Wuhan Pneumonia Epidemic Update: Brace Yourself!
“The reality is, Mother Nature has the upper hand, and she is using the trappings of modern life – air travel, burgeoning population and low-income country megacities, encroachment on natural habitats, and an interconnected global just-in-time delivery system – to extend her reach. We’ve had fair warning, but as soon as each crisis is over, we just want to forget rather than use our collective experience.”
Michael T. Osterholm
“Fear, left unchecked, can spread like a virus.”
What a difference a month makes. One month ago, the first Germ Gem was posted on an outbreak of pneumonia in Wuhan, China. At that time (January 15, 2020), 41 cases had been confirmed since the outbreak began in early December, 2019. Only one death was reported, and the disease had been detected in only one other country—a woman who had visited Wuhan died in Thailand.
The source of the pneumonia was linked to a seafood market in Wuhan that also sold other animals—most suspiciously, bats. The cause of the disease had been identified by Chinese researchers amazingly quickly— a novel coronavirus named 2019-nCoV. It appeared that the virus was not easily spread from person-to-person, and the Chinese government was praised for its transparency in dealing with the outbreak.
Then all hell broke loose!
By February 11, the disease had been confirmed in at least 42,000 people, and more than 1,000 deaths were recorded in China. Another 400 cases and one death were reported in 24 other countries, and a frenzied effort to contain the epidemic was by being coordinated by the World Health Organization (WHO). (The WHO had declared the outbreak a “public health emergency of international concern” on January 30.)
Also, on February 11, Tedros Adhanom Ghebreyesus, the director general of the WHO, announced a new name for the disease—COVID-19 (CO and VI from coronavirus, D meaning disease, and 2019 standing for 2019, the year the first case was seen). On that same day the Coronavirus Study Group of the International Committee on Taxonomy of Viruses designated a new name of the virus—severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The name reflects its genetic similarity to a sister coronavirus that caused the 2002-2003 pandemic of severe acute respiratory syndrome (SARS-CoV).
Again on February 11, a publication in JAMA(“Preparation for Possible Sustained Transmission of 2019 Novel Coronavirus: Lessons from Previous Pandemics”) underscored the two most critical factors that determine the fate of an epidemic—transmissibility of the pathogen and severity of the disease. For example, two recent epidemics caused by other coronaviruses, SARS-Co-V and MERS-CoV, are low transmissibility and high severity infections. Almost miraculously, the SARS-CoV pandemic that began in November 2002 was declared over by July 2003 (with cases totaling 8,098 and a case-fatality rate of 9.6%). While cases of MERS-CoV continue to be reported since it started in 2012, the total number of cases currently stands at 2,492 with a case-fatality rate of 34%.
What do you need to know now? Importantly, you need to know that the number of cases of COVID-2019 and the transmissibility of SARS-CoV-2 are being closely tracked by the WHO, Centers for Disease Control and Prevention (CDC), and many other public health institutions around the world. (The Lancet and the New England Journal of Medicine have dedicated websites that provide regular updates. You can find on-line minute-to-minute accountings on dashboards provided by public health agencies, as well as by Johns Hopkins University and the Infectious Diseases Society of America.)
While much is still unknown about the epidemic, so far it appears that the transmissibility and severity of SARS-CoV-2 mirror those of SARS-CoV. Airborne person-to-person spread is the primary mode of transmission of SARS-CoV-2. Hospital workers are at risk of infection, and at least six have died. Also, like with SARS-CoV, “super-spreaders” of SARS-CoV-2 (people who for unknown reasons readily transmit the virus to many others) have been identified.
Based on the reports from China, pneumonia is the major clinical feature of COVID-2019, with need for intensive care in a substantial number of patients. Not surprisingly, a majority of hospitalized patients are over 50 years-of-age, but children appear to be less affected. However, a recent report from China on COVD-19 in nine infants, all of whom had contact with infected family members, demonstrates that the virus can infect youngsters. But no evidence has emerged so far to suggest the virus can be transmitted to unborn children from infected pregnant mothers.
As I’m sure you are aware from daily news reports, the COVID-2019 epidemic has already made a major economic hit. Also, you’ve seen that quarantining of patients—in hospitals, at home, and most controversially, on cruise ships—is a major preventative measure to reduce the spread of SARS-CoV-2. Air travel has been curtailed by the United States to and from China, and along with Australia and Singapore, entry is being denied of non-citizens who recently traveled to China. Adding to all the public health challenges, a host of legal and civil rights issues have emerged.
What you should do now? Currently, the risk of COVID-2019 in the United States is considered low. (To date, a total of 15 cases have been reported, almost all of whom were travelers returning from China.) As you’ve likely seen in the news, everyone in China is wearing a face mask. Most of the masks they’re wearing, however, are thought to be of little or no value. But hospital workers caring for infected patients should wear special masks that do prevent acquiring the virus.
Precautions, such as staying away from people who are coughing or sneezing, washing your hands frequently, and keeping your hands away from your nose, are a good idea regardless of SARS-CoV2 because we are still in the flu season. (For comparison, here’s something to be more worried about—the CDC estimates that there have been more than 13 million illnesses and 6,600 deaths from influenza so far this year in the United States. So if you haven’t already been immunized, do so as soon as possible.)
Don’t panic. It’s also important to know that a great deal has been learned from other frightening epidemics earlier this century—in addition to SARS-CoV and MERS-CoV, H1N1 avian influenza, and Ebola. It is terribly disturbing to see what appears to be major chaos and panic throughout much of China, especially in Hubei Province where Wuhan is located. The city remains in lockdown. The good news, however, is that following initial coverups and the stifling of the whistleblower, Dr. Li Wenling, who subsequently died of COVID-2019, the Chinese government now appears to be openly sharing information on the epidemic and allowing researchers from other countries into China.
Also, there is some good news to report: drugs to treat patients with COVID-2109 are already being tested. The results of two clinical trials will be known soon, and other drugs are under development. Incredibly, four vaccine candidates are in development to prevent SARS-CoV-2 infection.
Of course, everyone wants to know the answer to the biggest question of all: When will the COVID-2019 epidemic end? The answer is: nobody knows and stay tuned. But it won’t be anytime soon. After what appeared to be a brief lull, on February 12 a surge of more than 15,000 new cases and 254 additional deaths, nearly all in and around Wuhan, were reported. It appears that this alarming increase may be due, in part, to a revised case definition that captures more patients.
What’s the animal connection?
“We cut the trees; we kill the animals or cage them and send them to markets. We disrupt ecosystems, and we shake viruses loose from their natural hosts. When that happens, they need a new host. Often, we are it.”David Quammen
As is the case for a majority of the 140 plus infectious diseases that have emerged in humans in the past 50 years, COVID-19 spilled over from animals into humans. It appears that as for SARS-CoV, the Chinese horseshoe bat is the primary reservoir of SARS-CoV-2. While the intermediate host for SARS-CoV was civets found in wild animal markets in Guangdong, China, preliminary evidence suggests that pangolins may spread SARS-CoV2 to humans. It seems like it is about time to close these wild animal markets. And it would be wise to stay clear of the Chinese horseshoe bat, an animal that warehouses coronaviruses.