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Seriously: How will Ireland cope with a Coronavirus outbreak?

There are, at the time of writing, 150 confirmed cases of Coronavirus in Italy. Three people have died to date. The numbers are likely to rise, as well.

It is estimated that the Coronavirus has an incubation period of at least two weeks – that is to say, you could be walking around feeling in perfect health and showing no symptoms while already having the virus. Add that to the fact that the initial symptoms are flu-like, and it’s perfectly reasonable to expect that you may have infected dozens of others before you even seek treatment. In fact, a report just yesterday suggests that in some people, symptoms might not materialise for up to a month:

The incubation period of the novel COvid-19 coronavirus could be as long as 27 days, noted Reuters citing reports from Chinese provincial government.

In Hubei province, hard-hit by the coronavirus epidemic, an infected 70-year-old man did not exhibit Covid-19 symptoms until 27 days later.

On 24 January, the man had close contact with his infected sister, said Hubei government website. He had a fever on 20 February and received test confirmation the next day.

This kind of epidemic is, if we’re honest about it, almost impossible to contain. Somebody infected with the virus, but who doesn’t know it, gets on a plane and arrives in Dublin airport. They wake up in a Dublin hotel exhibiting flu-like symptoms but assume that it’s a bad cold. They go to a conference in the RDS, and spend the day coughing and sneezing. It takes two or three days for them to seek treatment. By the time they’ve been diagnosed, 50 Irish people have been infected. By the time those 50 have been diagnosed, they have infected 500 more, and so on, and so on.

That’s obviously a worst-case scenario, but it’s far from an impossible one. The 150 cases in Italy almost certainly originated with one person arriving in the country totally unaware that they were infected. In fact, it’s perfectly possible that there are already Irish people walking around Dublin or Cork or Dundalk who have the Coronavirus but who haven’t exhibited any symptoms yet.

What’s worse, of course, is that new evidence suggests that the virus can be transmitted by someone showing no symptoms at all. A recent Chinese case involved a young woman passing the virus on to five family members, despite showing no symptoms of the illness herself:

Chinese researchers have confirmed a case of asymptomatic transmission of the new coronavirus: A 20-year-old woman from Wuhan passed it to five of her family members but never got physically sick herself.

The case study is the first concrete evidence that a person showing no symptoms can pass the coronavirus to others — a fact that could make curbing the outbreak even more challenging.

The researchers behind the finding said the 20-year-old woman was isolated and closely observed at the Fifth People’s Hospital of Anyang. She never become physically ill, even after her family members developed fevers. Two of them got severe pneumonia.

For now, the woman’s asymptomatic transmission appears to be an anomaly, but health experts have documented other instances in which people tested positive for the virus without showing symptoms.

So, assuming that the virus does break out here, which seems at least likely, how prepared is the Government, and what can it do to cope?

Once the first case is announced, the immediate problem will be public panic. Because the symptoms are flu-like, and because we’re currently undergoing a sustained period of bad weather, the biggest immediate problem will be diverting enough resources to diagnosis. It’s very likely that you will see a rush of people who have nothing more than a bad dose of the common cold rushing to doctors as a precaution, which will put pressure on an already creaking system of general practice. The list of symptoms of the virus, after all, are common to many other, much less serious, illnesses:

A study of 138 patients infected with the new virus in Wuhan, published in the Journal of the American Medical Association (JAMA) on February 7, showed the most common symptoms were fever, fatigue and dry cough. A third of the patients also reported muscle pain and difficulty breathing, while about 10 percent had atypical symptoms, including diarrhoea and nausea.

The patients, who ranged in age from 22 to 92, were admitted to the Zhongnan Hospital of Wuhan University between January 1 and 28. “The median age of patients is between 49 and 56 years,” JAMA said. “Cases in children have been rare.”

While most cases appeared to be mild, all the patients developed pneumonia, according to JAMA.

So far, the response in other countries has been, once a patient is identified, to quarantine them, placing them in isolation, away from anywhere where they might infect other patients. What facilities does Ireland have to hold a few hundred seriously ill people while keeping them quarantined?

The hospitals, after all, are full. Placing people with a serious, contagious virus into the existing hospitals would be to take a risk with the health of the patients already in those hospitals. Even if it were to be done, it would probably involve closing down whole wings and wards of a hospital just to cater for the quarantine of what might be a comparatively small number of initial patients.

In China, they went so far as to build a dedicated hospital, famously, in a few days, just to cope with the demand for quarantine beds. That kind of resource is not available to the Irish Government. A dedicated existing facility will have to be found.

And what about the medical staff for that facility? Coronavirus will be, if it comes to these shores, a genuine public health emergency. It will almost certainly require the cancellation of most non-emergency medical procedures, for an unspecified period of time, as nursing and medical staff are re-directed away to treat the afflicted.

And then there is the public order question and the economic impacts – to reduce the chance of the epidemic spiralling out of control, it would be reasonable to cancel almost every public event where large numbers of people are due to congregate. It is likely, in such a situation, that many people would simply stay at home as much as they possibly could. This will have a severe impact on hospitality and catering, with restaurants and pubs seeing a substantial short-term impact on their trade.

There is also the question of day to day functioning – for example, what does the Government do about schools and universities, or the leaving and junior cert exams in a situation where there is a live coronavirus outbreak? There will, no doubt, be some parents who decide not to send their children to school as a precaution. In such situations, public panic and over-reaction is almost always an exacerbating factor in the crisis.

Such an outbreak is potentially just days, or weeks, away. The country has no functioning Government, and there has been very little public information about how the state intends to respond to a medium or large scale outbreak of the illness on these shores.

Isn’t it time we talked about it?

Final thought: A company making a large-scale, quiet purchase of gas masks for sale to the public right about now would be making a very smart investment.

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