In the last two months, the world has been introduced to the newest of the coronaviruses. COVID-19 is causing epidemics in China, South Korea, Italy and Iran. Additionally, there are small pockets of coronavirus cases currently being monitored in 52 other countries, including the United States. What has gotten everyone’s attention is how rapidly this infection can spread to all nations of the world.
We are familiar with this family of viruses; they have caused past epidemics of Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). Both these viruses have caused many deaths and infected thousands in past years, and COVID-19 is the newest threat.
According to the Centers for Disease Control (CDC), coronaviruses are zoonotic, meaning they are originally transmitted between animals and people. For example, investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Because this is a new virus, its characteristics, origins and potential for spread are still under intense study.
Common signs of infection for this virus are mostly lower respiratory with fever, cough and shortness of breath. Severe cases can lead to pneumonia, renal (kidney) failure and death.
Here are some facts about the spread that have been observed so far:
People can become ill within two days of exposure and up to 14 days (similar to MERS-CoV). Again, this fact may change as infectious disease experts study this virus.
The virus is thought to spread mainly from person-to-person, between people who are in close contact with one another (within about 6 feet). It can happen via respiratory droplets produced when an infected person coughs or sneezes. These droplets can remain suspended in the air, even after the infected person has
exited from that area, and can be inhaled by the mouths or noses of people who are nearby. COVID-19 can be transmitted by touching an infected surface or object and then touching your own mouth, nose, or possibly eyes.
COVID-19 appears to spread easily between people living in close proximity. This was observed in China and on two cruise boats. Again, ways of transmission spread will be better defined as research continues.
At this time there are no known “cures” or antivirals that will fight this infection. Preventative methods, which will be discussed below, and isolating known cases are the primary methods of containment at the present time, along with providing supportive care for persons with pneumonia and renal failure.
Screening potentially infected individuals is done by using the World Health Organization (WHO) and CDC laboratory testing kits. As this infection spreads, it is getting increasingly difficult to keep up with the worldwide demand for these kits. There is an urgent effort for producing and stockpiling these test kits and training health departments in all countries to perform this testing.
WHO publishes a daily update of confirmed cases in China and other countries. There have been a total of 83,652 worldwide cases confirmed; 78,960 of those cases and 2,790 deaths occurred in China. There are now 4,690 or more cases in 51 countries with 67 deaths documented as of February 28.
We are fortunate in that COVID-19 appears to be much milder than SARS and MERS with a low percentage of mortality in chronically ill and immunodeficient individuals. Anthony Fauci, MD of the National Institute of Health, is estimating that the current mortality rate is in the two-percent range, but he and most infectious disease experts feel that the actual count of confirmed infections and associated deaths are probably underestimated.
This two percent may seem like a low number but, Dr. Fauci points out, our current influenza statistics in the U.S. show only a 0.1 percent mortality rate. Influenza this year has caused more than 32,000,000 cases, more than 310,000 hospitalizations and more than 18,000 associated deaths that also include children.
Prevention (from the CDC)
At present, there are many unknowns. Experts are now considering COVID-19 a worldwide pandemic. There is no vaccine to prevent COVID-19; it takes at least a year to develop and test a vaccine. The best way to prevent illness is to avoid being exposed to this disease.
The CDC and WHO recommend everyday preventive actions to help prevent the spread of respiratory diseases:
Avoid close contact with people who are sick and avoid crowded public areas, especially if there are reported cases locally.
Avoid touching your eyes, nose and mouth.
Stay home when you are sick.
Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
If no tissue is on hand, cough or sneeze into the inside of your elbow.
Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipes.
CDC does not recommend that people who are well wear a facemask unless there are cases in the area. The demand currently is outstripping supply.
Facemasks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to others. The use of facemasks is crucial for health workers and people who are taking care of someone in close settings (at home or in a healthcare facility). Facemasks used in a healthcare setting are different than those purchased in hardware stores. These masks need to be able to seal around facial structures and have microscopic filters to screen out viruses. There are other types of masks and breathing apparatus available for use in triage and isolation areas in hospitals.
Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom, before eating and after blowing your nose, coughing, or sneezing. If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60 percent alcohol. Always wash hands with soap and water if hands are visibly dirty.
At this time, there appears to be a small potential for community spread in our area and in the United States in general. This situation will change over time. Because we have had several viral invasions over the years, most healthcare facilities and physician offices have developed pandemic policies and procedures. Most schools, municipalities and larger employers also have similar policies. We are fortunate in the U.S. that we have effective regional isolation facilities and universal public health routines for large-scale screening and triage of people who may appear to be infectious. We are capable of having quick turnaround of results from testing kits, which very much assists in this process.
The public health challenge is that people move all over the world on a daily basis. A person can infect people sitting in the same area or just walking through a public area, especially if he or she is coughing. This infection is different in that a person with minimal symptoms from COVID-19 sheds as much virus as someone who is fully symptomatic.
Our best defense is following CDC guidelines for prevention. Also, if you have not had your flu shot this year, it is not too late; talk with your doctor. Continue to follow any recommendations or actions from the state and county board of health.