The Government has set out a COVID-19 action plan of what to expect across the UK and states that it is 'more likely than not that the UK will be significantly affected'.
As there is neither a vaccine against COVID-19 nor any specific, proven, antiviral medication,1,2 most treatment will therefore be towards managing symptoms and providing support to patients with complications.
It states that it is possible that up to one fifth of employees may be absent from work during peak weeks. As the majority of people with COVID-19 have recovered without the need for any specific treatment, they expect that the vast majority of cases will best be managed at home as with seasonal colds and flu.
The current novel coronavirus (COVID-19) outbreak began in December 2019 in Wuhan, China and on 30th January 2020, the World Health Organization declared the outbreak of COVID-19 a “Public Health Emergency of International Concern”.
Four phases to the plan
The document said the outbreak presented a challenge for the entire world but the health and social care systems in the UK were well prepared and had planned extensively over the years for an event like this
The UK plan contains four phases:
- Contain: detect early cases, follow up close contacts, and prevent the disease taking hold in this country for as long as is reasonably possible
- Delay: slow the spread in this country, if it does take hold, lowering the peak impact and pushing it away from the winter season
- Research: better understand the virus and the actions that will lessen its effect on the UK population; innovate responses including diagnostics, drugs and vaccines; use the evidence to inform the development of the most effective models of care
- Mitigate: provide the best care possible for people who become ill, support hospitals to maintain essential services and ensure ongoing support for people ill in the community to minimise the overall impact of the disease on society, public services and on the economy.
It added that the nature and scale of the response depends on the course of the disease, which cannot be predicted accurately at this point. As the understanding of the disease increases and its impact becomes clearer, the Government will issue further detailed advice about what to expect if/when further measures become necessary.
Risk to older patients
The main symptoms of COVID-19 are a cough, a high temperature and, in severe cases, shortness of breath. Early data suggest that of those who develop an illness, the great majority3 will have a mild-to-moderate, but self-limiting illness – similar to seasonal flu.4
According to the evidence available, the risk of severe disease and death increases amongst elderly people and in people with underlying health risk conditions due to development of severe and even fatal respiratory diseases such as acute respiratory distress syndrome (ARDS).5,6
One study of 99 cases found that it is more likely to affect older males with comorbidities and half of those infected had chronic underlying diseases, mainly cardiovascular and cerebrovascular diseases and diabetes.5
In general, the characteristics of patients who died were in line with the early warning model for predicting mortality in viral pneumonia in our previous study: the MuLBSTA score.7 This score system contains six indexes, which are multilobular infiltration, lymphopenia, bacterial co-infection, smoking history, hypertension, and age.
Another study of 41 patients found that the COVID-19 infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome and was associated with ICU admission and high mortality. In this cohort, most patients presented with fever, dry cough, dyspnoea, and bilateral ground-glass opacities on chest CT scans. The time between hospital admission and ARDS was as short as two days.6
If the outbreak worsens in the UK, an increase in deaths arising from the outbreak, particularly amongst vulnerable and elderly groups is expected.
Plan if the outbreak worsens
The document says that to ensure that the health and social care system is prepared to respond to all eventualities, other services will be reduced temporarily.
Plans are flexible to respond to different types of pandemics - ranging from a mild pandemic with a low impact on services (for example the 2009 H1N1 pandemic), through to a severe prolonged pandemic as experienced in 1918 ("Spanish Flu").
If the disease becomes established in the UK, it said it will need to consider further measures to reduce the rate and extent of its spread. Based on experience with previous outbreaks, it may be that widespread exposure in the UK is inevitable; but slowing it down would still nonetheless be beneficial.
For example, health services are less busy in the summer months when flu and other winter bugs are not driving GP consultations and hospital admissions. In the 2009 ‘swine flu’ pandemic school holidays significantly slowed transmission of the virus.
Action that would be considered could include population distancing strategies (such as school closures, encouraging greater home working, reducing the number of large scale gatherings) to slow the spread of the disease throughout the population, whilst ensuring the country’s ability to continue to run as normally as possible.
Such measures would be in order to protect vulnerable individuals with underlying illnesses and thus at greater more at risk of becoming seriously affected by the disease, but the effectiveness of these actions would be balanced against their impact on society.
- World Health Organization [Internet]. R&D Blueprint: Coronavirus disease (COVID2019) R&D; accessed 23rd February 2020. Available from: https://www.who.int/blueprint/priority-diseases/key-action/novel-coronavirus/en/
- Coalition for Epidemic Preparedness Innovations [Internet]. CEPI launches new call for proposals to develop vaccines against novel coronavirus, 2019-nCoV; accessed 23rd February 2020. Available from: https://cepi.net/news_cepi/cepi-launches-new-call-forproposals-to-develop-vaccines-against-novel-coronavirus-2019-ncov/
- The Epidemioloigcal Characteristics of an outbreak of 2019 Novel COVID-19 – China 2020 (China CDC Weekly Vol 2 No. x) https://github.com/cmrivers/ncov/blob/master/COVID-19.pdf
- Xu XW, Wu XX, Jiang XG, Xu KJ, Ying LJ, Ma CL, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ. 2020 Feb 19;368
- Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet. 2020 Jan 30
- Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020 Jan 24
- Guo L, Wei D, Zhang X, et al. Clinical features predicting mortality risk in patients with viral pneumonia: the MuLBSTA score.
Front Microbiol. 2019; 102752