Containing A Coronavirus

Note: Because the situation and facts around the 2019-nCoV coronavirus are rapidly evolving, the most recently updated information will be available from these sites: World Health Organization and Centers for Disease Control and Prevention

The word “coronavirus” has overtaken the news causing people to ask, “Exactly what is coronavirus?” Coronaviruses are a large family of viruses found in both animals and humans. Some of these viruses can infect humans and can cause illnesses that range from a common cold to more severe diseases like Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS).¹ A novel coronavirus (CoV) is a new strain that has not previously been identified in humans.¹

The most recent outbreak of novel coronavirus (2019-nCoV) was first reported from Wuhan, China, on December 31, 2019. According to the World Health Organization (WHO), as of February 5, 2020, there have been more than 24,000 confirmed cases in more than two dozen countries. There have been at least 492 deaths confirmed worldwide.² The Centers for Disease Control and Prevention (CDC) are currently reporting 11 positive cases and 82 pending cases within the U.S.³

This virus is a grave public health concern. WHO declared the coronavirus outbreak a public health emergency of international concern Thursday, January 30th as the first person-to-person transmission of the virus in the U.S. was reported.⁴ Still, the risk to people outside of China remains very low. In fact, the seasonal flu is a more significant threat to most Americans. Currently, scientists estimate that without effective public health measures, each individual with the new coronavirus could infect between 1.5 and 3.5 people. As the number of cases in China has accelerated, the new virus has far surpassed the rate of SARS, which circulated in China in 2003 and was contained after it infected 8,098 people and killed 774.⁵

While scientists have yet to determine the specifics of how this virus spreads, coronaviruses typically travel through the air in tiny droplets that are produced when a sick person coughs, sneezes, talks or breathes. Those droplets fall to the ground within about six feet. This is good news when we consider that illnesses such as chickenpox, measles and tuberculosis can travel hundreds of feet in the air before landing. Experts estimate that the incubation period is somewhere between two and 11 days, though they have yet to determine if the new coronavirus can be caught from individuals who aren’t symptomatic.¹

One of the most critical factors in determining how damaging the outbreak will be is determining how deadly this virus is. Since the worst cases are usually the first to be detected, this can skew our understanding of how likely fatalities will be. About one-third of the first patients in Wuhan required treatment in the I.C.U., but some people with milder cases may never even need to visit a doctor.⁵ On the other hand, deaths from the new coronavirus may be underreported since the cities at the center of the outbreak are short-staffed, undersupplied and have a shortage of testing kits. There’s still a great deal of uncertainty around this virus and what it does to the human body. The early indications are that it latches on to proteins on the surface of lung cells, but it’s not as destructive as MERS and SARS.⁵

A vaccine could certainly prevent future infections and stop the spread of the disease. But vaccines take time to create, and given the accelerated rate at which this illness spreads, we may not have the time. It took researchers roughly 20 months to prepare a vaccine for human trials during the SARS outbreak in 2003. In 2015, researchers were able to develop a vaccine for the Zika virus in six months.⁵

The hope is that lessons learned from previous outbreaks will cut down the production timeline even more. Researchers are already studying the genome of the new coronavirus and have discovered proteins that are vital for infection. However, it could take months or even years of trials and testing to prove that the vaccine is safe and effective for mass production. The best-case predictions show a vaccine becoming publicly available in a year from now.

Given that a vaccine to prevent 2019-nCoV infection does not exist and will not be fully ready for another year, our best bet to contain the virus is through public health measures. If each person infected with the new coronavirus infects two to three others, that spread would be enough to maintain and accelerate an outbreak.⁵ So what can be done to reduce it?

Public health measures are the best bet we have to combat the spread of the new coronavirus. For instance, one common tool for maintaining public health in extreme situations is to curb public gatherings. China has taken extraordinary measures by imposing travel restrictions on Wuhan and neighboring cities, but this lockdown may have been too little, too late. The mayor of Wuhan admitted that five million people had left the city to celebrate the Lunar New Year before the restrictions were enforced. Officials also shut down the Wuhan market that sells live poultry and other animals, suspended the trade of wild animals across the nation, closed schools, shut down the Great Wall and halted tourism packages.⁵

In a similar vein, travel restrictions are a common measure to limit outbreaks from spreading further. Internationally, many countries are temporarily denying entry to noncitizens who recently traveled to China, and several major airlines have stopped direct service to mainland China for months. Neighboring countries have restricted travel and visas for the time being to stop the coronavirus from spreading.⁵ In the U.S., federal health officials have quarantined all 195 American citizens who were evacuated from Wuhan. They’ve implemented airport screenings in 20 different cities and isolated sick patients.⁶

Since the new coronavirus is not spreading widely across U.S. communities, most health officials aren’t recommending that the general public take additional precautions such as canceling activities or avoiding leaving home. For now, normal safeguards like staying away from those who have symptoms of respiratory tract infections, washing hands regularly, covering coughs and sneezes, avoiding touching your eyes, nose and mouth are enough.⁷

However, the director of the CDC says that the agency is preparing as if the new coronavirus “is the next pandemic.” For now, it doesn’t look like the U.S. will see widespread cases like China is experiencing. Public health officials will be on the lookout for signs of sustained community transmission, or a rate of infection that exceeds what hospitals can handle. School closures can be an additional option as that is where a large number of viruses are regularly transmitted, and health agencies may also recommend that employers allow their workers to telecommute.⁶

One step that most public health officials loathe to implement is large scale quarantining, which can be disruptive and comes at a high cost. Because trade, travel and other significant functions of our global economy would be disrupted, the economic effect of a mass quarantine could spark another recession. It could also lead to more infections: During the 2003 SARS quarantine in Toronto, Canada, officials quarantined 100 people for each case of SARS detected. A CDC analysis later showed that they should have only isolated four people for each case of SARS.⁸

The highest costs of large-scale public health interventions are panic and increased concern. Experts say that the key is to keep the public informed and to be open and honest about why specific measures are being used. A critical aspect of any public health response must be frequent and factual communication. Fear and misinformation can prove more destructive than the virus you’re fighting against.⁶

With the current scope of this virus and the speed and complexity of international travel, the number of cases and deaths will likely continue to rise. We are dealing with a serious disease, but we shouldn't panic. Public health teams are assembling, and lessons they've learned from other coronaviruses such as SARS and MERS, will help mitigate the spread.

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