Vice-Provost's View – COVID-19: Predicting the future
27 August 2020
Vice-Provost (Heath) David Lomas talks about the origin and effects of the SARS-CoV-19 virus, and possible ways of dealing with – or living with – the coronavirus pandemic.
We live in the most extraordinary times. Never in my 35 years as a clinical academic, have I experienced such turmoil in the country, our healthcare system, the economy and, of relevance to us, the Higher Education sector. The future is difficult to gauge, with many potential outcomes. However, it is important that we have a prediction, however uncertain the impact may be to UCL. I write this as a practising respiratory physician, who helped out on the Assisted Ventilation Unit at UCLH in March/April 2020, at the peak of the London surge. I was directly responsible for the care of some of the most seriously ill patients with COVID-19.
The respiratory community is very familiar with coronaviruses. They arrive every winter and make up 15%-30% of common colds. There is no treatment for coronavirus infections and no vaccine. We know that individuals, who contract coronavirus, develop an immune response that is typically transient (12-18 months) and does not provide lasting immunity. It is through this lens that I make my predictions about the future. All of them are, of course, subject to change!
The SARS-CoV-2 virus emerged in Wuhan, China in November 2019. It arose in bats, as bats have vigorous immune systems which require continual mutation of viruses to survive. The virus was transmitted to man, either directly or via an intermediate host species, such as the pangolin in the wet markets. These are typically farmers’ markets in China and cater for demand for fresh meat, sold warm shortly after the animal has been slaughtered. In January 2020, China reported the first case of human to human transmission of SARS-CoV-19. As of 25 August 2020, more than 23.6 million cases have been reported across 188 countries, resulting in more than 813,000 deaths. More than 15.3 million people have recovered from coronavirus.
Coronavirus enters the lungs via the ACE2 receptor in the nose and lungs, has an incubation period of 2-14 days and an individual is, typically, infectious two days prior to developing symptoms. 90% of individuals develop a fever, 90% develop a cough, 15%-30% lose their sense of smell and only 6% have a runny nose. Some 80% of people, who are infected, have mild symptoms (a cough or fever), 14% have severe symptoms and 6% have critical symptoms requiring ITU care. The case fatality rate for coronavirus is approximately 0.6% compared with 0.1% for seasonal influenza and approximately 70% for Ebola, contracted in Africa. The people, who are mostly likely to succumb to the illness are men (70%), the elderly (the average age of death in Italy was 80), those who are overweight (risk increases as the BMI rises over 25), and those with co-morbidities, such as diabetes or cancer. There is an increased risk of death in the BAME population.
There are four likely scenarios for exiting this pandemic:
- Development of a vaccine. A vaccine that successfully blocks transmission would be the most ideal strategy. Over 170 companies are now developing vaccines with three in large scale, clinical trials. It is essential that vaccines show not only an immune response (which they all do) but that this is sufficient to protect against severe disease and against transmission of the virus. There are, however, concerns that any protection may not break the transmission cycle and that immunity will be transient, as is the case for natural immunity of people, infected with coronavirus. A new vaccine typically takes four years to develop. It is my view that a vaccine is unlikely to be successfully developed that leads us to exit the current crisis. The other concern is the recent report of the infection of an individual, who had already had coronavirus. Re-infection was with a mutated strain and this suggests that vaccines will need to deal with natural variation or target the invariable part of the virus.
- The SARS-CoV2 naturally loses infectivity, as may well have occurred during the Spanish influenza outbreak in 1918-20. However, coronaviruses do not mutate at the same rate as the influenza virus.
- We develop herd immunity: an R0 of 2.6 means that approx. 62% of the population would need to be immune, at any one time, in order to develop herd immunity. Herd immunity values are currently approximately 0.5-15% in different areas of the country. Any recurrent waves of infection will be required to acquire a 62% target and that would assume that immunity is long lasting, rather than transient.
- The virus becomes endemic: this would mean the virus circulating in the community with intermittent flare ups that are handled by local lockdowns and standard NHS treatment. Interpretation of the current data is that case numbers are going up but there are no significant numbers of admissions to hospitals, at least in London. This likely reflects the testing of younger, more mobile people who do not succumb to the symptoms of coronavirus whereas, in the past, the people, who were tested, were those who had been admitted to hospital.
If, indeed, we need to learn to live with coronavirus (i.e. it becomes endemic), then the university will need to adapt the way that it functions. It is critical for a large, successful university, such as UCL, that academics work face to face to develop research ideas, to deliver first-class education and to initiate novel strategies for enterprise. We cannot sustain a successful institution purely online. Thus, it is my view that we need to return to campus in a COVID-19 safe way in order to restore some of the essence of university life for our academics, and also for our students. It is inevitable that there will be flare ups of the virus, outside and within the campus, and we will need to react by localised lockdowns. The more effective the ‘test and trace’ system, then the quicker we can react and the more localised the lockdown can be. I believe that the university needs to develop both strong, online platforms and face to face teaching but to be prepared to move courses online at outbreaks of infection. The major threat of coronavirus is not to our students but to some of our older, ‘at risk’ staff members with co-morbidities or from the BAME community. These individuals need to have suitable risk assessments around work and their travel to work. UCL can then decide how best to manage their contribution.
In the long term an effective ‘track and trace’ system, an expanded NHS and clear public health message may mean that we learn to live with coronavirus in the absence of a vaccine.
For more information about our plans for reopening our buildings and the measures put in place to protect our community, please visit the Keeping Safe on Campus webpages.
The Working safely during a pandemic webpage contains information on a range of topics including risk assessments, remote working and DSE assessments and advice for line managers.