To some, it’s a terrifying new disease emerging from China to threaten health in the rest of the world.
To others, it’s not much to worry about, with barely a dozen cases in the entire U.S. and none at all reported to date in Alameda or Contra Costa counties.
The Wuhan coronavirus, as the disease has been called after the quarantined Chinese city where it seems to have emerged, has so far sickened more than 40,000 in China and killed some 1,000.
Tuesday, as the Independent was going to press, the World Health Organization gave the virus itself a formal name, COVID-19, which carefully avoids stigmatizing people or places. CO stands for coronavirus, VI for virus, D for disease and 19 for the year when it was first identified.
Coronaviruses are a family of viruses circulating throughout the world, most often in animals. “Corona” refers to a fringe reminiscent of a crown.
Five varieties of coronavirus, including COVID-19, are known to infect people with results ranging from mild colds to severe respiratory distress.
Some epidemics have been life-threatening. Beginning in 2002, for example, severe acquired respiratory syndrome, or SARS, killed nearly 800 in China and Hong Kong before burning out a year or so later. Middle East respiratory syndrome, or MERS, is highly lethal. It continues to be diagnosed occasionally.
Although the potential for spread of COVID-19 is considered real, few countries have had more than a handful of cases. By early this week, Thailand had reported 32, Taiwan 18, Vietnam 15, India 3.
The disease is so new that no one is quite sure how it spreads.
Jake Scott, an infectious disease physician at Stanford Health Care-ValleyCare in Pleasanton, marvels that a medical test was developed within a month that can identify victims of the disease. Less than two decades ago, development of a comparable test to identify SARS took several months, by which time the epidemic was burning itself out.
COVID-19 shows no signs of
disappearing, so epidemiologists and researchers around the world are working 24/7, openly sharing medical data in order to develop detailed models of how the disease progresses in a patient as well as how it can be transmitted between people.
Does it get passed on through the air? In saliva or bodily fluids? By physical contact? All of the above?
Of great importance for predicting how fast it spreads is the question of whether a sick person can pass it unknowingly to others before symptoms appear? This is one reason measles can burn so fast through unvaccinated school populations: It is transmitted before kids know they’re sick.
A report from Japan last weekend said that pre-symptomatic transmission is not only possible, but common. Based on case histories of 26 patients in several countries, medical researchers at Hokkaido University concluded that about half of transmissions came from people harboring the coronavirus who had not yet shown symptoms.
Scott, the ValleyCare infectious disease physician, says that until there is medical clarity about transmission, it remains difficult to give health-protective advice beyond the sensible counsel offered every winter against colds and flu.
That is: Wash hands often and use alcohol gel, especially after touching something that might be contaminated; avoid touching eyes, nose and mouth, where mucous membranes are a transmission route into the body; avoid contact with sick people; stay home if you are sick.
This is the kind of sound advice that has been circulating at Tri Valley schools and sent home to parents.
Scott does not recommend masks to protect against COVID-19; first, because it is not clear how it is transmitted; second, because there are so few cases in the U.S.; and third, because masks tend to become slimy and contaminated after constant use.
He does think that sick people should consider wearing masks to keep their germs from spreading, however.
Unlike seasonal influenza, for which there is a safe and reasonably effective vaccine, there is no vaccine for the Wuhan coronavirus. Richard Hatchett, an American physician who heads an international effort to develop a vaccine, has been quoted as saying the problem is being tackled at unprecedented speed, but success is probably a year or more away.
Like many other observers, Scott notes the irony of serious coronavirus alarm in a world where many people don’t bother with vaccinations that are readily available for influenza and other infectious diseases like measles and human papilloma virus.
Still, he sees the COVID-19 publicity as an opportunity to advise people about the importance of keeping vaccinations up to date.
Even how to treat Wuhan coronavirus patients is uncertain and being investigated urgently. After the Chinese government claimed last week that the fatality count had leveled off – that it had turned a medical corner — the number of deaths rose again this week to more than 100 in one day.
On the positive side, Scott has been highly impressed at the international medical community’s willingness to share medical information fast.
Where is he on an optimism-pessimism spectrum that seems to range from blasé indifference to panic?
At neither extreme, for sure. Scott considers the situation “serious” because of the many uncertainties while there is evidence of rapid spread inside China. He believes the U.S., like much of the rest of the world, has been investing too little in public health.
“This outbreak has quickly shown us that as a global society we were not repaired for this, not as prepared as we should have been,” Scott said.
He also points out that COVID-19, like the deadly SARS and MERS viruses, seems to have emerged from our interactions with the animal world. “If we were not disturbing these animal ecosystems so much, we might not be exposed to these exotic bugs,” he warned.
As for China, he faults local officials in Wuhan for not “raising alarms more effectively and more quickly” when early coronavirus cases appeared. He also thinks “the American public health system has been… overwhelmed, not by the (small) number of cases, but in trying to get a grasp of what has been going on.”
While it has declared a public health emergency over the Wuhan coronavirus and imposed quarantines of travelers from China, the Trump administration has cut the budget for the U.S. Centers for Disease Control for three consecutive years.
Still, the U.S. can consider itself fortunate that there have been so few domestic cases, especially during a time when U.S. health facilities are already stretched thin by a severe influenza season.
Scott thinks it possible that the seriousness of the situation in China, including the large number of fatalities, may not be universal but may stem in part from inadequate facilities.
“The cases seem to be milder outside of China partly because Chinese resources are overwhelmed and people aren’t getting the resources they need,” he said.
Flu Shots Safe for Pregnant Women and Fetuses
A Kaiser Permanente study has confirmed the prevailing medical view that pregnant women can get flu shots without risk to their fetuses.
The study made use of a standard screening questionnaire to evaluate the developmental progress of six-month-old infants who had been born to 1,225 Kaiser maternity patients.
The offspring of 799 women who received the flu vaccine were found to have developed equally with the offspring of 426 women who did not get the shots.
The finding was not a surprise. Pregnant women have long been advised to get flu shots for their own health and for that of the fetuses because getting the flu can have serious consequences including stillbirth.
The study did, however, examine infant developmental health over a longer term than previously, according to Lyndsay Avalos, a scientist with the Kaiser Permanente division of research.
The results of the study were published earlier this month in the journal Vaccine. The research ìoffers additional confirmation of the safety of the influenza vaccine for both pregnant women and their children,î said Avalos, lead author of the article.