11 minute read
LIVING WELL
awareness and preparedness without the panic CORONAVIRUS The novel
BY ROB SAINT LAURENT, M.Ed.
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Since the first case of the disease, now known as COVID-19, was confirmed in the Chinese city of Wuhan last December, the novel coronavirus has put the world on edge.
As of February 13, assuming the numbers coming from China are trustworthy, Johns Hopkins
University’s real-time novel coronavirus tracker indicates more than
60,000 people have been infected globally, with some 99 percent
of cases in China, and nearly 1,400 fatalities—exceeding both the 2003 SARS and 2019 MERS coronavirus outbreaks. 1
there are currently 15 confirmed cases, including a 20-somethingyear-old-man in Massachusetts who remains in isolation after seeking immediate medical attention upon returning from Wuhan. While there have been just two related fatalities outside of China thus far, a local state of emergency has been declared in California’s Santa Clara County in response to an original false negative report on a man returning from Wuhan.
The disease continues to dominate headlines, particularly after it was declared a public health emergency by both the World Health Organization (WHO) and U.S. Health and Human Services (HHS). As the chaos continues, some are questioning whether the fear being created is more dangerous than the disease itself.
WHAT IS CORONAVIRUS? Explains WHO, coronaviruses are a large virus group in animals and humans, ranging from the common cold to more serious conditions like Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). The virus can jump from animals to humans, especially if it mutates. 2, 3 The 2019-nCoV, which may soon be called SARS-CoV-2 to indicate its similarity to SARS coronaviruses, is a new strain not previously found in humans before the Wuhan outbreak. Physicians describe the virus as a loaded cold with symptoms of fever, cough, shortness of breath, and potentially pneumonia (fluid in the lungs). So while a common cold generally remains in the upper respiratory tract, the new strain can go low and threaten the lungs. 2-4 The New England Journal of Medicine (NEJM) has said that some patients have also presented with gastrointestinal symptoms (vomiting, abdominal discomfort, loose stools), which, if more widely reported, may help clinicians better recognize the virus in patients. GI symptoms are not uncommon with coronaviruses, experts say. 5 According to researchers, affected patients generally remain asymptomatic for some days.
One case study in NEJM followed an infected Shanghai businesswoman on a January 19, 2020, flight to Munich. She felt slight discomfort, but nothing especially unusual, for about five days after exposure to someone coughing on the plane. She developed a dry cough, fever, chills, and chest pain, and was hospitalized on January 25 where she remained as of the last contact on February 5. 6 China reported the first cases of viral pneumonia in people who were all exposed to a seafood and animal market in Wuhan. As it has since spread from person to person, many have become sick, though, at a fatality rate of two percent, most cases are believed to be mild with recovery in a few days. 7 Those growing seriously ill have typically been very young, elderly, or have lower immunity. 3 Deaths have mostly been among older Chinese men and/or those with preexisting conditions. A study in The Lancet showed that about half of 99 Wuhan coronavirus cases had chronic cardiovascular disease (example, high blood pressure) or brain-related vascular disease, diabetes, and, in severe cases, co-infections of various bacteria and fungi. Older men with reduced immune cell counts were more likely to be infected. 8 Few Wuhan victims may also be smokers, as were some of The Lancet cases, with China consuming roughly 40 percent of the world’s cigarettes.
Additionally, deaths may be due to the country’s lack of adequate healthcare.
UNPREDICTIBILITY Very little is known about the novel coronavirus because of its newness.
It is true that influenza kills many more people each year than this novel virus has to date, but not knowing this new virus’ behavior— how it travels and whether or how it is mutating—makes it more
than SARS, which had a 10 percent mortality rate among those
infected, the new coronavirus has the potential to spread more
easily than its cousin. The infected Chinese businesswoman, for
example, had spread the virus to her German colleagues despite
being just slightly symptomatic, or what the researchers had
considered asymptomatic. 9
At the same time, however, the virus’s speedier spread and low
death rate could hasten what’s called “herd immunity.” Explains
epidemiologist Rossi A. Hassad, Ph.D., MPH, this acquired
immunity acts as a barrier to further spread since viruses need a
susceptible host to propagate. 7
The U.S. Centers for Disease Control (CDC), though it has
been rushing to ship improved test kits to hospitals, has employed
an aggressive approach to the present outbreak. Informed by SARS
and MERS, it has employed public awareness campaigns; airport
screenings and travel restrictions (though restrictions remain
controversial in their effectiveness); and quarantine and isolation
for those with considerable symptoms, recent travel to Wuhan, or
contact with someone sick with the virus.
On January 31, 2020, at a White House press conference at
HHS.gov, Secretary Alex M. Azar II emphasized the virus’s low
threat to the U.S., stating, “I want to stress: The risk of infection
for Americans remains low.” 10 Massachusetts public health officials
echoed this feeling in a February 1 press release, saying the risk of
the virus to the public “remains low in Massachusetts.” 11
With the measures now in place, Prof. Hassad believes the risk
to the U.S. “remains low to zero.”
That said, WHO has warned of the possibility global incidence
could increase, especially in Africa, which lacks strict air travel
controls and medical resources and given the possibility of
continued false-negative test readings.
A map by Southampton University shows the virus may have
intersected nearly 400 cities around the world by 60,000 Chinese
travelers from Wuhan, from after the outbreak began to before
the lockdown. 12
Another unknown is the novel coronavirus’ incubation time.
Though the median period was three days, a Yale study of more
than 1,000 Chinese patients showed as much as 24 days—calling
into question 14 day quarantines. 13
Even if the virus doesn’t significantly affect the U.S. healthwise, there is the prospect of severe economic fallout, with the production and delivery of Chinese-made auto parts, electronics, and other items already being impacted.
Should Chinese businesses continue to remain offline and the disease becomes pandemic, there could be significant supply chain disruptions affecting all sorts of things, including medicines and medical supplies.
SELF-CARE
warm water for at least 20 seconds (or use hand sanitizer), not
touching your face, disinfecting common surfaces in the home and
office, carrying your own pen, and considering vinyl gloves when
out (especially with open wounds).
Building immunity is equally important: not skimping on
sleep, exercising regularly and eating healthy, getting enough fluids
while avoiding alcohol, avoiding chronic stress (worrying about
coronavirus), and not smoking while avoiding those who do.
Regarding vitamins, comprehensive research suggests that
1-2 grams/day of vitamin C, 400 IU/day of vitamin D, zinc
supplements/lozenges, and echinacea may be effective at preventing
and reducing the intensity of colds and flu. 15
If you do get sick, follow the basic principles of avoiding others, covering your cough, and throwing out used tissues. Though most colds and flu symptoms subside within a week if you feel something isn’t right, seeing your doctor is advised.
Finally, the federal government recommends people have enough essentials on-hand (see ready.gov). Many have pointed out that Americans are woefully prepared for any major disruptions. You can monitor this fluid situation through the CDC’s dedicated webpage: cdc.gov/coronavirus/2019-nCoV/index.html, as well the Massachusetts Department of Public Health: mass.gov/ guides/information-on-the-outbreak-of-2019-novel-coronavirus2019-ncov. H
1. https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/ bda7594740fd40299423467b48e9ecf6
2. https://www.who.int/emergencies/diseases/novel-coronavirus-2019
3. Ellerin, T. (2020, January 25). The new coronavirus: What we do—and don’t— know. Harvard Health Blog.
4. https://www.mass.gov/guides/information-on-the-outbreak-of-2019-novelcoronavirus- 2019-ncov
5. Holshue, M.L.; DeBolt, C.; Lindquist, S.; et al. (2020, January 31). First Case of 2019 Novel Coronavirus in the United States. The New England Journal of Medicine. [Epub].
6. https://www.nejm.org/doi/suppl/10.1056/NEJMc2001468/suppl_file/ nejmc2001468_appendix.pdf
7. Hassad, R.A. (2020, February 7). Novel Coronavirus: Understanding the Epidemiology. MedPage Today.
8. Chen, N.; Zhou, M.; Dong, X.; et al. (2020, January 30). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet. [Epub].
9. Gever, J. (2020, January 30). Novel Coronavirus: Transmission Before Illness Documented. MedPage Today.
10. Azar, A.M. (2020, January 31). Secretary Azar Delivers Remarks on Declaration of Public Health Emergency for 2019 Novel Coronavirus. [White House Press Briefing].
11. https://www.mass.gov/news/man-returning-from-wuhan-china-is-firstcase- of2019-novel-coronavirus-confirmed-in
12. Rahhal, N. (2020, February 10). Terrifying map reveals how thousands of Wuhan travelers could have spread coronavirus to 400 cities worldwide as global death toll tops 1,000. Daily Mail.
13. https://www.medrxiv.org/content/10.1101/2020.02.06.20020974v1
14. https://healthcare.utah.edu/healthfeed/postings/ 2014/12/122314_checklist-fluprevention.php
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