Coronavirus – What We Know and What We Can Do

Coronavirus Considerations

By: Douglas Dluzen, PhD

     It’s amazing to think that in the span of a few months the entire world has fallen under siege to a microscopic virus. The Coronavirus, also known as COVID-19, began in Wuhan, China and has since infected individuals in over 100 countries and in a majority of states in the United States. As of March 11, 2020, COVID-19 was confirmed in over 115,000 people and will likely spread its way to every continent, country, and state in the coming weeks.

Our ability in the United States and globally to slow and stop the spread of this virus will depend on local and regional preventative strategies and available healthcare resources. Below is a short consolidation of information about COVID-19 and considerations on how to best combat its spread.

    What We Know:

     The novel Coronavirus emerged in or near Wuhan, China sometime in late December of 2019. Dr. Ai Fen is the Director of the Emergency Department of Wuhan Central Hospital and identified a patient with a SARS-like infection. If you recall, SARS was an epidemic scare in 2003 caused by a coronavirus related to COVID-19. Dr. Fen began working with her colleague Dr. Li Wenliang on similar cases in the hospital, while at the same time alerting authorities about a potential new outbreak threat. Both doctors were muzzled by the Chinese government to limit the scope of publicly-available information, presumably to keep a panic from occurring or perhaps to outright deny the existence of the infection. Dr. Wenliang was harassed by police and government authorities and tragically died on February 6^th due to the coronavirus. We’ll come back to more recent scientific muzzling later on in this article.

     We know that COVID-19 is related to SARS, MERS, and other coronaviruses that can cause the mild common cold. However, COVID-19 has different and unique genetic and epidemiological characteristics that make this a novel and previously undetected virus. The US Centers for Disease Control and Prevention has very detailed information about the corona family of viruses, as well as how COVID-19 spreads. The World Health Organization also has extensive information about COVID-19 and both websites should be some of the only places you go to for information on the prevention, symptoms, and treatments for COVID-19.

This is extremely important as the spread of disinformation and xenophobia has put a lot of unreliable information online related to COVID-19 and how it spreads. It has become so problematic that the United Nations called this an ‘infodemic’ and these false claims could contribute to the spread of the disease. Relevant, factual, and life-saving information will help contain this pandemic and it’s important to familiarize yourself with the sources of the information you’re getting. By sticking with these trusted organizations and websites, you’re helping yourself and your community stay as healthy as possible.

We also know that the world wasn’t ready for an outbreak of this magnitude. Within a few short weeks, COVID-19 infected tens of thousands of people in China, and as mentioned before, COVID-19 has spread almost everywhere. Italy is on complete lock-down and Germany is preparing for infection rates as high as 70%. While these countries have formidable healthcare systems, the sheer numbers of potential infected will drive how this pandemic really plays out, particularly if countries try to avoid severe curfews, city lock-downs, and transportation bans.

What we can do:

1. #Flattenthecurve

Julie McMurry, MPH, has started an online database of resources that examine the stress of this pandemic on the healthcare system (you can even sign up for emails to alert you when new information becomes available). The nuts and bolts of the ‘Flatten the Curve’ movement is that anything one can do to ameliorate the spread of the virus within the US or abroad will lead to less pressure on each country’s health care system.

The curve comes in with respect to how many hospital beds and how many cases there are in any given region. An influx of patients that goes beyond the infrastructural capabilities of a given hospital or medical system increases the risk of patient mortality, spread of the infection to health care professionals (who will undoubtedly suffer both illness and psychological turmoil during this), and perpetuate other unforeseen complications. Simple activities such as: washing your hands often with soap and water, limiting yourself to essential travel, and avoiding large crowds for the coming months are little things everyone can do to help flatten the curve. This is critical, as reports from Italy’s frontlines are grim (read Dr. Silvia Stringhini’s and related threads on this) and it’s the most severe cases that will require prolonged hospital stays with important (and limited) resource expenditures. On top of this, little has been done to test the infrastructure of many developing countries who are just beginning to see the infection spread and which will undoubtedly burden the global response.

School systems around the United States have now begun the arduous task of restructuring higher education in real-time. Major universities have closed down live classes and are in the process of moving education on-line. My school, Morgan State University in Baltimore, has followed suit and this is all about flattening the curve to limit viral spread. It’s likely major sporting events, concerts, parades, rallies, science fiction and fantasy conventions, and other large gatherings will be postponed or cancelled. These SHOULD happen, as painful as it will be for the coming months. This will help limit the spread of the virus and ultimately flatten the curve.

2. Know the Symptoms

I won’t go into great detail here, other than to say that COVID-19 symptoms can be easily confused with the common cold and flu. Below is a helpful guide previously compiled from CDC and WHO resources about spotting the subtle differences among the three and here is a link for the CDC symptoms guidelines. But remember, as this virus is currently spreading, new information may become available and it’s best to check in often, particularly if you’re worried you may have become infected. Knowing the symptoms will also help you and the healthcare system by keeping cases of the common cold out of the clinic so resources can be diverted to COVID-19 patients.

Right now, COVID-19 has a much higher mortality rate than the flu and arguments that the virus isn’t deadly or serious are unjustified. This may change as infections rise and deaths decrease, but right now the mortality rate is an order of magnitude (at least) higher than the seasonal flu. Knowing and appreciating this helps us all flatten the curve.

3. Follow the Lead

Some countries have been very effective in limiting the spread of the virus. South Korea stumbled early but now seems to have a grip on the outbreak. Taiwan is a great example of a country that has dealt with prior epidemics (i.e. SARS) and put in healthcare and leadership infrastructure to ensure a proactive and rapid response. Cases are limited in Taiwan in spite of its connections and proximity to mainland China. Effective communication and crowd management were key elements to Taiwan’s containment success – things the United States and other large democracies are doing retrospectively.

   The United States certainly fumbled the football early with respect to appointing appropriate leadership, establishing new funding mechanisms, installing effective screening procedures, and reliably communicating the seriousness of this disease to ensure limited infectivity. Messages from the Administration have been muddled at best and at times downright confusing. As well, a mistake at the CDC caused an early shortage of testing kits for COVID-19, which has now been addressed: this means ramped up production of testing kits is only now just beginning.

There has also been speculation that scientists at the CDC, National Institutes of Health (NIH), and elsewhere have been muzzled with respect to reporting results and findings about the outbreak. All messaging must go through Vice President Pence’s Office first (despite his questionable history of controlling the HIV epidemic in his home state of Indiana). The good news is that there appears to be one scientist above any political messaging related to coronavirus: Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases.

If there’s one person to listen to during this entire crisis, it’s Dr. Fauci. He’s arguably one of the most important infectious disease doctors in the world and has the knowledge and resources to implement essential preventative and therapeutic interventions. He has the respect of the research and scientific community and the gravitas to be able to give clear messaging about the coronavirus, even in some cases correcting the President during Cabinet meetings and news conferences. This is a positive sign that our doctors and scientists are capable of doing their work to help develop new vaccines, treat patients, and spread the word on effective practices to flatten the curve. It is worth noting that Dr. Fauci is also spreading the word in Congress and on TV that things will get worse in the US before they get better, so we must be prepared. However, as of writing this article, the White House has ordered that some top-level COVID-19 meetings with government health officials be considered classified to limit release of these discussions and who can access them. It remains to be seen how this will impact the US response to the virus, as key personnel have apparently been left out of important meetings since January.

In summary, while COVID-19 is a dangerous and deadly disease, we can come together as a society to combat it. We can buy time for our scientists to develop a vaccine, we can buy time to slow the infection rate to give doctors the resources they need to treat patients, and we can be proactive about which information we choose to listen to and or ignore. Hopefully we can all do our part to #Flattenthecurve and stay informed, stay responsible and calm, and stay healthy.