As we in the United States grapple with widespread flu, alarming headlines about the newest lethal coronavirus, called the Wuhan coronavirus or the new or novel coronavirus (2019-nCoV), initially reported on December 31, 2019, in Wuhan, China, have been appearing daily in publications globally. Although the World Health Organization (WHO) has declared it a public health emergency of international concern (PHEIC), is it really a direct threat to us here in the States? The Where What When thanks Dr. Robert Edelman, Professor Emeritus of Medicine at the University of Maryland School of Medicine in the Center for Vaccine Development and Global Health, for graciously sharing his knowledge of this virus and its potential threat to us.
Margie Pensak: How dangerous is the coronavirus? How worried should we be?
Dr. Robert Edelman: I have no worries about it in this country, so far. The chances of getting it are very remote. Only 11 cases have been reported in the States, to date. I would be more worried about influenza right now than I would be about coronavirus.
MP: If coronavirus is so benign, why did WHO declare a global health emergency? Is this different than any other outbreak?
DRE: Not really. We experienced the same thing with the outbreak in 2002, when the SARS (severe acute respiratory syndrome) coronavirus emerged, which is related to the current 2019-nCoV. We are still trying to learn more about the virus from the current Chinese epidemic. To date, about one in five persons exposed to the 2019-nCoV gets sick – 20 out of 100. But please understand that everything I am telling you is going to change day by day. This is a rapidly moving epidemic, but so far, it is not as severe as the SARS coronavirus, which shut down the Toronto airport in 2003 and killed about 10% of the patients. So far, the 2019-nCoV death rates in China are probably around 2%, so it’s not as lethal.
MP: How does the new coronavirus spread?
DRE: Right now, it is spread from person to person via respiratory salivary droplets that contain the virus from coughing and sneezing. If you are less than six feet from a person coughing you have danger of getting infected by inhaling the virus. If the person is coughing at the other end of the room, you are probably not going to get infected. It’s much different than measles, where if someone with the measles walks into your living room and coughs a couple of times and walks out, most unvaccinated persons in that room are going to get measles. You have to use some common sense to avoid 2019-nCoV infection. Unless someone has been to China or knows someone who has been in contact with someone who has traveled to China recently – which is an infinitesimal number of Americans, by the way – there is really no risk to us at the present time.
MP: How did the new coronavirus get to America?
DRE: The first occurrence in America happened when a husband who traveled to China infected his wife when he returned home to Chicago. In a population of 330 million Americans, only 14 people in the U.S., so far, have gotten infected in China and returned sick. We need to keep things in perspective. Compare this to over 12 million cases of influenza illness in the U.S. this past year, with thousands of deaths. We don’t think very much about influenza because we are so accustomed to it. When we read something new, like the 2019-nCoV coronavirus and read of hundreds of deaths in China, we all get bent out of shape thinking, hey, this could be us. However, this coronavirus is not as bad as influenza, so far. Right now, the CDC has recommended that people travel to China only if there is a great need. The virus has now spread all over China, and even airlines are stepping up to the plate trying to prevent exposure by suspending flights there. People coming back from China are being screened at airports with infrared (thermal) imaging that can be used to determine if a passenger has a fever and thus may be infected and can potentially spread the virus. Unfortunately, it is becoming clear that some persons can be infected without developing a fever and unknowingly transmit the infection. This may emerge as a big impediment to control of the virus.
MP: How can you contain the new coronavirus?
DRE: This new coronavirus is much easier to contain than measles, for example, but you have to get it early. Once it spreads, one person can infect one to three people, on the average. Two people can then infect four people; four can infect eight; eight can infect sixteen, and so on. That’s how it spread with lightning speed in China, because it was not detected until it was too late to contain it effectively. In this country, if you block it after two infections and it doesn’t infect four persons, you’re probably okay; it won’t go any further. To combat the coronavirus in Wuhan, the Chinese just built two temporary pre-fab hospitals in 10 days to provide 2,600 beds in order to isolate sick persons and prevent them from infecting others. It could only be built this quickly in a state such as China, where everything is regulated from the top down; in the U.S., it could never happen that quickly due to local building regulations and lack of manpower.
MP: If the coronavirus should come to this country, how should it be treated?
DRE: Just like any other respiratory illness. You put a mask on the patient to reduce airborne spread of the virus, hospitalize him or her in a room where the air does not get sucked up into a filtered vent and leave the room, and you have the hospital staff wear masks and protective clothing so they don’t get infected. Or, if you suspect the person may be coming down with the illness, keep him home in his own bedroom away from the rest of the family as much as possible. Most importantly, everyone must wash their hands thoroughly and often.
As we discussed, the most important way a person can catch the virus is through droplets spread from coughing and sneezing. Let’s say you are coughing in your dining room and you get some droplets on the table or a chair and someone comes along and handles the table or the chair. He can unknowingly get your saliva on his hands. If that saliva contains the virus and you put your contaminated finger in your nose, mouth, or eye as people do several times an hour without even realizing it, you are inoculating yourself with the virus. Why the eye? Because itallows virus-contaminated tears to drain down to the nose via the tear duct. After you take a breath, the virus contaminates the back of the throat, and infects your lung via the bronchial tubes. That’s why so many patients develop a dry cough, shortness of breath, and even pneumonia.
MP: Are there any medications to treat this coronavirus?
DRE: Unfortunately, not yet. As we speak, they are working feverishly to test medications that are on the shelf that have already been approved by the Food and Drug Administration (FDA) to treat other respiratory virus infections, such as influenza and the AIDS virus. Also, some scientists know how 2019-nCoV is constructed from a genetic point of view. They are able to anticipate which drugs will work against this virus based on these genes. They are testing the drugs in infected tissue culture and then in infected animals for efficacy and safety before testing them in patients. They are working at full speed, as fast as science will allow, to come up with drugs for treatment and to develop a vaccine for prevention of the disease. Three biotech drug companies are trying to develop a vaccine within a period of three months. If successful, that will be the fastest I’ve ever seen any vaccine developed; it normally takes several years! Science now allows for rapid development in the test tube. We’ve just been asked by the National Institutes of Health (NIH) to test this new vaccine candidate in healthy volunteers at the University of Maryland. These clinical trials have suddenly become our highest priority once they are approved by the Food and Drug Administration for testing.
MP: Is it true the new coronavirus came from an animal source?
DRE: Chinese scientists have discovered through genetic research the 2019-nCoV is related to a bat virus and is probably passed through snakes. How in the world, you may wonder, did a bat and snake virus ever get into humans? The Chinese eat an array of foods, including bats and snakes! The two most dangerous viruses that preceded this new coronavirus were the SARS coronavirus that spread from a Chinese live animal food market in 2003, and the MERS (Middle East respiratory syndrome-related) coronavirus that broke out in 2009 in Saudi Arabia, which originated from camels.
MP: In the beginning of this interview, you mentioned that you would be more worried about influenza right now than you would be about the new coronavirus. What tools does modern medical science have to treat those who get it that it didn’t have, say, during the 1918 flu pandemic?
DRE: We can treat influenza with two drugs obtained via prescription. We are just discovering that one is good but two is better. They work to interfere with different parts of the virus’s replication in humans. It’s like a one-two punch, but this is the caveat: You have to get these drugs into the person within two days of the onset of symptoms. If you then take the drugs for seven-to-ten days, they either block the disease completely or attenuate the illness greatly so you don’t have to go to bed with anything more than, for example, a mild cough and mild sniffle. These drugs keep a lot of people out of the hospital, and they are very effective for people who are susceptible to the flu, like elderly people and those with kidney trouble, diabetes, heart disease, and lung disease, who can get very sick. Most of those who have died from this coronavirus in China, to date, are elderly people over the age of 60 and persons with chronic illnesses who are more susceptible to it than younger, healthier persons, just as they are to the flu. You can take a rapid influenza swab test at your doctor’s office, which will give you the diagnosis quickly, so anti-flu medication can be prescribed and taken within the first two days of illness. Similar, rapid diagnostic tests for the new coronavirus have just been developed but are not yet widely available.
MP: Are people getting sick with the flu even though they got inoculated?
DRE: Yes, the flu shot is not perfect this year; it varies from year to year. This year, it is around 30 to 50% effective in stopping it, but keep in mind that even if it does not prevent the illness, it attenuates it, so you may be sick for two days with a fever as opposed to four-to-ten days. This is an advantage that people don’t recognize concerning the flu vaccine.
MP: So, it is still worthwhile to get the shot, even it will be effective against the current strain of the virus?
DRE: When we say effective, everyone thinks it will stop all symptoms of illness. The shot will prevent illness in about 50% of persons depending on your age. Elderly people have less of a response because they develop an inability to respond to vaccines. It’s called immunosenescence, which is a fancy name meaning your immune system is not as robust as when you were younger. Some of them will still respond but not as much. The flu shot still provides some degree of protection in the majority of people. This is an important concept. Although a person may have gotten the flu despite being inoculated, who knows how much worse his case of flu might have been had he not gotten inoculated? The data clearly shows that inoculation keeps people out of the hospital.
MP: Is there any way to prevent the whole family becoming infected with the flu from one sick member?
DRE: Put a mask on the sick person; have everyone wash their hands well and frequently throughout the day. Don’t use the same towel or anything else contaminated with the saliva of the sick person. Avoid touching your eyes, nose, and mouth with unwashed hands. Avoid contact with the sick person.
MP: Do you recommend wearing a facemask if you are flying on airplane?
DRE: No.
