Thursday, February 27, 2020

Coronavirus: What You Need to Know About the Latest Outbreak

Mark M. Shelton, MD
Pediatric Infectious Diseases and Pediatrics, Fort Worth
Member, Texas Medical Association Committee on Infectious Diseases

Editor's note: The following article is up to date as of March 3. Case statistics are subject to change.

Coronavirus (COVID-19, otherwise called the 2019 novel coronavirus) is making news headlines worldwide. But what is it to us in Texas? This virus outbreak started in December of 2019 in Wuhan, China, and has spread to nearly 50 different countries and territories – including the U.S. As of Feb. 27, there have been nearly 90,000 reported cases and more than 3,000 deaths, mostly in China. The news and understanding of this outbreak are changing daily, and there are many unknowns about the virus and the disease it causes. At this point, risk to people in the U.S. is thought to be low. However, the Centers for Disease Control and Prevention (CDC) is urging the public to prepare for COVID-19 if it does become widespread in the U.S.

What is a coronavirus?
Coronavirus is a virus, a microscopic living infectious germ that can make people sick. Other similar viruses have infected humans: severe acute respiratory syndrome (SARS), which originated  in civet cats (small nocturnal mammals native to Asia and Africa) in China in open air “wet” markets (outdoor food markets that sell fresh produce, meat, and sometimes live animals); and Middle East respiratory syndrome (MERS), which came from camels in the Middle East. These two epidemics, which occurred in 2003 and 2012 respectively, were largely controlled by quarantine.

There are several common human coronaviruses. Coronaviruses (CoV), in general, cause upper respiratory illnesses similar to colds, and flu-like illnesses that generally cannot be distinguished from other viral infections without specialized laboratory testing. Most of these don’t spread widely. They are pretty common and typically occur in the winter in Texas.

Where did this disease come from and what happens upon exposure?
Scientists believe the current outbreak, COVID-19, is an animal-specific coronavirus transmitted from bats to an armadillo-like creature called a pangolin – which apparently is the animal that can spread this virus to humans. Pangolins are a wild endangered species but used for food and folk medicine in China (they can be found in “wet” markets there).

COVID-19 is a new virus to humans, also sometimes referred to as SARS-CoV2. The disease starts like other coronavirus infections. After exposure, the incubation duration (the period before symptoms of a viral infection first appear) is about four to seven days. Then the patient suffers upper respiratory and flu-like illnesses. For some people, it progresses to a “viral” pneumonia. People who are elderly or have underlying diseases seem to be at greatest risk of getting severely sick from COVID-19. 

There is a great deal that physicians and scientists do not know about this virus and how it might spread among large populations. For example, are people with a mild case of the disease contagious, and if so, for how long? 

Regular coronavirus infections are seasonal. In North America, they seem to correspond with influenza season, which typically starts in October and can run through May. It remains to be seen whether this will be the case with COVID-19.  

What’s being done to fight against COVID-19?
There are currently no drugs approved for, or that seem to be helpful for, this infection. Drugs are available that appear to have some effectiveness in laboratory studies and might be useful in some people. Scientists continue to study this to see if any drugs are useful

Historically it’s taken decades to produce a vaccine for an individual disease.  However, there may be an available vaccine for coronavirus within a year, which would be an incredible feat.

What is the coronavirus situation in the U.S.?
Right now, as of Mar. 3, there are 33 confirmed cases of COVID-19 in the U.S.1; So far, six people in the U.S. have died from the virus, all in Washington state. American public health authorities led by CDC have strongly recommended quarantines and infection-control measures, including isolating hospitalized patients. Hospitals across the state have developed action plans and are training staff in case they must care for patients with COVID-19. On Feb. 29, CDC confirmed 11 cases of COVID-19 at the Lackland Air Force Base in San Antonio2, one of the U.S.’ many quarantine stations. 

CDC has already developed a laboratory test for identifying
individuals with COVID-19 and is sending that test to selected
laboratories in the U.S. and abroad.
The Texas Department of State Health and Human Services (DSHS) is  active in tracking and identifying individuals who may have been exposed or infected. Incredibly, CDC already developed a laboratory test for identifying infected people and is distributing that test to designated state and local public health laboratories – including DSHS – U.S. Department of Defense laboratories, and select international laboratories. Standard tests used by physicians to identify “ordinary” coronavirus, will NOT detect COVID-19.

So how should Texans respond?  
First, it would be advisable not to travel to areas of the world where we know there is infection. ChinaIranItaly, and South Korea are on that list.  Japan is on alert, meaning certain high-risk populations should take precautions. Hong Kong is currently on watch, but the CDC does not recommend canceling or postponing travel there. CDC posts daily travel warnings to avoid COVID-19. People who have been exposed by travel, or other means, need to contact their physician and local health department for evaluation.

For perspective, influenza is spreading in Texas right now and is a much greater risk to all Texans. To avoid getting the flu, first have a flu shot, and practice everyday hygiene measures – cover your mouth and nose when coughing and sneezing and wash your hands or use alcohol gel.

Fortunately, CDC and our state and local health departments are monitoring the COVID-19 situation, aggressively testing people exposed to the virus, planning for outbreak control, and making recommendations for hospitals, in case the outbreak becomes worse.

If this coronavirus acts like SARS and MERS outbreaks, it will most likely be controlled by public health measures including quarantine and isolation. By following CDC’s travel restrictions and taking precautions to avoid exposure like you would do with any other infection, you probably not only will keep yourself from getting sick but also will prevent the spread of such viruses.

I would add, this is not 1918 – the year of the deadly Spanish flu – which was the year of a worldwide epidemic that killed millions. Our public health authorities have rapidly identified the cause of the outbreak and distinguished it as a unique and novel (new) virus, and there are ongoing epidemiologic studies to understand how it is spread. In the U.S., travel restrictions and quarantine measures are in place. The state health department has a way to test individuals suspected of being infected. Physicians and hospitals, along with state, local, and federal health departments, are working together to contain the virus. Several potential therapies have been identified, and a vaccine is being studied. If we play our cards right, our society will successfully get through this outbreak.

1 According to the CDC, 22 of these cases are travel-related; 11 cases were from person-to-person spread. (Twenty-seven cases are under investigation, making the total number of cases detected and tested in the U.S. to 60.) There are an additional 48 people who tested positive in the U.S. among repatriated persons, including individuals under federal quarantine from Wuhan and the Diamond Princess cruise ship.  2 One of these cases is from the repatriated group from Wuhan; the other nine cases are from the Diamond Princess cruise ship. According to San Antonio Metro Health, another patient who tested positive for COVID-19 is from California to receive treatment. 


G. Sealy Massingill said...

Nicely done, Dr. Shelton

Unknown said...

Our adminstration has dropped the ball. No screening at airports and still no test kits.

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