On 3 March 2020, Prime Minister Boris Johnson introduced the British government’s Coronavirus Action Plan, which had been produced in response to the recent outbreak of COVID-19 infection in the UK. At the emergency press conference called for the purpose in 10 Downing Street, and to lend authority to the proceedings, he was flanked by the Chief Medical Officer, Professor Chris Whitty, and Chief Scientific Advisor, Sir Patrick Vallance. Mr Johnson exhorted the nation to wash hands, frequently, with soap and hot water, for the length of time it took to sing “Happy Birthday” twice (around twenty seconds for most). Later during the same day, NHS England went on to declare a national major incident, thereby ensuring that English hospitals initiated preparations to deal with an increasingly likely epidemic.
As the “novel coronavirus” establishes itself in the UK, the British government has come up with an action plan with four “strands”, consisting of the serial phases of contain, delay, research and mitigate. The concept of delay, controlling the spread of the virus until the warmer summer months when the NHS is more able to cope, is a particularly important part of this strategy. Delay can be likened to getting the coronavirus to behave for the moment, at least until the nation is more easily able to deal with larger numbers of infected people. However, it must not be forgotten that containment failed to delay the spread of the global H1N1 outbreak in 2009. Either way, in the coming days and weeks, we can reasonably expect to receive regular updates of the progress of the government’s strategy in the face of increasing numbers of those infected in the UK.
One of the biggest challenges of dealing with any new infection is that there is no “expert” available who can provide information that is based on personal experience and knowledge. On the one hand, frequent media accounts of newly detected “clusters” and “cases” infected with coronavirus, arising from increasing numbers of new locations around the world, magnify the extent of the problem by what is often referred to as an availability heuristic, reinforced by frequent and repeated updates of information. What this means is that each time you come across someone who is either coughing, sneezing or blowing their nose, you automatically conclude that they are harbouring the coronavirus. At the same time, new questions continue to arise all the time, widening an already significant information gap. Experts then step into the resulting empty space, sometimes providing contradictory predictions and advice- based on educated guesswork-while different countries, regions and towns develop their own strategies to contain the spread of infection in the absence of any authoritative guidance. In this climate of misinformation and paranoia, it can soon become difficult to differentiate “evidence-based” information from that which is merely “eminence-based”.
The immediate behavioural effects of the coronavirus outbreak are already visible in many places. Some of the observed behaviours are the result of a lack of factual information about the newly recognised virus. Examples of obsessive hand washing are thus being witnessed in public toilets and washroom, while shops are running out of stocks of tissues and hand sanitisers, not to mention kitchen towels and toilet rolls. People are being advised on proper “cough etiquette”-to cover the mouth and nose while coughing, sneezing or nose blowing with tissues and then to safely dispose of them (“catch it, bin it, kill it”). Masked people are to be seen everywhere, in many places where coronavirus has not yet been reported. The masks on display vary widely in both appearance and apparent effectiveness. The usual norms of social etiquette are being redefined, with handshakes being replaced by fist punches, while air kisses take the place of social kisses. Better still, there is frequently no manual or facial contact whatsoever, and people go “contactless”. People are often finding a reason to “self-isolate”, voluntarily locking themselves into their own homes to avoid infecting others. This possibility of self-isolation is also leading some people to stockpile supplies of dried, powdered and tinned food, over-the-counter medicines, and many other “essential” items in preparation.
Behaviours are also changing on a wider front. Mass gatherings are being discouraged or actually prohibited. These proscriptions have led to the postponement or even cancellation of many sporting events, trade fairs, music festivals and other mass public gatherings. Schools and universities are being closed for varying periods of time. Travel to or from areas with clusters of infected people is being either restricted or altogether banned. This is leading to a drastic fall in air traffic and a consequent loss of airline revenues. Mass quarantine, even involving millions of people in certain cities of China, is being used to aggressively contain infection wherever possible.
The outbreak has led to predictions of economic contraction, even possibly leading to a global recession. Stock markets have plunged to levels last seen during the 2008 financial crisis. Certain sectors of industry have been particularly adversely affected, such as manufacturing industries with supply chains in China (automobiles, computers, electrical equipment), the pharmaceutical sector, business travel and tourism. Globalisation isn’t just about sharing goods, capital and services, but also viruses and other invisible organisms that can travel fast and widely, crossing international borders with impunity.
Some undesirable forms of behaviour are being noticed. For example, several xenophobic attacks on people of Chinese origin, maliciously blamed for the coronavirus outbreak, are being reported from various locations in the West. Global connectivity has also facilitated the “viral” spread of conspiracy theories, including allegations of biological terrorism, economic destabilisation, attempts at global domination, and even deliberate interference with the 2020 American presidential election. This is not to mention the many scares being caused by alarming and often apocalyptic predictions about the possible impact of coronavirus infection, some even coming from official sources and assorted “experts”.
Most people, however, continue to seek answers to questions for which there is often no reliable reply. Apart from self-protection, there are also concerns about what to do if one has symptoms suggestive of coronavirus infection, and what the potential economic impacts of isolation at home or in hospital are likely to be and how they are to be mitigated. People working in the gig economy and other low-paid jobs, often on zero-hour contracts, are particularly vulnerable to the effects of enforced inactivity during an epidemic. Many healthcare professionals also foresee difficulties in adequately dealing with a possible epidemic in the UK, given the critical state of the NHS, which may need to call upon the help of a “Dad’s Army” of retired nurses and doctors . The message for the moment is , however, to wash hands often, “more frequently than usual”, to avoid contaminating others with one’s own respiratory secretions, and above all to actively seek out reliable official sources of health information. In due course, we will all undoubtedly be better informed and thus better advised.
Ashis Banerjee (retired consultant in emergency medicine, with memories of the 2009 global H1N1 outbreak)