Month: February 2020

It would appear that outbreaks of SARS-CoV-2 virus (and the disease it causes, COVID-19) are springing up in places far from its birthplace in Wuhan, China: in South Korea, Iran, and Italy, among many other nations, with the coronavirus infection showing up in dozens of people who cannot be easily linked to China.

The Washington Post newspaper reported yesterday, in story titled Coronavirus outbreak edges closer to pandemic (original, archived copy):

In South Korea, coronavirus cases quadrupled over two days, as 144 people linked to a religious sect tested positive. In Singapore, clusters of infection have been traced to two churches, a hotel business meeting, a health products shop and a construction site. In Iran, an outbreak has seeded new cases in Lebanon and Canada — a worrisome sign the disease could be spreading more widely than realized.

There are outbreaks. There are epidemics. And there are pandemics, where epidemics become rampant in multiple countries and continents simultaneously. The novel coronavirus that causes the disease named COVID-19 appears to be on the verge of that third, globe-shaking stage.

Amid an alarming surge in cases with no clear link to China, infectious disease experts believe the flu-like illness may soon be impossible to contain. The World Health Organization has not declared COVID-19 a pandemic and the most devastating effects, including more than 2,200 deaths, are still in China. But the language coming from the organization’s Geneva headquarters has turned more ominous in recent days as the challenge of containment grows more daunting.

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“What we find is that this virus is going to be very difficult to contain,” said Jeffrey Shaman, an infectious disease researcher at Columbia University and co-author of the study posted Monday. “Personally, I don’t think we can do it.”

Harvard epidemiologist Marc Lipsitch estimates that 40 to 70 percent of the human population could potentially be infected by the virus if it becomes pandemic. Not all of those people would get sick, he noted. The estimated death rate from COVID-19 — roughly two out of 100 confirmed infections — may also drop over time as researchers get a better understanding of how widely the virus has spread.

That death rate, estimated at 2% of cases at present, is significantly higher than that posed by regular seasonal influenza, at 0.1%. While many people (especially the young) have only a mild response to this virus, the latest scientific research shows that approximately 20 percent of those who land up in hospital with COVID-19 are severe cases that often require intensive care. Those who are older, overweight, or have underlying health conditions such as asthma, heart disease or diabetes are more likely to have a severe or even deadly reaction to this virus.

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UPDATE Feb. 24th: The BBC reports in an article today titled Coronavirus: World should prepare for pandemic, says WHO, in answering people’s questions about the virus:

The current fatality rate is less than 0.5% for people under the age of 50. But it rises to 8% for people in their 70s and 15% for people over 80. Meanwhile, nearly 11% of people with diseases of the heart died when infected. As did 7% of people with diabetes and 6% of people with long-term lung problems. The average for healthy people is 0.9%.

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Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases (NIAID) in the United States, explained in a recent CNN interview why we’re nearly at the brink of a global pandemic with the novel coronavirus outbreak:

Yesterday, the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota reported:

Today officials from the Centers for Disease Control and Prevention (CDC) warned that although the agency is taking historic measures to slow the introduction of COVID-19 into the United States, the country should prepare for the possibility of community spread, as seen in China and neighboring Asian countries.

“The day may come when we may need to implement such measures as seen in Asia,” Nancy Messonnier, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases, said in a press conference, referencing the closing of businesses, schools, and churches in multiple countries where transmission is now occurring within the community.

This is no longer a “what-if” scenario for us in North America, or an “over there on the other side of the world” problem that we can ignore. This potential pandemic is already wreaking unprecedented havoc in Chinese society, and that havoc is spreading to other countries now—South Korea, Japan, Hong Kong, Singapore, Iran, and Italy all have documented cases of human-to-human transmission.

In other words, you need to prepare yourself—emotionally, mentally, and physically— for a pandemic. The time to begin preparing is NOW.

Part of the mental and emotional preparation for a pandemic is understanding something that risk communication expert Dr. Peter Sandman refers to as an adjustment reaction:

When someone first learns about a new and potentially serious risk, the natural, healthy, and useful reaction is, in a sense, an over-reaction:

– You pause
– You become hyper-vigilant
– You personalize the risk
– You take extra precautions

These responses are signs of what psychiatrists call an adjustment reaction. They are part of the process of adjusting to the new risk. Here are the key characteristics of the adjustment reaction to crisis:

1. It is automatic
2. It comes early
3. It is temporary
4. It is a small over-reaction
5. It may need guidance
6. It serves as a rehearsal
7. It reduces the probability of later over-reaction

This is just a summary; I very strongly suggest you go over and read the whole thing yourself, it’s not too long and it is fascinating. Dr. Sandman goes on to say:

This is the teachable moment! Instead of criticizing or ridiculing people’s adjustment reactions to emerging crises, smart crisis communicators encourage the adjustment reactions, legitimize them, ally with them, and guide them.

It’s okay to tell people that they’re jumping the gun a little – that there is still time and you advise them to hold off on particular precautions until the risk gets closer, bigger, or clearer. It’s okay to recommend substitute precautions – precautions that are more useful or less burdensome or less likely to backfire than the ones they’re attracted to. It’s okay to remind them that nobody knows yet whether the situation will worsen or blow over, that they should try to stay poised to ramp up or ramp down their level of concern. That’s all part of guiding the adjustment reaction.

What isn’t okay is to suggest that people shouldn’t be worried yet, that they shouldn’t take any precautions or even think about what precautions they want to take until you give the word. It isn’t okay to tell people that their normal and useful impulse to rehearse is irrational or panicky. Healthy people are going to rehearse. They are going to imagine the worst before it happens and before we know for sure if it’s coming. They are going to take premature precautions. An adjustment reaction is a big improvement over being caught unawares. Don’t try to tell people not to have one. Help them have a good one.

In other words, an adjustment reaction is normal, it helps you to begin to take the risk of a pandemic seriously, and it gives you the kick-start you need in order to begin preparing for it.

At this point all the experts are now saying the same thing: that the Wuhan coronavirus will continue to spread worldwide. It cannot be contained, either within the city of Wuhan, the country of China, or the region of south-east Asia. The best that countries outside China can do at this point is to use case isolation and contact tracing to slow down the spread of the virus within their countries, and implement quarantines and social distancing policies to buy more time in order to prepare. As Dr. Amesh Adalja says above, “It is not a matter of if—it is a matter of when”.

Remember, there is no vaccine against the Wuhan coronavirus, and there is unlikely to be one for at least a year. Also, no one has any natural immunity to the 2019-nCoV virus. Scientists still don’t know exactly what percentage of the people who catch this virus will develop only mild symptoms, and what percentage of infected people will land up in hospital. It has already been reported by Dr. Anthony Fauci of NIAID that approximately one in four people who are hospitalized so far have severe cases, requiring intensive care.

No hospital system, anywhere in the world, has enough intensive care beds to deal with a surge of tens of thousands of serious 2019-nCoV cases, as we have already seen happen in Wuhan, China.

As I have written before, throughout history there have been eight tactics used to combat infectious diseases. It is possible—some would say, likely—that national, state/province, and city governments will impose quarantines and social distancing policies in order to try and contain 2019-nCoV outbreaks.

What this means for you, reading this now, is that you need to prepare yourself and your family for the possibility that you will need to stay in your homes for a period of several weeks, avoiding contact with as many other people as possible, as a wave of illness caused by the Wuhan coronavirus sweeps through your community, forcing schools, businesses, and public transportation and public gathering places like movie theatres and shopping malls to close (as we already seen in Wuhan and many other cities in China). The time to prepare for this is NOW.

That means that you need to prepare by stocking up on food and other supplies to last you at least two or three weeks. Start by reviewing the Personal Health Preparedness lists provided by the U.S. Centers for Disease Control and Prevention here and the Pandemic Preparations list by Ready, an official website of the U.S. Department of Homeland Security.

You will need to have on hand:

• At least two weeks of food and other supplies (toilet paper, first aid supplies, soap and hand sanitizer, garbage bags, etc.). There are already reports of panic buying in places such as Hong Kong, Singapore and Italy. You do not want to leave it to the last minute! For example, both my local drug store and my local grocery store are now completely sold out of hand sanitizer, and the manager at the grocery store said they’ve been out of stock for two weeks now.
• Refills of all your presecription medications, plus a stock of over-the-counter medicines (talk to your doctor and pharmacist about creating an emergency supply of your prescription medication).
• Power sources (flashlights, extra batteries, car chargers and adapters for your mobile devices, etc.).

Other things that you should do:

• Sign up for any local alerts from your city, state/province, or federal government (or know where to find the information on the Internet). Find out what plans your employer is making (and if they’re not making them now, they should be).
• If you haven’t yet, get your seasonal flu shot. It can’t hurt, and it will help to figure out whether or not you do have 2019-nCoV if/when you do become sick. Many areas now give out the flu shot for free.
• Train yourself NOT to touch your eyes, nose, and mouth! The SARS-CoV-2 virus can remain viable on hard surfaces anywhere from 2 hours to 9 days (scientific journal article source), and you can transfer the virus from your infected hands to your mouth, nose, and eyes by touching or rubbing them.
• Watch the following video from the World Health Organization on how wash your hands! Yes, I know I have posted it before. You may think you already know how to wash your hands properly, but you still might learn something you didn’t know before. Proper hand hygiene will also help you avoid catching regular seasonal colds and influenza, so there’s a net benefit to society.

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Good Sources of Information on SARS-CoV-2 and COVID-19

Here is my updated list of good, credible, authoritative resources to learn more about the Wuhan coronoavirus (formerly called 2019-nCoV and now officially called SARS-CoV-2; the disease the virus causes is now called COVID-19):

• the United Nations World Health Organization
• the U.S. Centers for Disease Control and Prevention
• Personal Health Preparedness information from the U.S. CDC
• Health Canada, including an FAQ and a fact sheet
• Public Health Canada
• Information for the Public from the Department of Health and Social Care and Public Health England (U.K.)
• the European Centre for Disease Prevention and Control (new!)
• Public Health Ontario (Canada)
• Coronavirus Information for the Public (British Columbia Centre for Disease Control; see also this series of tweets)
• University of Chicago Medicine
• 2019-2020 Wuhan coronavirus outbreak (Wikipedia)
• Dr. Roger Seheult is posting short videos to his YouTube channel, explaining the medical concepts behind the Wuhan coronavirus in an easy-to-understand way
• Another instructive YouTuber to watch is Dr. John Campbell, a British nurse educator who very clearly explains what you need to know
• If you prefer to get your informtion via audio, the Infectious Diseases Society of America (IDSA) has started a weekly half-hour podcast on SoundCloud, called COVID-19: What’s Happening Now.
• If you want a credible list of people to follow on Twitter, epidemiologist Dr. Ellie Murray has compiled a curated list of coronavirus experts that you can subscribe to.

If you want a quick, up-to-date overview of the current situation, here are three good places to check:

• 2019-nCoV Global Cases (by the Center for Systems Science and Engineering at Johns Hopkins University) UPDATE Feb. 24th: This website appears to be down (temporarily, I hope!); other good statistics dashboards are here and here.
• Tracking coronavirus: Map, Data and Timeline by BNO News
• the Wikipedia article on the Wuhan coronavirus outbreak is constantly updated by an army of volunteer editors, and provides a good overall summary of the situation

Stay informed, get prepared, and stay healthy!