As COVID-19 becomes a global issue, most people seem too nervous to notice that the virus is actually showing a flu-like epidemic pattern with more countries reporting more cases around the world. Based on the pattern observed, the epidemic could be ended if an international organisation steps forward to coordinate a global force to thoroughly implement flu control protocols, including public education on good personal hygiene, the home or institutional quarantine of sick people, a flu surveillance network that asks clinics and hospitals to report patients with flu-like symptoms for further testing and so on, in most of countries as soon as possible.
At the end of January, Germany’s first two cases contracted the virus from a colleague who had flown in from Shanghai to join their company’s workshop, with a further two colleagues - who did not come into contact with the Chinese visitor - testing positive as well soon after. This cluster has preliminarily showed the human-to-human transmission of the virus could be very easy, and very similar to what the flu virus does. Furthermore, the similarity of the German patients’ Coronavirus symptoms to very mild flu hasn’t gone unnoticed.
Singapore and Japan offered significant evidence of a larger scale in February. As of 29 February, Singapore had reported 93 cases, including five clusters and quite a number of patients whose source of infection is not known. It was showing that the spread of the virus could easily happen in the community, exactly as the flu virus would do. And, just like the earliest German cases, patients in Singapore were fighting with only flu-like symptoms; no severe cases were reported.
Excluding the cruise ship cases, Japan found more than 250 cases in different cities and prefectures in February. Most of infected people just had flu-like symptoms and six elderly patients died from pneumonia. So, in Japan, the virus was also showing a flu-like epidemic, which usually puts senior people at a higher risk in terms of severity and morbidity.
That is why the world's leading countries should consider flu control protocols and call for all countries to move forward in the same direction for a quicker resolution of the epidemic.
In addition, a BMJ (originally called British Medical Journal) article published on 18 February shared evidence from the comparison of case fatality rates (CFR), which is the ratio of deaths from a certain disease to the total number of people diagnosed with this disease for a certain period of time representing a measure of disease severity. SARS had a CFR of around 10%. MERS killed 34%. COVID-19’s overall CFR was around 2%. A collaboration of Hong Kong University and Harvard University also estimated the CFR of COVID-19 is around 1.4%.
As it stands, the COVID-19 virus appears to be mostly causing a flu-like illness only. It does not seem to be the SARS-like or MERS-like super killing bug of the new decade. The frightening death toll in China, for instance, could be the result of a medical system collapse caused by too many patients rushing into hospitals, which is the scenario we have usually seen during a flu pandemic. Countries with increasing death tolls - such as Italy and Iran - therefore need international aid.
Although the CFR number of COVID-19 (mentioned above) is lower than that of SARS’s and MERS’s, most experts agree the CFR of a seasonal flu is around 0.1% only in comparison. Therefore, we still have to take Coronavirus seriously, and more importantly, implement the right strategy to deal with it.
Based on its flu-like epidemic pattern, the goal of a global response to COVID-19 should change from containment to mitigation by, for example, helping the elderly and people with underlying health conditions to avoid potentially fatal exposure. We shouldn’t waste resources on finding asymptomatic infections. We should make sure that medical institutions are ready to deal with a large number of patients. We should remind healthy people to wash hands more often and sick people to stay home. Besides these, Taiwan’s recent experience shows that wearing a mask is an effective extra precaution.
Excluding three small clusters with the index case contracting the virus in January, Taiwan did not report any new domestic case after 31 January until a local woman tested positive on 28 February. Besides washing hands, it is worth to notice that the majority of Taiwanese have been promptly wearing a mask since the epidemic started concerning people at the beginning of January, even though many experts claimed that wearing a mask was not necessary at that time. Although the shortage of surgical masks has caused chaos, the chaotic situation is believed to have become a reminder for most Taiwanese to practice good personal hygiene at all times, which is the main preventive measure before we have vaccines and new drugs to combat it.
Before Valentine's Day, the Centers for Disease Control and Prevention (CDC) in the US had actually started applying the existing flu surveillance network to COVID-19's prevention and control. It honestly works, and thus far, the US is doing well. President Trump should have been more confident in his country’s efforts and not announce the travel ban on visitors from 26 Schengen zone countries. If the US needs to take extra precautions, it would make more sense to ban Italian citizens only - as Italy has almost locked the whole country down - instead of affecting other EU member countries.
Research on the virus takes time and epidemic control can’t wait. It is necessary to find clues through the epidemiological analysis of reported cases to help form a proper response strategy. The best solution for now is to strictly follow flu control measures to the letter, plus taking a few extra precautions - such as wearing a mask and maintaining healthy immune defence - to carry everybody through. The EU should learn lessons from the current situation, especially from the US' latest travel ban, and take responsibility for leading a global force to handle COVID-19 with flu control protocols as soon as possible.
- Ping-yuan “Edward” Lu is the Director of the Public Health Office for NGO HSVG Mission.
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