The conversation around how we prepare for coronavirus here needs to be guided by a sense of our common humanity, write Ruth Cunningham, Charlotte Paul, Andrew Moore, Ayesha Verrall of the University of Otago.

Borders have been closed, arrivals from Wuhan are in quarantine, and New Zealanders who have travelled from China are being asked to “self-isolate’’. Despite 49,000 lab-confirmed cases of Covid-19 worldwide, there are, as yet, no cases in New Zealand. They are, however, expected. 

These public health measures need to be justified in terms of both the rapidly changing scientific data and the application of ethical values; otherwise, fear of an outbreak can lead to excessive coercion and race-based stigma. In these situations, efforts to prevent the outbreak can cause more harm than good. Our decisions need to be guided by a sense of our common humanity; a sense that “it could be me”. As Dr Tedros Adhanom, director general of WHO, said earlier in the month: “We are all in this together, and we can only stop it together.” Our shared responsibilities to each other need to become part of the conversation and preparation for Covid-19 here in New Zealand.

The National Ethics Advisory Committee developed and widely consulted on ethical values for managing each phase of a pandemic, as part of New Zealand’s pandemic preparedness efforts. Getting Through Together explores the place of widely shared ethical values. The committee arrived at two sets of values for decision-making: those informing how we make decisions and those informing what decisions we make.

Good decision-making includes following good processes such as being open to public scrutiny and being explicit about the science and values that underlie decisions. This builds trust and confidence in authorities, and leads to greater acceptance of public health measures. After all, the reality of New Zealand’s small public health workforce means in a pandemic we are reliant on voluntary adherence to measures such as self-isolation. For public health measures to succeed, people and communities need to trust decision-makers. 

The values and processes outlined in Getting Through Together offer support to decision-makers at all levels of society who face difficult choices. At this stage, where the focus is on border control, decisions are being made about who is allowed into New Zealand. The World Health Organisation has cautioned against border control actions that promote stigma or discrimination. Closing borders has the potential benefit of delaying the arrival of people infected with Covid-19. But as the epidemic develops and more is known about both the infectivity and the case fatality, the benefits of border closures may be outweighed by potential harms. 

When restrictive measures are required, the least restrictive measures possible should be used. People subjected to restrictive measures such as quarantine may be deprived of their freedom of movement, but they should not be deprived of other rights. Quarantine measures can be implemented in ways that are respectful, supportive and fair, and cater for diverse needs. 

Similarly, reciprocity is crucial when people are subject to quarantine because quarantine is performed for the good of others, not for the person’s good. In other words, people are required to bear an extra burden in the interests of others. Reciprocity can be expressed by ensuring people who are quarantined are given extra support and well looked after, in keeping with the extra burden they carry for protecting others.

In New Zealand, Chinese people have already experienced stigma and discrimination associated with fear of the coronavirus. It is encouraging that at the Whangaparāoa Reception Centre, where 157 people from Wuhan are being held in quarantine for two weeks, the Ministry of Health organised Chinese New Year celebrations. Director general of health Dr Ashley Bloomfield said, “Chinese New Year is an important cultural event and we organised this to honour that for both our guests with Chinese heritage and all others.”

This is exactly the respect and reciprocity we need. 

With the potential that an increasing number of people will require quarantine or isolation if cases occur here, the responsibility for providing this support will not remain with government agencies alone. We will need to recognise the values of neighbourliness and unity in coming together to support those whom we are asking to “self-isolate”. This might mean offering to walk a neighbour’s dog, or drop around a casserole. It’s worth thinking now about neighbours who might need extra support.

These values will also inform prioritisation decisions by health professionals who care for those who become ill, and guide consideration of what we owe to these professionals who care for the sick. Recognising the humanity of healthcare workers means prioritising their special need for protection with evidence-based equipment. It also means ensuring healthcare workers are not unduly penalised in terms of lost wages or sick leave if they are stood down from duties (for up to two weeks) following unprotected exposure to the virus. Otherwise non-disclosure of exposures could lead to infectious healthcare workers transmitting the illness in hospital. These types of issues are most pressing for staff like cleaners who play a vital role in hospital decontamination and yet are often low paid and on casual contracts. Finally, healthcare workers are among New Zealand’s most multicultural workforce and racism during a pandemic undermines the cohesion of a workplace under extraordinary pressure. 

New Zealand needs to prepare for managing Covid-19 cases. This includes improving hand and respiratory hygiene practices, making available personal protective equipment, and preparing for potential self-isolation, as well as preparing our health system to cope with increased demands. It must also include much more, through discussions at all levels of society about our shared responsibilities to each other. 

We use ethical values all the time in deciding how to behave; what is different with a pandemic is that there will be many conflicts between our impulses to protect ourselves and our families and the protection of our common humanity.

We know that coronavirus is dangerous, but what does it actually do to your body? Epidemiologist Allen Cheng explains.

We usually think of viral respiratory infections, like the common cold, as mild nuisances that pass in a few days. But the Wuhan coronavirus has proven to be different. Of those infected, around 2% are reported to have died but the true mortality is unknown.

There’s much we’re yet to learn about this new virus, but we know it often causes pneumonia, an infection of the lungs which produces pus and fluid and reduces the lungs’ ability to absorb oxygen.

Of the first 99 people with severe infection, three-quarters had pneumonia involving both lungs. Around 14% appeared to have lung damage caused by the immune system, while 11% suffered from multi-organ system failure, or sepsis.

Others are at risk of complications from being treated in hospitals, such as acquiring other infections.

At this stage, we know some people develop only a mild infection, while others become critically ill, but the exact proportion of each is not yet clear.

Overall, there are four key ways the Wuhan coronavirus can cause severe disease – and some can occur at the same time.

1. Direct viral damage

For the SARS (severe acute respiratory syndrome) coronavirus, direct viral damage was probably the most common way the infection caused disease. This is likely the case with the Wuhan coronavirus.

Early studies have found the Wuhan coronavirus attaches to a particular receptor found in lung tissue. This is like a lock and key mechanism allowing the virus to enter the cell, and is the same receptor the SARS coronavirus used.

Viruses “hijack” the host cell’s mechanisms to make more copies of itself. Damage results from either viruses taking over the cell completely and causing it to die, or immune cells recognising the viral infection and mounting a defence, triggering cell death.

If large numbers of cells die, then the affected organ can’t function effectively.

Studies from patients who died from SARS coronavirus showed the virus caused damage to not only the lungs, but also other organs in the body. Early research suggests the Wuhan coronavirus can also damage other organs, including the kidneys.

2. Pneumonia

While we’re still piecing together the relationship between the Wuhan coronavirus and pneumonia, there’s much we can learn from influenza.

Influenza is a virus but it commonly leads to bacterial pneumonia – this is what’s known as a secondary infection.

It’s thought the influenza virus weakens the usual protective mechanisms of the lung, allowing bacteria to establish and multiply. This is especially true in children, older people and those with compromised immune systems.

Secondary bacterial pneumonia is more severe than influenza alone – in hospitalised patients, around 10% of those with influenza and pneumonia die, compared to around 2% of those who don’t have pneumonia.

The Wuhan coronavirus appears to cause pneumonia in two ways: when the virus takes hold in the lungs, and through secondary bacterial infections, however, the first way appears to be more common.

3. Sepsis

Sepsis is a serious condition that can be caused by many infections.

When we get an infection, we need to mount an immune response to fight off the pathogen. But an excessive immune response can cause damage and organ failure. This is what happens in the case of sepsis.

Although it can be difficult to determine whether organ damage from the Wuhan coronavirus is a result of direct viral infection or indirect “collateral damage” from the immune system, initial reports suggested around 11% of people severely ill with the Wuhan coronavirus experienced sepsis with multi-organ failure.

So far no drugs or interventions have been able to dampen this immune response. Although several treatments have been proposed for Wuhan coronavirus, none have yet been shown to work.

4. Complications of hospital care

Finally, patients who require hospital care may have complications. These include infections from intravenous lines (for drips/medication) or urinary catheters (flexible tubes inserted into the bladder to empty it of urine), pneumonia, or non-infectious complications such as falls or pressure sores.

Studies have found 10% of patients in hospital have some sort of health care-acquired infection, and around 5% have a pressure sore.

Hospitals work hard to try to prevent these complications, by making sure health care workers disinfect their hands and other equipment. However, complications still occur, particularly in patients who are debilitated from long hospital stays.

While most respiratory viral infections are mild, some can trigger serious complications, either directly or indirectly. It’s too early to tell how often this occurs with the Wuhan coronavirus. While we have initial data on those who were severely affected, many others may not have required medical care.

Allen Cheng is a professor in Infectious Diseases Epidemiology at Monash University in Melbourne. This article is republished from The Conversation under a Creative Commons license. Read the original article.