There are now more than 100,000 suspected cases of nCoV worldwide, the majority in China, but the number of confirmed cases is less than 20,000. The count of confirmed cases, deaths and recoveries is updated hourly by the folks at Johns Hopkins at this link.
There are a lot of medical and public health concerns, but there are also political and economic affects that will impact all of us whether or not we ever come in contact with 2019-nCoV.
But first…since my first post on this a week ago, I’ve heard from people who are starting to panic. Now is NOT time to panic. It’s time to be smart, to ignore the falsehoods about this illness, and to follow standard infection controls that you should be following anyway….when it’s time to panic, I’ll let you know. So, NO this is not a bioweapon, and NO you can’t get it from drinking Corona beer, and NO there is no specific treatment made from saline solutions. You can check the list of all the fake news on 2019-nCov here.
Medical Considerations
At the present time, your chances of infection outside of China are very low. At the time of this writing, there are 8 confirmed cases in the US. For comparison, so far in the US in the current 2019-2020 season, there have been more than 20,000,000 cases of flu, with more than 10,000 deaths – and that’s just in the US, the worldwide totals are much higher. Therefore, take the standard infection control precautions related to hand-washing, wiping non-porous surfaces, stay away from sick people, and get that flu shot. For more information on hand-washing, read this post.
How did we get here?
The W.H.O. finally, belatedly, issued a Public Health Emergency of International Concern (PHEIC) two days ago. A PHEIC is defined as an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response. International Health Regulations (updated in 2005) require member states (think: all countries in the UN) to undertake responses in their individual countries to the cause of the PHEIC, in this case 2019-nCoV.
Why did they take so long? Well, first, they’re normally a day late and a dollar short out of an abundance of caution. Further, the Chinese government lied about all sorts of information related to the virus. They lied about the number of cases, the spread, Patient Zero, and all sorts of other things, and so the W.H.O lacked legitimate information on which to make a good decision. A good chronology of China’s lies can be found here.
The W.H.O specifically told countries that they shouldn’t shut their borders with China, so of course, many countries did, and they cancelled flights, and are basically in the process of cutting physical ties with the exception of sending in needed medical supplies, repatriating their citizens, and allowing the Chinese to repatriate their citizens. The exception here is Cambodia, which is so dependent on Chinese tourism for the maintenance of their economy that they believe the risk is okay. At the other end of the spectrum, Hong Kong is part of China, but semi-autonomous, and did not shut its border. Their doctors are going on strike for everything non-emergency on Monday if they border isn’t shut.
Public Health Consideration: Asymptomatic Transmission
2019-nCoV for “novel Coronavirus” is part of the group of coronaviruses including SARS, MERS, a number of other named viruses, and, believe it or not, the common cold. Not a lot of research was accomplished on these types of viruses until SARS, and we know that nCoV shares a large portion of its DNA with SARS. However, there are differences, and give the propensity of coronaviruses to mutate, there is a lot we don’t know: information that will make itself known in the coming weeks and months as virologists and epidemiologists study, research, work towards quicker and more accurate tests, and endeavor to find both successful treatments and vaccines.
This week, German researchers proved asymptomatic transmission. What this means is that someone can “give” someone else the disease even if they show none of the symptoms of the disease. This matters for a number of reasons. First, one of the symptoms of nCoV is fever, which is why in scanning people, thermometers are used. This means that someone with no fever can pass the disease to another person. Thus, there is no simple scan that can tell whether or not a person is infected.
Second, the assay tests used to diagnose nCoV (or any virus) depends on viral load, that is, how much virus is in someone’s system. When samples are tested, it’s possible that the viral load is so small that the current screening test is not sensitive enough to pick up the virus: thus, a patient could test negative while asymptomatic, but later test positive once they show symptoms. This potentially increases the R0 of the disease. “R0” indicates how many new patients contract the disease from someone who has it. The chart shows some R0 numbers for various diseases. Measles is one of the most contagious diseases known, and the current thinking about nCoV is that it has an R0 of 1.3 – 2.5.
Third, diseases with asymptomatic transmission require different public health undertakings than other diseases. Pretend that there is a disease which causes people’s skin to turn bright lime green, and that patients are not contagious until they are that color. From a public health perspective, it’s pretty easy to identify who has the disease and, if necessary, quarantine them. But if you can’t identify who has the disease, it’s very difficult to ascertain who is at risk, who should be monitored, and who, if necessary, needs to be quarantined.
Public Health Consideration: Epidemics and Pandemics
The difference is that an epidemic is widespread disease in a country or countries, while pandemic is worldwide. In the past, for all but the largest pandemic, quarantine has worked well for the containment of epidemics and pandemics. As of today, the United States has secured quarantine facilities at a number of military bases with medical care being the responsibility of HHS. At the present time, these sites are for people entering the country from China, and all flights from China are now being routed through seven airports for enhanced screening.
The last time quarantine was used for a pandemic was the Spanish flu in 1918. This outbreak infected about a third of the world’s population, killed between 20 and 50 million people, and most of the deaths occurred in the first 6 months. Thus, quarantine worked to likely prevent many more deaths.
The world, however, is very different now in terms of how we diagnose and treat illness. In 1918, we didn’t have ANY diagnostic tests or equipment, didn’t have antibiotics for secondary infections, didn’t have antiviral medicines, didn’t have HEPA filtered hospital rooms, nor did we know what we know now about infection control. We also didn’t have computers that could model viral DNA, and compare it to various medications, and track spread, etc. Thus, we are in a much better place to deal with this monster than we were in the past.
The largest pandemic is HIV/AIDS. The total number of worldwide cases from the start of the disease in 1981 through the end of 2018 is approximately 75 million, with 37 million deaths. No quarantines were ever put in place, the disease is now manageable; and while infections continue, the number of people living with HIV at the end of 2018 was approximately 38 million.
Political Considerations
From everything I have read from the W.H.O., HHS, CDC, NIH, JAMA, NEJM, and the Lancet, we are doing everything right at the current time, although this may well change for political and not medical considerations.
While there are appropriate standards in place for potentially infected people coming into the States, if anyone is missed and the disease becomes community-based, then other options will need to be considered. The problem is that the mob bosses in charge of what’s left of the government are racist xenophobic non-readers, and the fear is that they will do something idiotic, like quarantine anyone who is Asian, even if they were born in the states and never left the country.
In addition, we lack strong Public Health leadership that would dedicate itself to strong infection control while simultaneously tamping down unwarranted panic.
What can we do as individuals? The same thing we do in other political situations – learn the facts and then make our feelings known to our elected officials and hope they listen.
What do **I** do now?
Live your life. Don’t travel to China. If you feel unwell (fever, cough, trouble breathing) CALL your doctor. You probably have the flu. If you feel unwell and decide to go to a doctor’s office, hospital or even to the pharmacy to pick up meds, wear an N95 face mask. If you’re well, they offer scant protection, but if you are sick (even with a cold) they help you prevent a spread to others. If you are sick, follow these guidelines. And by the way, they’re good guidelines for any time you are ill with something contagious.
As for protecting yourself in general from all sorts of germs:
- Wash your hands. I can’t say this often enough. Fingers, nails, fingers, fingers, fingers. Watch the video at this link to learn how. Most people wash their hands incorrectly – they wash their palms. Think about it – do you touch more things with your palms or your fingers?
- If you have no access to soap and water, use alcohol-based hand sanitizer. Personally, I have bottles in my car, my purses and my backpacks. I do my hands whenever I get into my car from being in a public place (you touch doors to get in and out), after doing a lot of handshaking, etc.
- Avoid touching your face unless your hands are clean.
- If you have a chronic illness, take your medications as directed.
- Eat healthy, get enough sleep, get fresh air and exercise.
- If you go to a gym to exercise, wipe down equipment used by others with alcohol-based wipes. (Also a good idea for things like supermarket carts and the coffee machine at work and other shared non-porous items.)
That’s it for this update. Please use the comments with any questions you have.
