By Tharosa Missaka Rajaratne –

Tharosa Missaka Rajaratne

The world at present is facing a pandemic caused by the virus identified as Severe Acute Respiratory Syndrome – Coronavirus-2 (SARS-CoV-2), which is also named as ‘COVID-19’ along with other names such as nCoV (Novel Coronavirus), or simply ‘Corona Virus’ etc.. The epicenter of the outbreak is Wuhan, Hubei, China. The first cases were recorded in December 2019, but it spread extremely rapidly causing an epidemic in China, and a pandemic as declared by the WHO, in March 2020. At present 528,000 confirmed cases, 23,669 deaths, and 122,000 recoveries have been reported as of 27^th March 2020. This series of articles intends to present a brief analysis of the patterns, potential trends in propagation of the disease, severity of the epidemic in selected countries in each continent and effectiveness of the measures taken to mitigate the epidemic by these respective countries.

What is COVID-19 Virus?

COVID-19 is a member of the Coronavirus family that commonly manifests in humans as a respiratory tract infection. The symptoms caused by Coronaviruses are often mild and represent general profile similar to that of common cold. However few Coronaviruses have been identified to be of high virulence, high severity and mortality to some communities. SARS-CoV (2003), MERS-CoV (Middle Eastern Respiratory Syndrome), and SARS-CoV-2 (2019) are such high virulent viruses of the Coronavirus family that caused multiple outbreaks in the recent history. 

COVID-19 is spread through airborne droplets of respiratory matter produced at events of coughing or sneezing. The basic reproduction value denoted as R₀ (pronounced R-Naught) is a mathematical value which reflects the possibility of average number of people that get infected from an individual carrying a transmissible disease, upon effective contact. The R₀ of COVID-19 is estimated to be in the range of 1.4 to 3.9. This indicates that a person contracted with COVID-19 virus would pass the disease down to two to four healthy uninfected and unimmunized people on average. Although the R₀ value has limitations (which are not intended to be reviewed in this particular discussion), the trend that is observed in this pandemic suggests that the virus indeed is somewhat contagious in moderate to high levels. In absence of an effective antiviral medication to treat COVID-19, the outbreak could only be contained through prevention.

Battling Coronavirus

At present, the epicenter of the pandemic has been shifted from its birthplace in Wuhan, China to Lombardy, Italy. However, analysis of the propagation of the disease in China that started as an isolated case dated 17^th November 2019 (Patient Zero), to a suspected outbreak by 8^th December 2019, to a confirmed epidemic status by 23^rd January 2020 and finally to a well-controlled situation reveals an ample amount of information on how China successfully battled the pandemic. When this analysis is expanded to the countries that are currently considered at risk, a few features in the spread of the disease could be observed. Both actions and inactions on the timeline explain the effects rendered on the spreading of the disease. It is observed that conspicuous geocentric differences, between East and West, of spread and containment of the disease are present.

China as a case in point

Being the birthplace of the pandemic and the first country to successfully mitigate the spread of the disease, China first moved towards a possible catastrophe due to negligence and suppression of information. The first sign of a viral outbreak was reported by the media as early as on 12^th December 2019. China carried out a scientific analysis and informed the WHO of ‘cases of Pneumonia of Unknown Etiology’ observed in Wuhan, Hubei province. By January 1^st 2020, Chinese authorities had identified around 250 persons who were suspected to have contracted the disease from the previous year. Although attempts made by certain medical professionals (specifically Dr. Li Wenliang) since December 2019 to raise public awareness of a SARS-like viral outbreak taking place in Wuhan, the local authorities suppressed such attempts by stamping respective individuals as ‘rumormongers who spread rumors’, and censoring sensitive social media handles such as #WuhanSARS. It should be noted that amidst the suppression, the government had implemented vigilant screening processes to monitor the spreading of the disease, and the virus type was isolated and the gene sequencing data of the virus was made available on the internet by January 10^th. Due to the insufficiency of data relating to human-to-human transmissibility of the disease, stern actions were not taken to mitigate the propagation. In the following days to come, China would witness the first case outside China in Thailand, and several new cases and few deaths also. On the 18^th January, while the total cases had risen about to 300, an annual banquet involving 40,000 families at nine locations was held by the Wuhan City Government. Ultimately by 20^th January, the Chinese National Health Commission confirmed that the disease is human-to-human transmissible. Due to the increasing number of cases and deaths in Wuhan City, the Chinese Government finally imposed quarantine over Greater Wuhan on 23^rd January 2020. Several other cities with high risk were then imposed with strict quarantine procedures and since then extremely authoritarian measures were taken to deter the spread of the disease.

It is certain that China started its remedial process of treatment from the worst possible stage of the outbreak. Had the authorities taken measures to raise public awareness instead of suppressing, the situation would have steered towards a less chaotic state. However, even at the direst situation to have things started with, a commendable effort was taken by the citizens and the officials who were engaged in controlling the disease. The vigilance and the efficiency of the officials and the cooperation of the citizens by way of strictly adhering to the orders announced by the authorities managed to bring down the curve of the disease statistics. Strict quarantine procedures and self-confinement methods proved effective against the exponential spread of the disease. 

(Note – Due to an adjustment made in the diagnostic definition used to confirm a suspected patient, a notch followed by a sharp increase of 14,480 cases is observed at 12^th February 2020)

Figure 1 – COVID-19: Cumulative Active Cases, Recovered Patients, and Deaths. Location: Mainland China (Data – JHU CSSE, March 26th 2020)

Although the Chinese authorities had started quarantine procedures, the number of active cases grew as a proportion of the population that had already been exposed to the disease prior to the quarantine was imposed. The constraining factor (‘buffer’) in this specific case was the number of hospital beds and equipment that were vital to diagnose patients. Inability to control the rate of active cases would fill the ‘buffer’ and eventually leave out the recoverable patients untreated that would end up with potentially avoidable deaths. Due to the rapid influx of active cases at first, Chinese authorities constructed temporary hospitals to cater to the demand. Inability to have met such a critical demand would have resulted in a higher mortality rate than what was experienced. Continuous and uninterrupted quarantine procedures and added healthcare facilities with strict screening methods, the resilience shown by the citizens and the authorities, and the realization of the importance of individual responsibility by everyone, made it possible for China to control the outbreak within the country. 

South Korea as a case in point

South Korea had already confirmed the existence of COVID-19 positive patient as early as by 20^th January 2020. Due to the general influx of Chinese and Korean citizens from China, South Korea had implemented an advanced and well organized mechanism of screening, identifying and quarantining individuals that are susceptible to have contracted COVID-19 virus as well as individuals who had kept close dealings with them. Due to the high rate of success in this method, South Korean authorities had only imposed moderate restrictions in public operations. Until 18^th February 2020, South Korea was able to retain an exceptionally low propagation rate of the disease, with only 30 cases and 19 recoveries and no deaths.

Figure 2 – COVID-19: Cumulative Active Cases, Recovered Patients, and Deaths. Location: South Korea (Data – JHU CSSE, March 26th 2020)

The notorious Patient No.31 incident is considered to be the patient who had attributed in piloting a sudden and an alarming surge of infection across the population after attending a mass gathering of a religious service while showing symptoms of the disease. This immediately spiked the count of infected population and by two days, 70 out of 90 new confirmed cases were linked to the Patient No.31’s involvement. By 22^nd February, out of some 9300 participants of the mass gathering, 1261 individuals had presented symptoms. The effect rendered from this surge is apparent on the graph shown above. This shockwave of infection was immediately handled by the authorities by deployment of maximum intervention. About 230,000 followers of this particular religious movement were monitored thoroughly to ensure no further breach would take place. The downfall of active cases observed in the graph witnesses to the effectiveness of the quarantine process and the treatment that the patients received. The measures taken by South Korea in controlling the disease at the most critical point was praised by the international community also. 

The Eastern Curve

China, South Korea and several other countries are battling against COVID-19 at present. Their approach however differs from that of the Western countries and in consequence the outcomes are also quite different. The shape of the curve can be employed as a brief indicator to determine whether the spreading of the disease is under control or not. An exponential escalation indicates that the spreading of the disease somewhat is beyond control, whereas a linear or a decelerating increase indicates that it is controlled (does not necessarily mean that the spreading is halted), or the rate of the spreading is steadily decreasing, respectively. These individual shapes can be observed at various coordinates of time in the graph below. For an instance, South Korea has shown a near-exponential growth after the Patient No.31 incident, but due to the extreme controlling process, the spread hindered to a near-linear growth and then the growth seems to have decelerated even further. In addition to South Korea, it should be noted that Japan, despite the close proximity to the epicenter of the disease, has been able to keep a possible breach of infection and the general rate of spread at bay. In comparison, the effectiveness of the remedial methods carried out by the respective countries is well apparent. In general, majority of the Asian countries has been somewhat successful compared to other countries, in controlling the spread of the disease at a stunted rate thanks to their effective containment and treatment methods. However, it should be noted that few countries are at the risk of heading towards an uncontrollable stage. Malaysia, Pakistan, Thailand, and Russia can be identified as countries that are potentially at risk as of now.