EUROPE'S CORONAVIRUS RESPONSE: MATTERS ARISING by Niyi Olarewaju

With Europe now becoming the epicentre of the novel coronavirus SARS-CoV-2 (Covid-19), European nations’ response to the pandemic will soon come under scrutiny on how they largely failed to learn vital lessons from China’s initial lacklustre response to Covid-19, and the Chinese authority’s subsequent aggressive and efficient management of the epidemy which ensued across mainland China. As the second wave of infection struck Europe, Italy emerged as the incubation hotspot in February, most European nations paid lip-service to the evolving epicentre in Italy, largely ignoring the incredible mobility of this novel virus. These nations largely failed to put in place any concrete measure to alert their citizens on the very high transmissibility of Covid-19. It is understandable that European governments want to prevent panic and disruption to economic activities, which can incur overwhelming consequences, but downplaying a global health emergency which has for weeks tilted towards a pandemic is even a more costly alternative. Disappointedly, opportunities were missed to completely arrest the virus when it started reaching other European Union (EU) member states from Italy. Basically, contact tracing, isolation and quarantine became the gold standard for combating the spread of the virus. I have wondered all along if this approach can sufficiently stop the spread of SARS-CoV-2 based on the dynamism of this not fully understood novel virus.

The question is, how effective is contact tracing for such a highly infectious respiratory virus like SARS-CoV-2? Sure a thorough contact tracing regiment will slow down the transmission of this pernicious pathogen and help identify or prevent the next cluster of infection, but the overall transmission will persist while we get a false sense of containment, till the virus spreads to all the nooks and crannies of the country. The recent Ebola virus (EBV) outbreak in West Africa testifies to the effectiveness of adopting stringent contact tracing measures, not only in containing but also efficiently putting a stop to the continuous propagation of the highly contagious and deadly EBV. Contact tracing significantly exploits the mechanism of transmission of EBV, which is neither airborne nor casually transmitted. Hence, the identify-isolate-treatment of EBV patients approach as well as, the identify-quarantine approach for close contacts worked perfectly in finally surmounting the community dissemination of EBV. SARS-CoV-2, on the other hand, is a highly infectious and transmissible upper respiratory tract viral pathogen which can spread via the release of viral particles in respiratory droplets by infected persons, as well as casual contact with them. SARS-CoV-2 transmission is further complicated with the possible dissemination of the virus by asymptomatic carriers.

Cumulatively, the pattern of SARS-CoV-2 transmission suggests governments can't continue to solely rely on contact tracing and isolation as it is presently being hyped and adopted in combating Covid-19. Different variables and dynamics must come to play in designing a public health measure to combat Covid-19. Cases/country-specific scenarios and patterns should largely be considered in formulating policies to deter the spread of the virus. European nations have so far employed a “contain and delay” approach largely predicated on identifying, isolating and contact tracing. The big problem with this approach is that it utterly disregards the method of transmission of the virus. Instead of confronting the virus, and going for its jugular, nations like Germany, Italy and France have allowed the virus lead while they follow. This approach simply puts the virus one step ahead of these countries. While Italy is learning the lesson the hard way, interestingly, Germany, France and the United Kingdom appear they still want to make their own experiences instead of learning from Italy's mistakes. SARS-CoV-2 has for the umpteenth time, demonstrated its pestilence, resilience, persistence, and ability to maintain a near exponential infection rate. In fact, reports have shown that patients who recovered from the infection could also be re-infected.

The propagation of the virus in Europe will largely continue until very bold steps are taken to contain and stop its sustained transmission. Otherwise, the virus will end up overwhelming and crippling healthcare infrastructure and effectively initiate the grounding of the economy of many EU nations. The pattern of transmission in China offers classical evidence of the depth of the resilience of SARS-CoV-2, and its ability to propagate. The virus ravaged the soul of the country until extreme and drastic measures were taken by the Chinese authorities to halt its spread. Despite the aggressive crackdown on the virus in China, at least 81,000 people have tested positive for the virus with about 3200 deaths reported so far, all in a span of about three months. More detailed evidence of the high transmissibility of the virus is shown by the pattern of transmission on the Diamond Princess cruise ship, which provided a confined space for the virus to incubate and propagate. Within a month of the presence of the virus on-board, 698 passengers out of the 3711 passengers on the ship tested positive. Probably if all passengers remained on the ship for another two weeks, the infection could have reached in excess of 70 percent of the passengers, despite the strict quarantine regimen enforced on the ship. The cruise ship presents valuable microcosmic insight on the community transmission of COVID-19, and a lot of lessons can be learnt to devise a more efficacious containment strategy.

The initial response to containing the virus has proven very effective especially in Germany and France in the first few isolated cases of outbreaks in January, where there was a single source of transmission and the index patients and their contacts were quickly identified and traced. The same is true for many other countries like Nigeria where the infection was presented by one index patient and everybody in contact with the index patient was quickly mapped, tracked down, isolated and tested; thereby preventing community transmission of the virus. This approach has now shown low efficacy in either stopping or delaying the spread of the virus in the second wave of outbreaks in Europe, which originated majorly from Italy. As multiple index patients returned from holidays in Italy, they easily established new infection clusters across Germany, leading to a spike in the number of people infected. Unfortunately, the epidemiological potency of the virus was probably underrated; a golden opportunity to contain the virus in Germany and many other EU countries was missed in the early stages of cluster formation and enlargement in these countries. As of 13th of March, confirmed Covid-19 cases in Germany have risen to at least 3675 cases (with 46 patients fully recovered) from 18 cases (with 13 patients fully recovered) reported on the 25th of February, 2020. This is an incredible spike in the number of cases in less than three weeks. If concerted and very drastic measures are not quickly put in place to halt the continuous dissemination of the virus, the number of cases can hit 20,000 to 25,000 in another two weeks in Germany, if the virus continues to disseminate at its current pace. By then, the only option going forward will be a complete lockdown of the country for 14 to 30 days or even more, depending on how long it takes to identify and extract positive cases. This same pattern and exponential multiplicity of infection are also true for most of the other major EU nations.

I am of the opinion that now is the moment for European governments to accelerate and present a united effort against the spread of  SARS-CoV-2. No amount of effort is too much. In fact, in the face of a global pandemic, it is better when efforts are too much than when they are too little. The human and economic costs of overreacting to quickly arrest the spread of the virus will be far less than under-reacting. Now is the time for countries with community transmission and with more than a thousand confirmed cases to lockdown, and focus on isolating infected people in order to inhibit further propagation of the virus. A cursory analysis of the Covid-19 transmission data shows infection rate can double every 2 to 3 days. With that doubling rate, cases can go from just 1,000 to more than 1,000,000 within 30 to 35 days, if no aggressive measures are put in place to combat the spread of the virus. No wonder, the German Chancellor, Angela Merkel announced that Covid-19 could hit up to 60 – 70 percent of the German population which will stand at a staggering 48-55 million people. If the virus continues to spread without any real and concerted efforts to slow it down - in fact, 70 million people can be infected in less than 60 days in a worst-case scenario. This is the massive pandemic the world is facing right now and the earlier we aggressively act to confront it, the better for all of us. This approach has been employed and demonstrated to be very effective in China. Within one month of very aggressive counter-measures against SARS-CoV-2, China progressively slowed down the transmission of the virus and in the last one week, data from China shows a steeper downward infection’s trajectory, with confirmed new cases ranging between 15 and 40 cases daily.

It is understandable that most European governments do not want to cause panic or overreact, at the same time, the government can conveniently convey the reality of the situation to their citizens with detailed explanations on why it is imperative to take very drastic steps to stop Covid-19. European powerhouses like Germany, France, Spain, may already have missed the opportunity to avoid a largescale outbreak of Covid-19, many other EU nations are still reporting less than 1000 cases. These countries still have the opportunity to adopt a community lockdown-isolate-quarantine approach in every area the virus is identified, in other to prevent cases reaching the 1000 mark and at the same time not effectively putting the entire country on lockdown. Otherwise, at some point in the future, we will all look back and ask ourselves why it took so long to take decisive actions against such a notorious and cantankerous virus. 

While the national governments are still figuring out a robust response to the Covid-19 spread, as for now, we all should stay safe, maintain high hygienic standards and social distancing and if you exhibit any symptoms of the virus, follow the approved guidelines and report to the appropriate authorities. Together, we can give this virus hell and show it we are more resilient than it can ever be.