Many people are reaching out to me to ask about the coronavirus (COVID-19) outbreak in China. Maybe the news stories have you worried. Perhaps you’re unsure if you should be concerned at all.
The answer is that it’s still early in the assessment of the outbreak to give definitive answers to many specific questions. In a January 31 press briefing, CDC director and member of the President’s Coronavirus Task Force Robert Redfield stated, “There are a lot of unknowns. Obviously, almost every other day, we’re learning something we didn’t the day before about this. And we’ll continue to do that.”1
In December 2019, individuals in Wuhan City, Hubei Province, China became ill with respiratory infections resulting in cases of atypical pneumonia. The cause of these infections has been identified as a novel coronavirus (2019-nCoV). For subsequent identification of cases to be associated with 2019-nCoV infection they must meet three clinical criteria (or two clinical criteria and one epidemiological criterion) set by the Chinese Center for Disease Control:2
- Clinical criteria: fever; radiographic evidence of pneumonia or acute respiratory distress syndrome; and low or normal white blood cell count or low lymphocyte count.
- Epidemiological criteria: living in Wuhan or travel history to Wuhan within 14 days before symptom onset; contact with patients with fever and symptoms of respiratory infection within 14 days before symptom onset; and a link to any confirmed cases or clusters of suspected cases.
At this point, drawn from observations surrounding the 2019-nCoV outbreak and what we know about previous coronavirus outbreaks (SARS in 2003 and MERS in 2012), the virus likely entered the human population via contact with animals sold in markets in or near Wuhan City. Because the source has not been identified it is difficult to discern how many new cases in Hubei Province may be due to person-to-person spread or ongoing environmental exposures.
Dr. Redfield’s statements on January 31st included more details:3
“This is a serious health situation in China, but I want to emphasize that the risk to the American public currently is low. Our goal is do all we can do to keep it that way…As of today, there are nearly 9,700 cases in China, with more than 200 deaths. Additionally, currently there are another 23 countries that have confirmed, totally, 132 cases. This also includes 12 individuals who have been confirmed in six countries who did not travel to China. CDC has launched an aggressive public health response focused on early case recognition, isolation of those cases identified, and contact tracing around those individuals. This response is a layered response, which includes both targeted airport screening, as well as heightened education and awareness of the American healthcare community to be vigilant in ascertaining the possibility of recent travel to China when they are evaluating patients with upper respiratory tract infection.”
On January 30th, the World Health Organization (WHO) issued a Public Health Emergency of International Concern. This action was not based only on the numbers coming from China but also on confirmed secondary cases of person-to-person spread from infected individuals returning to their home countries. Moreover, reports indicate that person-to-person spread can occur even if the infected person is asymptomatic.
The number of cases is rising rapidly. The WHO situation report for February 11 indicates over 43,000 cases globally with ~2,560 new cases in the previous 24 hours. The death toll currently sits at 1017 (all but one death in China).
This rapid increase in cases is a significant concern, but other observations help alleviate that concern. For example, researchers have not seen a high rate of transmission to health care workers, which suggests proper protective measures can help contain the spread and that human-to-human contact may not be at high transmission rates due to possible characteristics of the virus itself. Thus far, the mortality rate is less than that observed for SARS (~10% mortality rate) and MERS (~35% mortality rate) outbreaks (although it is still early in the outbreak and the epidemiology, morbidity, and mortality data is still evolving). As with MERS and SARS, the mortality rate in elderly individuals with comorbidities (simultaneous health conditions) may be much higher.4
As per the WHO statement and CDC assessments, the US is taking aggressive public health actions to limit potential spread to and within the US. These measures (implemented on February 2) include mandatory 14-day quarantine of any US citizen returning to the US who has traveled to Hubei Province, China, in the previous 14 days. Also, self-quarantine and health monitoring for up to 14 days will be required of any US citizen returning from any other part of China in the previous 14 days.
Foreign nationals—other than immediate family of US citizens or permanent residents—traveling to the US who have been in China within the last 14 days will be denied entrance into the US while these protective measures remain in effect.
As Redfield pointed out, there are still many unknowns and new information is emerging daily. For example, experts have only an estimate (up to 14 days) for the virus incubation period. The virus infectious cycle may have two or more stages based on virus isolation from patients. Other missing or incomplete pieces of data include:
- Virus shedding and routes of transmission
- Speed or rate of transmissibility, including rate of asymptomatic transmissibility
- Morbidity and mortality rates
Should I Wear a Mask?
As mentioned above, the route(s) of transmission has not been confirmed. The virus may spread through aerosol transmission, but it appears to be spreading through direct contact and may spread via contact with contaminated surfaces as is true for SARS-CoV. A mask will offer some protection from direct inhalation of large aerosolized particles, but will not prevent other potential forms of transmission. A mask may help protect you from influenza virus infections. Flu has killed over 8,000 people and hospitalized over 100,000 people this season in the US.5
So, what’s the best way to stay on top of a developing situation of global significance that may evolve quickly and with potentially dire effects? I recommend checking for updates from the CDC and the WHO, as well as watching for press briefings from the President’s Coronavirus Task Force. On social media, two sources I trust are Helen Branswell (@HelenBranswell) and Laurie Garrett (@Laurie_Garrett). Branswell is an infectious diseases and public health reporter for STAT, and Garrett is a Pulitzer Prize-winning science journalist. I would trust these sources before most national or international news sources. Please realize that they, and I, are only as good as the information we receive from other well-informed individuals on the ground. And remember it is early in this outbreak, and we’re all watching together as the situation continues to evolve.
And above all, as Christians let’s remind one another that we are invited to come alongside others with hope and peace that our lives are in God’s care and that we walk through all adversity with God’s presence and help sustaining us as we bring healing and prayer into every area of uncertainty. Many Christians in China are putting their faith into action by helping others. Let us keep them all in our prayers too.