awareness and preparedness without the panic CORONAVIRUS The novel

BY ROB SAINT LAURENT, M.Ed.

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.

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