Individual Response is Key in Coronavirus Outbreak, Just Like Government Response

Individuals’ response to the novel coronavirus is as important—if not more important — than governmental response, according to commentary published in The Lancet.

Authors from the United Kingdom and the Netherlands surmised the current knowledge about coronavirus and said that governments will not be able to minimize deaths and the economic impact from the infection. They highlighted several key unknown factors: first, the unknown case fatality rate, though it is estimated to be at about 0.3-1%; secondly, whether the infectiousness starts before the onset of symptoms, though some studies suggest the incubation period is about 5 days.

There are lessons that can be learned from both influenza A and SARS epidemics, said the authors. The presymptomatic infectiousness of coronavirus is unknown, but SARS had little of that and influenza A has about 1 to 2 days. School closures are often utilized in influenza A outbreaks but may have little use among the coronavirus outbreak as there is little known about the infection rate among children.

By monitoring the Southern Hemisphere, the authors said, investigators should hopefully be able to determine if the coronavirus may be more similar (ie seasonal) to influenza A, which is limited by warmer weather.

The number of asymptomatic cases and the duration of the infectious period are more important but still unknown factors, the authors said. With only 6% of coronavirus cases critical and 14% severe, symptom-based control is not likely to be sufficient on its own.

“Completely preventing infection and mortality is not possible, so this is about mitigation,” one of the lead researchers, Deirdre Hollingsworth, said in a press release. “Our knowledge and understanding of COVID-19 will change over time, as will the response. High quality data collection and analysis will form an essential part of the control effort. Government communication strategies to keep the public informed will be absolutely vital.”

Mitigation methods such as quarantines, stopping mass gatherings, closings of various educational institutions and workplaces, and isolating households, towns or cities are the current options being employed, the authors said. Social distancing may also be effective, but ultimately depends on how quickly symptomatic individuals voluntarily isolate themselves.

To the end that these government-mandated rules have any effect on infection spread depends on the individual response, the commentators said. A government’s communication strategy to keep their citizens informed of how best to avoid infection is also vital in addition to extra support to manage an anticipated economic downturn.

“Government needs to decide on the main objectives of mitigation—is it minimizing morbidity and associated mortality, avoiding an epidemic peak that overwhelms health-care services, keeping the effects on the economy within manageable levels, and flattening the epidemic curve to wait for vaccine development and manufacture on scale and antiviral drug therapies,” co-author Sir Roy Anderson added in the statement. “We point out they cannot achieve all of these — so choices must be made.”

Additionally, the authors pointed out that a vaccine or effective antiviral drug is expected to be available soon. Despite a vaccine development arms race underway, phase 3 trials are a long way out. The authors anticipate we are 12 to 18 months from significant vaccine production.

For the most recent case counts in the COVID-19 outbreak, check out the Contagion® Outbreak Monitor.