Virology expert says Government 'caught napping' by coronavirus pandemic
Professor Jangu Banatvala, emeritus professor of clinical virology at King's College London, says Britain was "caught napping" by the coronavirus and lessons from previous outbreaks were not learned by the Government. Here, the retired Henham resident gives his expert view on the causes of the pandemic, the vital need for testing and his view of disease control with a vaccine in the future...
In 1996 an electron microscopist, June Almeida, showed me the first picture of a human coronavirus which had been isolated from a child with a mild respiratory infection at St Thomas' Hospital Medical School (now part of King's London).
The virus particles have a distinct layer of projections which give the virus a crown-like appearance, hence the name 'coronavirus'.
The human corona respiratory viruses are still the cause of relatively mild respiratory infections, but it could not have been anticipated that other members of the coronavirus family – found in animals, which are biologically quite different – would skip the species barrier from animals to humans and be the cause of severe outbreaks of transmissible infection with appreciable mortality many years later.
In 2002 an outbreak of another coronavirus, SARS (Severe acute respiratory syndrome), now designated Covid-1, originated in China and spread via international travel to about 25 countries. The virus caused pneumonia and was transmissible from person to person, mostly in healthcare settings.
In 2012 another coronavirus, MERS-CoV (Middle East respiratory syndrome-related coronavirus), caused an outbreak of severe respiratory infection in the Middle East. This infection is still smouldering, with sporadic outbreaks in that part of the world.
In December 2019 yet another coronavirus appeared, now designated Covid-19, originating in Wuhan in China's Hubei province.
Rather more transmissible than Covid-1, Covid-19 also caused pneumonia and, within a short time, was transported to other countries in the Far East and then later worldwide to result in a global infection with more marked person-to-person transmission than with Covid-1.
Like the other coronaviruses, Covid-19 was transmitted to humans by contact with various species of live animals in large seafood markets. These animals, in turn, are infected by bats, which are the natural reservoir for transmission to live animals.
Although earlier attention was mainly focused on severe cases of pneumonia in which presenting features were a persistent dry cough, fever, shortness of breath and fatigue, it is now known that the clinical spectrum is much broader and many people have mild symptoms or no symptoms at all, except perhaps feeling a bit achy for a day or two and a few sniffles.
A newly recognised feature is the loss of smell and taste, and some develop, or may present with, gastrointestinal symptoms such as abdominal pain and diarrhoea. Perhaps GPs should be suspicious of the possibility of Covid-19 among patients complaining of gastrointestinal symptoms. The reason for the cough, as well as the infection localising in the lower respiratory tract, relates to the virus binding to specific receptors in the lungs, and this may also be true for the gastrointestinal symptoms.
People with defective immune responses from disease or its treatment, as well as diabetics and those with chronic heart and lung conditions, are particularly susceptible to severe and sometimes fatal disease.
Many studies have shown that the elderly experience the highest mortality, having a severe and often rapidly progressing pneumonia, whereas younger people, particularly children, usually have a mild or asymptomatic infection. However, the occasional younger person may have a severe or fatal infection, although the reason for this is not understood. Perhaps they may have an unusually vigorous immune response (cytokine storm).
The Government has been criticised for its handling of the pandemic. Little heed was paid to the repeated advice of the director-general of WHO (World Health Organisation) to "test, test, test". This is of critical importance since identifying those who are infected means that they can be isolated and allows for contact tracing, enabling those who have been in contact with those infected individuals to be quarantined.
Although this seems to be a rather medieval approach, in the absence of specific antiviral treatment or a vaccine, it is all we have and seems to have worked alongside social distancing in parts of the world where it has been strictly implemented, for example, South Korea.
Tests to identify Covid-19 are also of importance as they ensure that healthcare workers who may have a minor respiratory infection unrelated to Covid-19 are not unnecessarily quarantined, thereby avoiding unnecessary reduction in a skilled workforce.
Britain, among other nations, has been caught napping. Covid-19 is now the third member of the family of coronaviruses which has caused life-threatening infections since 2002. It should have been predictable, or indeed probable, that further epidemics would occur.
After this pandemic, we should remain vigilant to further possible coronavirus epidemics, during which time attention should be focused on appropriate coronavirus technology, i.e. detecting viral components and detecting its antibodies as well as developing specific antivirals and vaccines.
We are woefully short of kits for testing, but even more surprisingly short of swabs. Can there be an excuse for this?
Prime Minister Boris Johnson has stated that we are at war against the virus. But you can't win a war if you don't have the equipment or cannot locate the enemy or its strength.
Widespread community testing is essential to let us know how many people have already been infected; many would have suffered minor or even sub-clinical infections. Currently, this means not so much tests to detect those with acute infections (these tests detect viral DNA in clinical specimens), but also to perfect tests for antibodies, providing evidence of past infection.
The rapid detection of antibodies by a finger-prick blood sample will be a major advance, but the test has yet to be evaluated thoroughly. Hopefully before long it can be used for evidence of past infection, which will also be of value for individuals as well as epidemiologically.
The questions most frequently asked by the general public relate to the viability of the virus on surfaces, specific treatment, vaccines and whether the infection will result in long-term immunity.
On copper the virus persists for about four hours, on cardboard for up to 24 hours and on stainless steel and plastic up to 72 hours.
Of course, viruses are rapidly destroyed by soap and water and commercially available household disinfectants. All authorities correctly stress the importance of thorough handwashing with soap and water.
With regard to specific treatment, a number of broad-spectrum antivirals are being tested as well as chloroquine. Some appear promising.
Most importantly, there is a need for a vaccine. Numerous candidates are being assessed and some are in early trials. Urgency is resulting in accelerated progress, but it is unlikely that a vaccine for general use will be available for about a year; hopefully, sooner.
It remains to be established whether the natural infection will result in long-term immunity, but it seems likely that this will be the case.
Vaccines will be of critical importance in many developing countries which do not have the necessary infrastructure for the identification and control of infectious diseases.
The WHO should have a role in orchestrating vaccine delivery in such parts of the world. Difficult though this may seem, the WHO has been remarkably successful in its polio eradication programme.
Professor Banatvala is Stop Stansted Expansion's advisor on the health impacts of aircraft noise and pollution, and added this footnote...
The planet has experienced major ecological changes due to human behaviour resulting in factors which are impacting climate change. Communities are moving from rural to urban areas, often with gross overcrowding, poverty and emergence of newly recognised infections.
Aviation encourages population movements at the risk of transmitting infectious diseases. There are considerable demands worldwide for the development of new airports or, in Britain, for the expansion of existing ones; for example, Stansted.
This should be called into question. Should such developments be allowed only if it is consistent with targets for climate change? Government authorities should ensure that the health of the population is not at the expense of apparent short-term economic initiatives.