Coronavirus has been seen in more than 30 countries, with signs it is getting a foothold in Europe. But what is the government planning to do if there is a major outbreak in the UK and how prepared is the NHS?
The hope is it can still be contained
The government has said the UK is prepared for all eventualities.
But ministers and health officials are still working on being able to contain any outbreaks in the UK.
That involves spotting any cases quickly, isolating them and chasing up any contacts they have had to ensure they do not spread it if they have been infected. This is being done by Public Health England’s (PHE) nine regional teams. The devolved administrations have their own arrangements.
So far it has worked well. There have been 13 cases – but all have involved infection abroad in China and other Asian countries.
There has been no transmission within the UK, but even if there is, that does not mean containment is defeated. If the authorities can chase the links in the transmission chain, they have a good chance of stopping its spread.
There is obviously concern that more countries are seeing cases, particularly those in Europe where there is more frequent travel to and from the UK.
So what happens if containment fails?
Containment should not be seen as a win-or-lose game. Even if it fails, it will have bought the UK valuable time. Scientists will be closer to a vaccine being developed and if containment lasts until the spring or summer, the milder weather will help.
There had been some hope the virus would find it harder to spread in warm weather – although the experience of other countries so far shows that is not the case.
Nonetheless, delaying an epidemic until the summer would have the added benefit that the NHS would not be under so much pressure to cope. It is currently in the midst of its most difficult winter for a generation.
Is the NHS ready?
The NHS has detailed escalation plans to cope with outbreaks of disease and surges in demand. Key to respiratory illnesses caused by coronavirus are the five specialist hospitals that have treated the UK patients. Another 19 regional infectious disease units are on stand-by to take patients if numbers dramatically increase.
All hospitals have been asked to set up isolation pods in case patients with the virus come in, although the official advice is to phone NHS 111 and self-isolate.
Currently there is no treatment or cure, so hospitals are trying to relieve the symptoms. Specialist equipment called ECMO is available at a small number of units to support the most severely ill patients if their lungs fail.
As well as looking for a vaccine, researchers are exploring whether existing treatments for other conditions, such as malaria and HIV, can be used to help coronavirus patients.
What if there are mass outbreaks?
In the worst-case scenario of widespread transmission in the UK – classed as an epidemic – hospitals could start cancelling routine treatments to provide spare capacity to treat coronavirus patients.
Assessments will also have to be made about which patients can be advised to stay at home and isolate themselves, because the illness for many seems to be mild and passes.
PHE has already announced a programme of wider surveillance to see if coronavirus is spreading undetected. Eight hospitals and 100 GP surgeries are providing testing to patients with flu-like illness and respiratory problems.
Could schools be closed and freedoms curtailed?
Under the Civil Contingencies Act, the government can close schools, shut down public transport and stop mass gatherings to protect the public.
But all the evidence suggests those measures are not particularly effective at stopping the spread of something like coronavirus.
What is more, there has to be a balance between public safety and economic and social impacts.
Closing schools, for example, could disrupt exams and force parents to take time off work.
It is why both ministers and health officials keep stressing schools do not have to close – those that have done are down to head teachers.
The virus appears to cause a fairly mild illness for many. Elderly people and those with other health conditions appear to be most at risk.
The same is true for seasonal flu, which kills several hundred people every year, but despite this the government does not insist on mandatory vaccination or curb freedoms.
New legal powers have been given to force people to stay in quarantine. But this is a measure more about containment than a practical step that will be taken in the event of the virus becoming an epidemic in the UK.
The government and NHS simply do not have the facilities to contain many more than a few hundred people.
In the event of mass transmissions, responses will be co-ordinated at a central level by the government’s Cobra committee and locally by 43 “resilience forums” in England and Wales.
These include PHE officials, the NHS, local councils and the emergency services. Northern Ireland and Scotland have their own arrangements, although they do liaise closely with England.