As of 29 January, the number of infections in mainland China has now surpassed the total number of SARS infections, albeit with a death rate two-thirds lower. There are signs that this will soon be a pandemic, as the R0 number appears to be increasing.
The most disturbing thing I’ve seen comes from a study in The Lancet indicating some issues with the initial information from the Chinese government. Whereas China had said that all the initial infections were tied to the Wet Market in Wuhan, the Lancet article indicates that only 66% had visited the market, and that the onset of symptoms in the first patient was earlier than reported. With a two-week incubation, this sets onset back to November.
As an aside, I had never heard the term “wet market” until a few days ago. It turns out that it refers to any market that sells animals, dead animals or produce, as opposed to a “dry market” which sells only durable goods like clothing and electronics. Learning is life-long.
The most encouraging thing I’ve seen comes from Anthony Fauci, who spoke at the HHS/CDC press briefing yesterday. When asked about asymptomatic transmission, Robert Redfield, the head of the CDC, said that while China has said it’s possible, they have not shared any data, so we don’t know the veracity of that claim. Dr. Fauci pointed out that while asymptomatic transmission of certain viruses has occurred, in no case has this been a driving force in any epidemic or pandemic. I trust him (he’s one of my heroes) as his work speaks volumes (even though his team was cheated out of a Nobel Prize for their HIV work, but I digress.) Anyway, there’s no one better in this regard.
The political response to 2019-nCoV is interesting. In both China and Malaysia, they are shutting down social media accounts of people who put forth false information, and in one case, the perpetrator was arrested. Certain countries, like North Korea and Russia, are taking very strong stances to prevent epidemic spread in their countries, North Korea being the most extreme. Anyone entering North Korea (even diplomats and citizens) is being quarantined in a “high class” hotel, under medical supervision for a month. Russia has shut its abutting borders to China. Certain countries have ceased air travel to/from China, and as of last night, the US is considering doing so also. Many nations, including the US, have also arranged charter flights to repatriate citizens from Wuhan and the surrounding province, with attendant medical checks and quarantines.
Yesterday’s HHS/CDC press conference was led by Alex Azar. I’d never heard him speak before and while I hate his politics, he’s whip smart, and he said all the right things, answered questions appropriately. AND HE GOT THE MASK QUESTION CORRECT! I will spare you all of the drill down details into the sequencing of the 2019-nCoV genome, the rapid response testing protocols and the related medical information – but the upshot is that the US is doing everything that we should be doing from a public health perspective. One point of note from the press conference: all the cases in the US were contracted prior to the implementation of traveler screening.
I have received questions about whether or not it is safe to travel to other countries. The first point is that your chances of catching the seasonal flu are much higher than your chances of catching 2019-nCoV at this time, and if you are traveling, there are precautions you should take. In reality, airports and especially airplanes are breeding grounds for all sorts of germs so there are things you should do as a matter of course. First, hand-washing, as described in my last post. Second, because many airplane passengers are disgusting and do things like change diapers on tray tables…when you get on an airplane, use an alcohol wipe on the tray table, the arm rests, and any non-porous surface you’ll touch (like the air vent). Second, never use an airplane pillow or blanket, they get reused. Bring a small bottle of hand sanitizer, and use it after you touch things at an airport (door handles, touch screens when checking in, etc.)
So long as you are not traveling to China, your travel plans shouldn’t be impacted, at this time.
I have also received questions about touching things in public, like ballet barres and supermarket carts. In general, it’s flu season…wipe things down that others have touched. If you can’t, use your hand sanitizer before and after touching shared surfaces. If you work in an open office, the transmission of colds and flu on things like coffee makers, printers and other surfaces is very high, so follow the same safety protocols.
That’s it for today’s update. I will keep you apprised as the situation unfolds. Based on the R0 number, we can expect that there will be many more cases in the near future. Control of the epidemic, and stopping it from becoming a pandemic will depend on government response AND the actions we all take as individuals to stop the spread of germs.
