The Novel Coronavirus
Word and fear of the coronavirus have spread contagiously since the outbreak was declared in January 2020 by the WHO. The latest number of confirmed cases (as of 10th February 2020) is 40 554. However, due to many people having mild symptoms and not seeking medical help to confirm their diagnosis, this figure could be higher. There have been 909 deaths so far.
The outbreak is evolving on a daily basis. For instance, over the course of writing this blog (from the 7th of February to 10th February), the number of cases has increased by 9073 cases and one GP surgery in Brighton has closed after two healthcare professionals were diagnosed with the infection. The guidance on the management of the disease is also evolving to try and tackle the virus. Therefore, it is important to stay up to date with the outbreak and understand how the disease is spread and who is at risk of it in order to enable you to stay informed. A useful source is the Public Health England page (see bottom of the article) which outlines precautions one can take as well as providing regularly updated information on the outbreak.
The figure below outlines the proportion of confirmed cases compared to deaths for recent epidemics. The figure shows the case-fatality ratio of the novel coronavirus to be 2%. This is higher than the case-fatality ratio of flu (0.1%) but lower than that of SARS epidemic of 2012 which was 10% and the 2014 Ebola outbreak which was 40%! Given the lack of information and treatment for the virus, fear of the virus has been rife, and newspapers have added to this, fuelling rumours to spread. This blog aims to explore what is already known of the virus as well as exploring factors which have contributed to the hysteria surrounding this epidemic.
Fig. 1 curtesy of National Geographic
Coronaviruses are a family of viruses, which cause illnesses from the common cold to Severe Acute Respiratory Syndrome (SARS-CoV). The current epidemic is caused by a new strain of a coronavirus which has not been seen in humans before and is called novel coronavirus or 2019-nCoV.
This family of viruses are zoonotic (they can be spread from animals to humans). For instance, the SARS-CoV was seen to be transmitted from civet cats to humans in China in 2002. For the 2019-nCoV no animal source has yet been identified. However, there are suggestions that it was transmitted from animals from a seafood market in Wuhan.
The symptoms of the 2019-CoV are very similar to that of a common cold. Someone with suspected coronavirus infection has signs of either a:
• shortness of breath
They may also have:
• a history of being in contact with an infected individual
• a history of recent travel from mainland China, Thailand, Japan, Republic of Korea, Hong Kong, Taiwan, Singapore, Malaysia or Macau in the last 14 days.
Due to the vague symptoms, a laboratory test is required to diagnose this condition.
The 2019-nCoV is similar to other coronaviruses i.e. it is spread from human to human, through inhalation of infected respiratory droplets, for instance, coughs or sneezes, from someone who is infected with the virus. Studies are currently ongoing which are looking into how long the incubation period of the virus is (i.e. how much time elapses from infection of the virus to the manifestation of the symptoms) and how quickly it reproduces. The Centres for Disease Control and Prevention (CDC) mention that the incubation period may range from 2 to 14 days based on the Middle Eastern Respiratory Syndrome (MERS) epidemic of 2012, which also belongs to the coronavirus family. The lack of knowledge on the virus has clearly contributed to the hysteria surrounding the outbreak as well as difficulty implementing control procedures. It would appear that older people and those with pre-existing medical conditions are at higher risk of developing severe disease.
The use of medical masks in individuals with symptoms has been used to control the spread of other respiratory diseases. However, a mask alone is not sufficient in stopping infections and should be done in parallel with other measures. Individuals with symptoms and who have recently travelled to China (or the eight other countries listed above) or been in contact with an infected individual should seek immediate medical care and try to avoid contact with others.
There is no evidence that a medical mask can help protect those who are not infected. Contrary to the evidence of medical masks, the demand for masks in the United Kingdom has increased and according to a BBC article, one company has sold out of its 500 face-mask stock! The price of masks has also increased. Public Health Wales has advised that you should only wear a medical mask if directed by a doctor.
For those who do not show signs of an infection, WHO-recommended measures which can be taken include: avoiding closed, crowded spaces, maintaining a distance of at least one metre from individuals who respiratory symptoms and also performing frequent hand washing and covering nose and mouth with a flexed elbow or tissue. It is important to put the used tissue in the bin immediately. So far, in the UK, there have been eight identified cases of 2019-nCoV, which may rise (as of data from 11th February 2020). To best protect yourself, it is important to stay up to date with the outbreak and limit travel to affected areas.
There is currently no treatment available for the 2019-CoV. However, like a cold, most cases have resolved spontaneously. As the 2019-CoV is caused by a virus, antibiotics (which target bacteria, another microorganism) are not effective in treating this infection.
What is more shocking than the outbreak of the virus is the epidemic of racism which has accompanied it. There have been many accounts of people not sitting next to East Asian individuals on public transport and being suspicious in spite of not having any knowledge on whether or not they have any symptoms, nor whether they have recently travelled to any of the “high risk” countries like China. There is a clear level of ignorance of the risk factors for developing this disease which needs to be addressed as it is feeding into the hysteria already surrounding the epidemic.
Another factor which may have led to heightened fear was the delayed response from the Chinese Government. Dr Li Wenliang, an ophthalmologist, first warned colleagues of a SARS-like virus in December 2019 via a WeChat group. In an interview conducted with him from the New York Times, he states that he had been suspicious of an epidemic at the end of December as there were “already patients being treated under quarantine.” He was detained by the police in Wuhan on 3rd January and accused of spreading “false rumours” and made to sign a document acknowledging that he had breached the law. The police later apologised to Dr Wenliang. However, the fact he was reprimanded may deter healthcare professionals in China in the future from coming forward in similar ways.
Unfortunately, Dr Wenliang contracted the virus on 30th January and passed away on the 7th February 2020, aged only 34 years old. This is in stark contrast to the majority of the severe cases which have been in the elderly or those with other medical conditions. In his interview with the New York Times, he was wanting to recover quickly in order to be able to get back to the hospitals to help.
His death led to an outcry in China, with many videos being uploaded on Chinese Social Media pages of people saying “Do they hear the people sing?” Despite the strong censorship normally in place in China, officials have been unable to control the online messages from people, accusing the government of not being transparent with them. This level of mistrust may come from the delayed response of the government. According to both Dr Wenliang and other sources, cases were beginning to be identified towards the end of December. The government has been accused of initially downplaying the outbreak, labelling it as a mysterious pneumonia in December 2019. It was also thought to be something which was not transmissible between humans, rather people were catching the virus directly from the animals in the Wuhan market. The public was only alerted of risk of human to human transmission on 18th January 2020. At this point, several healthcare workers had already contracted the disease, suggesting that there was evidence prior to this of transmission between humans. That said, once the epidemic had been acknowledged by local authorities, great steps have been taken in controlling the outbreak. For example, on 24th January 2020, Wuhan was quarantined.
From reading the papers, it does appear as though scaremongering has been going on. This has been further heightened due to lack of knowledge of the virus as well as mistrust in China between the Chinese Government and the public stemming from the delayed acknowledgement of the outbreak.
Real Science, Real Evidence