Q&A: Understanding transmission, origins of Chinese coronavirus key for global security
The United States reported its first case of the novel coronavirus earlier this week. Hundreds of cases of the illness have now been reported, primarily from China.
WHO has decided that the outbreak does not yet meet the criteria of a global public health emergency.
Healio spoke with Amesh Adalja, MD, infectious disease, bioterrorism and emergency medicine specialist and senior scholar at the Johns Hopkins Center for Health Security, and Anne Rimoin, PhD, MPH, professor of epidemiology at the University of California, Los Angeles Fielding School of Public Health and director of the UCLA-DRC Research Program in Kinshasa, about what U.S. clinicians should look for and global health priorities related to the epidemic. – by Caitlyn Stulpin
Q: Why did the number of reported infections increase over the weekend?
AA: The case counts jumped because Chinese authorities began to look for cases of pneumonia in health care facilities that weren’t part of the immediate seafood market cluster identified at the start of the epidemic.
AR: This is an emerging, rapidly evolving situation. Case counts are continuing to mount as disease surveillance improves and the virus continues to spread.
Q: What does that mean?
AA: This higher case count reflects the fact that some degree of human-to-human transmission of this novel virus is occurring.
AR: Early on, many of the patients in the outbreak in Wuhan, China reportedly had some link to a large seafood and animal market, suggesting animal-to-person spread, which would have limited the scope of the outbreak. However, a growing number of patients reportedly have not had exposure to animal markets, which suggests person-to-person spread is occurring. At this time, it’s unclear how easily or sustainably this virus is spreading between people.
Q: What aspects of global security should be prioritized?
AA: The most important thing for global security is to understand where this virus came from, how it is behaving and the level of its severity. The priority should be on understanding how transmissible this is between humans.
AR: Outbreaks of novel virus infections among people are always a public health concern and could impact global health security. The risk from these outbreaks depends on characteristics of the virus, including whether or not and how well it spreads between people, the severity of resulting illness and the medical or other measures available to control the impact of the virus. There is still a lot we don’t know about the 2019-nCoV virus. As we learn more about its potential for transmission from person to person and the severity of infection, its potential impact on public health and global health security will become clearer. We are still in the early days of this outbreak.
Q: What should doctors in the United States know about this virus?
AA: The threat to the U.S. is currently not very high despite the diagnosis of a case here. However, travel screening of individuals arriving from the outbreak zone in Wuhan is a prudent step and, it is hoped, will identify those who may be infected earlier or provide those at risk with information should they get sick later. Clinicians taking care of patients with pneumonia should always ask patients about their travel history. This outbreak reinforces the necessity of that practice.
AR: Doctors and other health care professionals will be looking for people who present with fever and symptoms of lower respiratory illness and who have either had a history of travel to Wuhan, China or close contact with a person who had or is under investigation for 2019-nCoV. This information is being disseminated to hospitals and clinics throughout the U.S.
Q: Is China releasing information as readily as they can and/or should be?
AA: Right now, it appears that China has been releasing information regularly. In an outbreak situation, there is always a need for more information. This outbreak will best be managed through full transparency and the sharing of information throughout the global public health community.
Disclosure: Adalja and Rimoin report no relevant financial disclosures.
Editor’s note: This article was updated on Jan. 24 to show that an emergency committee convened by WHO leadership on Thursday recommended against declaring the coronavirus outbreak in China a public health emergency of international concern.