Coronavirus test confusion as Public Health England expert says 3.5million antibody kits will be available in Boots within days – but Chief Medical Officer admits he has no idea if they work yet and officials STILL won’t say who is making them
- A PHE official yesterday said home-testing kits could be available within days
- But the CMO backtracked on the claim and said they are still being evaluated
- Scientists claim the process to prove the tests work could take a ‘few weeks’
- Officials have still yet to reveal who is manufacturing the antibody testing kits
- Coronavirus symptoms: what are they and should you see a doctor?
The Government has admitted it has no idea if the 3.5million antibody tests it has ordered work – despite a senior official saying they would available in Boots or on Amazon within days.
Professor Sharon Peacock, director of Public Health England’s National Infection Service, yesterday told MPs the home-testing kits could get clearance and start being distributed for use within days.
But England’s Chief Medical Officer Professor Chris Whitty backtracked on the claims and said the tests are still being evaluated, a process which scientists claim could take a ‘few weeks’.
Despite repeated pleas from MailOnline, the Department of Health has still yet to reveal who makes the kits – which could give patients a result within 10 minutes.
Speaking alongside Boris Johnson at a press conference in Downing Street this evening, Prof Whitty warned that the ‘one thing worse than no test is a bad test’
Prof Whitty (left) took questions alongside Boris Johnson (centre) and chief scientific officer Patrick Vallance
An antibody test is one which tests whether someone’s immune system is equipped to fight a specific disease or infection.
When someone gets infected with a virus their immune system must work out how to fight it off and produce substances called antibodies.
These are extremely specific and are usually only able to tackle one strain of one virus. They are produced in a way which makes them able to latch onto that specific virus and destroy it.
For example, if someone catches COVID-19, they will develop COVID-19 antibodies for their body to use to fight it off.
The body then stores versions of these antibodies in the immune system so that if it comes into contact with that same virus again it will be able to fight it off straight away and probably avoid someone feeling any symptoms at all.
To test for these antibodies, medics or scientists can take a fluid sample from someone – usually blood – and mix it with part of the virus to see if there is a reaction between the two.
If there is a reaction, it means someone has the antibodies and their body knows how to fight off the infection – they are immune. If there is no reaction it means they have not had it yet.
Antibody tests differ to a swab test, known as a PCR (polymerase chain reaction) test, which aims to pick up on active viruses currently in the bloodstream.
A PCR test works by a sample of someone’s genetic material – their RNA – being taken to lab and worked up in a full map of their DNA at the time of the test.
This DNA can then be scanned to find evidence of the virus’s DNA, which will be embroiled with the patient’s own if they are infected at the time.
The PCR test is more reliable but takes longer, while the antibody test is faster but more likely to produce an inaccurate result. It does not look for evidence of past infection.
Antigens are parts of a virus that trigger the immune system’s response to fight the infection, and can show up in blood before antibodies are made.
The key advantage of antigen tests is that it can take several days for the immune system to develop enough antibodies to be picked up by a test, whereas antigens can be seen almost immediately after infection.
Antigen tests are used to diagnose patients with flu, as well as malaria, strep A and HIV.
In a Downing Street press conference last night, Professor Whitty tried to dampen expectations of an imminent testing breakthrough.
Speaking alongside Prime Minister Boris Johnson, he warned that the ‘one thing worse than no test is a bad test’ – incorrect results could lead to Britons unknowingly spreading the virus.
Professor Whitty added the ‘technology is quite close and it is being evaluated this week, but it is not there’.
The finger-prick tests will scour blood samples for antibodies, substances created by the immune system to train itself to fight off an infection.
He said: ‘The thing we would like to do next which would certainly make a difference less to the disease but definitely to the NHS is being able to test NHS and other critical workers who are self isolating who currently are not being tested because we do not have sufficient testing.
‘This is a global problem because basically every country is wanting this new test which for a disease which wasn’t actually being tested for anywhere three months ago so everybody wants this and there is a global shortage and that is a bottleneck for us.
‘But the next priority is to get critical workers back to work or to say to them you have got this. We definitely would like that not to fight the disease but to support the NHS.’
In terms of tests for people who currently have the virus, Professor Whitty defended the government’s decision to stop doing routine tests for those with symptoms.
‘When that ceased to be a sensible policy we moved onto testing people in intensive care and in hospitals and we have sufficient tests for that. At the moment the system for that is working fine and is being scaled up,’ he said.
‘That side of testing is in place and is working well. So if a patient gets as far as a hospital we are confident on the testing and the scale up.’
He said ‘once we have more testing than we need for that capacity then we want to go out to test a much wider range of people with mild symptoms’.
‘Some people are already having it as part of our surveillance system but we would obviously like to go wider.’
He added: ‘Our bottle neck is largely global shortages which we are obviously doing our level best to free up because it would make it a lot better for us to be able to test health care workers and know for sure.’
Professor Whitty said there were shortages along many supply chains in the production of tests because ‘every country in the world is simultaneously wanting this new thing’. He added: ‘It’s not that there is no testing going on, what we need, clearly, is to be able to scale it up.’
The World Health Organisation (WHO) and other experts have been warning that mass checks are crucial for keeping the spread of the killer disease under control.
Countries like South Korea and China have been praised for their wide-scale testing regimes, which seem to have helped limit cases.
However, the UK shelved efforts to test everyone with symptoms earlier this month, when the response moved into a ‘delay’ phase.
Instead people who thought they had the illness were urged to self-isolate unless their conditions became so severe they needed medical help.
Amid criticism, Mr Johnson then declared last week there would be a big expansion of tests from under 5,000 a day to 25,000.
Ministers now hope a test could be ready soon that does not need to be processed in a lab and will give results much more quickly.
Professor Peacock yesterday told MPs the Government had bought 3.5million tests which will be available in the ‘near future’.
‘Several million tests have been purchased for use. These are brand new products. We have to be clear they work as they are claimed to do,’ she said.
‘Once they have been tested this week and the bulk of tests arrive, they will be distributed into the community.’
Asked whether this could be days rather than weeks or months, she told the Science and Technology Committee ‘absolutely’.
Professor Peacock did not explain if the test were free on the NHS or if suspected patients would have to pay.
PHE has not revealed who is manufacturing the tests, which detect if someone has had the infection previously and is now immune.
Boots said that while it was keen to work with the Government, it had not yet heard about the plan to stock tests in its stores.
The new antibody tests snapped up by the Government are thought to use a lateral flow device (LFD) which takes a drop of blood by a finger prick (like this one, pictured), according to Professor Ian Jones from the Unversity of Reading
They work like an at-home pregnancy test and a colour develops if the patient is positive
HOPES LOCKDOWN COULD ‘KEEP INFECTION AT MANAGEABLE LEVELS’
It is hoped that once the coronavirus lockdown is lifted the infection can be kept at manageable levels, an expert has said.
Professor Neil Ferguson, who is recovering from COVID-19 himself, told the Science and Technology Committee measures taken by the Government could tip the outbreak from a growing epidemic to a declining epidemic.
He also explained there was some uncertainty, but that if current measures work as expected, then intensive care demand would ‘peak in approximately two to three weeks and then decline thereafter’.
Professor Ferguson, of Imperial College London, told the committee current predictions were that the NHS would be able to cope if strict measures continued to be followed.
He said: ‘There will be some areas that are extremely stressed but we are reasonably confident – which is all we can be at the current time – that at the national level we will be within capacity.’
Drinking from a Keep Calm and Carry On mug, he explained: ‘There will be some resurgence of transmission but the hope is that by employing more focused policies to suppress those local outbreaks, we can maintain infection levels at low levels in the country as a whole indefinitely.
‘It remains to be seen how we achieve this and how practical it proves to be.’
Appearing via videolink, he added that it was ‘plausible’ COVID-19 could behave like other coronaviruses and transmission could be somewhat reduced in the summer months but perhaps not by more than 10 per cent to 20 per cent.
Professor Ferguson said it was clear that the country could not be in lockdown for a year, and that ‘the long-term exit from this is clearly the hopes around a vaccine’.
‘The challenge that many countries in the world are dealing with is how we move from an initial intensive lockdown… to something that will have societal effects but will allow the economy to restart,’ he said.
‘That is likely to rely on very large-scale testing and contact tracing.
‘It should be stated that the entire world is in the very early stage of developing such strategies.’
The committee heard that the current strategy aim is to suppress transmission indefinitely until other counter-measures are put in place, including a vaccine.
It was also told that widespread testing was needed to help move the country from suppression measures and lockdown into something the country can manage longer-term.
Professor Peacock explained a small number of tests would be tested in a laboratory before being distributed via Amazon and in places like Boots.
She added: ‘Once we are assured that they do work, they will be rolled out into the community. Testing the test is a small matter, and I anticipate that it will be done by the end of this week.
‘In the near future people will be able to order a test that they can test themselves, or go to Boots, or somewhere similar to have their finger prick test done.’
But Boots said Professor Peacock’s comments today were the first the pharmacy chain had heard of the plan.
A spokesman added: ‘We are keen to work with the Government to explore opportunities to support COVID-19 testing and to support the NHS in any way we can.
‘However we do not have any type of COVID-19 tests in our stores. Customers should not make a trip to a Boots store or pharmacy for this purpose.’
The UK’s deputy chief medical officer today said antibody tests will ‘initially’ be available for frontline healthcare staff.
Speaking on a webchat on Mumsnet – a popular forum for parents – Dr Jenny Harries said this was ‘so we can manage patients and vulnerable people safely and keep our NHS and care systems running.
‘But we will be able to roll out to other people after that,’ she added.
The new antibody tests are thought to use a lateral flow device (LFD) which takes a drop of blood via a finger prick and a colour develops if the patient is positive.
The test looks for antibodies, the immune system’s defence mechanism, which are produced to fight off the killer virus.
They work like an at-home pregnancy test and take just minutes to produce a result.
But the deal has raised fears about whether the Government has rushed into buying the tests.
In the UK routine tests are only given to people so ill they have to go into hospital, or those who are already on wards – even NHS staff don’t get tested.
It means the official tally of just over 8,000 coronavirus patients is much lower than the reality.
Those who test positive will have already been infected – sometimes without knowing or showing symptoms – and are likely to be immune to reinfection.
But they are only around 80 per cent accurate, according to Professor Ian Jones, a virologist at the University of Reading.
And the devices are even less effective at spotting if someone is currently infect, he added.
Professor Jones told MailOnline: ‘They [antibody tests] are typically around 80 pe cent efficient and at this figure I guess they are good enough to give an idea of what percentage of the population has been infected, which is the denominator that nobody really knows.
‘It would be important to stress that they should only be used as directed and they are only a backwards look at the infection, they cannot be used in real time.’
Professor Jones stressed the importance of scaling up testing methods which can tell if someone is currently contagious so patients are not roaming the streets infecting others.
‘…as far as I know only hospitalised patients [are being tested]. Ideally this would extend to random testing as capacity cranks up.
‘This is obviosly more important when dealing with a current rather than historic infection – you wouldn’t want to send someone home if they were actually infected.
‘So in my view current tests would be better kept to reference centres where there is level of quality assurance.
‘Its the scaling up of the throughput so that these could take general population samples that should be the focus.’
Test by test: The types of coronavirus kits from 10-minute finger-prick results to a mask which can diagnose instantly that the government could be using amid row over shortage – as PM brands impending antibody check a ‘game changer’
Boris Johnson yesterday announced that coronavirus testing was to be ramped up to 25,000 per day after the government was slammed for potentially allowing tens of thousands of infected people to walk the streets undiagnosed.
Only 5,000 were being swabbed for COVID-19 previously, a fraction of the number seen elsewhere.
Mr Johnson said a new ‘game changing’ coronavirus test which analyses antibodies in the blood could detect asymptomatic patients and those who have already shrugged off the bug.
The Prime Minister said this would allow people to know whether they had gained immunity and get back to their working and social lives as soon as possible.
Public Health England previously said that only patients who meet certain criteria will be able to be tested for the bug and those who were being screened were having nasal swabs.
The Prime Minister conceded that the NHS will continue to use nasal swab tests that take up to 48 hours to be analysed in a lab.
Other countries around the world – including the US, China, South Korea, Japan and Italy – have been using testing kits that take just minutes to produce results.
And in a further development, Oxford University researchers claimed that they have created a new test which analyses viral RNA to detect COVID-19 in just 30 minutes.
Here, MailOnline looks at the cutting-edge testing kits currently being rolled out in other counties and at private clinics in Britain:
FINGER PRINT TEST
Name: COVID-19 IgM IgG Rapid Test
Diagnostic time: 15 minutes
The blood test is not being used in the UK, despite health bodies in China, Italy and Japan diagnosing patients with it.
On March 5, BioMedomics claimed its ‘quick and easy’ test was ready and being used in South Korea, Japan, Italy, China and some countries in the Middle East.
After the sample of blood is collected, a technician injects it into the analysis device – which is about the size of an Apple TV or Roku remote – along with some buffer, and waits 15 minutes.
One line means negative, two lines in a spread-out configuration means the sample contains antibodies that the body starts making shortly after infection.
A blood sample is collected, inserted into the reader, a buffer is combined, and results come back within 15 minutes, the company claims
Two lines closer together mean the person is positive for the later-stage antibodies, and three lines mean the patient is positive for both types of antibodies.
A small study showed the test produced a correct response 80 per cent of the time.
PHE confirmed it was not using the advanced blood test because it was not accurate enough, and are hoping to develop their own. The US Food and Drug Administration (FDA) is also yet to approve it.
A former PHE strategist said he was ‘not confident’ the test could produce correct results and is therefore unlikely to be rolled out. However, the method was desirable.
Name: TaqPath COVID-19 Combo Kit
Diagnostic time: Four hours
The DIY test detects specific DNA given off by the coronavirus in the noses of infected patients.
Samples are then delivered to labs where they are analysed and results are produced within four hours.
The test was approved by the US Food and Drug Administration this week and 5million kits will be sent across America in the coming days.
It is hoped the UK will follow suit after representatives from ThermoFisher, based in Waltham, Massachusetts, were seen entering Downing Street last night carrying a box with the tests.
It is understood ministers were giving a demonstration of how the test works.
FINGER PRICK TEST
Name: COVID-19 Rapid Test Cassette
Manufacturers: SureScreen Diagnostics
Diagnostic time: Ten minutes
The private firm, based in Derby, has created a test which can allegedly determine with 98 per cent certainty if a person is infected.
It involves taking a blood sample via finger prick and then putting it into a screening device.
SureScreen Diagnostics says a prick of blood from the fingertip is sufficient to determine with more than 98 per cent accuracy
The private firm says its test has been validated and is already being used in the UK, Ireland, Germany, Spain, Switzerland, Netherlands, Turkey, UAE, Kuwait and Oman. Currently, official swap-based methods take between 24 and 48 hours for results to come back
Public Health England cautions members of the public against using such tests amid fears they are unreliable, saying there is ‘little information on the accuracy of the tests’
Results are displayed in a similar fashion to those of an at-home pregnancy test within minutes and could potentially save delays in diagnosis.
SureScreen says its test has been validated and is already being used by private buyers in the UK, Ireland, Germany, Spain, Switzerland, Netherlands, Turkey, UAE, Kuwait and Oman.
It is believed around 175,000 tests have been conducted with the SureScreen kit so far. The company claims it has had over two million orders for next month.
Director David Campbell said: ‘We’ve been working hard to produce a coronavirus test (COVID19) that can be used at the patient side, with capillary blood, easily taken from someone’s fingertip and diagnose them within 10 minutes.
‘There is a big problem with the diagnosis of the disease currently because the standard method of screening is to send samples to the laboratory, which takes a lot of time.
‘Meanwhile, someone could be spreading the virus without knowing, or having the issue of self-isolation.’
FACE MASK TESTS
Manufacturers: University of Leicester
Diagnostic time: 12 hours
How it works: Breath test inserted in a mask
Scientists have started a trial of the pioneering £2 gadget, which tests have already proven can detect tuberculosis, a deadly lung infection.
Scientists have started a trial of the pioneering £2 gadget (pictured), which tests have already proven can detect tuberculosis
The researchers at the University of Leicester and the University of Pretoria designed 3D printed strips of polyvinyl alcohol that are inserted into the mask (pictured)
The masks, which could cost pennies if manufactured on a wider scale, are fitted with strips that soak up droplets from the wearer’s breath, which may be carrying traces of bacterial or viral infection.
The strips can be tested in labs with results coming back within hours. Current tests for coronavirus can take up to 48 hours.
University of Leicester researchers believe it will be at least two months before they can test the masks on actual COVID-19 patients.
But they are hopeful it will work because it is a respiratory disease, meaning it infects the lungs and can is present in the air people breathe out.
After 30 minutes, the strips can be tested in a laboratory (pictured)
First, the team have to test the gadgets on dozens of patients with other lung infections to prove they can pick up bugs other than tuberculosis, which they were designed for.
Patients with infections such as flu and bronchitis will have the results from their mask tests compared to those from throat swabs, which are known to be accurate.
Tests on tuberculosis patients, the only ones that have been done so far, show the masks can detect the killer disease almost 90 per cent of the time.
Leicester’s Professor Mike Barer and colleagues are hopeful they will be successful because the coronavirus infects the lungs in a similar way to tuberculosis.
Manufacturers: Northumbria University, Newcastle
Diagnostic time: Almost instantly
A breath test that helps rapidly identify patients with coronavirus has been developed by British scientists.
The technology, developed by a team at Northumbria University in Newcastle, is still in development and needs further testing.
But experts believe it could be quickly change the way the virus is spotted around the world.
A breath test that helps rapidly identify patients with coronavirus has been developed by British scientists (file)
Dr Sterghios Moschos, right, said the test could be used to produce results in minutes
The Northumbria team’s test collects breath samples which can be tested separately for biological information – known as biomarkers.
These biomarkers, which include DNA, RNA, proteins and fat molecules, can spot diseases of the lung and other parts of the body.
People simply breath into the device, which is similar to a breathalyser used by the police.
Dr Sterghios Moschos, associate professor at Northumbria University, said: ‘Our ambition is to reduce the need for bloodletting for diagnosis in its broadest sense.’
The test is currently being trialled.
PRIVATE HARLEY STREET CLINIC
Manufacturers: Private Harley Street Clinic
Diagnostic time: Three days
How it works: Nose and throat swab
More than 2,000 people have ordered a £375 home testing kit from a Harley Street clinic in London after being turned down by the NHS, according to the Daily Telegraph.
In addition to individuals, some 60 firms including oil and telecoms companies, have bought them for their staff.
On its website, the item can be easily ‘added to cart,’ much in the same way as conventional online products
Dr Mark Ali, director of the Private Harley Street Clinic on London’s world-renowned medical avenue, said his practice was offering a new kit for £375 each
The test is posted to the client’s home or preferred address, where the client takes swabs from both the nostrils and throat.
The sample is then placed in the box provided and posted back as per the instructions.
Dr Mark Ali, director of the Private Harley Street Clinic on London’s world-renowned medical avenue, said his practice was offering a new kit for £375 each.
On its website, the item can be easily ‘added to cart,’ much in the same way as conventional online products.
The practice says the test is ‘performed by a world renown UKAS accredited British laboratory and the test results are 100 per cent accurate and do not require further tests to confirm any diagnoses.’
The website hastens to add, that though it oversees the entire process, patients should not attempt to pick up their kits from Harley Street.
‘Please note under no circumstances can this test be done in our clinic or be collected from our clinic.’ The website states.
‘It is sent to your designated address by courier service within 48 hrs. Please refer to the details below and order through the link at the bottom of this page.’
Dr Ali told The Telegraph he has received countless requests from buyers.
‘People are worried sick. They want to get some clarity back in their lives,’ he told The Telegraph.
‘We’ve got university students in England who want to go back to Nepal, but need to know if they have the disease so they can be let back into their own country.
‘We’ve got a businessman who owns a construction company employing 60 people. He needs to know the state of play, or he risks letting down his customers. So every single person in that company is being tested.’
Diagnostic time: Ten minutes
British firm Mologic is working on an antigen test after receiving £1million from the UK Government.
Prime Minister Boris Johnson was taken on a tour of the Bedford laboratory of Mologic earlier this month
The firm hopes it will take just 10 minutes to produce a result, like that of the antibody test.
Antigens are parts of a virus that trigger the immune system’s response to fight the infection, and can show up in blood before antibodies are made.
Manufacturer: myLAB Box
US-based firm myLAB Box is mass producing a home test that requires a saliva swab to be sent away to an overnight lab to be analysed
Diagnostic time: One day
US-based firm myLAB Box announced this week that it has opened pre-sales of its COVID-19 home test for health professionals, doctors surgeries and pharmacies.
They require suspected patients to self-collect a saliva swab sample. These samples are sent away to a CDC lab to be analysed overnight.
myLAB Box also said that free telephone consultations will be made available to those who test positive for the virus.
It is planning to process up to 20,000 tests per day once it is approved by the FDA. It is currently under review.
FINGER PRICK TEST
Diagnostic time: 15 minutes
American startup Scanwell has produced a finger prick coronavirus test that takes just 15 minutes to complete at home.
It is posted to users via next-day delivery and is used alongside the Scanwell Health App.
American startup Scanwell has produced a finger prick coronavirus test that takes just 15 minutes to complete at home. It will work in conjunction with a health app (similar to its UTI test)
The test can be completed and uploaded through the app within 15 minutes, according to the company
The test is being fast-tracked for approval by the FDA but isn’t expected to hit the US market for another six to eight weeks.
Scanwell is best known for its smartphone-based urinary tract infection screening platform.
Who came up with the idea? Mount Sinai Health System, New York
Diagnostic time: 1 hour 30 minutes
How it works: Detects lung damage
Doctors from The Mount Sinai Health System in New York say CT scans may be faster than nasal and throat swabs at diagnosing coronavirus patients.
The team were the first in the US to analyze lung scans of patients in China with the highly contagious disease.
They said they were able to identify specific patterns in the lungs as markers of the virus, also known as COVID-19, as it developed over the course of about two weeks>
Patients who received scans zero to two days after symptoms first appeared had little to no evidence of lung disease in their results like this 19-year-old male who had a CT scan one day after symptoms first appeared
The team said the pattern in the lung of coronavirus patients are similar to scans of patients with SARS and very different from diseases such as bacterial pneumonia (pictured)
The researchers say these quicker diagnoses could help keep patients isolated in early stages of the disease, perhaps even before symptoms appear and when it may not show up on other scans such as chest X-rays.
‘CT scans are an extremely powerful diagnostic tool, because you can seen the inner organs in a three-dimensional way,’ lead author Dr Adam Bernheim, an assistant professor of diagnostic, molecular and interventional radiology at the Icahn School of Medicine at Mount Sinai, told DailyMail.com.
‘And you can see the manifestation of many diseases.’
For the study, published in the journal Radiology, the team analyzed scans of 94 patients at four medical centers in four Chinese provinces.
The patients had been admitted between January 18 and February 2, and all had either recently traveled to Wuhan – the epicenter of an outbreak – or had come into contact with an infected person.
Radiologists reviewed the scan and took notes based on when symptoms first appeared and when the CT scan was performed.
Thirty-six patients received scans zero to two days after reporting symptoms and more than half showed no evidence of lung disease.
The team says this is important because it suggests that CT scans cannot reliably detect coronavirus in its very earliest stages.
Nasal and throat swabs test can identify patients even before patients become symptomatic, although some may still have the virus if they first test negative.
Its results, however, may take days to get back from the agency’s labs.
But 33 patients who received scans three to five days after symptoms developed had patterns of ‘ground glass opacities,’ or haziness in the lungs.
‘The lung abnormalities are very round in shape and affect the perimeter of the lung,’ co-author Dr Michael Chung, an assistant professor of diagnostic, molecular and interventional radiology at the Icahn School of Medicine at Mount Sinai, told DailyMail.com.
WHAT DO WE KNOW ABOUT THE CORONAVIRUS?
What is the coronavirus?
A coronavirus is a type of virus which can cause illness in animals and people. Viruses break into cells inside their host and use them to reproduce itself and disrupt the body’s normal functions. Coronaviruses are named after the Latin word ‘corona’, which means crown, because they are encased by a spiked shell which resembles a royal crown.
The coronavirus from Wuhan is one which has never been seen before this outbreak. It has been named SARS-CoV-2 by the International Committee on Taxonomy of Viruses. The name stands for Severe Acute Respiratory Syndrome coronavirus 2.
Experts say the bug, which has killed around one in 50 patients since the outbreak began in December, is a ‘sister’ of the SARS illness which hit China in 2002, so has been named after it.
The disease that the virus causes has been named COVID-19, which stands for coronavirus disease 2019.
Dr Helena Maier, from the Pirbright Institute, said: ‘Coronaviruses are a family of viruses that infect a wide range of different species including humans, cattle, pigs, chickens, dogs, cats and wild animals.
‘Until this new coronavirus was identified, there were only six different coronaviruses known to infect humans. Four of these cause a mild common cold-type illness, but since 2002 there has been the emergence of two new coronaviruses that can infect humans and result in more severe disease (Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses).
‘Coronaviruses are known to be able to occasionally jump from one species to another and that is what happened in the case of SARS, MERS and the new coronavirus. The animal origin of the new coronavirus is not yet known.’
The first human cases were publicly reported from the Chinese city of Wuhan, where approximately 11million people live, after medics first started publicly reporting infections on December 31.
By January 8, 59 suspected cases had been reported and seven people were in critical condition. Tests were developed for the new virus and recorded cases started to surge.
The first person died that week and, by January 16, two were dead and 41 cases were confirmed. The next day, scientists predicted that 1,700 people had become infected, possibly up to 7,000.
Where does the virus come from?
According to scientists, the virus almost certainly came from bats. Coronaviruses in general tend to originate in animals – the similar SARS and MERS viruses are believed to have originated in civet cats and camels, respectively.
The first cases of COVID-19 came from people visiting or working in a live animal market in Wuhan, which has since been closed down for investigation.
Although the market is officially a seafood market, other dead and living animals were being sold there, including wolf cubs, salamanders, snakes, peacocks, porcupines and camel meat.
A study by the Wuhan Institute of Virology, published in February 2020 in the scientific journal Nature, found that the genetic make-up virus samples found in patients in China is 96 per cent identical to a coronavirus they found in bats.
However, there were not many bats at the market so scientists say it was likely there was an animal which acted as a middle-man, contracting it from a bat before then transmitting it to a human. It has not yet been confirmed what type of animal this was.
Dr Michael Skinner, a virologist at Imperial College London, was not involved with the research but said: ‘The discovery definitely places the origin of nCoV in bats in China.
‘We still do not know whether another species served as an intermediate host to amplify the virus, and possibly even to bring it to the market, nor what species that host might have been.’
So far the fatalities are quite low. Why are health experts so worried about it?
Experts say the international community is concerned about the virus because so little is known about it and it appears to be spreading quickly.
It is similar to SARS, which infected 8,000 people and killed nearly 800 in an outbreak in Asia in 2003, in that it is a type of coronavirus which infects humans’ lungs. It is less deadly than SARS, however, which killed around one in 10 people, compared to approximately one in 50 for COVID-19.
Another reason for concern is that nobody has any immunity to the virus because they’ve never encountered it before. This means it may be able to cause more damage than viruses we come across often, like the flu or common cold.
Speaking at a briefing in January, Oxford University professor, Dr Peter Horby, said: ‘Novel viruses can spread much faster through the population than viruses which circulate all the time because we have no immunity to them.
‘Most seasonal flu viruses have a case fatality rate of less than one in 1,000 people. Here we’re talking about a virus where we don’t understand fully the severity spectrum but it’s possible the case fatality rate could be as high as two per cent.’
If the death rate is truly two per cent, that means two out of every 100 patients who get it will die.
‘My feeling is it’s lower,’ Dr Horby added. ‘We’re probably missing this iceberg of milder cases. But that’s the current circumstance we’re in.
‘Two per cent case fatality rate is comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally.’
How does the virus spread?
The illness can spread between people just through coughs and sneezes, making it an extremely contagious infection. And it may also spread even before someone has symptoms.
It is believed to travel in the saliva and even through water in the eyes, therefore close contact, kissing, and sharing cutlery or utensils are all risky. It can also live on surfaces, such as plastic and steel, for up to 72 hours, meaning people can catch it by touching contaminated surfaces.
Originally, people were thought to be catching it from a live animal market in Wuhan city. But cases soon began to emerge in people who had never been there, which forced medics to realise it was spreading from person to person.
What does the virus do to you? What are the symptoms?
Once someone has caught the COVID-19 virus it may take between two and 14 days, or even longer, for them to show any symptoms – but they may still be contagious during this time.
If and when they do become ill, typical signs include a runny nose, a cough, sore throat and a fever (high temperature). The vast majority of patients will recover from these without any issues, and many will need no medical help at all.
In a small group of patients, who seem mainly to be the elderly or those with long-term illnesses, it can lead to pneumonia. Pneumonia is an infection in which the insides of the lungs swell up and fill with fluid. It makes it increasingly difficult to breathe and, if left untreated, can be fatal and suffocate people.
Figures are showing that young children do not seem to be particularly badly affected by the virus, which they say is peculiar considering their susceptibility to flu, but it is not clear why.
What have genetic tests revealed about the virus?
Scientists in China have recorded the genetic sequences of around 19 strains of the virus and released them to experts working around the world.
This allows others to study them, develop tests and potentially look into treating the illness they cause.
Examinations have revealed the coronavirus did not change much – changing is known as mutating – much during the early stages of its spread.
However, the director-general of China’s Center for Disease Control and Prevention, Gao Fu, said the virus was mutating and adapting as it spread through people.
This means efforts to study the virus and to potentially control it may be made extra difficult because the virus might look different every time scientists analyse it.
More study may be able to reveal whether the virus first infected a small number of people then change and spread from them, or whether there were various versions of the virus coming from animals which have developed separately.
How dangerous is the virus?
The virus has a death rate of around two per cent. This is a similar death rate to the Spanish Flu outbreak which, in 1918, went on to kill around 50million people.
Experts have been conflicted since the beginning of the outbreak about whether the true number of people who are infected is significantly higher than the official numbers of recorded cases. Some people are expected to have such mild symptoms that they never even realise they are ill unless they’re tested, so only the more serious cases get discovered, making the death toll seem higher than it really is.
However, an investigation into government surveillance in China said it had found no reason to believe this was true.
Dr Bruce Aylward, a World Health Organization official who went on a mission to China, said there was no evidence that figures were only showing the tip of the iceberg, and said recording appeared to be accurate, Stat News reported.
Can the virus be cured?
The COVID-19 virus cannot be cured and it is proving difficult to contain.
Antibiotics do not work against viruses, so they are out of the question. Antiviral drugs can work, but the process of understanding a virus then developing and producing drugs to treat it would take years and huge amounts of money.
No vaccine exists for the coronavirus yet and it’s not likely one will be developed in time to be of any use in this outbreak, for similar reasons to the above.
The National Institutes of Health in the US, and Baylor University in Waco, Texas, say they are working on a vaccine based on what they know about coronaviruses in general, using information from the SARS outbreak. But this may take a year or more to develop, according to Pharmaceutical Technology.
Currently, governments and health authorities are working to contain the virus and to care for patients who are sick and stop them infecting other people.
People who catch the illness are being quarantined in hospitals, where their symptoms can be treated and they will be away from the uninfected public.
And airports around the world are putting in place screening measures such as having doctors on-site, taking people’s temperatures to check for fevers and using thermal screening to spot those who might be ill (infection causes a raised temperature).
However, it can take weeks for symptoms to appear, so there is only a small likelihood that patients will be spotted up in an airport.
Is this outbreak an epidemic or a pandemic?
The outbreak was declared a pandemic on March 11. A pandemic is defined by the World Health Organization as the ‘worldwide spread of a new disease’.
Previously, the UN agency said most cases outside of Hubei had been ‘spillover’ from the epicentre, so the disease wasn’t actually spreading actively around the world.
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