Are you aware of how the COVID-19 pandemic is going to play out?
People are being lulled into a sense of security that over the next 2-3 months the pandemic and mini-epidemics in each country and region will be over and things will start to return to normal. This is not correct.
The current strategy is to flatten the curve and extend the tail of the epidemic. What this means is that the COVID-19 epidemic will last many more months and is likely to extend into next year. The purpose of flattening the curve is simply to manage limited NHS resources, i.e. ventilators, CPAP (continuous positive airway pressure) machines, ITU and hospital beds, supplies of PPE (personal protective equipment) and staff. At present, it is estimated that 25% of NHS staff are off ill and/or self-isolating because another family member is ill.
By flattening the curve it will keep the stream of patients with severe COVID-19 infection to a manageable level. Instead of them arriving at NHS hospital in a 3 month window they will now arrive over a 6 to 9 month window.
If the lockdown is very extensive and prolonged as it has been in China you can stop the spread of infection in the community, but there will still be flares of infection and hence further lockdowns will be required. These flares will be triggered by asymptomatic viral shedders or people returning to China from outside its borders who are infected. I am almost certain that China is not telling us their whole story. We are not hearing about the COVID-19 flares, which according to basic epidemiological principles has to be happening.
I think it is highly unlikely that the UK will take the Chinese approach to our epidemic. This means that COVID-19 will move from being an epidemic, i.e. an increasing number of cases, to becoming endemic. The latter means the number of new cases becomes stable and at a level, the NHS can cope with. Eventually, herd immunity will occur that will slow down the spread of infection to very low levels. For herd immunity to occur it is estimated that at least 80% of the population, and possibly more, will have to get infected with SARS-CoV-2 so that it will ring-fence people who are susceptible to infection and stop the person-to-person spread, which has driven the epidemic.
How quickly herd immunity occurs depends on how soon the government relaxes or stops the lockdown and start letting people socialise and to start spreading the virus again. If the government removes the lockdown at the end of June as some commentators have suggested then I would estimate it would take about 18 months for the British population to acquire herd immunity.
One strategy that is likely to be employed is for high-risk people to be screened for immunity to SARS-CoV-2 by testing for the presence of antibodies in their blood and only letting them out of self-isolation if they are immune. This strategy is in anticipation that there will be an effective vaccine for SARS-CoV-2. I personally think this is a high-risk strategy. Vaccines for respiratory infections are notoriously difficult to make. Immunity from a vaccine may not be lifelong and the virus will mutate and drift, which will make the vaccine less effective. Importantly, the logistics of getting a vaccine tested and deployed globally makes it highly unlikely that we will see a vaccine deployed at a population level before 18 months. Just maybe a vaccine may be ready for very high-risk patients towards the end of 2021.
What does this mean for people with MS and the general population? It means that you really need to prepare yourself to be infected with SARS-CoV-2 and to possibly get COVID-19. I predict at 80% of us, yes 4 out of 5 of us, will be infected with SARS-CoV-2. The good news is that it looks like at a population level the proportion of people who get asymptomatic infections may be higher than previous estimates. The CDC (Centre for Disease Control) estimates asymptomatic infection rates as being 25% and higher. This means that when we get the real denominator of people infected with SARS-CoV-2 we will find that the proportion who get severe COVID-19 will be much less than 5% and the mortality or death rate from the infection will be much lower than the 2-5% that is currently being quoted.
Another possibility that I think is more likely than a vaccine is the emergence of effective antivirals and immunotherapies for treating COVID-19 and severe COVID-19. There are a lot of ongoing trials with repurposed drugs. I predict that when one or more of these trials are positive the registration of the drug, and adoption of the drug, into clinical practice will be very rapid. This means COVID-19 will be treatable and the proportion of people needing ITU and ventilation will drop and the mortality rate will improve. I predict that such a drug discovery is only months away.
You also have to realise that the ‘suits’ (yes, they tend to be men in grey suits) or the ‘Whitehall economists are frantically working away at their various economic models and will be weighing up the economic costs of the COVID-19 epidemic versus the health of the population. At some point in the near future, they will decide that GB Inc. has to to get back to work and the consequences of doing that will be the loss of lives due to severe COVID-19. The decision will be based on four competing factors (1) is the NHS now in a position to cope vs. (2) the mental health of the population (will they continue to adhere) vs. (3) the cost of a continued lockdown to the British economy vs. (4) the number of lives that will be lost. This is the harsh reality of being in charge of a country.
So, in conclusion, please don’t be lulled into a sense of false security; the COVID-19 pandemic is far from over, you are likely at some point to get COVID-19, don’t hold your breath expecting a vaccine to save you, but be optimistic and expect an anti-viral and/or anti-inflammatory to change the prognosis of COVID-19 soon. Please don’t believe China’s figures and take our politicians comments for what they are; political spin to manage expectations (unrealistic expectations).
CoI: I am about to leave the trenches to start fighting the war and I am very anxious.