In the first part of our article, we told you about the ability of viruses to mutate and how the Coronavirus is an example of this. In this article, we will tell you more about the challenge to public health which it represents.
Check the first part here
A public health problem
The Basic Reproductive Rhythm (R0) is an estimated epidemiological index of how many new cases derive from a given case throughout an infectious period. In other words, how many new infections can be estimated from a single case? For SARS the R0 is 1.2, for the Coronavirus a much higher contagious rate, which is estimated from 1.4 to 3.8, but rather low if we compare it to whooping cough, which has an R0 of 5.5.
Well, some people would say that the Coronavirus is not so terrible with these data. However, this statement depends on which form is addressed. A disease that has an R0 greater than 1 supposes a possibility for an epidemic. But there are other elements that should be considered as well, such as how long does it take for the original carrier to be potentially contagious, for Coronavirus the estimated time is 14 days.
The combination described above gives us the following result, in an average period of 14 days, a carrier is capable of infecting up to 3.8 people. A high rate, we can surely expect that the cases will double or triple within a week, as it appears in the media.
This fact has been dealt with in different ways, in China and Italy (and now many other European countries), for instance, entire cities have been isolated and public events have been suspended in order to avoid large-scale spread.
It is highly relevant to clarify that the Coronavirus, by itself, does not represent a significant risk to the health of the world population.
This is due to its low general mortality (only 2%) and depending on different age groups, its mortality is always associated with other diseases (cardiac pathologies, respiratory problems, etc.).
We must also observe the rate of cases that require hospitalization according to the associated severity, as this data can be truly revealing to measure the impact that the virus could have. Regarding that matter, it is estimated that the Coronavirus reaches 17%.
In epidemiological and public health terms, asymptomatic patients today pose the greatest challenge. These are the cases where a person carrying SARS-COV2 does not present symptoms or visible development of the disease (COVID-19 or Coronavirus), being potentially dangerous in the spread of the virus.
Does Coronavirus represent a real problem?
We have intensively studied epidemiological elements and medical teams collecting full-time data and the result is overall a relatively low mortality rate.
Thus the true challenge is how to deal with asymptomatic patients, how to deliver the fastest solution in terms of controlling the spreading and here is when it becomes a question of infrastructure. If a country lacks the necessary infrastructure to properly isolate the patients infected or if they can not offer the minimum hygienical requirements to stop the spreading, well, in those cases the virus becomes a real problem. It becomes then a question about how efficient a national health system is.
We will consider the data previously exposed, that is; the rate of transmission from person to person (3.8), a half of life of the virus (14 days), rate of those infected who need hospitalization (17%) and mortality data according to age range (2% overall and 14% for those over 80 years of age) and finally, we will use a speculative data, the real contagion rate, since the recent appearance of the Coronavirus does not allow us to even estimate its real impact worldwide. For this purpose, we will base ourselves on the rate provided by seasonal influenza, which affects 10% -20% of the world population every year and is treated in a palliative manner, without forgetting that the rate of transmission from person to person is three times higher for Coronavirus.
All the information mentioned above, in order to carry out a basic exercise and clarify how much of a burden a pandemic in these regions would represent in terms of public health.
The estimated population of Switzerland is 8.5 million inhabitants (2015). With a contagious rate of 10%, the 850,000 people of Coronavirus could be affected. It is estimated that 17% of those infected would need hospitalization, that is, 144,500 available beds in the hospitals to treat the disease if we make a monthly average per calendar year (12 months) we would have to have 12,041 beds per month. Finally, it would have a mortality rate of(2%) of 17,000 people.
By 2015, the population over 80 years old exceeded 400,000 people, almost 5% of the country’s total population. In this case, we would have as a result around 40,000 infected (10%) over 80 years old, 5,600 people would eventually die, an equivalent of 14% of those who contracted the virus.
In the case of a country like Chile, with little more than a minimum infrastructure, the situation though is quite different. With 18 million inhabitants (2018). 10% of the population supposes 1.8 million infected seasonally by Coronavirus. 17% is equivalent to 306,000 people who would require hospitalization, an annual monthly average of 25,500 hospitalized. The general mortality of 2% would imply that of the 1.8 million infected, 36,000 people would die. About 12,000 people monthly, 3,000 a week, 428 a day, if we consider only the winter season.
What is the problem behind this huge difference in the mortality rate? Chile has 2.1 beds for every 1,000 inhabitants. If we take this into account, there is a total of 37,800 beds available in the hospitals. With a monthly load of 25,500 patients, the Coronavirus itself would represent 67% of the total number of beds available in both, the public and private systems.
By 2016 the country had already a deficit of 15,000 beds, something like 30 hospitals with 500 beds each and it is not even just about the problem of the people who need treatment. This approximation of 36,000 people who would die, amounts an equivalent of three times the number of autopsies carried out by the Legal Medical Service (SML) each year and this is something that must be carried out due to the protocols established by the health ministry. So, in a country like Chile, the system will be completely overburdened.