As the U.S. flu season has been churning away, with nearly double the number of pediatric deaths at this point compared to the 2018 flu season, we now are presented with a novel coronavirus (2019-nCoV) which
As the U.S. flu season has been churning away, with nearly double the number of pediatric deaths at this point compared to the 2018 flu season, we now are presented with a novel coronavirus (2019-nCoV) which has just entered the picture, spreading from southeast Asia into the U.S.
The first U.S. case was reported earlier today, a young male, (a resident of Snohomish County in Washington State) who flew from Wuhan, China into Seattle 6 days ago, 2 days before the screening procedures were instituted at U.S. Airports in Los Angeles (LAX), San Francisco (SFO) and New York’s JFK International Airport. While the patient is stable, he is currently being monitored at Providence Regional Medical Center in Everett, Washington for any progression of illness, “out of an abundance of caution”, according to officials at the medical center, as reported earlier today by the Washington Post.
Data indicate that nearly 300 people have been infected thus far, resulting in 6 deaths, as of today. The outbreak, which began in the Wuhan province of China, has spread to Shangahai, Guangdong, and Beijing. Additional cases have been confirmed in Thailand, South Korea, Japan, and Taiwan. Health officials are also monitoring suspected cases in Australia and the Philippines.
Coronaviruses can lead to a variable spectrum of disease. In most cases, the majority of them cause just mild symptoms including low grade fever, cough, and nasal congestion similar to the common cold caused by a rhinovirus. However, certain types of coronaviruses—the type that is responsible for MERS, SARS and now the novel Coronavirus 2019—lead to a more severe set of symptoms including pneumonia which can progress to injury to the lungs known as acute respiratory distress syndrome, (ARDS), as well as kidney failure.
Certainly, this will be alarming to many Americans, reminiscent of the SARS (2003) and MERS (2012) outbreaks that stirred widespread fear of uncontained spread. Fortunately, SARS never led to widespread disease in the U.S.
While over 8,000 persons became ill with SARS during the 2003 outbreak, and 774 persons died worldwide, only 8 people in the U.S. had laboratory confirmed evidence of SARS-CoV infection, according to the CDC data. In the end, SARS never spread throughout the U.S.
Coronaviruses are spread by droplets, via coughing and sneezing, but close contact is generally required to spread the virus. (That’s why health care workers are generally at higher risk than the general population). Coronaviruses such as SARS can survive on surfaces for several hours, with reports of up to 2 days.
With this in mind, we will also need to better understand the genetics of this novel coronavirus 2019 that is now upon us in Seattle, so we can evaluate its virulence, infectivity, and ability to spread person-to-person in the U.S.
In fact, according to Gabriel Leung, the University of Hong Kong Dean of Medicine, there may be as many as 1300-1700 undetected cases in Wuhan, China, the epicenter of the outbreak.
In the early phases of the spread of the coronavirus outbreak, there appeared to be only limited propensity of the virus to spread person to person. No healthcare workers were infected and no contacts of infected persons were affected in the initial days of reporting.
This has now changed, as there are reports out of China of 15 healthcare workers being sickened. There are also reports of close contacts that have tested positive for the novel coronavirus as well. This is certainly concerning, meaning that this particular virus has a higher likelihood of being transmitted person to person.
The bottom line is that we are learning about this virus—hour by hour and day by day. We don’t know yet how easily it can spread. The virus is part of a large family of viruses known as coronaviruses, which primarily infect animals, including bats.
These viruses are able to undergo mutations in their genetic sequences, and after they infect animals, become human coronaviruses. It’s at this point, with a mixture of genetic material, that they can increase their infectivity, and hence virulence. What we do know is that 7 types of coronaviruses—including 1019-nCov, SARS, and MERS—that are able to be spread to humans.
So far, we know that 2 of the 7 coronaviruses that infect humans—SARS and MERS—can cause severe illness, including pneumonia, leading to ARDS and kidney failure—and may be deadly. The other types of coronaviruses generally lead to mild illness similar to a common cold. We just don’t known how virulent the 2019-nCoV truly is at this point in time.
Whether this will become a global public health emergency is unknown at this time. But, it’s definitely being taken seriously, as the WHO has convened an expert panel tomorrow to make a determination whether 2019-nCoV rises to the level of a public health emergency of international concern (PHEIC). It’s largely a political tool that the WHO employs to elevate the concern about a serious disease that threatens global public health. It helps to mobilize resources and garner the world’s attention, with the goal to limit spread of the disease. It’s also key decision in whether to restrict travel and tra