In the time of Corona

These are strange times.

I had planned other posts, but it feels impossible to continue with these and ignore the coronavirus pandemic. At the same time, although I am compulsively reading about the coronavirus at the moment, I am also getting tired of hearing about it to the exclusion of everything else. The World Health Organization (WHO) actually recommends not checking the coronavirus news more than twice a day, to avoid stress and anxiety. So, expect posts about other things in the next weeks too. But for now, I’ll summarize our experience of the pandemic so far.

Summary of the pandemic

Although it’s now estimated that the first case may have occurred in mid-November 2019, it was in December that Chinese doctors first noted a cluster of patients with “pneumonia of an unknown cause”. Later in December, the virus was identified as a coronavirus, now known as SARS-CoV-2, causing the disease now called COVID-19. Worldwide, the news of the novel virus broke on the 31 December. Little did the world realize what the new year would have in store.

As someone who works on infectious diseases, I read all the news with interest from the beginning. By late January, cases of COVID-19 started appearing in other countries as well. On the 23rd January, China put Wuhan into lock down. As the numbers of infected rose in China, I could not comprehend why flights with passengers travelling in both directions were still being allowed. As one would predict as a result, cases of COVID-19 started appearing in more and more countries. Most cases occurred in small clusters. In Germany, where I currently live, an employee of the company Webasto became infected by a visiting Chinese colleague. Several other Webasto employees and some of their family members also became infected, but  this cluster of cases was contained.

WHO met on the 22 January to decide whether to label the outbreak as “a public health emergency of international concern”. They decided against it. By the 30th January, they had already reversed this decision due to the growing number of cases.

The next big outbreaks would occur in Iran, Italy and South Korea. Up until February, only a few cases had been confirmed in Italy. But a cluster of cases was detected in Lombardy on the 21st February. By the 22nd February an additional 60 cases had been confirmed. The last two days of the carnival in Venice were cancelled. At this point, it should have been clear that something was going wrong. The numbers were increasing by the day. From the outside, it appeared there was uncontrolled spreading, and flights to and from Italy should have been stopped. But as usual, politicians were slow to act, no doubt fearful of being blamed for the economic consequences, or of offending their neighbours. A pity, because two or three weeks of cancelled flights then would have prevented the months of possible economic disruption we face now.

On the 24th February, a week of spring/carnival holidays started in Germany. Many people went on holiday to Italy (often ski trips in the north, where the outbreak was). A week later, new cases of infection with SARS-CoV-2 imported from Italy started popping up in Germany, all over Europe, and all over the rest of the world. At this time, when I raised my concerns to people that travel to Italy should be stopped, they didn’t think it necessary. And a lot of people were scoffing online: what’s the big deal, it’s just like flu! It’s just media hype! This, despite the fact that Wuhan had to build 16 new hospitals to cope with all the patients.

Many people had the same mindset, so without any intervention by governments, flights continued, and people continued going on holiday, both from and to Italy. Despite the number of people returning home infected, flights continued and there was no quarantine for returning travellers. On the night between 7 and 8 March, some parts of Italy went into lock down.

We all know what happened next. The numbers of cases and deaths soared in Italy, with mortality in Italy over 8% as of today. An Italian doctor reported the situation in hospitals as similar to a war, where it is impossible to treat all patients and some have to be left to die. Similarly in Iran, the mortality rate is at 7%. Both cases and deaths are now also soaring in Spain. In contrast, South Korea managed to limit its outbreak by extensive testing and tracking of case contacts, and there the mortality rate is currently around 1%. Germany also has almost 14 000 cases, but a mortality rate of only 0.3%.

The cases that had popped up worldwide were like sparks, starting fires all over the world. Some were contained, and others grew larger. My home country South Africa reported its first case on the 5th March (a traveller returning from Italy). Related cases were confirmed on the 8th March. Since then, there has been a gradual increase in cases. In the beginning almost all of them were travellers returning from Europe, the UK or USA. Lately, the cases have included those who acquired it by local transmission. Currently, there are 150 cases.

As the number of cases have grown world-wide, governments started to take the situation more seriously. Over the last week (mid-March), many countries have implemented border checks and travel bans. Every day the measures get stronger. While the number of cases grows worldwide, in China, the epidemic is almost over. The lock down worked, and new cases now are primarily from people entering the country. This brings hope that with tremendous effort it is possible to contain the outbreak – but how long will it take?

How it has affected us in Germany

It is becoming hard to remember a time before COVID-19, when everything was normal. In the last two weeks, the situation has changed almost every day, and it is all that everyone talks about.

5th March: We were informed at work that business trips to high risk areas were not permitted (regions of China, Iran, Italy and South Korea). People who had been in a risk area for the last 14 days but did not have symptoms did not have to stay away from work, but if they developed symptoms they should stay at home.  When applying for a new business trip within the next 6 weeks, employees should assess if it was worth the risk, and obtain approval from management.

At this point, things were still relatively normal, but awareness of the risk had started to change. Some conferences and events with large numbers of people were being cancelled. People at my work were wondering if a conference they were due to attend the next week would be cancelled or not, since a number of them were going. In the end it wasn’t cancelled because it would have bankrupt the society that was hosting it.

7th March: I had a one-day meeting in Frankfurt, to which I had to travel by train. The conference organizers had already sent an email around that the meeting would still take place but that people should not attend if they were ill or had been in high risk areas recently.  It was an important conference to attend, but my husband and I were already aware that travelling by public transport was not ideal. The trip there was fine, but on the way back I was horrified how many passengers on the train were travelling while obviously sick (coughing, runny noses, etc). Of course they may just have had colds or flu, but it was very irresponsible, considering the circumstances.

10th March: Our work announced that no external events with more than 1000 attendees should be attended, no matter where these events would be held.

11th March: WHO declared COVID-19 a pandemic.

13th March: It was announced that university lectures would stop in Würzburg. It was also declared that all schools in Bavaria would be closed from the 16 March to the 19th April.

Czech Republic closed its borders. No foreigners would be allowed in, and returning Czechs would be quarantined and then not allowed back out, for the next 30 days. We had planned to visit my husband’s family in the Czech Republic that weekend, the 14th and 15th of March (driving on the 13th), so had to cancel. Now we will not see them until after the birth of our child.

15th March: My home country, South Africa announced a national state of disaster, in order to stem the coronavirus outbreak. There would be a travel ban on foreign nationals from high-risk countries such as Italy, Iran, South Korea, Spain, Germany, the United States, the United Kingdom and China, from the 18 March 2020. Returning South Africans would have to go to 2 weeks quarantine. Schools would be closed and people were encouraged to work from home. Gatherings of more than 100 people were banned and social distancing was encouraged.

Berlin announced that all public and private events with more than 50 people would be cancelled, and cinemas, theatres, concert halls and sport facilities, including gyms and fitness studios, along with bars, pubs, casinos and clubs, would be closed until at least April 19. Restaurants would remain open if customers are able to keep a 1.5-metre distance from one another. Hospital patients would no longer be allowed visitors.

Similarly, the Bavarian Prime Minister declared that an official state of emergency would be called in Bavaria, lasting 14 days. Only supermarkets, pharmacies, drugstores, banks and petrol stations would remain open.

In addition, it was announced there would be border controls and entry bans at the German borders to Switzerland, France, Austria, Denmark and Luxembourg. Schools and day-care centres would be closed throughout Germany.

A few hours later, my midwife cancelled the baby’s check-up appointment (required every 2 weeks during pregnancy) for the next morning, saying she would only go to emergency cases. Checking the facts online, I found out that the rule relating to hospital patients not being allowed visitors may even extend to fathers not being allowed in the delivery room, although apparently most hospitals still allow this at the moment. Will I have to give birth alone, I wonder? We are already separated from both my family and his by the new border regulations.

16th March: The official state of emergency was called in Bavaria. Public transport would run on the holiday schedule. The Robert Koch institute appealed to people to stay at home if possible and limit social contact. The Czech republic went into quarantine, allowing only essential movement. Prague banned travel on public transport without masks.

Like they did in other countries, people in South Africa immediately beginning stockpiling toilet paper and food. In Germany this was named Hamsterkäufe (hamster shopping), because of the way hamsters gather food to save for later. So far in Würzburg we didn’t’ see much of it, although toilet paper shelves were quite low, hand sanitizer is hard to find, and there was an increase in sales of pasta and other long-lasting foods. But friends sent us photos of empty shelves in Berlin supermarkets. To combat people’s stockpiling, some shops have special hours for the elderly to shop, and/or limit the amount of each item that people can buy.

17th March: The German government issued a warning on traveling for tourism purposes worldwide, as many countries started closing their borders.

18th March:  Merkel appealed to the public to take the coronavirus pandemic seriously, calling it the biggest challenge since World War II. Instructions from my work: keep distance from others, avoid crowds, regular hand-washing, don’t sneeze/cough into hands, communicate electronically when possible, have meetings by tele- or video conference, work from home if possible.

19th March: Our institute announce that all postgraduate students must stay at home. Staff may be redirected to working in diagnostics (not me, since I’m pregnant). Heads of state have threatened to introduce curfews if people will not voluntarily practice social distancing, as social media showed people still gathering in parks and restaurants.

What next?

This is where we are at right now. It is expected that in the next days curfew may be announced, meaning that people will not be allowed to leave their homes except to go to work, supermarkets, pharmacies etc, as some other countries have done. Although the number of new cases has already dropped substantially in Würzburg, it could be that we fall under a blanket curfew announced by the country or the state of Bavaria.

All of the measures listed above and the possible curfew looming will certainly reduce the number of new cases as contact between people is reduced. The question is how long it will take for cases to stop occurring, and how to proceed from then.  Keep the borders closed until all countries are down to zero cases? We do wonder, when things will return to normal. Will our baby be born during the height of the pandemic, or after the worst is over? The effect on the economy will be huge, but the government will pour a lot of money into supporting businesses who will struggle.

In the meanwhile, all we can do is stay at home as much as possible, stay away from others as much as possible, and wash hands often. The idea of all of this is to slow down the number of new cases so that hospitals can cope and scientists have more time to develop treatments and vaccines.

These are strange times. 

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