Saturday, January 25, 2020

The Novel Coronavirus - should you worry?

The sky is falling, the sky is falling! We are all going to die of coronavirus! Or are we?

(Note that I will periodically update this post though the original posting date of 1/25 will not change. Last update 2/24.)

In December 2019, there was an outbreak of pneumonia in Wuhan, a city of 11 million people in central China. All the patients with pneumonia were linked to a seafood wholesale market in Wuhan. A previously unknown coronavirus was discovered in samples from the patients and named 2019-nCoV (now officially named SARS-CoV-2). Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. While most coronaviruses found in humans are associated with the common cold, the MERS and SARS variety were the cause of severe disease in humans, and both were transmitted from animals (camels and swine respectively) to humans and then human-to-human. The illness caused by this virus is now officially called COVID-19.

The major concern is the history of MERS and SARS. The Middle East Respiratory Syndrome resulted in 2500 cases, of which 34% died. The Severe Acute Respiratory Syndrome which broke out in China in 2002-3 led to some 8000 cases, of which 10% died. Could this new virus behave similarly? As of February 18, there have been some 72,500 confirmed cases in China, and 1870 (2.5%) have died. The facts of modern travel have resulted in spread outside Wuhan. Small numbers of cases have been reported from Thailand, Japan, Hong Kong, South Korea, France, Australia, Canada and the U.S, where 35 cases have been found as of Feb 24, all in returning travelers from Wuhan or their spouses or passengers evacuated from the Diamond Princess cruise ship. As of February 24, the large majority of cases have been in China, most of those in Hubei province around Wuhan. There have been over 1000 cases world-wide outside of China, with South Korea reporting a sharp upsurge from 30 last week to 602, linked to a packed church service and few deaths outside China have been reported. Another hot spot is Japan, and Italy is also reporting an upsurge from 3 to 219 this week. While you will see headlines proclaiming that the death toll exceeds that from SARS, note that from the beginning, the death rate from this virus has stayed at 2-2.5%. It should also be noted that the number of new cases in China appears to be falling. Reported cases took an apparent upward spike mid-February when Chinese doctors adopted a new definition of the disease but are now falling.

The Chinese authorities have responded vigorously. After an unfortunate period in which they tried to keep the outbreak a secret, they have been open about the situation, which is very helpful to public health personnel in other countries. They have implemented a virtual quarantine of the entire city, to the consternation of its people, but which should help contain the epidemic. Chinese scientists were on the scene early, identified the virus DNA and shared this with the global scientific community, which has proven very helpful in understanding the epidemic. Unlike it's response during the SARS epidemic, China will finally allow WHO experts to evaluate and offer advice, Returning travelers from central China are being identified at airports and checked for fever. Flights to and from China have been curtailed or stopped completely.

Given the relatively low fatality rate, and the relatively low person-to-person spread (estimates are that every person infected could infect between 1.5 and 2.5 others), it does not appear there is a need to panic. The World Health Organization initially decided against declaring this a public health emergency, but did do so on January 30. An obvious concern is the belief that spread can occur before someone has symptoms.

What does this mean to you? First, I would call off that trip to Wuhan specifically and China in general (if you could even find a flight!). Second, if any of your friends or colleagues have recently returned from central China, be extra careful to avoid them if they are at all ill. Masks? Don't bother; they may do more harm (by frequent touching) than good. Wash your hands regularly with soap and water. Don't worry about packages - the virus will not survive over the trip from China. Recent arrivals from China, who may arrive via third countries, should self-quarantine for 14 days or be required to do so if they do not do so voluntarily. The incubation period is between 5 and 14 days, so anyone who is not ill after two weeks is very unlikely to carry the virus. If you are the sick one, cover your mouth and nose when you cough or sneeze - but NOT with your hand - use your elbow or a tissue that you then toss.

Most important, while the 2019 Novel Coronavirus has so far killed over 1000 people, there is a much worse virus circulating that has already killed some 14,000 Americans this season, and is estimated to kill 35,000 each year. That virus is the influenza virus. So, if you have not already done so, get your flu shot!

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