Coronavirus: Everything you need to know about Covid-19

THE ORIGINS

Start at the beginning. Where did the coronavirus come from?

It originated in Wuhan, China, last December. The most likely scenario is that a bat developed the illness, after which it was transmitted to humans.

When did we become so concerned about it here?

When the illness was confined to remote parts of China – or at least to places in that country that few people in this part of the world had heard of – it was easy to imagine it would not affect Ireland too much. That myth was exploded in the final week of February after a spike in confirmed cases of Covid-19, as the newest coronavirus iteration is now formally known, in Italy.

Sourcing equipment to protect against coronavirus a major challenge - HSE

---

Coronavirus and the etiquette of working from home

---

Trump names Mike Pence to lead US coronavirus response

---

What has happened there?
It has become the epicentre of the spread of the virus in Europe. It started with towns being quarantined, tourist spots emptying, museums closing, and major events such as Venice's traditional pre-Lenten carnival curtailed. With the free movement of people through the EU, it suddenly became a lot more likely that the virus would take hold in this part of the world.

And it did

That finally happened on February 27th, when Ireland’s first case was announced in Belfast, involving a person who had returned from Italy through Dublin Airport. A second case was confirmed on Tuesday, March 3rd: a female whose infection was unrelated to the first case but also associated with travel from Italy. Since then, the number of cases in Ireland has continued to grow. The first death in Ireland from coronavirus was confirmed on Tuesday, March 10th - a woman in Naas General Hospital, Co Kildare.

After weeks of trying to contain the virus, Ireland has moved on to a delay phase in its efforts to combat it. The change in strategy was prompted by a big jump in confirmed cases and further evidence of clusters of the disease, as well as unexplained community transmission.

On Thursday, March 13th, unprecedented restrictions on public life aimed at curbing the spread of coronavirus were announced by Taoiseach Leo Varadkar, with schools, colleges and creches, along with museums, galleries and other public buildings beginning a 19-day enforced period of closure. It is likely the school closures could extend to five weeks, until the end of the Easter holidays.

And outside Ireland? 

Different countries have adopted completely different approaches to tackling the virus. Italy has ordered a virtual lockdown across the country, in a major attempt to try to contain the rapidly growing outbreak of coronavirus. “We are facing a national emergency,” said prime minister Giuseppe Conte. “We chose from the beginning to take the line of truth and transparency and now we’re moving with lucidity and courage, with firmness and determination. We have to limit the spread of the virus and prevent our hospitals from being overwhelmed.”

But overwhelmed they have been, with more than one thousand deaths from Covid-19 so far. The global death toll from the outbreak is now well over 5,500. On Friday, March 13th, Minister for Health Simon Harris said all people coming back from Italy and Spain (which also has thousands of cases) will be asked to restrict their movements for two weeks, which includes not going to work.

However, some countries are reporting successes in combating the virus. By the second week of March new cases in China had dropped to single digits for the first time since January. Wuhan city, ground zero of the new coronavirus outbreak, reported just five new cases on Friday, March 13th, the second day in a row the tally was been less than 10, while no locally transmitted infections were reported in the rest of the country. The National Health Commission in China claimed on Thursday, March 12th that China's coronavirus epidemic had passed its peak.

THE VIRUS

So how bad is this virus?

Studies from China point to a mortality rate of about 2 per cent for laboratory-confirmed cases. That’s about 20 times worse than the flu, but a lot lower than for other nasty bugs such as Sars, Mers or ebola. The overall rate will drop ultimately when the final tots are done because many people will have recovered without coming to the attention of of the health services.

So, 2 per cent? I think I’ll take my chances

Four out of five people will experience only mild symptoms from this virus. The young are largely spared unless they have underlying conditions. The overall mortality rate varies hugely according to age – one study put it at nothing for young children and up to 15 per cent for those aged over 80 years.

Why is there so much concern?

A key factor when considering an infectious disease is its transmissibility. Covid-19 seems to be pretty good at getting around the place. European Union interior ministers have been trying to co-ordinate their response to the coronavirus, but the virus is now present in all 27 EU countries.

One way of measuring transmissibility is the virus’s reproduction number or R0 (“R naught”), effectively the number of people an infected person will go on to infect. Cillian de Gascun, head of the National Virus Reference Laboratory in UCD, says estimates from China put the R0 at somewhere between 1.5 and 4, compared with 1.4 for the average flu (and up to 18 for measles).

However, R0 varies across different environments. It can be reduced by effective hygiene control measures – handwashing, proper sneezing, even social distancing. And whereas the people of Wuhan didn’t know what was about to hit them last January, we here in Ireland have had ample warning.

What is the incubation period?

The incubation period – the time between infection and the onset of symptoms of the disease such as cough, fever and shortness of breath – is thought to range from two to 14 days.

Can you carry this virus and pass it on without showing symptoms?

This is a big area of uncertainty. De Gascun says “the jury is still out” on asymptomatic transmission, but that some reports may involve people who actually had a mild illness but “maybe didn’t appreciate this”.

Talk to me about the name of the virus?

There are actually names, rather than a name.  According to the World Health Organisaltion, the illness is to be known as Covid-19 but the virus responsible for Covid-19 is known – at least officially – as severe acute respiratory syndrome coronavirus 2  (SARS-CoV-2)

Why do the virus and the disease have different names? 

"Viruses, and the diseases they cause, often have different names," WHO says.  "For example, HIV is the virus that causes AIDS.  People often know the name of a disease, such as measles, but not the name of the virus that causes it (rubeola”).

Okay? What else?

Viruses are named based on their genetic structure to facilitate the development of diagnostic tests, vaccines and medicines. Diseases are named to enable discussion on disease prevention, spread, transmissibility, severity and treatment In the middle of February it was announced that  “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)” was the name of the new virus. WHO also announced “COVID-19” as the name of this new disease on the same day. WHO has said that “from a risk communications perspective, using the name SARS can have unintended consequences in terms of creating unnecessary fear for some populations, especially in Asia which was worst affected by the SARS outbreak in 2003.  For that reason and others, WHO has begun referring to the virus as “the virus responsible for Covid-19” or “the Covid-19 virus” when communicating with the public.

COVID-19 IN IRELAND

Will Ireland be able to cope?

As the number of cases grow, which experts say is inevitable, the question is can they be spotted early. Measures such as the the restrictions on indoor gatherings to less than 100 people and outdoor ones to less than 500 people, are designed to slow the spread of coronavirus in Ireland.

But can we cope?

If we get a relatively small number of cases – as happened with Sars in Ireland in 2003 – we’ll cope. The worry is if we find ourselves in a replica of the Italian situation with multiple clusters of cases.

The HSE says isolation rooms have been identified in all the major hospitals, where patients would be treated. We have only one state-of-the-art isolation unit in the country, in the Mater hospital, but local arrangements and transfers to the Mater would probably suffice in the event of a small number of cases.

The HSE is stocking up on new ventilators to prepare for more people in respiratory distress from coronavirus, but medics have raised concerns about staffing levels to manage them. The HSE would not disclose the number of ventilators in the Irish system but said that it had purchased an additional 12 portable ventilators and 60 intensive care unit (ICU) ventilators. Nearly half of the ventilators used in acute hospitals around the globe are made in Ireland. Galway-based Medtronic is one of the biggest manufacturers.

How many could fall ill here?

The Business Post reported on Sunday March 8th that health authorities were forecasting that about 40 per cent of the population could become sick as a result of the virus.  In response Paul Reid of the HSE said he could not dispute those reported projections that up to 1.9 million people could become sick as a result of contracting the coronavirus, although he said the work was not yet concluded and the evidence was changing day by day.

Can the virus be treated?

Doctors try to keep patients’ bodies going, providing breathing support where necessary and waiting for their immune system to fight off the virus. There is no vaccine as yet, though one might be ready by the end of the year. Antivirals are being tested in China, but there are no clear results yet.

PRECAUTIONS

What can I do to protect myself?

You have probably heard the advice by now; wash your hands with soap or gel regularly; cover your mouth and nose when coughing or sneezing; avoid touching your face; keep your distance (one metre) from people who are coughing, sneezing or running a fever.

Should I stock up on face masks and gels?

Good luck with that. Even before there was a case of the coronavirus in Ireland, panic-buying of face masks in pharmacies and hardware shops had led to shortages across the country. Wholesale prices have soared as much as 500 per cent, and some canny people are looking to make a killing on online classified sites by selling masks at multiples of their original price. Pharmacies have also reported that alcohol-based hand gels are in short supply, while the demand for thermometers has spiked as fears mount about the spread of the coronavirus.

Do the masks work?

People wearing face masks are likely to be the most enduring images of 2020, but many are not as efficient at preventing the transmission of minute viruses as people might hope or believe. Some medical professionals argue that regular hand-washing is a far more effective way of protecting yourself.

Having said that, people might derive comfort from a mask but it is worth bearing in mind that they were originally designed to filter the air you breath out and to protect the well person from the sick person, rather than the other way around.

Masks are generally not recommended for people who feel well and have no symptoms. People who should use masks include those with the virus, their close contacts and healthcare workers caring for infected people.

If I think I have the virus, what should I do?

If you’ve come back from one of the affected areas and you have symptoms, contact your GP urgently, and do not leave the house. The principal symptoms are headache, dry cough, shortness of breath, muscle pain and fever. If you have come back from these areas and are feeling well the advice is to consult the HSE website, or ring the HSELive helpline on 1850 24 1850 for advice.

How should people being tested behave around those they live with?

The HSE advises that family members or people sharing a residence with a suspected case should avoid contact, communicate by phone and not answer calls to the door.

TRAVEL

Okay, talk to me about me. How is this going to affect my summer holidays?

It is too early to say what impact it is going to have on summer travel. In recent days, words such as “fluid”, “evolving”, “ever-changing” and “fast-moving” have been used to describe the situation, and those words still apply. It could be that by July, the start of the high season for tourism in Europe, the virus will have peaked. It could be that things will be much worse than they are today. There is too much uncertainty to make a firm decision on your travel plans now.

So what advice can you give me?

The best advice is sit tight and not to panic. Pay attention to the travel advice from the Department of Foreign Affairs and other relevant sources.

What is the department saying?

Its advice is fluid and evolving. (See? They are words we can’t escape.)  For many weeks China was the only county the Department of Foreign Affairs (DFA) was warning people not to travel to. It also identified other areas – including Japan, Hong Kong, Iran, and where restrictions have been imposed. It is urging people not to travel to affected areas.

These areas extend to Europe as well - and not just Italy. For example, the DFA are recommending against non-essential travel to Spain (including the Balearic and Canary Islands). “A significant number of cases of novel coronavirus (Covid-19) have been confirmed in Spain,” it says on the DFA website. “The highest incidences are in Madrid, Vitoria and Labastida in the Basque Country, Catalonia and the Rioja region.”

Is that official advice important?

It is very important. If an official advisory against travel is in place then people who have booked independent holidays and have travel insurance to that location could be able to claim for any losses they are likely to incur. With advisories in place, people who have booked with tour operators should also be able to process refunds or reschedule trips.

What about flights?

According to the European Consumer Centre Ireland (ECC Ireland), a natural occurrence such as Covid-19 that causes travel disruption is considered “extraordinary circumstances” outside the control of a transport provider, such as an airline. Consequently, compensation would not normally apply. For air travel, according to EU Regulation 261, passengers on cancelled flights may be entitled to have their journey either re-routed to the final holiday destination or refunded. If a land or sea journey is cancelled, passengers are entitled to re-routing or a refund.

What about package holidays?

For package holidays involving a journey to, or a stay in, areas affected by travel restrictions due to the virus, consumers may have the right to terminate the booking contract without paying a termination fee. This applies only to unavoidable and extraordinary circumstances that may pose a significant risk to human health and prevent consumers from making use of or reaching the destination of their booked holiday, as agreed in the travel contract.

The place I am going is near an affected area. Can I cancel?

If consumers choose to cancel their holiday to an area where no emergency measures have been declared that is their right, but the holiday cancellation is, of course, strictly within the limits of their booking contract. Refunds may be possible but that is by no means certain. And if passengers cancel flights voluntarily they are entitled to a full refund of airport taxes as the cancellation takes place before the flight check-in operation. But it is worth bearing in mind that admin fees imposed by airlines often make such refunds pitifully small.

So what should I do?

Dominic Burke, chief executive of Travel Centres, the Republic’s biggest consortium of travel agents, says many Irish holidaymakers are asking this very question. “What travel agents are saying is that if your travel date is some way in the future don’t do anything rash as you run the risk of losing money if you have paid a deposit.”

Is there anything more practical to do?

Now would be as good a time as any to ensure you have adequate travel insurance covering any trips you may have coming up. If you are travelling anywhere in the EU in the months ahead and do not have a European Health Insurance Card (EHIC) or think the one you do have may has expired, then get it sorted.

Remind me what is the EHIC again?

If you are travelling in Europe the card gives you access to public health services at no cost. If you have a smartphone download the EHIC app to help you navigate overseas health systems, and remember: your card needs to be renewed every five years. Don't ever pay for the card. Some sites will try charging for the service, but it is free through the official site, ehic.ie.

When it comes to travel insurance should I just go with the cheapest one?

No. The price difference between the cheapest travel insurance policy on the market and the most expensive can be – relatively speaking – very small, but the level of cover they offer can be substantial. And you should take out your travel insurance the moment you book your holiday. Better still, take out an annual policy. Almost 40 per cent of the claims are made before travel, with illness and death the most likely reasons for cancelled holidays.

Is there anything specific I should look for in my policy

Ensure your policy covers cancellations as a result of official warnings from government not to travel to a destination. But timing is crucial here. Mapfre, one of the biggest travel insurance underwriters in the State, says that if a policy covers a government recommendation to avoid a country or area, a claim will be considered only if that recommendation is in place within 48 hours of a person’s intended departure.

If trips do not involve travel to affected areas but consumers are still concerned about going, travel insurance does not cover “disinclination to travel”.

What are the airlines doing?

Many airline, including Ryanair, have cut back on flights - especially to regions such as Italy. Some carriers face calamity, with Korean Air Lines warning in the second week of March that the virus outbreak could threaten its survival after it scrapped more than 80 per cent of its international capacity, grounding 100 of its 145 passenger aircraft. Flybe, the British-based regional carrier, went into administration blaming, at least in part, the fall off in bookings as a result of the spread of the disease.

What about the tour operators?

The Irish Travel Agents Association (ITAA) has advised Irish travellers and holidaymakers to follow the advice of the Department of Foreign Affairs when travelling overseas. It also called on the public to be pragmatic about their holiday bookings.

What does that mean?

“We would ask that travellers ensure they have adequate travel insurance. Follow advice of local authorities on the ground and take all preventative measures as recommended,” says the president of the ITAA John Spollen. The association also says people should follow the advice from the Department of Foreign Affairs and download the official Travelwise app, which provides specific travel health advice for individual countries. Travelwise advises that travellers in countries that are reporting cases of Covid-19 should follow local public health advice.

Among the airlines that currently have policies for free of charge changes in place are American Airlines, British Airways, KLM, Air France, United Airlines, Virgin Atlantic, Emirates, Turkish Airlines, AirCanada and WestJet. It is important to note that each airline has slightly different rules, but most offer changes valid for ticketed/issued bookings from the month of March.  Other suppliers offering flexibility include The Travel Corporation, MSC Cruises and Silversea Cruises.

Okay, so I am going to leave the country. What can I expect when travelling?

It depends on where and when you go. There are likely to be enhanced health screening procedures at arrival and departure areas in many countries. And these will probably lead to delays, depending on how bad things get.

Are people being screened before being admitted to Ireland?

No. Chief medical officer Dr Tony Holohan says entry screening for the coronavirus "doesn't work, wouldn't work" and would be a "waste of resources".

EVENTS IN IRELAND

Will Ireland have to turn foreign tourists away this summer?

Again it is too soon to say. Many sporting events in Ireland and throughout the world have been cancelled - including hurling and gaelic football at all levels. The top-flight football leagues in Ireland, England, Spain, Italy, Portugal, the Netherlands, and the United States have all been suspended amid the outbreak, while the German Bundesliga are holding matches behind closed doors. The Six Nations rugby tournament was also suspended.

St Patrick's Day parades in Ireland have also been cancelled, along with some of that day's biggest parades across the world - including in New York and Chicago.

BUSINESS

Outside of travel and health, what else is happening?

Many Irish companies have operations in regions badly affected by the coronavirus or depend on them for supply lines. Companies such as Penneys have said there may be supply issues as the year progresses, while Kerry Group has said its sales in China are set to fall by about 30 per cent in the first quarter of the year. Apart from that global trade is being disrupted across the board, stock markets are falling and there is a very real risk that this "black swan event" – something profound and unexpected that has lasting consequences – will tip the world into a prolonged recession.

Economist and Irish Times columnist David McWilliams has written that economic contagion spreads more easily than physical illness in a globalised world, that China will suffer economically as a result of the virus, and therefore the global economy too.

THE  LONG TERM

What's a pandemic?

A pandemic sees the virus spreading globally, with massive health and economic consequences. But eventually things settle down. On March 10th, the World Health Organisation (WHO) declared coronavirus a pandemic, warning that countries weare not doing enough to stop the spread of the virus around the globe.

How is this going to turn out?

For the Republic, until recently, the big challenge has been to keep the virus out. Currently, it is about slowing its spread.