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5 Things Everyone Should Know About the Coronavirus Outbreak

COVID-19, the disease caused by the new coronavirus (SARS-CoV-2), continues to spread around the world, with an increasing number of cases here in the United States. The World Health Organization (WHO) has declared the disease a pandemic—a disease outbreak occurring over a wide geographic area and affecting an exceptionally high proportion of the population. While individual risk for the disease is dependent on exposure, the CDC is recommending that Americans be prepared for significant disruptions, especially as reports of community transmission in the U.S. grow.

According to the WHO, there have been almost 125,000 confirmed cases of people sickened by COVID-19 and over 4,500 people have died from the disease—a death toll that has far surpassed that of the severe acute respiratory syndrome (SARS) epidemic that occurred in 2002 and 2003. Officials everywhere have implemented measures to contain the virus, including travel restrictions and quarantines.

SARS-CoV-2 is a virus that scientists haven’t seen before. Like other viruses—including Ebola (a deadly infectious disease that originated in Africa) and influenza—it is believed to have started in animals and spread to humans. (Specifically, SARS-CoV-2 is a betacoronavirus, which means it had its origins in bats.) Animal-to-person spread was suspected after the initial outbreak among people who had a link to a large seafood and live animal market in Wuhan, China.

Scientists and public health officials are working to find answers to key questions about the severity of the disease and its transmission.

“I think there are two main questions,” says Richard Martinello, MD, a Yale Medicine infectious diseases specialist and medical director of infection prevention at Yale New Haven Health. “First, we need to know how this virus is transmitted between people so we can be more precise in our efforts to stop its spread. Second, there needs to be a better understanding of the pathogenesis of the infection and resulting inflammatory response, so that knowledge can drive the development of therapeutic and preventive medications.”

Below is a list of five things you should know about the coronavirus outbreak.

1. While COVID-19 has been compared to the flu, there are differences

From a media briefing on March 3, WHO Director-General Tedros Adhanom Ghebreyesus outlined important differences between the two viruses. “First, COVID-19 does not transmit as efficiently as influenza, from the data we have so far,” he says. “With influenza, people who are infected but not yet sick are major drivers of transmission, which does not appear to be the case for COVID-19.”

The second major difference is that COVID-19 has caused more severe cases of the disease than seasonal influenza, he says. “While many people globally have built up immunity to seasonal flu strains, COVID-19 is a new virus to which no one has immunity. That means more people are susceptible to infection, and some will suffer severe disease.”

Third, we have vaccines and therapeutics for seasonal flu, but at the moment there is no vaccine and no specific treatment for COVID-19, he says.

While China is reporting a decrease in new cases, possibly as a result of containment measures, the potential public health threat from the new coronavirus may be ongoing, according to the CDC, which considers it likely that widespread transmission of COVID-19 will occur in the U.S. Cases in this country have included imported cases diagnosed in travelers, people who were close contacts of other known cases, and community-acquired cases, meaning there was no known source of the infection. But while the number of people infected here has been increasing, so far, influenza is having a greater impact in Connecticut and across the country this year.

In addition to COVID-19 testing being done by the CDC, state and local public health labs in all 50 states and the District of Colombia are currently using the CDC’s COVID-19 diagnostic tests, although the number of available tests is limited at this point. Until there can be comprehensive testing for COVID-10 in Connecticut, it’s difficult to know how many cases may be here that have not been identified. “Testing is still very limited in Connecticut,” says Yale Medicine infectious disease specialist Manisha Juthani, MD. “This will hopefully change, but testing will have to be prioritized for those that are the sickest.”

Meanwhile, doctors in the U.S. are keeping a close eye on the new virus. “With the new virus in a culture dish, they are looking at the biology and working to make drugs to treat it,” says Yale Medicine infectious diseases specialist Joseph Vinetz, MD. There is also a great deal of effort underway to assess drugs in development (and some medications currently available) to determine if they are beneficial for treating patients infected with COVID-19, adds Dr. Martinello. “There is a clinical trial evaluating different potential therapeutics at the University of Nebraska Medical Center in Omaha, the first of which is remdesivir,” says Dr. Juthani. Remdesivir is an antiviral treatment that, according to the National Institutes of Health, was previously tested in humans with Ebola virus disease and has shown promise in animal models for treating Middle East respiratory syndrome (MERS) and SARS, which are caused by other coronaviruses.

2. The disease is thought to be most contagious when people are most symptomatic

While there has been sustained person-to-person spread in China, according to the CDC, the exact mechanism for transmission is still unclear. “There is still much to learn about how this pathogen is transmitted between individuals,” Dr. Martinello says. “Data is needed not only to better understand when those who become ill shed the virus, but also which body fluids contain the virus and how those may contaminate surfaces and even the air surrounding them.”

The disease is believed to be most contagious when people are the most symptomatic, and there may be some spread before people with the virus exhibit symptoms, although this is thought to be minimal. Symptoms can appear anywhere between 2 to 14 days after exposure.

Doctors say the most important route of transmission is likely close contact (six feet or less) with infected people who spread respiratory droplets when they cough or sneeze. The risk of spread from asymptomatic people, and from touching surfaces and objects contaminated with virus is thought to be much lower than droplets spread from sick patients. It may be possible to spread the disease before symptoms are present, but that’s not believed to be the primary way COVID-19 is spreading.

3. If you feel ill, here’s what you can do

So far, information shows the severity of COVID-19 infection ranges from very mild (sometimes with no reported symptoms at all) to severe to the point of requiring hospitalization. Common symptoms have included:

  1. Fever (of >100.4 F)
  2. Cough
  3. Sore throat in some people
  4. Difficulty breathing that can be severe enough to cause people to seek hospital care

Officials are urging patients to stay home and contact a health care provider (or hospital emergency room) for guidance if they experience fever, cough, or difficulty breathing, and if they have had contact with a confirmed COVID-19 patient and/or traveled from a hard-hit area within 14 days of the onset of illness.

4. There are things you can do to protect yourself

As with a cold, there is no vaccine for the coronavirus—and a flu vaccine won’t protect people from developing it. While researchers are working on a vaccine for the new virus, it could take as long as 12 to 18 months to develop one, according to Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases.

To protect yourself from the new coronavirus, Dr. Vinetz says, “The best thing you can do at this point is take care of yourself the way you would to prevent yourself from getting the flu. You know you can get the flu when people sneeze and cough on you, or when you touch a doorknob. Washing hands—especially after eating, going to the bathroom, and touching your face—and avoiding other people who have flu-like symptoms are the best strategies at this point.”

The CDC also recommends the following preventive actions:

  • Wash hands with soap and water for at least 20 seconds. Dry them thoroughly with an air dryer or clean towel. If soap isn’t available, use a hand sanitizer with at least 60 percent alcohol.
  • Stay home if you’re sick
  • Avoid touching nose, eyes, and mouth. Use a tissue to cover a cough or sneeze, then dispose of it in the trash
  • Use a household wipe or spray to disinfect doorknobs, light switches, desks, keyboards, sinks, toilets, cell phones, and other objects and surfaces that are frequently touched
  • If you must touch something, use a tissue or sleeve to protect your hand.
  • It may also be important to create a household plan of action. You should talk with people who need to be included in your plan, plan ways to care for those who might be at greater risk for serious complications, get to know your neighbors, and make sure you and your family have a household plan that includes ways to care for loved ones if they get sick. This includes planning a way to separate a family member who gets sick from those who are healthy, if the need arises.

As for masks, there is little evidence supporting their widespread use for people who are not sick. “We generally do not recommend the use of masks for the general public,” says Dr. Martinello. “Masks may provide a modest degree of protection against fluids, including spray from a cough or sneeze, and they provide some filtration of the air. But, since the masks do not provide a tight seal around the wearer’s nose and mouth, much of the air inhaled and exhaled remains unfiltered.” However, the CDC does recommend face masks for people who have symptoms of COVID-19, as well as for health care workers and others who may be caring for them. “Since we are experiencing mask shortages, it is important to save masks for health care workers and patients that are sick in the emergency room to prevent other patients from getting sick,” says Dr. Juthani.

Some people are considered to be at higher risk of getting very sick from COVID-19, based on early information out of China. While everyone should take precautions, older adults and those with chronic conditions (such as diabetes, heart or lung disease, and other conditions that suppress the immune system) especially should avoid crowded places and stock up on household items, groceries, medications, and other supplies in case they need to stay home for an extended period.

5. Precautions remain extremely important

The CDC is taking measures to prepare communities to respond to any local transmission of the new virus. In addition to large numbers of people needing medical care, widespread transmission will mean that people will need to stay away from schools, workplaces, and other places where people gather.

“Based on Governor Ned Lamont’s declaration of a public health and civil preparedness emergency in the Connecticut, we anticipate that schools, businesses, churches, and other organizations may be closed,” says Dr. Juthani. “Events and other activities will likely be canceled, and many businesses will encourage employees to work remotely.”

Since threats like COVID-19 can lead to the circulation of misinformation, it’s important to trust information only from reputable health organizations and government sources such as the CDC.

Guidelines will evolve as doctors learn more

Here’s the latest information everyone should have to minimize the risk of exposure to the new virus. “Whether it is the flu, which we see every winter, or an outbreak of an emerging infectious disease, the public health infrastructure in the U.S. is a critical resource for leading the federal, state, and local response,” Dr. Martinello says. Because knowledge about the new virus is evolving rapidly, you can expect recommendations to change, even frequently.

In addition to earlier travel restrictions in place for people traveling from China, on March 11, the U.S. suspended most incoming travel from Continental Europe for 30 days in an effort to help slow the spread of the virus into the U.S.

Anyone planning to travel out of the U.S. will want to check the CDC’s travel advisories concerning several countries that have had confirmed cases of COVID-19. The CDC’s latest recommendations include avoiding all nonessential travel to China, Iran, South Korea, and most of Europe. The CDC is recommending older adults and those with chronic medical conditions consider postponing any travel plans. “Given the recent declaration of a pandemic, it may be reasonable to avoid international travel in case returning home becomes problematic,” says Dr. Juthani.

The CDC recommends that all travelers postpone cruise ship travel, because the disease seems most likely to spread in close quarters if a fellow traveler is infected. It also advises people who are traveling in the U.S. to practice precautions, since they may be at higher risk of exposure if they visit an area that is experiencing community spread of COVID-19.

If you have traveled to an affected country, taken a cruise in the past 14 days, or been exposed to another person with COVID-19, health officials will give you instructions on limiting your activities and movement for up to 14 days in order to help keep the virus from spreading.  “If you are recovering well from a respiratory illness that you think might be COVID-19, we encourage you to call your doctor to see if you should be treated for influenza and remain at home as you continue to recover,” says Dr. Juthani. “As testing becomes more available in the next few weeks, it may be possible to be tested as an outpatient.”

Infection prevention specialists at Yale New Haven Health (YNHH) have provided guidance for the screening of patients with acute respiratory infections to determine whether they have been to China or other hard-hit locations across the globe in the few weeks before they got sick, or if they’ve been exposed to anyone who may have been ill with COVID-19. YNHH is taking a cautionary approach by putting masks on patients who may be at risk and placing them in a private room to ensure the safety or all patients and staff.

Meanwhile, public health authorities strongly advise everyone to get their annual flu shot if they have not done so already. “We continue to remain in the midst of a bad flu season,” says Dr. Juthani. In addition to preventing or mitigating the severity of flu, the vaccine will simplify the evaluation of patients with flu-like symptoms if potential cases of COVID-19 surface in the community.

Author: KATHY KATELLA

Content Source: Yale Medicine

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