OUTSIDE THE PREP BUBBLE: Medical overview of the coronavirus and its international impact
From Issue 7
February 19, 2020
As the coronavirus outbreak has developed into an international concern, paranoia and misinformation have made their way around the world. To gain a more complete view of what exactly the coronavirus is, how it originated, and what threat it poses to the United States, I interviewed Dr. Rathel Nolan, an infectious disease physician at St. Dominic hospital in Jackson, Mississippi.
There are different strains of coronavirus, one of which was responsible for the SARS (severe acute respiratory syndrome) epidemic in 2002-2003. The strain of coronavirus responsible for the recent outbreak, named COVID-19 and first identified in Wuhan, Hubei Province, China, is thought to have originated in bats, then jumped to another species of animal in a wet market—a type of Chinese market where a variety of live animals are sold—and from there to have been transmitted to humans. Dr. Nolan explains, “Occasionally you see a virus jump from one animal species into another, and, in its experience with that new animal, the virus may mix with a different virus that’s in this other animal; and they exchange genetic material, and all of a sudden there’s a brand new virus out there.”
The SARS epidemic was a result of a similar process, when a coronavirus was transmitted from civet cats to humans. Unfortunately, Dr. Nolan said, there is much that is relatively unknown about COVID-19, as we are still in the early stages of the epidemic, and “at the present time the Chinese are just trying to deal with stopping it from spreading and treating the people who are sick.” Furthermore, the Chinese public health system is not as well fleshed out as the United States’s nor is its government as forthcoming.
Dr. Nolan explained that, with an epidemic, the first cases to gain widespread coverage are those in which people die, the most serious, tip-of-the-iceberg cases. Then numbers concerning cases where people were sick enough to go to the hospital and those who fell ill from the virus but not severely enough to go to the hospital are reported. In the following months, Dr. Nolan expects that the Chinese health department will begin to run tests on people in the Wuhan area who never fell ill to see if they show signs of having contracted the virus. This information will provide better statistics for what percent of people who came in contact with the virus actually manifested symptoms and help better calculate an accurate mortality rate. With the data currently available, the mortality rate of coronavirus COVID-19 in China lies just under 2%. The United States has seen several confirmed cases of coronavirus but no deaths.
The most common result of the coronavirus is simply the common cold, and the virus can be spread through coughing and sneezing as well as hand-to-hand contact, though how long the virus lives on surfaces is yet unknown. Other common symptoms of this strain of coronavirus include chest colds with coughing and sneezing, fever, chills, and it can also result in pneumonia. Of those infected, the majority who have become extremely ill have been males over the age of 60 with pre-existing health problems. Dr. Nolan also stated that with similar viral epidemics, healthy children rarely become seriously ill from contracting the virus.
In terms of prevention, Dr. Nolan stated, “The main thing is good hand hygiene of washing your hands with alcohol based hand rubs, like Purell,” and further elaborated that “the surgical masks probably don’t afford you any kind of protection.” He also advised sick people to stay home because, even if they feel well enough to work or attend school, they can still spread their illness to others. To those in the United States who might be concerned about contracting COVID-19, Dr. Nolan said, “ Right now, the people that we would be worried about are people that have traveled back from that area in China, in Wuhan, or have had contact with someone who has. If that’s not the case…they probably haven’t gotten coronavirus. If you’ve got something that sounds like a chest cold, it’s probably a chest cold.”
As the epidemic is still in the early stages, there is no definitive treatment for the COVID-19 strain of coronavirus. In China, many options are being tested, including treatment utilizing medication for HIV. Dr. Nolan says, at this stage, no clinical trials have been conducted confirming the effectiveness of any medications against COVID-19, and people are simply trying to get their hands on anything that might work. A test has been developed through the Center for Disease Control (CDC) to detect COVID-19, though it has not yet been made commercially available. Any possible specimens in the United States must be sent to the CDC for testing, but Dr. Nolan believes these tests will soon be accessible to state health departments.
According to the CDC, confirmed COVID-19 cases have been reported in the following countries as of February 12, 2020: China, Malaysia, Nepal, Philippines, Taiwan, Russia, Australia, Sri Lanka, Belgium, Singapore, Cambodia, Spain, Canada, Sweden, Finland, Thailand, France, The Republic of Korea, Germany, United Arab Emirates, India, Italy, the United States, the United Kingdom, Japan, and Vietnam. According to reports by CNN, the worldwide death toll from COVID-19 was 1,873 as of February 18.
Currently, people in the United States have little cause for concern over COVID-19. Resulting in about 8,000 deaths per year, the flu presents a more immediate concern for American citizens. Anyone travelling abroad should monitor travel advisories from the CDC and the World Health Organization (WHO). The US government is monitoring the situation and enforcing strict quarantine and testing for those returning from regions where COVID-19 has been confirmed.
The outbreak has resulted in travel warnings and will inevitably affect trade with and tourism to China and surrounding nations. The International Civil Aviation Organization (ICAO), a United Nations agency, has reported that some 70 airlines have cancelled all international flights into China. The ICAO estimates a 39% to 41% reduction in air travel passengers to China in the first quarter of 2020 and that nearby countries Japan and Taiwan could lose up to 1.29 billion and 1.15 billion USD respectively in tourism revenue. These estimates do not take into account travelers on cruise liners or utilizing other methods of transportation, so it is reasonable to assume that the loss in tourism revenue could be higher.
Over the past week, several incidents involving cruise ships have captured international attention. The ship MS Westerdam was turned away from five Asian ports under the suspicion that passengers may have been infected with coronavirus. On February 13, the ship was finally permitted to dock in Sihanoukville, Cambodia, where the country’s Minister of Health certified that all ill passengers had tested negative for the virus. The US Embassy has moved to help US citizens prepare to travel home out of the capital, Phnom Phen. Another cruise ship, currently quarantined in Japan, had 355 confirmed cases of COVID-19 as of February 16, and that total is expected to rise as all passengers have not yet been tested. A third ship had been quarantined for several days off the coast of Hong Kong, but all passengers were eventually permitted to disembark.