Note: The information within this article reflects the situation as of 10/03/2020.
The COVID-19 outbreak is a topic that may come up in your medical interviews or MMI – these discussions could take a number of different forms. The outbreak is of great global significance and continues to impact healthcare services throughout the world. It has received a large volume of media coverage and it is an issue at the forefront of the public’s mind. Below is our guide outlining the key aspects.
What is the Coronavirus or COVID-19?
The use of the word ‘coronavirus’ during the outbreak has been misleading. Coronavirus is a broad term and refers to members of a family of viruses that can be found both in mammals and in birds.
Typically, in humans, most coronaviruses cause respiratory tract infections that are mild, with some causing symptoms of the common cold.
However, there are types of coronavirus that have more serious effects on the human body; in the past these have included those responsible for ‘Severe Acute Respiratory Syndrome (SARS)’ and ‘Middle East Respiratory Syndrome (MERS).’ Recently, the term ‘coronavirus’ has been widely used to refer to the strain whose first animal to human transmission is likely to have come from a wet market in Wuhan, China. The animal source is yet to be definitively identified, though it is believed bats were involved at some stage of the transmission process.
The official name for the pathogen responsible is SARS-CoV-2 and the disease has been called COVID-19.
What are the symptoms of Coronavirus?
Like many coronaviruses, SARS-CoV-2 will frequently cause a mild respiratory infection and symptoms of the common cold. These symptoms will include fatigue, a cough, and elevated temperature – some people may develop a runny/congested nose, sore throat, diarrhoea and generalised aches and pains. Others may experience no symptoms at all.
However, for a subset of individuals this disease will lead to a serious illness and breathing difficulties that may ultimately prove to be fatal. Those who appear to be at highest risk of developing a severe illness appear to be those with weaker immune systems including older people and those with additional medical problems.
How is the Coronavirus transmitted?
The virus can be transmitted between humans through respiratory droplets from both the mouth and nose, and expelled through coughing or exhaling. These droplets can either enter the respiratory system of an individual directly, or via a surface that is then touched by something which goes on to contact a person’s eyes, nose or mouth. There is also a concern that it may be possible to catch the virus from the faeces of an infected person.
There are several unknowns regarding transmission, including how long the virus can survive on surfaces – it is currently thought that this may be up to several days.
There is a low risk of the virus being transmitted by someone with no symptoms, though this is an area which is being researched further, as is the ‘incubation period’ which refers to they time between catching the virus and beginning to display symptoms. This period is currently estimated to be up 14 days and has important consequences for the times individuals are advised to self-isolate.
What is being done in terms of prevention?
Individual Level: People are being advised to take simple infection control precautions which involve practicing good handwashing, appropriate respiratory hygiene techniques, avoidance of touching the face, isolating oneself if unwell and seeking medical attention in accordance with published advice from healthcare authorities.
If a person has travelled to an area where COVID-19 is spreading, there are some additional guidelines to follow.
Organisational Level: Responses to public health emergencies such as COVID-19, which play out on a global stage, can broadly be divided into two categories – containment and mitigation.
Containment is the initial focus, with measures that are designed to slow, or ideally halt, the progress of the outbreak. They include isolation attempts, contact tracing and quarantines. Even if the outbreak cannot be stopped, the reduction of the rate of spread gives organisations a very important opportunity for preparation.
Mitigation efforts often signal that containment no longer remains a possibility and infected individuals no longer know how they were exposed. These include closing cities, cancelling mass gatherings and shutting schools, all of which are already being seen in countries such as Italy and China.
Role of the World Health Organisation
The WHO plays an important role during these outbreaks. Countries look to it for decision-making, up-to-date information and the co-ordination of response against the threat of the outbreak. It provides a platform where the public can access reliable facts about key preventative measures and seek answers to frequently asked questions.
During the COVID-19 outbreak, the WHO has also had to divert resources to combatting the misinformation that has spread both online and within the mainstream media. This has included false-cures, inaccurate information about the origin of the outbreak and several conspiracy theories.
This has led to the confusion and suspicion amongst the general public and made it difficult for important public health messages to be communicated to their target audience.
What is the impact on the NHS in the UK?
Although the total number of cases is currently relatively low, the COVID-19 is already having a significant impact on the NHS and this is set to increase. This includes a greater number of people seeking medical advice through mechanisms such as 111 and GP surgeries.
It is predicted that high numbers of people will require hospitalisation, and they will need to be kept isolated from other patients. Many of these patients will need to be managed in intensive care units, which have limited capacities.
There is a risk that hospitals and their resources could be overwhelmed, further complicated by the fact healthcare staff will be at high-risk of contracting the disease and the workforce may therefore be depleted. This is in the setting of a system that is only just recovering from the recent winter bed-pressures.
medical interview questions you could expect to face
A good answer for this question will look to cover areas such as:
- The different forms of media including mainstream media (TV, online, paper-based) and social media (Facebook, Twitter, Instagram).
- The positive roles that it can play including the engagement of the public with the issue and conveying important information.
- Other positives including the ability to encourage people to follow certain behaviours, an example of which would be the ‘catch it, bin it, kill it,’ campaign.
- The emergence of ‘fake-news,’ misinformative content and disinformative content and how this can be damaging and confusing for the public.
- How the WHO is trying to counter this misinformation and disinformation with the help of social media companies.
- The volume of information and pace at which new stories arise.
- By covering these areas, the answer will show an awareness of the different media channels and balance the opportunities and risks that these provide, both of which have been very important in the current COVID-19 outbreak and will be in future public health emergencies.
A strong medical interview answer for this question would cover the following points:
- The simplistic definition of a pandemic is the worldwide spread of a new disease to which we don’t have immunity.
- Acknowledge that there must be other factors as the WHO hasn’t declared one yet, even though COVID-19 meets this simplistic definition.
- The WHO may have some criteria that need to be met for it to declare a pandemic.
- The WHO may not want to cause unnecessary panic and fear which may lead to consequences such as hospitals and healthcare resources being overwhelmed and individuals stockpiling items.
- Past-experience may be a factor. The WHO was criticised for prematurely declaring a pandemic during the 2009 H1N1 ‘swine-flu’ outbreak (note, this will not be assumed knowledge).
- A range of other possibilities including that a declaration may: trigger more misinformation, have economic consequences, cause people to stop attempting to contain the virus and switch to mitigation efforts.
There is no perfect answer to this question as there are multiple reasons behind the decision. It is important to acknowledge this whilst coming up with logical possibilities.
A good answer will look to cover areas such as:
- What we know currently regarding the rate of spread, how many countries it is in and the fatality rate.
- The world population is much larger now, so if it killed the same percentage of the population the figure would be much higher.
- The world is far more connected with travel, creating more channels for the virus to spread.
- Basic infection control and hygiene measures are much improved.
- Our scientific and medical knowledge has advanced significantly, so there is more chance of developing vaccines, treatments etc than there was in 1918.
- A logical conclusion based on the above, acknowledging that that there are still many unknowns that could influence this.
Looking at arguments for the total deaths being both higher and lower that 50 million people, shows an ability to critically evaluate a problem in a balanced way and reach a rational and appropriately cautious conclusion.
Advice for medical interview candidates
In order to successfully answer questions like these, it is vital to keep up to date with important healthcare stories and developments. It is crucial to look at what key organisations/individuals are saying about these issues and think critically about the reasons behind their statements. Reading opinion pieces from experts in the relevant fields is often a very helpful way of doing this.