Coronavirus Q&A: We are now in uncharted waters

It seems like the world has been turned upside down in recent days as a result of the coronavirus spread. Where are we now?

We are in absolutely uncharted waters. And yes the world has been turned upside down. What started out as a flu-like illness passing among a relatively small number of people in Wuhan, a Chinese city most of us had probably never heard of, has spread across the world with frightening speed. At the time of writing – Tuesday, March 10th – more than 110,000 people in over 100 countries have now contracted coronavirus, also known as Covid-19, and almost 4,000 people have died.

How serious is it?

It is very serious, there is no two ways about it. While the vast majority of people who contract coronavirus will be fine within a couple of weeks, about 15 per cent of people will become very ill while about 5 per cent will get critically ill. The mortality rate of the illness is fluctuating from country to country and from week to week as it spreads, but with the information we have at this stage it looks like about 2 per cent of those who get the illness may die. The number falls dramatically amongst younger people and – so far at least – the percentage of children who have become seriously ill or died is minuscule.

How does 2 per cent compare with flu?

The mortality rate of Covid-19 is about 20 times higher than the seasonal flu. And while a mortality rate of around 2 per cent may seem small, if the disease takes hold in a country and many people are taken ill – as has happened in Italy – it can quickly equate to thousands of deaths and an enormous volume of people requiring hospital treatment. There are few countries in the world that are in a position to cope with the demands such a situation might place on their health system.

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How fast is it spreading?

Fast. Three weeks ago there had been no reported cases in Italy. One way of measuring transmissibility is the virus's reproduction number or R0 ("R naught"), effectively the number of people an infected person will go on to infect. Estimates from China put the R0 at somewhere between 1.5 and 4, compared with 1.4 for the average flu (and up to 18 for measles).

However, R0 varies across different environments. It can be reduced by effective hygiene control measures – handwashing, controlled coughing and sneezing, even social distancing. It is also worth remembering that while the people of Wuhan didn’t know what was about to hit them in December and January, the rest of the world has had more warning.

What is the incubation period?

The incubation period – the time between infection and the onset of symptoms of the disease such as cough, fever and shortness of breath – is thought to range from two to 14 days.

Can you pass it on without symptoms?

This is a big area of uncertainty. The European Union's disease prevention agency is set to tighten its advice on coronavirus in the days ahead as evidence emerges that people showing no symptoms can spread the virus. Until Monday the European Centre for Disease Prevention and Control (ECDC) had advised that "people who are infected but who do not show symptoms cannot transmit the virus", a belief that has influenced policy and quarantine decisions in several EU countries as cases balloon. This was in conflict with advice from the World Health Organization and the US Centers for Disease Control and Prevention. The WHO states that, while rare, "there are people who can shed Covid-19 virus 24-48 hours prior to symptom onset".

Will we cope in Ireland?

The HSE says isolation rooms have been identified in all major hospitals, where patients would be treated. We have only one state-of-the-art isolation unit in the country, in the Mater hospital, but local arrangements and transfers to the Mater would probably suffice in the event of a small number of cases. The fear is that there will be a large number of cases. Emergency medicine doctors have said they don’t have the ICU beds to handle that. One doctor in St Vincent’s hospital has pointed out that he has not had a free ICU bed since Christmas.

How many people could fall ill here?

The Business Post reported on Sunday, March 8th, that forecasts were suggesting that about 40 per cent of the population could become sick as a result of the virus. Paul Reid of the HSE said he could not dispute reported projections that up to 1.9 million people could become sick as a result of contracting the coronavirus, although he said the work was not yet concluded and the evidence was changing day by day.

Can the virus be treated?

It cannot be cured, if that is what you are asking. Doctors try to keep critically ill patients’ bodies going, providing breathing support where necessary and waiting for their immune system to fight off the virus. There is no vaccine as yet, though one might be ready by the end of the year. Antivirals are being tested in China, but there are no clear results yet.

Do face masks work?

People wearing face masks are likely to be the most enduring images of 2020, but many of these devices are not as efficient at preventing the transmission of viruses as people might hope. The consensus now is that regular hand-washing is a far more effective way of protecting yourself. People might derive comfort from masks, but it is worth bearing in mind that they were originally designed to filter the air you breath out and to protect healthy persons from sick persons, rather than the other way around.

If I think I have the virus, what should I do?

If you’ve come back from one of the affected areas – such as northern Italy where person-to-person transmission is widespread – and you have symptoms, contact your GP urgently and do not leave the house. The principal symptoms are headache, dry cough, shortness of breath, muscle pain and fever. If you have come back from these areas and are feeling well the advice is to consult the HSE website or ring the HSELive helpline on 1850 24 1850 for advice.

How should those being tested behave with co-residents?

The HSE advises that family members or people sharing a residence with a suspected case should avoid contact, communicate by phone and not answer calls to the door.

What is happening in Ireland now?

As of Tuesday, March 10th, the number of people in the Republic who have been diagnosed with the illness is still small. A total of 24 cases of the virus had so far been confirmed, but the outlook for the days, weeks and months ahead is still grim.

Are projections of 1.9m sick people an exaggeration?

Not according to Taoiseach Leo Varadkar. He delivered a bleak assessment on Monday, March 9th, of the potential consequences of the coronavirus outbreak in Ireland. "It is possible we are facing events that are unprecedented in modern times," he said. He warned that more than half of the population could contract Covid-19 and he referenced death rates for the virus ranging from less than 1 per cent to more than 3 per cent, meaning large numbers of people could die of the disease in a worst-case scenario.

“For the vast majority of the population this will be a mild illness and may even by asymptomatic,” he said. “However, there will be a significant part of the population who will require critical care.” The virus cannot be stopped, he said, but “it can be slowed” with the right response from the health service and across society.

How can it be slowed?

There are things that can be done by the Government and its agencies. But there is one thing every person in this country can do to help slow the spread of the virus.

What is that?

Wash. Your. Hands.

What?

Yes. There is universal agreement among politicians and health professionals that proper hand sanitation is the most effective thing people can do to stop the spread of the illness. When an infected person coughs or sneezes, they release droplets of saliva or mucus. These droplets can fall on people in the vicinity and can be either directly inhaled or picked up on the hands, then transferred when someone touches their face, causing infection. That is why frequent hand-washing and the use of hand sanitisers are so important in combating the spread of Covid-19.

And how do I do that properly?

To answer that we will turn to the official HSE guidelines.

Wet your hands with warm water and apply soap. Rub your hands together until the soap forms a lather. Rub the top of your hands, between your fingers and under your fingernails. Do this for about 15 seconds. Rinse your hands under running water. Dry your hands with a clean towel or paper towel.

What else is being done to stop it spreading here?

A lot. A €3 billion package to deal with coronavirus will pump more money into the health service, help at-risk businesses and change the rules around sick pay to encourage people who will need to self-isolate and stay away from their workplaces. An additional €435 million will be allocated to the HSE. Minister for Health Simon Harris has said this money is to be used to increase the public health capacity to trace contacts of people with the virus, as well as providing for more beds, more overtime, more staff and more homecare packages to help take pressure off hospitals.

Is there more?

There is a lot more. Patients have been told not to turn up at GP surgeries without an appointment in order to reduce the risk of spreading coronavirus. And patients who have been to an affected area and are showing respiratory symptoms have been reminded not to go to their GP surgery, hospital emergency department, out-of-hours service or pharmacy. Instead they should phone ahead or call 112.

What about public gatherings?

All St Patrick's Day parades across the country are being cancelled on foot of a recommendation of the National Public Health Emergency Team. Trinity College Dublin said all lectures would take place remotely. And both Ryanair and Aer Lingus said they would be cancelling all flights to and from Italy for almost a month. Ryanair is also cancelling all internal flights in Italy for the same period.

What about schools?

To date only a handful of schools – in Dublin and Clare – have closed following known cases of Covid-19. During a containment phase, wider school closures “are not justified”, the European Centre for Disease Control has said. If transmission of the virus becomes widespread in the days ahead, school closures will be inevitable, even though they probably would not reduce the impact of the epidemic. For now, though, it seems unlikely.

What is happening across the EU?

According to data from the ECDC on Tuesday, 14,890 cases were reported in the EU/EEA and the UK. Italy had reported 9,172 cases, followed by France on 1,412 and Spain on 1,204. Germany had reported 1,139 cases, while there were 321 in the Netherlands and 373 in the UK. Across the EU there were 532 deaths reported, with the vast majority being reported in Italy where – at the time of writing – 464 people had died.

Italy is bearing the brunt of the virus?

Italy has – so far – been the the epicentre of the outbreak in Europe, and the country's 60 million people have been placed in lockdown. Italian prime minister Giuseppe Conte said after Italy's death toll jumped by 97 to 463 that it was the country's "darkest hour".

How are drug supplies in the EU?

The European Medicines Agency (EMA) has said it is closely monitoring what the spread of Covid-19 could mean for the pharmaceutical supply chains in the EU.Its officials are looking at ways to protect at-risk patients if there is a temporary lockdown of medicine manufacturing sites in areas affected by Covid-19. It is important to stress that there are no reports of such shortages of medicines within the EU.

Okay, so talk to me about travel?

On Tuesday, March 10th, the Minister for Foreign Affairs Simon Coveney announced an update on his Department's travel advice, saying no residents of Ireland should travel to any part of Italy unless it is absolutely necessary. The red warning "do not travel" status is extremely unusual and will have to be heeded by everyone.

Has it been heeded by airlines?

Yes. Both Ryanair and Aer Lingus are suspending all flights to and from and within Italy following the decision of the Italian government to lock down the entire country to contain the spread of virus.

Ryanair said the suspension of internal flights would come into force at midnight on Wednesday. Flights into and out of Italy will be suspended at midnight on Friday, March 13th. The measures will be in place until April 8th. Aer Lingus has cancelled all flights to and from Italy from Wednesday, March 11th until April 3rd.

What if I am in Italy and not due back until Saturday?

There has been no formal comment from Aer Lingus, but Ryanair passengers looking for repatriation can obtain a free move to an earlier Ryanair flight operating up until midnight on Friday, March 13th. Affected passengers who were due to travel to the country will be able to choose between a full refund or a travel credit that can be redeemed on Ryanair flights in the next 12 months.

Are the Italian land borders still open?

Yes, but the Austrian chancellor, Sebastian Kurz, has announced an entry ban for people entering Austria from Italy by car, train or plane, unless they can provide a doctor's certificate. Controls will be imposed along the border between the two countries. Austrians visiting Italy will be allowed to return home only if they agree to a two-week home quarantine.

Is Ireland using such controls on those returning from Italy?

As yet, no.

How will this affect my summer holidays?

It is too early to say what impact it is going to have on summer travel. If you had asked us this question two weeks ago we would have said that everything will be grand. Now, we’re not so sure. It could be that by July, the start of the high season for tourism in Europe, the virus will have peaked. Maybe it will be gone altogether. It could be that things will be much worse than they are today. There is too much uncertainty to make a firm decision on your travel plans now.

So what advice can you give me?

Pay attention to the travel advice from the Department of Foreign Affairs and other relevant sources.

Is that official advice important?

It is very important. If an official advisory against travel is in place then people who have booked independent holidays and have travel insurance to that location could be able to claim for any losses they are likely to incur. With advisories in place, people who have booked with tour operators should also be able to process refunds or reschedule trips.

What about flights?

According to the European Consumer Centre Ireland (ECC Ireland), a natural occurrence such as Covid-19 that causes travel disruption is considered “extraordinary circumstances” outside the control of a transport provider, such as an airline. Consequently, compensation would not normally apply. For air travel, according to EU Regulation 261, passengers on cancelled flights may be entitled to have their journey either rerouted to the final holiday destination or refunded. If a land or sea journey is cancelled, passengers are entitled to rerouting or a refund.

What about package holidays?

For package holidays involving a journey to, or a stay in, areas affected by travel restrictions due to the virus, consumers may have the right to terminate the booking contract without paying a termination fee. This applies only to unavoidable and extraordinary circumstances that may pose a significant risk to human health and prevent consumers from making use of or reaching the destination of their booked holiday, as agreed in the travel contract.

I am headng overseas soon. Can I cancel?

If consumers choose to cancel their holiday to an area where no emergency measures have been declared, that is their right, but the holiday cancellation is, of course, strictly within the limits of their booking contract. Refunds may be possible, but that is by no means certain. And if passengers cancel flights voluntarily they are entitled to a full refund of airport taxes as the cancellation takes place before the flight check-in operation. But it is worth bearing in mind that admin fees imposed by airlines often make such refunds pitifully small.

What about travel insurance?

Now would be as good a time as any to ensure you have adequate travel insurance covering any trips you may have coming up. Ensure your policy covers cancellations as a result of official warnings from government not to travel to a destination. But timing is crucial here. Mapfre, one of the biggest travel insurance underwriters in the State, says that if a policy covers a government recommendation to avoid a country or area, a claim will be considered only if that recommendation is in place within 48 hours of a person's intended departure.

Anything else?

If you are travelling anywhere in the EU in the months ahead and do not have a European Health Insurance Card (EHIC) or think the one you do have may have expired, then get it sorted.

Remind me of what the EHIC is again?

If you are travelling in Europe, the card gives you access to public health services at no cost. If you have a smartphone, download the EHIC app to help you navigate overseas health systems, and remember: your card needs to be renewed every five years. Don’t ever pay for the card. Some sites will try charging for the service, but it is free through the official site, ehic.ie.

What else is happening?

This remains first and foremost a public health emergency. But the pandemic is almost certainly tipping the world into a global recession. Airlines and the tourism sector at home and abroad will suffer. Some businesses will close. Stock markets will continue to take a hammering. Pension funds will be hit hard and jobs will be lost.

What’s this about stockpiling food and fighting over toilet roll?

That is happening alright. In countries as far apart as Japan, Australia and the US there have been reports of panicked shoppers stocking up on everything from long-life milk to noodles, while videos of people fighting in supermarket aisles over toilet paper in Australia have gone viral as coronavirus has spread.

Large retail chains in the UK, including Tesco, have started rolling out a rationing system for key products and shoppers are not being allowed buy more than five of certain goods, including antibacterial gels, wipes and sprays, dry pasta, UHT milk and some tinned vegetables. Pictures of empty shelves are circulating widely on social media.

Is it happening in Ireland?

While there has been no formal rationing in Ireland – and no reports of loo roll riots – this country has not been immune to the panic buying and there has been a noticeable surge in the sale of canned goods, pasta and cleaning products in supermarkets here. Items deemed to be essential in the current climate, including hand sanitiser and face masks, have largely disappeared from shelves while wholesalers are reporting sales levels for groceries normally not seen outside of the peak shopping period before Christmas.

This is all incredibly gloomy and scary.

It is. But it is not forever. Things will settle down. Most experts say several scenarios are possible with Covid-19. It might join the four other existing coronaviruses in being endemic around the world, causing respiratory illness of varying degrees of severity. Or it may become a seasonal illness like the flu, adding to the pressure on hospitals during the winter. It is important to bear in mind that scientists all over the world are working on vaccines and treatments, and while they are still some way off, such treatments will come.

So how is this going to turn out?

We don’t know. But it is worth looking at China, where this whole thing is believed to have started. Its most recent figures put the number of new cases across the whole country at 19, with 17 additional deaths. It has closed the 14 emergency hospitals it built in Wuhan and Chinese President Xi Jinping flew into the city on Tuesday morning to inspect new coronavirus control efforts, according to state news broadcaster CCTV.

Anything else?

Just one thing. Wash your hands.