The emergence of a new, potentially dangerous coronavirus in the city of Wuhan in China’s Hubei province has sparked a flurry of articles in the international media and widespread discussion on social media, much of it poorly informed or coloured by politics. With epidemiologists from multiple nations working together to tackle the outbreak, cooperation and the clear exchange of information is vital. What do we know about the virus so far? How is research progressing? What should individuals do to protect themselves, and what does this outbreak tell us about the bigger picture, where novel infectious diseases are concerned?
Understanding the virus
The first cases of 2019-nCoV (as it has been temporarily named) were identified in Wuhan on 31 December. On 7 January, Chinese researchers confirmed that the virus was indeed new. Coronaviruses generally spread into the human population from animal reservoirs but although it is believed to have originated in a wet market, where live animals are handled and sold, the precise source of this virus has yet to be identified. Of course, there is a lot of speculation surrounding this but the working theory in China right now is that the most likely source is bats.
“We know that, among those infected, one quarter of patients have experienced severe disease,” says Dr Tedros Adhanom Ghebreyesus, Director General of the World Health Organization (WHO), explaining that most of those patients had other, underlying health problems and that most of those infected experienced milder symptoms.
To date, there have been multiple reported cases of human-to-human transmission in the Asia-Pacific region, Europe and North America. In China, clinical research is underway into the mechanisms through which the virus passes between humans. All these cases of such transmission identified so far have concerned people who were in extended, direct contact with the infected, such as healthcare workers and family members.
Current antiviral medications seem to be doing little to help the infected, so the focus is now on alleviating symptoms as much as possible.
The city of Wuhan has taken the lead in introducing travel restrictions, since extended to other parts of Hubei, to improve the chances of successful containment.
The International Health Regulations Emergency Committee considers the virus to represent an emergency in China but not, at the present time, a Public Health Emergency of International Concern, since cases outside China are sporadic and can still be contained. It has encouraged other countries to be on the alert in case that situation changes.
Areas of research
Epidemiologists working on this outbreak are pleased that the virus itself has been identified so quickly, as this can sometimes take weeks after symptoms first appear. Some critical uncertainties remain, however. It’s important to identify the animal source of the virus in order to prevent further animal-to-human transmission. It’s also important to develop diagnostic tools so that infected individuals can quickly be identified. This would enable treatment of the symptoms to begin sooner, increasing the odds of patient survival, and it would enable testing to be carried out in high-risk localities, decreasing the risk of infected persons spreading the virus during the incubation period before symptoms appear.
It’s fortunate that health is currently a big investment priority for the government in China, with clinical trial quality and the provision of infrastructure both improving rapidly as a result. Research is now underway into the most effective ways of treating infected people both at home and in hospital environments, minimising the risk of transmission to caregivers.
The high mutation rate of coronaviruses means that vaccines may not be very successful, but work is nevertheless being done in this area. Tongji Medical College, part of the Huazhong University of Science and Technology, has tested a vaccine that appears to have reduced symptoms in seven infected healthcare professionals, but it has yet to go through clinical trials or be assessed by the NMPA (National Medical Products Administration).
While there are still a number of unknowns with 2019-nCoV, coronaviruses in general are fairly well understood, so it’s possible to extrapolate from this to identify means of reducing the risk of transmission. The first line of defence is good hand hygiene – several media reports have compared the risk presented by this virus to the 1918 global influenza pandemic, but it’s worth noting that hand hygiene was poorly understood at that time and the first-pass campaigns promoting it took place partly as a result of the recognition that it could have significantly reduced the death toll.
WHO also recommends avoiding close contact with people with acute respiratory infections, minimising contact with farm animals, and covering the mouth and nose (with a cloth or sleeve, not with the hands) when coughing or sneezing.
Although 2019-nCoV is getting a lot of attention, it’s worth noting that flu viruses spreading around the world lead to the deaths of between 290,000 and 650,000 people annually. In our modern interconnected world, pandemics will always be a risk. It’s only by maintaining high standards of monitoring, research and intervention that we can keep them as well controlled as we do. WHO has praised China’s prompt action and willingness to share information in this case, and it is to be hoped that the partnerships formed as a result will endure into the future.
Right now, I am in Shanghai. While there is undeniable tension, there is a resilient and encouraging determination that the virus will be contained soon.
If you have any concerns or questions about 2019-nCoV and would like further information on what is happening here in China, please do not hesitate to email me at email@example.com.