For many years the world has been living with the question – when are we going to have the next pandemic? The last catastrophic pandemic was influenza in 1918 – just over a century ago, and forecasters have been saying we are long overdue for the next one. The Ebola virus, which is still active, seemed like a good candidate in 2014, but it has been reasonably well contained in Africa.
Now we have the Coronavirus. The disease was first recognized in China in early January. By February 1 the Coronavirus was declared a “global emergency” by the World Health Organization (WHO) because it was diagnosed in 25 different countries in people who had been exposed in China or to an infected person elsewhere. President Trump issued an executive order closing the U.S. border to any alien (foreign national) who had been in China within two weeks of arrival at the U.S border.
What and Where is It?
The Coronavirus’ scientific name is 2019-nCoV and it belongs to the family of viruses that cause the common cold. However, this virus is not a common cold virus, but is a new virus that spread to man from an animal source in China. Coronavirus is related to two previous serious viral illnesses: Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). Both of these proved deadly and also caused world panic a few years ago.
The epicenter of the current viral outbreak is Wuhan, a large city in central China. Most of the world’s cases are in Wuhan and the surrounding region. Wuhan is also a major domestic and international transportation center for business people from all over the world. Thus, the threat of a communicable disease in Wuhan becomes a threat to the world from its rapid spread within the city and then through travelers from Wuhan to other countries. Coronavirus is now being spread not only from animal to man, but more alarmingly from man to man. Hence, the scientists at the WHO have declared the emergency with about 20,000 confirmed cases in China and isolated cases in 24 other countries around the world including eight cases in the U.S. One case in the U.S. is known to have been transmitted within the U.S between two spouses.
The disease has the following symptoms – cough, fever, shortness of breath, and muscle aches and pains. It starts much like the common cold or the flu. The problem is that in many people the symptoms of Coronavirus are mild. Infected people do not know they are infected and thus spread the virus to others by coughing or sneezing. The others in turn will spread the virus to even more people. The incubation period is believed to range from day 2 of the infection to day 14. During this time people may not even know they are sick but they are still infectious which means they can transmit the virus to others
As mentioned above the symptoms mimic a cold or the flu. Please see the figure. Of more consequence than the symptoms in making the diagnosis is a history of travel to the affected area in China or contact with someone known to have the disease. The diagnosis is confirmed in the U.S. by the Centers for Disease Control and Prevention (CDC) which has already devised a blood test that is sensitive and specific to the virus. Anyone who has the symptoms and the exposure history must be reported to a doctor who can proceed according to the WHO and CDC protocols including performing the blood test.
Coronavirus course is not well understood yet because of the short time it has afflicted man. However, it is known that for patients hospitalized with pneumonia caused by the virus the death rate is around 10 to 15% which is higher than for normal influenza. The overall death rate is probably considerably lower, however, because there are undoubtedly people who have had the disease, but have not been hospitalized with pneumonia. Still Coronavirus is a severe viral illness.
As with any new viral disease there is no specific treatment or immunization. We have only what is called supportive care – meaning everything is done to keep the patient hydrated and to treat bacterial infections. The primary strategy is to isolate the sick so that they cannot continue to spread the disease in the general population. Thus, the sick are hospitalized and kept away from others during the two weeks that they are infectious. Healthcare workers must be protected so that they do not contract the virus and spread it to other patients and their friends and family. This is done by the use of masks, gloves, gowns, and head coverings to keep them from being infected while caring for the patients. Hand hygiene is an obsession and the single most important protection for healthcare workers because the virus can also be spread by contaminated blood and feces as well as by “droplet” – coughing and sneezing. As a physician who has recently investigated the viral protection of healthcare workers, this question is not only interesting but of vital importance as well.
What to do?
We have before us the possibility of a major public health challenge in the form of a viral pandemic. In response the WHO and CDC have created enormous information resources and press advisories not to mention surveillance methodologies and cooperative projects with the Chinese government. The WHO has declared the global emergency. Our own President has closed the borders of the U.S. to foreigners who have been in China and arranged to quarantine Americans returning from China for a minimum of 72 hours. Airlines have stopped serving China. Transportation within and out of China has also been curtailed by the Chinese government.
A lot has happened in the space of a month. Some of it is being criticized by scientists and infectious disease physicians as over- reaction because the disease is still pretty well contained in one small section of a very large country, China. The proclamation by President Trump banning all foreign nationals who have been in China from entering the U.S. might be charitably called exercising an abundance of caution. Nevertheless, all of us need to keep up with the news and track the spread of the disease.
Bear in mind as well that this is flu season in the U.S. Concern about the Coronavirus reminds us to use all the techniques we have to prevent infection during our own flu season: do not go out if you are sick; stay away from people who are sick; cover your face when coughing or sneezing; do not touch your nose or mouth area; and wash your hands frequently with soap and water or a dilute alcohol sanitizer – especially before eating finger food (or dispense with eating finger food altogether).
The Bottom Line
Since the pandemic of influenza that began in the U.S. in 1918, the world has watched for another such devastating contagious disease. The Coronavirus might be just such an agent of a new pandemic. On the one hand the world is now far more urban and far more connected by rapid transportation. These two ingredients have set the stage for a worldwide pandemic. On the other hand, public health measures, even in China, are far more developed and there are more resources to help the victims than were available a century ago. We would be wise to be vigilant about not spreading our own illnesses and avoiding those who could transmit their viral diseases to us. We will soon see if Coronavirus is the next big one or if it will be contained like Ebola, MERS, and SARS.