There’s a New Virus in Town (Well, most likely not your town). What You Should Know
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Last month, the World Health Organization was informed of a cluster of cases of a mysterious pneumonia in Wuhan City, China. Two weeks later, cases were identified in Thailand, then Japan. (WHO) Last week, the US Centers for Disease Control and Prevention (CDC) announced enhanced health screenings for passengers with travel history from Wuhan, China at three major U.S. airports (CDC, https://www.cdc.gov/media/releases/2020/p0117-coronavirus-screening.html, Accessed 1/23/2020) and will now be expanded to 5. And Tuesday, January 21st, the CDC confirmed the first case of the Wuhan Coronavirus in the United States. Detected in a patient in Washington, officials are monitoring him and any known contacts out of an abundance of caution. As evidenced in the events of the past month, this outbreak is rapidly developing with early data still emerging.
What is the first thing I need to know?
Most importantly good infection prevention and control, particularly hand hygiene, can reduce the risk of many infections, including this novel coronavirus.
Additionally, our systems are better prepared to protect than ever before. Since first reports of the outbreak, public health agencies, healthcare systems, and clinicians in the U.S. began putting procedures in place to identify people at risk for this infection, isolate them safely so they can receive proper care without risk of further transmission, and inform the appropriate authorities so a diagnosis may be established or ruled out quickly. Signage such as these from Emory Healthcare are posted and healthcare workers trained to identify ill patients with significant travel history.
How does a new virus like this emerge?
Many of these novel viruses develop in an animal host and can evolve to infect other types of animals, including humans. For SARS and MERS-CoV, two emerging human coronaviruses within the past 17 years, the viruses initially evolved in bats. Both developed the ability to infect an intermediate host (Civet cats for SARS and camels for MERS-CoV), and then evolved an ability to infect humans (Chan and Chan). Genetic changes that have led to the virus being able to jump to new species is still being researched.
Why is it concerning that it’s spread person to person?
Humans generally have infrequent contact with the animal hosts of these virus; thus, it would be very unlikely for someone to come in contact with an infected animal. However, once the virus is able to spread from human to human, the chances that an individual will come in contact with an infected person grows rapidly. At this point, the outbreak can be propagated at a rapid pace in the area where it started. And given the increasing mobility and travel of many societies, these outbreaks can move into new regions and move across the globe quickly.
This also creates additional risk to healthcare workers as they care for ill patients. In order to mitigate the risk of transmission, the CDC has recommended that healthcare workers use standard, contact and airborne precautions with eye protection (CDC, 2019 Novel Coronavirus, Wuhan, China, https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html, Accessed 1/23/2020).
What are the similarities and the differences between this new virus, SARS and MERS-CoV?
Genetically, these viruses seem quite similar. Both are betacoronavirus (a genus within the family of coronaviruses) and appear to be a “B lineage” of this genus. Clinically, they both start as upper respiratory tract infection, often indistinguishable from other more common respiratory tract infections. And like SARS and MERS-CoV, both can progress to cause lung infections, including pneumonias. . As the medical and scientific communities receive more data from the outbreak, we will have a better understanding of the full spectrum of disease for this new virus and how it compares to other infections such as SARS and MERS-CoV.
Does the infectious disease community have this under control?
Through partnerships between CDC, the Assistant Secretary for Preparedness and Response (ASPR), state and local public health agencies, NETEC, and many others, we are steadily increasing our preparedness to face novel infectious diseases threat.
The healthcare and scientific communities and our public health partners have learned much from SARS, the 2009 H1N1 pandemic, MERS-CoV and the Ebola outbreak from 2014-2016. Importantly, we have all learned that infectious disease outbreaks can spread from remote regions to become global treats rapidly in the modern world. By deploying medical, public health, and scientific resources to the primary area of these outbreaks, we address, curtail, and prevent the spread of these outbreaks. Locally in our healthcare and public health systems, we have shown that instituting strong measures of “Identify, Isolate, and Inform,” can significantly reduce the risk of these outbreaks affecting our communities.
See NETEC’s Novel Coronavirus (2019-NCoV) Update page for further resources.