Public/Global Health

What to know about the coronavirus

Public health officials, experts and members of Congress this week sounded new alarms about the spread of a coronavirus that broke out in China late last year, after hundreds of cases erupted in Italy, Iran and South Korea in recent days.

During an extraordinary news conference Tuesday, officials at the Centers for Disease Control and Prevention (CDC) said the virus is almost certain to begin spreading in the United States. Asked about the prospects of an outbreak here, several top health experts used the word “inevitable.”

Here’s where things stand with the coronavirus and the government response.

What is this thing?

Coronaviruses are a relatively broad family of viruses named for the spikes that come out of a virus particle. Under a microscope, they look like a crown, or a halo — like the sun’s corona.

The current coronavirus first emerged from Wuhan, in China’s Hubei Province, most likely from a fish and animal market where humans routinely come into direct contact with animals. The virus probably jumped from an animal — we still don’t know for sure what species — to a human, a process of interspecies transmission called zoonosis.

The virus itself is called Severe Acute Respiratory Syndrome coronavirus 2, or SARS-CoV-2. The disease caused by the virus is called coronavirus disease 2019, or COVID-19.

How many people are infected?

The World Health Organization (WHO) has reported at least 81,191 cases of the virus as of Wednesday morning. The vast majority of those cases, 78,064, are in mainland China, and most of those are in Hubei Province, the epicenter of the outbreak.

But officials are increasingly worried about South Korea, where the number of cases has climbed from just a handful to more than 1,200 in the last week or so. An outbreak in Italy has infected 322 people, a worrying sign that the virus may be gaining a foothold in Europe. Seven other European nations confirmed new cases of the virus overnight. And an outbreak in Iran has infected more than 100 residents.

“The sudden increases in cases in Italy, the Islamic Republic of Iran and the Republic of Korea are deeply concerning,” WHO Director-General Tedros Adhanom Ghebreyesus said Wednesday.

The Iranian outbreak has spawned new cases in Bahrain, Iraq, Kuwait and Oman; the Italian outbreak is now linked to cases in Algeria, Austria, Croatia, Germany, Spain and Switzerland.

Tuesday marked a sobering moment for epidemiologists watching the virus: It was the first day that more new cases were confirmed in countries besides China than new cases in China itself, according to the WHO.

There have been 57 cases diagnosed in the United States, 36 of whom were repatriated from the Diamond Princess cruise ship. Most of the rest of the cases have occurred in travelers who have recently returned from China. Just two people have been infected in the United States itself.

How deadly is the virus?

We don’t entirely know yet. Of the 81,191 confirmed cases, 2,768 people have died, a mortality rate of about 3 percent. That would be worse than the Spanish Flu, which had a mortality rate of about 2 percent, and substantially worse than a more ordinary influenza, which kills between one in a thousand and one in ten thousand people.

But there are lots of unknowns.

First, the bad news: Only about 30,000 people have recovered from the virus, which leaves 50,000 or so still in some stage of treatment. Not all of those people will recover, so the mortality rate is expected to rise at least a little bit.

Now, the good news: That 81,191 figure represents only the number of confirmed cases. It appears likely that many thousands more were infected and either did not suffer symptoms or suffered symptoms too minor to seek treatment. In that case, the mortality rate is probably substantially lower than the statistics make it seem.

How sick will the coronavirus make someone?

That depends on your underlying health. Coronaviruses are not uncommon — you’ve almost certainly had several during your lifetime, and at worst you might have called in sick with a common cold. And even if you contract this particular coronavirus, you may show few if any signs.

But if your health is poor already — especially your respiratory system — this virus is more troubling. Many of those who have succumbed have been older, and young children may be particularly susceptible as well. Those who become ill will have problems in their upper respiratory tract; those who become severely ill will have problems in the lower respiratory tract, and those can lead to really serious health concerns like pneumonia and bronchitis.

What are the symptoms?

The CDC says the symptoms are similar to those of a common cold. A patient might develop a fever, a cough, and shortness of breath. At the moment, it appears someone who is infected can show symptoms as early as two days later and as long as 14 days after they have been infected, based on past coronavirus outbreaks like MERS and SARS.

How easy is it to catch the coronavirus?

Tom Frieden, who directed the CDC for eight years during the Obama administration, says it’s too early to know exactly how transmissible the virus is, how long it lives on surfaces or how many people who get the disease become really sick.

“There’s still a lot we don’t know about this infection. We don’t know how readily it spreads, we don’t know, really, what proportion of people get severely ill,” he told The Hill.

But what we do know is that the virus spreads from person to person through air droplets, much like an influenza. That makes it dissimilar from something more deadly, like Ebola, which spreads only when someone comes into contact with another person’s bodily fluids. There are signs, too, that the coronavirus can transmit even before someone shows symptoms, which is going to cause problems for health officials trying to contain its spread.

Now is a good opportunity to remind ourselves the lessons we teach toddlers: Wash your hands a lot. Cough or sneeze into your elbow. Stay at home if you’re sick. Those little steps end up having big, positive consequences.

Anyone who comes into contact with someone infected with the virus should notify their health care provider, the CDC says. Older people and young children, especially those with underlying health concerns, are at the most risk.

What about a vaccine? Or treatments?

The coronavirus is a new phenomenon, which means scientists are only now beginning to research possible treatments or vaccines. No treatments have been approved by the Food and Drug Administration, though there is a drug being tested on a patient who was repatriated from the Diamond Princess cruise ship.

That drug, Remdesivir, was first developed as a potential treatment for MERS and SARS in animals and for Ebola in humans. The National Institute of Allergy and Infectious Diseases (NIAID) is working on a study to test whether the drug would be a suitable treatment for this coronavirus.

But until a treatment is developed, someone with a severe case of the virus will be treated with supportive care — in extreme cases, with intubation tubes and breathing machines.

The real silver bullet for any epidemic or pandemic is a vaccine — and that’s going to take a while. Some in the Trump administration have promised a vaccine within the space of a few months, but that’s extremely unlikely. Instead, the top expert in the federal government, NIAID Director Anthony Fauci, has said he hopes to have a vaccine developed in the next 12 to 18 months, a relatively fast timeline by scientific standards.

Where should I get my information about the virus?

Public health officials are increasingly worried about misinformation that seems to accompany every outbreak, fueled by social media and inflammatory rhetoric.

If you hear a rumor about the virus, check it out with reputable sources — the CDC, state health agencies and the WHO all have websites with the most up-to-date information about the virus and its spread.

Increasingly, those agencies also have fact-checking sections on their websites, aimed at combating misinformation. One of the most troubling rumors that often spreads alongside outbreaks is who exactly has the disease — something that can lead to racial and ethnic profiling.

Nirav Shah, director of the Maine Center for Disease Control and Prevention, said it is important to separate the disease from the person suffering from the disease. No ethnic group is more or less susceptible to the coronavirus.

“My concern is that fear and misinformation will spread much faster than this virus will,” Shah said in an interview Wednesday.

Bottom line: If you hear what sounds like unrealistic information, check it out before you pass it around social media.

What is the U.S. government doing to combat the virus?

At the moment, the federal government is doing a lot of warning. The CDC has produced two dozen guidance documents for hospitals, instructions for preparedness and infection control. Crucially, they are offering guidance on preserving personal protection equipment — like masks and gloves — in a recognition that a widespread outbreak is likely to impact already-low supplies.

The Trump administration has created a task force to oversee the response, led by Health and Human Services Secretary Alex Azar. But the administration has not named a coordinator to oversee a whole-of-government response, similar to what the Obama administration did during the 2014-2015 Ebola outbreak in West Africa.

In other words, there is no one person whose full-time job is to oversee the government’s response.

President Trump plans to hold a press conference on Wednesday at 6:30 p.m. ET alongside members of his coronavirus task force. His administration has requested $2.5 billion in emergency funding, but even Republicans have been skeptical that that’s enough to handle a widespread outbreak. Senate Democrats on Wednesday said they would seek $8.5 billion in funding.

On a state level, hospitals and public health officials are preparing for a growing number of cases. State health directors happen to be in Washington this week for an annual meeting, and many spent Wednesday walking the halls of Congress, lobbying their members to support funding.

At home, those officials are working to make sure their hospitals have the capacity they need to handle an outbreak — enough beds, enough equipment and protective gear, enough laboratory capacity to test samples they take from potentially infected victims, and enough people to run the tests.

“We’re starting to work with hospitals and EMS systems initially to make sure that they have all the capacity that they need,” Shah said of Maine’s preparations. “The public should appreciate that hospitals are used to taking care of sick people. That is what they do.”

What are the broader risks, beyond the virus?

We’ve already seen the virus’s impact in China, where factories and stores closed for days or weeks and cities have been quarantined to stop its spread. Other countries may follow China’s lead. Frieden said the outbreak is likely to cost at least $100 billion to combat globally — and maybe ten times as much, if things spiral out of control.

But as in other outbreaks, the fallout is going to extend beyond immediate health concerns. When Ebola broke out in West Africa, more people died from other, treatable diseases — malaria, cholera, even HIV — because the health systems shut down.

In this case, China is a major source of the generic drugs used in the United States, for everything from hypertension to diabetes. The virus is likely to impact supply chains, making scarce drugs that are completely unrelated to the coronavirus. Experts recommend keeping a three-month supply of any prescription drugs you take on hand in case of that disruption.

“The Chinese manufacturing issue will affect us,” says Michael Osterholm, who directs the Center for Infectious Disease Research and Preparedness at the University of Minnesota. “We’ll have a major shortfall between what will be needed and what will be available.”

Personal protective equipment, like masks and gloves, are already in short supply after a particularly bad flu season. Manufacturers are rushing to fill the gaps, but that takes time, and global demand is growing.

The Department of Health and Human Services said it has a stockpile of about 30 million masks, but says it needs 300 million to protect front-line health care workers. Those workers, who treat patients, would be most at risk of contracting the virus; more than 3,000 health care workers have been infected in China already.

The broader economic impact is also unknown, though Mark Zandi, the chief economist at Moody’s Analytics, said in a note to investors Wednesday that the odds of a recession in the first half of the year now stand at 40 percent, twice what he predicted a few months ago.

“If it is a pandemic, if it does show up in Europe and the United States, then that is the prescription for a global and U.S. recession,” he said.

The Dow Jones Industrial Average and the S&P 500 are both off more than 6 percent in the last two days, the worst two-day drop in years.

There is a decent chance that major sporting events and public gatherings will be delayed or canceled. A major trade show, the Mobile World Congress, has already been canceled in Barcelona, Spain. Soccer games have been canceled in Italy, and political demonstrations are temporarily banned in Seoul, South Korea.

The organizers of the Tokyo Olympics, set for later this year, have insisted the games will go on. But a former top International Olympic Committee official, Dick Pound, cast doubt on those plans on Tuesday, saying the organizers had about a three-month window in which to decide to pull the plug.

The last time the Olympics were canceled was in 1944, when games scheduled for Italy and London were scrapped because of World War II.

Tags Barcelona CDC China Coronavirus Donald Trump Iran Italy NIAID Seoul South Korea WHO
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