Sunday, March 1, 2020

What is the latest on Coronavirus?

I don’t usually revisit topics this soon, and have tried to update my original post as new data was available, but feel it is time to re-look at the coronavirus story based on where we are now. The suggestion from the French government that people stop greeting each other with a kiss shows how profoundly this epidemic has affected the world.

As most people know, 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 new virus is now officially called COVID-19, and is similar to influenza, with fever and cough and sometimes shortness of breath.

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 27, there were some 82,500 confirmed cases and 2801 (3.3%) have died. The facts of modern travel have resulted in spread outside Wuhan, with cases now reported from 56 countries. While the vast majority of both cases and deaths have been in China, most of those in Hubei province around Wuhan, South Korea, Japan, Iran and Italy have had major outbreaks. South Korea reported a sharp upsurge linked to a packed church service. Of 2801 deaths, 2745 have been in China. 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 2.3-3.3%. 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 peaked around Feb 5-6 and are now falling rapidly, from almost 4000 new cases a day to about 500.

The Chinese authorities initially tried to keep the outbreak a secret, but in a “better late than never” response, they implemented a virtual quarantine of the entire city, to the consternation of its people, but which clearly helped to 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 its response during the SARS epidemic, China allowed 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, which has been predominantly in frail elderly or those with other major diseases, there is clearly cause for worry but it does not appear there is a need to panic. An obvious concern is the belief that spread can occur before someone has symptoms, which seems to have been behind the outbreak in Italy. Unlike influenza, the illness seems to spare children. While this is good for them, it means they can spread the disease to others. Japan took the unprecedented step of closing schools to cut the risk of transmission. While the initial cases seen in the U.S. were all in recent arrivals from Wuhan or their immediate contacts, there have now been two reported cases with no obvious connection to China, raising fears of wider spread not easily stopped by quarantining travelers. The CDC found that there was transmission of the virus to 10% of household contacts but only 0.5% of other "close contacts."

The fear of a pandemic has been reflected in our behavior. The most obvious is the drop off in travel and cancellation of trade shows. The interdependence of economies around the world means that when China’s economy slows dramatically, economies around the world suffer. The coronavirus outbreak resulted in a huge slump in the stock market, with U.S. stocks losing $3.6 trillion last week.

What does this mean to you? First, I would call off trips to Asia in general (if you could even find a flight!). Avoid areas with known outbreaks: northern Italy at the moment; this is clearly going to change, so look at the State Department’s web site for up to date information: 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. I would avoid cruise ships, which are notorious for disease spread due to close contact. Avoid crowds. Avoid cruise ships. Take airplanes only if critical.

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. If you are sick, please stay home – this is good advice for ALL respiratory illness. You bridge players – and I know you are out there – who are sneezing or coughing should stay home and play on-line. Do not share your virus with others.

Get your information from the CDC or the WHO, not from the myriad web sites that have sprung up to peddle conspiracy theories (no, this coronavirus was NOT developed as a bioweapon) or useless cures.

While you do NOT need to horde, it would be prudent to have an adequate supply of non-perishable food and enough of needed medication on hand should your community see cases and you would rather stay home. Ask your employer if they have plans to let you tele-commute in a pinch.

Most important, while the 2019 Novel Coronavirus has so far killed over 2800 people, there is a much worse virus circulating that has already killed some 16,000 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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  1. Thank you, Dr Ed!

    This is very helpful. There's one question for you please which I haven't heard raised yet.

    Like some others, I've found over the last few years that the zinc lozenge approach to an emergent cold often works well. If I suck a few in the 24 hours after first feeling any hint of symptoms, I don't get the cold at all, or I only get it very mildly compared to the experience of the quasi non-zinc 'control group' of people around me.

    I've heard that 15-25% of common cold viruses are also similar coronaviruses. Please, do we know enough about the mechanisms of zinc lozenge protection to know if there is a chance it may help protect us against COVOD-19?

  2. Zinc taken early does seem to have some benefit against the common cold, so it MAY help against the coronavirus. It is totally harmless and not terribly expensive, so worth trying.

  3. Great detailed update, and practical. I will link for my patients. I would also consider the issue of alcohol-based hand cleaners in between soap and water washes for individuals.

    And environmental surface wipes that kill viruses. They can be used in airplanes, door handles and so forth. I believe (but will check) that restaurant style surface antiseptics (such as Q-San10), which are sprayed on counters after cleaning with soap and water, likely have efficacy for home and office use (without damaging the surfaces). They are readily available and may really be appropriate for selective use for some time.

  4. I take Sanbucus (Elderberry Syrup)! 2 teaspoon a day it sedms to help my immune system. I also use 91 proof Alcohol around the house and spray my counters with it every so often and it greatly polishes the faucets.

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