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Coronavirus and what needs to be done to get in front of global pandemics

Coronavirus and what needs to be done to get in front of global pandemics
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There’s a lot we don’t know about Covid-19 — the coronavirus now spreading around the world, aided by air travel. 

Fighting Covid-19 has been complicated by a lack of transparent information from China about the exact origin of the disease, but there’s much that we do know, including that the number of cases in China is plateauing due to their efforts to fight the disease, as well as the genome of this virus, which will quickly lead to an accurate diagnostic tool.

In the U.S., the next steps are to marshal that information and be smart about fully investing in our nation’s infectious disease safety net in order to protect people here at home.

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But, because infectious diseases don’t recognize borders, we must fight this disease with a global mindset, working with the World Health Organization (WHO), other global stakeholders, and the Chinese Center for Disease Control. 

They must be our partners in charting disease origins, its current status, and what our next steps should be. As of Feb. 24, there have been more than 79,000 cases and over 2,500 deaths worldwide, underlining the urgency of concerted action.

Covid-19 is the latest of the coronaviruses, most of which only cause colds in humans, but these can mutate to forms that cause serious, sometimes life-threatening illnesses. In this case, the virus is zoonotic, meaning that it originated in an animal species and was transmitted to humans. Zoonotic diseases are very common and include ebola, salmonella, HIV, anthrax, and others. 

A new study published in the Lancet confirmed that Covid-19 – like SARS, another coronavirus - began in bats. However, no bats were sold at the market where the outbreak is centered, which suggests that another, yet-to-be-identified animal acted as a bridge, transmitting the virus to humans. Study authors wrote that the outbreak "again highlights the hidden virus reservoir in wild animals” and its potential affects human populations. 

Several factors are increasing human-to-animal contact, locally and globally. According to WHO, environmental changes such as urbanization, crowding and deforestation bring populations into closer contact with wild animals. This can promote the spread of cholera, dengue, leishmaniasis, oropuche and hemorrhagic fever. 

Climate change also impacts the spread of infectious diseases. Recent analysis shows that the “risk of malaria epidemic increases five-fold” in the year following an El Niño event that brings large amounts of rain. Long-term climate change impacts the character of the habitat and has allowed diseases such as dengue fever and chikungunya to spread and recently become endemic in parts of the southern U.S. And, as we saw with ebola – air travel has accelerated the spread of infectious diseases, including flu, West Nile, and SARS. 

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The similarity of Covid-19 to SARS may be helpful. Canadian public-health authorities, who dealt with the biggest SARS outbreak outside of Asia, are applying lessons learned then to fight Covid-19 now. 

Their approach stresses testing, training and communication. When SARS first appeared in March 2003, there was no diagnostic test available; it took months, even years, to develop reliable tests. 

Now, computer-aided genetic analysis has driven a revolution in viral diagnostics and AI-aided border screening is enabling Canadian authorities to flag those likely to have been exposed to Covid-19 before they even meet with a control agent. Finally, communication as every level has been improved, and health workers are able to take precautions no more stringent than when they faced SARS.

SARS may have given us a head start but it also presents a cautionary tale. The genomes of SARS and Covid-19 are 82 percent identical, and now there is renewed interest in a vaccine that began development in 2003 which has been sitting, untested, in cold storage since. 

As lead vaccine researcher Peter Hotez said recently, “When the threat is ongoing, it’s all hands on deck, everyone gets worried…when the problem’s not there, they lose interest.”

Much needs to be done at the federal level to ensure that we protect public health now, but also attain ongoing security from infectious disease outbreaks. 

The Trump Administration is expected to ask for emergency funding, after weeks of urging by Congress, but there’s no word on what the expected amount will be.  We also need to learn all that we can about emerging pandemics when there isn’t an emergency brewing, and the House spending package passed in December is a modest start.

It includes a $636.8 million increase for the Centers for Disease Control and Prevention (CDC) for public health prevention programs and $50 million for the CDC’s Public Health Scientific Services to modernize public-health data infrastructure. 

However, these investments are insufficient to effectively combat emerging pandemics. With coronavirus looming — and other diseases that will assuredly follow it — the Senate should quickly pass the House bill. In the immediate future, it is important that lawmakers promptly work with the CDC to further increase funding to adequately address our local, state, national and global health-security shortfalls. 

In the meantime, what can you do to protect yourself? The CDC asks the public to do three things and also puts forward three things they should not do. 

Among the “do’s,” the CDC asks the public to stay informed via their coronavirus website which is updated daily. 

They also ask the public to take measures to prevent the spread of respiratory viruses:

  • Avoid close contact with people sick with respiratory symptoms.

  • If you’re sick, stay home and limit contact with others as much as possible.

  • Stop the spread of germs: Cover your nose and mouth when you cough or sneeze; avoid touching your eyes, nose and mouth.

  • Clean and disinfect surfaces and objects that may be contaminated with germs.

  • Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand rub with an alcohol level of 60 percent or higher.

Finally, do seek medical care if you have a fever, cough, or difficulty breathing and you have traveled to China or have been in close contact with someone with Covid-19 in the 14 days before you began to feel these symptoms. Before you go to a doctor’s office or emergency room, call ahead and tell them about your recent travel and your symptoms. 

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On the CDC’s list of three don’ts: do not travel to China; do not use facemasks — they don’t prevent the spread of Covid-19. Finally, the CDC reminds you to not show prejudice toward people of Asian descent because of fear of this new virus and to not assume that someone of Asian descent is more likely to have Covid-19.

There’s still much that we don’t know about Covid-19 and the approach that we take to solving it will involve the CDC and other agencies within Health and Human Services working transparently and in good faith with the WHO and Chinese authorities. 

The administration’s ban on China travel and quarantines may have the effect of making some Americans “feel” more secure, but they could have the effect of making it more difficult to work with China on the issue of Covid-19. 

In the case of infectious diseases, America’s public safety cannot be addressed in a vacuum. Instead, we need to work with all global stakeholders to effectively fight this disease and other diseases that will certainly follow it.

Jonathan Fielding, M.D., is a professor of public health and pediatrics at the University of California, Los Angeles.