There’s a new virus in town, and no one is happy about it. Could this be it? Could the recently emerged coronavirus from China be the source of the next great pandemic?
Why are people worried about the new coronavirus?
The world has had viral pandemics before that have killed millions. With the increased mobility of people around the world — and thus the increased ease of spread — the risk of another massive pandemic has amplified. It is in many people’s opinion (mine included, by the way) one of the most credible of the Big Disaster scenarios facing the world.
In December of 2019 a new coronavirus appeared which displays the kind of characteristics that make epidemiologists worry about pandemics. It’s a virus, so we’ve got no good drugs to squelch infections. It can be passed from person to person. And it causes significant illness in a fair number of people and death in some.
What is this coronavirus thing anyway?
There are many viruses in the coronavirus family, and most of them aren’t a problem to people. They infect other animals, or infect without causing symptoms, or only cause mild upper respiratory (cold-like) or gastrointestinal issues. The new virus, tagged 2019-nCoV, is a member of the family. But so are the SARS and MERS viruses.
Coronaviruses wear a ‘crown’ of proteins designed to latch onto our cells. (5)
SARS stands for Severe Acute Respiratory Syndrome. Ominous name, right? This virus emerged in 2003 in China. SARS infected over 8000 people before the outbreak was contained. The nasty part was the fatality rate: 9.6% of known infected persons died; and nearly 50% of persons over 60 who were diagnosed with it. (1) MERS, the Middle East Respiratory Syndrome, arises from a coronavirus as well. It has only been known to affect about 2500 people, but it has a 35% fatality rate.
2019-nCoV, today’s problem child virus, was probably a new mutation from an animal virus. (2) The first known human cases appeared in December 2019 in people associated with a livestock market in Wuhan district, China.
Where the coronavirus 2019-nCoV problem stands today
Since last December, 2019-nCoV has been spreading … and sickening … and killing. The first couple of hundred cases were in China and among people from the one seafood market. Then cases popped up in other Chinese districts. Taiwan, Japan, and Thailand diagnosed cases. Yesterday the first U.S. case (in a man returning from China) was identified. As of Jan 23, 2020, there have been 570 confirmed cases and 17 deaths. China is restricting internal travel to and from areas with lots of cases. Many other nations (U.S. included) are screening those entering from China.
Coronavirus 2019-nCoV transmits among humans … but it’s not great at it
News flash: China has a lot of people. Given that it’s been loose for more than a month, 570 confirmed cases isn’t a lot. Human to human transmission has been confirmed, and that’s bad. However, although the stats of transmission have yet to be nailed down, 2019-nCoV doesn’t seem to be highly and easily transmissible between humans. It’s looking like fairly close personal contact is required. (1,3)
For comparison, 2019-nCoV appears to be harder to transmit between people than SARS; but easier than MERS. Most MERS cases have been among people in contact with infected animals (mostly camels) and people sharing the health care setting with a MERS patient. (1) 2019-nCoV does not seem to be nearly as easily transmitted among people as, say, your average influenza virus. That makes containment of epidemics much easier.
CoV-2019 is lethal … but it’s not great at killing either
Another big consideration is lethality. There’s a lot we still don’t know about CoV-2019’s health risks, but it seems to be milder than SARS, and far milder than MERS. 17 fatalities of 570 confirmed cases is about a 3% fatality rate. That’s way worse than the 0.1% of most flu varieties; but it’s less than the 9-10% of SARS or the historical Spanish Flu. It’s way less than the 35% of MERS.
Given what we know about confirmed cases, it’s likely there are a lot of coronavirus infections out there that haven’t been reported because the infected persons aren’t going to hospital. Here’s the reasoning: Of the persons at hospitals diagnosed with 2019-nCoV, only about 20% of them required advanced treatment (being put on a ventilator). (1) That means 80% had fever, cough, malaise and so forth but were mostly just given supportive treatment and sent home. That pattern usually means there’s a bunch of people getting it but not bothering to get treated.
Also, the hospital patients don’t all present the same way. They’re not all dying of, say, a cytokine storm reaction as so many of the SARS and MERS victims did.
Why to keep an eye on the 2019 coronavirus
2019-nCoV doesn’t, at the moment, look to be the Next Big Pandemic. But there are reasons to keep our guards up.
One is that it’s early days. The data on cases, transmission, and fatality are still thin. At the moment it doesn’t look that bad … but there’s a reason scientists don’t trust small data sets very far.
Viruses also mutate like crazy. We think this version moved from bat to snake to human, so it looks rather prone to new mutations. Other viruses have mutated worse characteristics. Easy transmission among people, where only a few virus particles could cause a new infection, would greatly increase the spread potential. 20% of hospital cases have required ventilators; so it’s not hard to visualize hospitals being overwhelmed if the virus spread easily. Mutating to a more lethal form, such as one more likely to cause a cytokine storm, remains another troubling possibility.
It’s also likely that 2019-nCoV will be a lot more widespread in a month than it is now. You know how many Americans hit the road for travel during our big holidays? Well, it’s almost time for the New Year celebration in China. That’s a big deal there. Public health people are getting pretty squeamish about the idea of all those potentially infected people moving far and wide over the holiday. (3)
Supply chain disruption is an often over-looked problem
Did you know that for months after Hurricane Maria hit Puerto Rico, the U.S. was critically short of small bags of sterile saline (used for IV drug delivery)? Half of the U.S. supply had been coming from a Puerto Rican manufacturer. (4) Let’s see now….does the U.S. use anything made in China? If China has a big epidemic problem, even if the problem is mostly contained there, the whole world could see shortages of particular items.
A respiratory infection epidemic co-occuring with a shortage of the masks you can wear to reduce transmission of respiratory infections — gosh, what a lousy combination. But many of our bulk medical supplies, including such masks, come from China.
N-95 masks like this are commonly worn by Asians during outbreaks, and they do help to reduce disease transmission. Most are made in China.
So it isn’t just the usual things we think of with pandemics to keep in mind as this situation develops. The modern world has added its own twists to the very old story of killer diseases.
Coronavirus, a summary for today
I’m not terribly worried about this particular coronavirus, at this moment. It doesn’t seem to transmit well enough or be lethal enough to cause The End of the World As We Know It.
But that may change. This virus, or some other virus down the road a year or five … I wouldn’t be the least surprised to see a major life disruption from a virus of this basic sort. It’s a real vulnerability of modern life. How are your preps for such a situation?
Selected sources
1) Hui, David S.I Azhar, EsamMadani, Tariq A.Ntoumi, FrancineKock, RichardDar, OsmanIppolito, GiuseppeMchugh, Timothy D.Memish, Ziad A.Drosten, ChristianZumla, AlimuddinPetersen, Eskild et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China, International Journal of Infectious Diseases, Volume 91, 264 – 266.
3) Cyranoski, D. 20 January 2020. New virus surging in Asia rattles scientists. Nature; news. https://www.nature.com/articles/d41586-020-00129-x
4) https://theconversation.com/three-reasons-the-us-is-not-ready-for-the-next-pandemic-100799
