Coronavirus ‘We cannot afford to have an influx of potentially infected individuals’ – obstetrician’s plea Dr Carmen Regan wants flights from northern Italy to Ireland stopped, and writing in a personal capacity, she has penned an open letter to the Government: Close 1/1 Carmen Regan Gallery 1 Carmen Regan

I write as a consultant specialist in maternal medicine with 30 years of experience in caring for high risk pregnant mothers. I have never written to the media nor made public comment on matters of policy in relation to healthcare. I do so now out of grave concern.

The novel coronavirus has now become a global epidemic spreading rapidly across continents. More than 92,000 cases have been confirmed worldwide and the number of deaths from the virus has reached 3,110 worldwide (WHO figures). The number of cases outside of China now exceeds those occurring within. And, as of today, Italy has overtaken Iran with the most deaths outside of China.

According to the World Health Organisation we are now in “unchartered waters”. However there are some facts of which we have a degree of certainty. We know that this infection is highly contagious with a replication rate of approximately 2.5, which means for every case two to three more people will get the disease.

There is some evidence for asymptomatic shedding of the virus in the prodromal (early pre-clinical) phase. It is thought that children can be asymptomatic or have mild infections but are more effective vectors (transmitters) of the disease. Although less contagious and less lethal than other coronaviruses SARS and MERS it appears to travel and spread more rapidly.

We know that the conservative estimate of the death rate due to the disease is about 2pc, but may be higher. We also know that of those infected, 80pc will have a mild disease and 20pc will be more severely affected with about 5pc requiring intensive care.

Older individuals (over 60s), those with underlying heart or lung disease and immunocompromised patients are particularly at risk of severe infection and death, and healthcare workers are at increased risk due to occupational exposure. We also know that there is no therapy apart from supportive treatment and no immediate prospect of a vaccination.

Experts agree that containment of the virus is the only way to slow down the population spread of this condition. Key to this is reducing the rate at which the virus gains access to a population. This was the basis for quarantine in Wuhan and other Chinese cities, and areas in other countries including regions in northern Italy.

Italy is second only to China in the number of deaths worldwide and many of the newly identified cases in European countries appear to originate from northern Italy, including recently identified cases in Ireland. Despite this we continue to have direct flights from airports all over northern Italy into Ireland on a daily basis with no prospect of identifying infected travellers.

Cases will inevitably come, but a rapid increase in the numbers is likely to overwhelm our healthcare system, one which is not ready for the contagious nature of this disease. In this event contact tracing will rapidly become impossible due to numbers and resources and cases will rapidly increase, as has been seen in other regions.

Other countries have begun to restrict and stop air travel from affected areas. Britain has stopped BA flights from London to several cities in northern Italy. Many countries have closed land borders.

We have an opportunity to slow the rate of infection down by restricting access to our region from other areas showing a surge in infections, but we must act quickly.

The government here were acting in the country’s best interest when they cancelled the Ireland-Italy rugby match. They pointed out the folly of many thousands of people arriving into a packed stadium.

However many travellers who intended to travel will still do so. And when they come they will congregate in restaurant, bars, shops, hotels and nightclubs. The potential to bring the virus also (if asymptomatic or in the early stages of infection) cannot be understated. We cannot afford to have an influx of potentially infected individuals at this critical time.

The Irish Government recommends that citizens avoid travel to affected regions in northern Italy but continues to allow unregulated access to Ireland from these areas, despite the fact that both index cases arose following the return of individuals from northern Italy.

They speak of containment of the virus but are failing to take the most obvious containment measure, that of stopping air travel from these areas. They give reassurances that there have been no case to case infections within Ireland but fail to deal with the issue that is that both of the imported cases came from an area in which the infection is epidemic.

Yesterday the ECDC (European Centre for Disease Prevention and Control) raised the risk of contracting the virus from moderate to high.

The WHO has said that key to dealing with the epidemic is an attempt to reduce the rate of spread. As an island with an over-burdened health system we cannot afford a peak in cases presenting within our population and we need to slow the numbers of new cases down.

We can do this by reducing the footfall from areas where the prevalence of the infection is high and by increasing the public awareness of the risk of foreign travel. At a minimum I believe it is time to suspend flights to and from northern Italy.

We are only at the beginning of this journey. I, for one, do not want to look back with regret at what I should have done on behalf of our people in the early stages of this epidemic.

On January 23rd the WHO said that the outbreak “did not yet constitute a public emergency of international concern” and that there was no evidence of the virus spreading between humans outside of China. At that time the death toll in China stood at 26 with the government reporting 830 infections. However by February 1st this number had risen to 259 with 11,791 confirmed cases and the WHO had declared coronavirus a global emergency.

Fast forward one month and the virus has now become a global epidemic spreading rapidly across continents. More than 92,000 cases have been confirmed worldwide and the number of deaths from the virus has reached 3,110 worldwide (WHO figures). The number of cases outside of China now exceeds those occurring within. And, as of today, Italy has overtaken Iran with the most deaths outside of China.

According to the World Health Organisation we are now in “unchartered waters”. However there are some facts of which we have a degree of certainty. We know that this infection is highly contagious with a replication rate of approximately 2.5, which means for every case two to three more people will get the disease. There is some evidence for asymptomatic shedding of the virus in the prodromal (early pre-clinical) phase.

It is thought that children can be asymptomatic or have mild infections but are more effective vectors (transmitters) of the disease. Although less contagious and less lethal than other coronaviruses SARS and MERS it appears to travel and spread more rapidly. We know that the conservative estimate of the death rate due to the disease is about 2 per cent, but may be higher.

We also know that of those infected, 80pc will have a mild disease and 20pc will be more severely affected with about 5pc requiring Intensive care. Older individuals (over 60s), those with underlying heart or lung disease and immunocompromised patients are particularly at risk of severe infection and death, and healthcare workers are at increased risk due to occupational exposure. We also know that there is no therapy apart from supportive treatment and no immediate prospect of a vaccination.

Experts agree that containment of the virus is the only way to slow down the population spread of this condition. Key to this is reducing the rate at which the virus gains access to a population. This was the basis for quarantine in Wuhan and other Chinese cities and areas in other countries including regions in northern Italy.

Italy is second only to China in the number of deaths worldwide and many of the newly identified cases in European countries appear to originate from northern Italy, including the two newly identified cases in Ireland. Despite this we continue to have direct flights from airports all over northern Italy into Ireland on a daily basis with no prospect of identifying infected travellers.

Cases will inevitably come but a rapid increase in the numbers is likely to overwhelm our healthcare system, one which is not ready for the contagious nature of this disease. In this event contact tracing will rapidly become impossible due to numbers and resources and cases will rapidly increase, as has been seen in other regions.

Other countries have begun to restrict and stop air travel from affected areas. Britain has stopped BA flights from London to several cities in northern Italy. Many countries have closed land borders. We have an opportunity to slow the rate of infection down by restricting access to our region from other areas showing a surge in infections, but we must act quickly.

As I write the number of new fatalities in Italy had risen from 52 to 79 (an increase of 50pc over 24 hours) with over 2502 people infected since the first reported hotspots identified 12 days ago. The government were acting in the country's best interest when they cancelled the Ireland Italy rugby match.

They pointed out the folly of many thousands of people arriving into a packed stadium. However many travellers who intended to travel will still do so. And when they come they will congregate in restaurants, bars, shops, hotels and nightclubs. The potential to bring the virus also (if asymptomatic or in the early stages of infection) cannot be understated. We cannot afford to have an influx of potentially infected individuals at this critical time.

The Irish government recommends that citizens avoid travel to affected regions in northern Italy but continues to allow unregulated access to Ireland from these areas, despite the fact that both index cases arose following the return of individuals from northern Italy. They speak of containment of the virus but are failing to take the most obvious containment measure, that of stopping air travel from these areas. They give reassurances that there have been no case to case infections within Ireland but fail to deal with the issue that is that both of the imported cases came from an area in which the infection is epidemic.

On Monday the ECDC (European Centre for Disease Prevention and Control) raised the risk of contracting the virus from moderate to high. The WHO has said that key to dealing with the epidemic is an attempt to reduce the rate of spread. As an island with an over-burdened health system we cannot afford a peak in cases presenting within our population and we need to slow the numbers of new cases down.

We can do this by reducing the footfall from areas where the prevalence of the infection is high and by increasing the public awareness of the risk of foreign travel. At a minimum I believe it is time to suspend flights to and from northern Italy. We are only at the beginning of this journey. I, for one, do not want to look back with regret at what I should have done on behalf of our people in the early stages of this epidemic.

Dr Carmen Regan is a Consultant Senior Lecturer at the Royal College of Surgeons Ireland and is based in the Coombe Hospital

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