Simpson FFOM territories (compared to 72 on 02.03.2020 and 37 on
Chief Medical Officer 24.02.2020).
The reported global shortage of Personal Protective
Equipment (PPE) for healthcare workers is of
considerable concern as case numbers and duration
grows.
The Covid-19 Outbreak - Update 10th March 20 Page 1
The containment measures put in place in China now seem to be having a positive effect with a sustained fall in the rate of new cases. There were 44 new cases on 08.03.2020 as opposed to a figure of 202 new cases on 01.03.2020. The majority of new cases have been in Wuhan but there have been 2 days in which there were no new cases in Hubei Province leading to a slight relaxation of the restrictive measures currently in place. However, the growth in case numbers in Iran (now 7161), South Korea (now 7478) and Italy (now 7375) does not show any early signs of diminishing. Despite relatively similar case numbers in these countries, the number of deaths has varied with only 53 in South Korea as opposed to 237 in Iran and 366 in Italy. The reasons for this are not immediately clear at this time. Please see below for the latest update. On 08.03.2020 the Italian government approved a new emergency decree placing 16 million people living in Northern Italy inside a new quarantine zone. This applies to the entire Lombardy region including Milan and Venice. This is designated the “Orange Zone” and some of the restrictions include: • All schools, universities, museums, nightclubs, bingo halls, gyms, spas, swimming pools and similar public buildings in the affected areas are closed. • Civil and religious ceremonies, including weddings and funerals, are prohibited unless held behind closed doors with the minimum number of attendees. • Churches may remain open but must enforce the one-metre distance rule. Mass is prohibited. • Bars and restaurants may open between 6am and 6pm, if they can ensure that everyone is seated at least one metre (three feet) apart, with any business found violating the rules facing “suspension of activity”. • Shops can remain open “provided that the operator guarantees access in a quota- based manner or in any case suitable for avoiding crowds”. Shopping centres are to be closed on weekends. • Sporting events of all types must be held behind closed doors or suspended. • Ski resorts are closed. • Remote working and teleconferences instead of face-to-face meetings are advised “in all possible cases”. These will remain in force until at least April 3rd. The Covid-19 Outbreak - Update 10th March 20 Page 2
In addition, the even more stringent limitations in the “Red Zone” continue to be enforced. On Monday 9th March this advice was superseded by the Italian government’s decision to extend its quarantine measures to the entire country, which comes into effect on Tuesday 10.03.2020. This follows a sudden rise in case numbers from 7375 to 9172 overnight from Monday to Tuesday and a rise in the death toll by 97 to a total of 463 cases. Cases of Covid-19 have now been confirmed in all 20 Italian regions. Case numbers continue to increase in Europe with Germany 1164 (+124 new cases on 08.03.2020), France 1209 and Spain (+376 new cases on 08.03.2020). On 08.03.2020 the French government has placed a restriction on any events for more than 1000 people, which replaced the previous ban on events of over 5000 people. However there are 4 main clusters in France in in these areas additional measures have been put in place. They are Morbihan in Brittany, Haute-Savoie in eastern France near the Swiss border and the départements of Oise and Haut-Rhin in north east France. In these places there is a ban on all public gatherings including markets, community groups and church services. Spain continues on the lowest of three alert levels at present but has moved some sports fixtures to closed doors in an empty stadium. There are no school closures (apart from Vitoria-Gasteiz, a city of 250,000 people, which became the first Spanish city to order the closure of all schools for 15 days following an outbreak after a funeral). Spain has also issued guidelines to employers to introduce home working and video conferencing. Global Travel Advice The CDC alert status remains unchanged from last week’s update. The Covid-19 Outbreak - Update 10th March 20 Page 3
UK Specific Advice
As of 09:00 on 09.03.2020 a total of 24 960 people have been tested in the UK, of
which 24 641were confirmed negative and 319 positive. The comparable figures from
last week’s update were 13 525 tested and 13 485 were negative with 40 positive.
There have now been 4 deaths in the UK. This BBC graphic shows the case progression
to date and this trend is likely to accelerate despite the mitigation efforts to date.
Forty-six more UK patients test positive
Daily confirmed cases of coronavirus in UK
60
40
20
0
29 Jan 8 Feb 18 Feb 28 Feb 9 Mar
Source: BBC & Department of Health and Social Care, updated 9 Mar, 14:00
NHS 111 remains the default contact point for all Covid-19 enquiries. The service has
enlisted an extra 700 people to support a growing number of enquiries, which is now
dealing with more online enquiries than telephone calls.
Following a Cobra meeting on 09.03.2020 the UK remains in the “Containment” phase
of its response and social distancing options will not be deployed yet.
However, I do feel it is only a matter of time until we move into the “Delay” phase –
hence the outline above of the different strategies deployed across Europe to date.
Many employers are already taking precautionary measures with regard to remote
working and limiting non-essential travel where it is practicable to do so.
The Covid-19 Outbreak - Update 10th March 20 Page 4The previous travel advice remains applicable and the FCO has updated its advice regarding Italy as follows: FCO advises against all but essential travel to the following lockdown areas of northern Italy: • Lombardy region (which includes the cities of Milan, Bergamo, Como). • The provinces of Modena, Parma, Piacenza, Reggio Emilia and Rimini (all in Emilia Romagna). • Pesaro e Urbino (in Marche). • Alessandria, Asti, Novara, Verbano-Cusio-Ossola and Vercelli (all in Piemonte). Padova, Treviso and Venice (in Veneto). However, this advice may well be modified in the light of Monday night’s announcement by the Italian government to apply quarantine measures to the entire country. This is shown on the map below. Those returning from the “Red” and “Orange” lockdown areas should self-isolate on return whilst those from outside the lockdown areas should self-isolate if they have symptoms of cough, fever or shortness of breath. It should be noted that the advice from NHS 111 and Public Health England has, at times, been ambiguous and confusing for travellers. It does seem remarkable that travel to these areas has not been suspended in the light of this advice. My own guidance is that all non essential travel to both these designated zones should be avoided unless quantifiably essential. The Covid-19 Outbreak - Update 10th March 20 Page 5
LESSONS FROM THE
PAST AND RELEVANCE
TO THE PRESENT
As I have described in previous updates, global pandemics have been with us through
history. They vary in severity – Spanish Flu (1918-1919) was classified as severe and
brought 200 000 deaths to the UK. Asian Flu (1957-1958) and Hong Kong Flu (1968-
1969) were both classed as moderate and brought 33 000 and 80 000 deaths to the
UK. However, most of us remember Swine Flu 2009-2010) which was graded as a very
mild pandemic and brought 457 UK deaths.
The WHO was widely considered to have acted in an alarmist manner in classifying it as
a pandemic, which may explain the current reluctance to move from their current disease
status. There were also allegations that drug companies exploited the fear associated
with the terminology.
Unlike Covid-19, Swine Flu had a high attack rate in children and 36% of hospital
admissions were for those under 16 years old.
Swine Flu Cases per Week 2009
120000
100000
80000
60000
40000
20000
0
Jun Jul Aug Sep Oct Nov Dec
The Covid-19 Outbreak - Update 10th March 20 Page 6This pattern of initial and secondary waves is common in many epidemics and will be a consideration for the government in the current situation. However, many of the strategies regarding quarantine or social containment were not put in place during this outbreak. For the first time, it was possible to map the genetic code and this was achieved in May 2009 with first supplies of a vaccination becoming available in November 2009 – uptake was poor as case numbers were already rapidly diminishing by that time. In addition, the early level of agitation and concern seen at the start of the outbreak had almost completely abated. Further studies showed that the main drug thought to be effective (Tamiflu) in reality made virtually no difference to outcomes despite the UK government having stockpiled vast quantities in preparation. Covid-19 does seem to have a higher Case Fatality Rate (CFR) than Swine Flu and the R0 figure (the number of people infected by each case of the illness) appears slightly higher at 2.0-2.5 compared to 1.5- 1.8 for Swine Flu. These are significant factors both in investigating new treatments (described last week) and a novel vaccine. The latter is being addressed by a range of different development programmes under way on a global basis. If you have any specific or business related concerns, or simply want to talk to one of our clinicians please do not hesitate to contact the Health Management Occupational Health and Support line on 01273 555666. Our clinical team will be pleased to assist. The Covid-19 Outbreak - Update 10th March 20 Page 7
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