As the world grappled with the COVID-19 coronavirus disease pandemic in early 2020, people around the globe began to consider the dread possibility that COVID-19 might not only be more infectious and have a much higher mortality rate than the seasonal flu, but that at least some persons who survived it might become reinfected rather than developing an immunity to it.
A few reports have trickled in from around the world suggesting that someone who had COVID-19 recovered and then fell ill with it again, such as the following account from China:
Mr. Wang, a resident of Xuzhou, in Jiangsu province, appeared to have emerged victorious from a monthlong battle with the illness.
Three days later, though, Wang tested positive for the coronavirus again. He was re-hospitalized and his neighbors were locked down once more. His current condition is unknown.
Wang, whose full name has not been disclosed for privacy reasons, is one of more than 100 reported cases of Chinese patients who have been released from hospitals as survivors of the new coronavirus only to test positive for it a second time in the bewildering math of this mysterious illness.
However, at this juncture its difficult to determine whether such reports document that fully recovered COVID-19 patients truly became infected anew, or whether those persons may have relapsed or not completely recovered from their first bout of the illness. Problems with diagnostic testing techniques have been raised as one possibility to explain why some patients might have retested positive for COVID-19 after seemingly recovering:
[Such cases] are raising questions in China about the reliability of diagnostic tests, the possibility of reinfection and whether patients are wrongly designated as recovered and released too early from hospitals.
Scientists in and outside China agree that reinfection is a highly unlikely explanation for the patients who retest positive. They say testing errors are more likely to blame either false negatives that resulted in patients being discharged too early, or false positives when they retested and were taken back into hospital.
Those errors could be attributed to contaminated test samples, human error while taking swabs, or an oversensitive nucleic acid test that detects strands of virus.
The Los Angeles Times quoted Dr. Keiji Fukuda, director of Hong Kong Universitys School of Public Health, as saying that COVID-19 reinfection was unlikely and that false positives in testing procedures were a more likely possibility:
If you get an infection, your immune system is revved up against that virus, he said. To get reinfected again when youre in that situation would be quite unusual unless your immune system was not functioning right.
Whats more likely is that people are being released from hospitals while still carrying dormant fragments of the disease that are not infectious but resemble the virus when put through a nucleic acid test, he said.
The test may be positive, but the infection is not there, he said
Dr. Clifford Lane, deputy director for Clinical Research and Special Projects at the National Institute of Allergy and Infectious Diseases, was also quoted as suggesting that the real issue was with inaccuracies in testing patients who had not fully recovered rather than with reinfection:
Another possibility is that the level of virus fell below the threshold that tests could detect but then resurfaced, [Lane] said.
So it looks like [some patients] cleared the virus and then the virus came back, Lane said. But they never really cleared it and they had a more prolonged course of infection.
Lane was one of only two U.S. experts in a World Health Organization delegation that visited China in February. He said Chinese experts told the visitors that there were no examples of people who became reinfected.
A coronavirus infections going into a dormant stage and then re-emerging was another possibility for explaining the appearance of reinfection suggested by Dr. Philip M. Tierno, Clinical Professor of Microbiology and Pathology at at New York University: Once you have the infection, it could remain dormant with minimal symptoms. And then you can get an exacerbation if it finds its way into the lungs.
The Associated Press also offered the possibility that mutations in the virus might conceivably make it different enough to reinfect persons who had acquired immunity to an earlier version:
Scientists at the at the Fred Hutchinson Cancer Research Center in Seattle say the 30,000-letter genetic code of the virus changes by one letter every 15 days. Its not known how many of these changes would be needed for the virus to seem different enough to the immune system of someone who had a previous version of it for it to cause a fresh infection.
Dr. Anthony S. Fauci, the Director of the National Institute of Allergy and Infectious Diseases who is for many Americans the most familiar source for information on the coronavirus disease (due to his numerous appearances at government press conferences and cable television news reports), told Congress that he felt it was unlikely anyone could become reinfected by the virus: We havent formally proved it, but if this acts like any other virus, once you recover, you wont get reinfected.
While this topic is an area that requires additional study, medical professionals still caution that The things to worry about are at the other end of the illness that the primary focus should still be on limiting the outbreak by trying to ensure that symptomatic and undiagnosed persons are not exposing themselves to, and potentially infecting, others.
A sign encourages people working out at a YMCA to maintain a healthy environment amid concerns of ... [+] the coronavirus,
In the U.S., there have been more than 3,200 confirmed cases of COVID-19 and over 60 deaths, according to estimates from Johns Hopkins University. Limited initial availability of diagnostic tests mean that the numbers are likely far higher than that.
So how bad might the COVID-19 outbreak get in the United States, and what measures are needed to contain it? We reviewed statements from government health officials and surveyed infectious disease experts to forecast the coming weeks. Heres what we found.
A lack of testing makes it impossible to estimate how many people in the U.S. might become infected.
Right now, there simply isnt enough data to make a realistic prediction of how many people in the U.S. might eventually contract the new coronavirus. I do not know and cannot even guess, Dr. Stanley Perlman, a microbiologist whose lab at the University of Iowa specializes in studying coronaviruses, told Forbes. One reason that data isnt enough is that not enough people in the U.S. have been tested for the disease. While other countries, such as South Korea, enacted systems to test a wide swathe of the public, the mechanisms for doing so dont exist in the U.S.. Were not set up for that, National Institute of Allergy and Infectious Diseases (NIAID) Director Dr. Tony Fauci said in Congressional testimony earlier in March. Do I think we should be? Yes. But were not.
Another point to consider, adds Dr. Andrew Pekosz, a virologist at Johns Hopkins University Bloomberg School of Public Health (JHU-SPH), is that the United States is a big country. But unlike China, U.S. outbreaks began at multiple times and places as people traveled from different exposed areas, spreading the disease through communities at different rates. As a result, he notes, Washingtons outbreak is several weeks ahead of outbreaks in Boston and New York Citys, which are in turn ahead of cities like Baltimore. We need to be prepared at the local level to respond to the situation and realize that different parts of the country will have peaks at different times.
The rate of infection appears to have peaked in countries like China and South Korea, but experts urge caution.
Countries where the COVID-19 coronavirus spread early, such as China and South Korea, are still seeing increases in the number of confirmed cases, according to the latest statistics from the World Health Organization, but the rate of infection appears to be decreasing. Epidemiologists are encouraged, but warn against being too optimistic as people limit contact with others, avoiding gatherings and working from home.
We dont yet know whether we will see transmission surge again when people return to normal life, says Dr. Steffanie Strathdee, Associate Dean of Global Health Sciences at UCSD and author of The Perfect Predator. We also dont know if people can become re-infected, or if people who appear to have recovered can still shed the virus, infecting others even though they are well.
Its also difficult to say how a leveling off of infections in China and South Korea translates for the U.S., given that the American response to the outbreak is markedly different from those two countries, Perlman adds.
Seniors are particularly at risk from COVID-19, but so are others.
The elderly is probably the population most at-risk of death, with the mortality rate for COVID-19 patients over 80 being estimated to be 15%. But other factors can increase risk, including compromised immune systems, heart disease, high blood pressure and respiratory issues. Obesity and smoking are other risk factors that I expect will increase the risk of serious complications, so its a good time to act on those New Year's resolutions, says Strathdee.
Social distancing should help slow disease spread, but there are nuances to the right approach.
Every expert we spoke to said that social distancing is a key to both slowing down rates of infection and preventing hospitals and doctors from being overwhelmed. Limiting large gatherings such as sporting events, theme parks and cruises are pretty easy calls. Other types of social distancing can involve more nuance, and their effectiveness might might depend on other circumstances.
Closing schools, says Dr. Rupali Limaye, a scientist at JHU-SPH, is one such example. If parents have to work and cant take care of their children, that may lead them to finding alternative child care that might not be ideal, increasing the risks of exposure to the disease in other ways.
On a similar note, Dr. Tom Inglesby, director of JHUs Center for Health Security, noted in a March 9 Twitter thread that while social distancing measures should be encouraged, lockdowns by force to contain COVID-19 are counterproductive. [T]he impact of forcible lockdown of city, state, region could cause people to lose confidence in govt, make provision of health care harder, cause major econ hardship, or be life threatening to some who lose access to food, medicine, clinic access, home care, he tweeted.
Imposing travel restrictions will do very little to limit the spread of COVID-19.
President Trump announced a 30-day travel ban from the European Union earlier this month, which was later extended to include the United Kingdom and Ireland. While theres some evidence that early travel restrictions against China may have slowed down the outbreak, most experts agree that new restrictions will not have an impact now. At this point, person to person transmission in communities is the biggest concern.
I think this policy was too late, too little, Limaye says. This would have been more useful if it had been implemented before the virus made it to the U.S.
Rather than worry about travel, experts suggest that government officials focus their attention on slowing the spread of disease locally. The example of other countries shows that strong public health efforts can be successful, says Pekosz, meaning that the U.S. still has a chance to curb the epidemic.
The World Health Organization (WHO) finally declared the Covid-19 outbreak a pandemic on Mac 11 (2020).
In many countries, pandemic action plans were already activated before this, including in Malaysia.
Pandemics are usually declared for influenza A, and this is the first time that a pandemic has been declared for a coronavirus.
Since the SARS-CoV-2 virus is rather similar to influenza A(H1N1), which was declared a pandemic in 2009, Malaysia can tweak its National Influenza Pandemic Preparedness Plan (NIPPP) prepared in 2006 after the Nipah virus outbreak in 1999 so that it will suit the Covid-19 pandemic.
Compared to the rest of the world, where 114 countries and all continents except Antarctica, have reported cases, Malaysia is still in the early phase of the Covid-19 outbreak, with only 161 confirmed cases to date (as of Mac 13).
The public health measures of containment by Health Ministry have been effective so far.
However, if the number of cases continues on an upward trend, then the ministry will have to change its strategy, moving from containment to mitigation.
Containment is effective when there is little or no community spread, and the number of cases is low.
Public health measures during containment include rapid identification of cases, contact tracing, testing of samples, isolation of confirmed and suspected cases, and mobilisation of resources where needed.
In mitigation, the main objective is social distancing, avoiding large crowds, closing of schools, working from home and reducing unnecessary travel.
This is very disruptive of social life, and requires the cooperation and commitment of the public.
Plan activated
Although the situation in the country is still manageable, Malaysia started its pandemic preparedness plan well ahead of time and long before WHO decided to declare the outbreak a pandemic.
Several hospitals were identified to handle Covid-19 patients; a rapid RT-PCR (reverse transcriptase-polymerase chain reaction) test on patients and contacts was developed, used and distributed to several government hospitals and medical laboratories; and management protocols were developed.
It is important that there are enough drugs and medication to treat the symptoms of severe Covid-19 patients, although there is no medical cure for the condition.
More ICU (intensive care unit) facilities will be needed if the cases soar, and we must be prepared for this eventuality.
As for frontline healthcare personnel, they must be provided with respiratory protection devices and protective clothing, including N95 masks, gloves, goggles and PPE (personal protection equipment).
The Government should also ensure that essential services are maintained during the pandemic.
The police force, armed forces, firefighters and those manning essential services such as electricity and water supply, should all be given proper protection as well.
We certainly do not want to see the country become chaotic and dysfunctional if these services should fail.
Individual action
In Malaysia, we still have time to start preparing ourselves in case the situation worsens and the ministry has to enforce mitigation measures.
By all means, stock up on non-perishable items to last for about two weeks, but let us avoid excessive hoarding of goods, which can cause a shortage of these goods and create panic in the community.
Those on regular prescription drugs for chronic diseases like diabetes, heart conditions, liver disease, kidney disease, cancer and chronic respiratory illnesses, should get additional supplies of their medication sufficient for an extra month.
And of course, stock up on face masks and hand sanitisers.
Families with elderly parents really need to pay special attention to precautions for this novel coronavirus.
Bear in mind that the death rate in the elderly is more than 10 times that in the normal population.
In Italy, 56.6% of patients who died are over 80 years old, with two-thirds of them having at least three pre-existing chronic conditions.
Of particular concern are those elderly people staying in nursing homes.
They may already have debilitating diseases and cannot afford to get infected with Covid-19.
The Government should come up with guidelines for these homes, and if necessary, restrict visitors.
We do not want to see a situation like in the Life Care Center in Kirkland, Seattle, United States, which has contributed to 19 of the Covid-19 deaths in the Washington state.
Despite the official declaration of a pandemic, our country has made contingency plans early on to tackle this global crisis.
If we all play our part individually and collectively, we will overcome this pandemic like we have done in the past.
Do not leave it entirely to the Government to handle this crisis.
Be prepared to make personal sacrifices, change our lifestyle, exercise social responsibility and be inconvenienced.
The conquest of this pandemic will make it all worthwhile!
Emeritus Professor Datuk Dr Lam Sai Kit is an Academy of Sciences Malaysia senior fellow and Universiti Malaya research consultant. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
A newborn in London has tested positive for the novel coronavirus SARS-CoV-2, just minutes after being born to a mother who was also infected with the virus, according to news reports.
Days prior to giving birth, the woman was admitted to a hospital for symptoms of pneumonia, finding out she had tested positive for the virus that causes COVID-19 only after her baby was born at North Middlesex hospital in Enfield, in north London, The Guardian reported.
According to The Sun, the baby was being treated at the hospital, while the mother had been transferred to an infectious-diseases hospital.
It is not known when the child contracted the disease. "We can't say it happened while the baby was still in the womb," Dr. William Schaffner, a professor of Preventive Medicine and Infectious Diseases at the Vanderbilt University School of Medicine, told Live Science. The baby could have also contracted the virus during, or immediately after, birth, Schaffner said.
Some infections pass from a mother to her baby through the mother's placenta, while the fetus is still developing in the womb, or from bodily fluids during delivery. For instance, the Zika virus which is in another family of viruses from this coronavirus can pass to newborns both in the womb and during delivery, according to the Centers for Disease Control and Prevention (CDC). When passed to a baby in the womb, the Zika virus can cause microcephaly and other severe brain defects, the CDC said.
"That was a terrible phenomenon that happened with Zika," Schaffner said.
The first known newborn who tested positive for SARS-CoV-2 did so within 36 hours of birth. In that case, it also wasn't clear whether transmission happened in the womb.
Following that news, researchers analyzed samples from nine women who came down with COVID-19 when they were 36 to 39 weeks pregnant, and were admitted to a hospital in Wuhan, China, where the outbreak began. All of the women delivered via C-section. To find out if and perhaps when the virus could be transmitted, the team looked at samples of amniotic fluid, umbilical cord blood, breast milk and samples from the newborn's throat.
None of those samples tested positive for the coronavirus, and both the mothers and babies survived, according to that study, published Feb. 12 in the journal The Lancet. In those cases, at least, the virus didn't appear to pass between a mother and her developing fetus.
Right now, the bigger question is how the baby will fare.
"Does the baby become sick?" Schaffner asked. "Does the baby also develop pneumonia?"
Children infected with this coronavirus are mostly showing mild symptoms. But there isn't enough data yet to say whether babies would fall into this category.
"Newborns are particularly vulnerable, and they may be exceptions to that general rule since they are so vulnerable," Schaffner said.
As the coronavirus spreads across the globe, everyday life is being transformed with social-distancing measures, school closures, event cancellations, and in some cases, entire city lockdowns.
Though pregnant women tend to be at a higher risk of catching some respiratory infections and developing more severe symptoms from those infections, that doesn't seem to be the case for the coronavirus, according to a report published at the end of February by the World Health Organization-China Joint Mission on Coronavirus Disease 2019. Of 147 pregnant women with either confirmed or suspected cases of COVID-19, only 8% had a severe form of the disease and just 1% were in critical condition, according to that report.
Originally published on Live Science.
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News Release
Sunday, March 15, 2020
NIH informed its staff early this morning that it has its first known case of an NIH staff member who has tested positive for COVID-19, the disease caused by the SARS-CoV-2 coronavirus. NIH has reported the case to state and local public health officials. While this is an unfortunate development, it is not surprising, and NIH expects that there will be more cases of infection among NIH staff.
The individual works for the National Institute of Arthritis and Musculoskeletal and Skin Diseases but is not involved in patient care. The individual is quarantined at home and doing well. Importantly, the individual was asymptomatic while at work, which is believed to lower the risk of transmission. After developing symptoms, the individual took the appropriate action, stayed home and called the NIH Occupational Medical Service (OMS), which is managing potential COVID-19 infection among NIH staff. OMS arranged testing, and the result was positive.NIH commends the infected individual for following the NIH guidance, which has allowed us to take swift action.
OMS and the NIH Clinical Center Hospital Epidemiology Service have identified staff who work in close proximity to this individual and may have been exposed. Those individuals have been contacted and will be screened for symptoms as soon as possible and asked to self-quarantine at home if their exposure constitutes a significant risk of infection according to Centers for Disease Control and Prevention (CDC) guidelines. OMS will monitor them closely for infection.
NIH will handle each case with the utmost respect to privacy while also informing potentially affected staff and taking swift measures to mitigate spread of the virus. NIH is reminding staff to follow the CDC guidance about COVID-19 toprevent illnessand recognizesymptoms.
About the National Institutes of Health (NIH):NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
NIHTurning Discovery Into Health
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In 2011, two scientists at Cambridge University in the UK devised a clever way to measure and model the spread of the fluan app called FluPhone that used Bluetooth and other wireless signals as a proxy for interactions between people, and asked users to report flu-like symptoms.
If youd had lunch with someone who later got sick, FluPhone would let you know. Besides slowing the spread of the flu, the app promised to help health authorities monitor and model the spread of influenza. FluApp made headlines and the front page of the BBC website at the time. But in the end fewer than 1 percent of people in Cambridge signed up to use it.
As the deadly Covid-19 respiratory virus stalks the US, some techies suggest using smartphones to track and report transmissions. The idea raises many questions, including how well such a system would actually work, whether it might sow unnecessary alarm or confusion, and whether such tools might enable unwanted corporate or government surveillance.
The creators of FluPhone, Jon Crowcroft and Eiko Yoneki, certainly believe an app like theirs could help fight the coronavirus.
The health protection agencies could use it to populate anonymized map data, which might help reduce transmission, Crowcroft says. He says an app would also help researchers learn how long the virus survives on a surface, what fraction of the population are asymptomatic carriers, and where to target critical medical resources.
Read all of our coronavirus coverage here.
Inspired by the way China and South Korea apparently used smartphones to slow the spread of Covid-19, some US technologists have begun working on tracking apps. An open source project called CoEpi sprang up in February to develop an app with similar functionality to FluPhone. Ramesh Raskar, a professor at the MIT Media Lab, and colleagues are developing an app that would let people log their movements, and compare them with those of known coronavirus patients, using redacted data supplied by the state or national public health departments. Over time, users would be asked whether they are infected, providing a way to identify potential transmissions in a similar way to FluPhone. The team released a prototype for testing on Friday.
Raskar has been rallying other researchers and tech executives to the effort, and he has been in contact with the World Health Organization, the US Centers for Disease Control and Prevention, and the US Department of Health and Human Services. They are giving us guidance on what will work, he says, although none has yet endorsed the idea.
Stefan Germann, CEO of the Botnar Foundation, a Swiss organization focused on health and child welfare, has been advising Raskar. He says the proposed app has strong potential but should be tested in a single sandbox city first. It is important to respond fast, but not to rush efforts, he says.
Others suggest similar technology be added to smartphones by default. An open letter signed by several dozen prominent technologists, executives, and clinicians, posted on Tuesday, called on the tech industry to do more to combat the coronavirus. Among other things, the group recommended that Apple and Google update their smartphone software to make it possible to track contact between people, providing users grant permission. Apple and Google did not return requests for comment.
If such a feature could be built before SARS-CoV-2 is ubiquitous, it could prevent many people from being exposed, the letter suggests. In the longer term, such infrastructure could allow future disease epidemics to be more reliably contained, and make large scale contact tracing of the sort that has worked in China and [South] Korea, feasible everywhere.
In early March, President Donald Trump tweeted a statistic he said we all should think about.
It was a comparison of the flu to the current coronavirus pandemic. The flu kills tens of thousands of people a year, he reminded us. At the time, only under a dozen or so people in the US had died of Covid-19, the disease caused by the novel coronavirus. The tweet read a lot like much of the rhetoric coming out of the White House, which, for weeks now, has been trying to downplay the severity of the situation.
A lot of people besides Trump have been comparing the coronavirus to flu. And its a question friends and family members who want to know how worried they should be keep asking me: Isnt this like the flu?
So, a quick unambiguous answer: No, this is not like the seasonal flu. It is worse.
Put simply, while the exact death rate is not yet clear, this disease kills a larger proportion of people than the flu (and its particularly lethal for people older than 80).
It also has a higher potential to overwhelm our health care system and hurt people with other illnesses.
At present, there is also no vaccine to combat it, nor any approved therapeutics to slow the course of its toll on the human body. (Doctors can treat cytokine storm syndrome, an immune response that may in some cases be dealing the fatal blow to those dying of Covid-19.)
Sober-minded epidemiologists say, without exaggeration, that 20 to 60 percent of the worlds adult population could end up catching this virus.
Biologically, it behaves differently than the flu. It takes around five days for Covid-19 infection to develop symptoms. For the flu, its two days. That potentially gives people more time to spread the illness asymptomatically before they know they are sick.
Around the country, health care providers are worried about their facilities being overrun with an influx of patients, and having to ration lifesaving medical supplies.
Were already overwhelmed here, in terms of patients coming in the middle of a terrible influenza season, says Barbara North, the medical director of a small, rural clinic in Northern California. If the pandemic hits her community, her clinic is the only provider for miles. She fears theyd be overrun. We are struggling to establish the isolation and infection precautions needed at the clinic.
Three months ago, this virus was not known to science. No human immune system had seen it before January, so no unexposed human has any natural immunity to it. That means its more contagious than the flu about twice as contagious, perhaps more; the numbers are still being worked out.
This is bad. Its bad enough to roil our stock markets, put people out of work, potentially cause a recession, and infect millions, if not billions, of people around the world. It could also kill millions, both here and abroad.
Its possible that Covid-19 will become endemic meaning it will be a disease that regularly attacks humans and will not go away until theres a treatment or a vaccine.
Yes, flu variants kill tens of thousands a year in the US. But imagine if there was another kind of flu, except potentially with a higher case fatality rate, Angela Rasmussen, a Columbia University virologist, told me recently. Which is definitely a problem because the seasonal flu kills 30,000 to 60,000 Americans every year. And even if its the same case fatality rate of seasonal flu, that still presents a substantial public health burden.
If that spooks you, now is the time to take a deep breath, and know that there are many things you can do to prepare (read more about them here). We can still avoid the worst-case scenario.
I think I get why Trump is so eager to compare Covid-19 to the flu.
Flu is a regular occurrence, and its toll is something that weve grown numb to. Psychology teaches us a depressing lesson here: As we think about larger and larger numbers of people, our empathy and our ability to care and take action decreases. Its called psychic numbing and studies show our willingness to take action to protect others even decreases when the number of victims increases from one, to two.
By mentioning the flu numbers, Trump is hoping to get people thinking of big numbers, and induce numbing. He might want us to think: Tens of thousands of people die of the flu, this new disease isnt a big deal.
Paul Slovic, one of the lead psychologists who has studied psychic numbing, says he doesnt expect Americans to grow numb to this growing crisis. It hits on a lot of the psychological buttons that tell us to be fearful.
Slovic does call comparisons to the flu misleading. But he doesnt think people are going to fall for it.
People are not numb with regard to this new virus, Slovic writes in an email. This virus hits all the risk perception hot buttons ... It is new, unfamiliar, and hard to control through individual or societal action. There is no vaccine and it spreads invisibly, adding to the difficulty of controlling it. It can be fatal and widespread (hence pandemic). All of these qualities ramp up the dread feelings that we have long known to be the major drivers of risk perception.
Its okay to be a bit scared in times like these. Its natural, and extremely human. I can even understand why many people might be asking the flu comparison question themselves, in an attempt to maybe numb themselves to the stark reality were facing. (Trump, and other leaders, should know better, and not give people seeking psychological relief an easy out.)
But we cant be numb. We can channel fear into useful tasks. The bigger concern is that people wont act in the way they really need to. During a flu season, schools arent typically shut down; people dont stop going to the movies. To fight Covid-19 requires a much larger disruption in our lives.
For what its worth, in his Oval Office address on March 11, Trump did outline the danger of the situation and gave basic, decent, public health advice. But it might not make up for the months of him trying to downplay the outbreak.
If you see people make the flu comparison, dont be fooled into thinking that Covid-19 is an equivalent. It doesnt look as bad as the flu in terms of raw numbers. But the top minds modeling this outbreak fear that will change. And, again, we really need to act differently than normal to prevent contagion and deaths.
So, here we are.
Pretty much nobodys going to school on Monday, thousands are working from home, stores are struggling to stock their shelves and health officials are scrambling to respond to an unknown number of patients who will be taken ill with COVID-19.
Unprecedented actions taken since Wednesday to halt the spread of the coronavirus, from the total shutdown of K-12 school districts to significant curtailment of public gatherings, will surely have significant social and economic costs.
Especially hard hit will be those in the service industry who may not get paid in the near future or who must now try to find child care while they continue to fill essential jobs in health care, law enforcement, logistics and retail.
The question is, what does all of this swift action buy? How does it change the end game for the COVID-19 epidemic? How long will it take for the highly contagious virus to run its course? There are several factors at play.
Judging by the studies now coming out of China and other nations that have already taken such measures, infectious disease experts seem universally confident that having as many people stay as far away from each other as they can for several weeks in a row will make a significant difference.
But its tough, they add, to say how much novel coronavirus will still be circulating in the community come New Years Day, or even the Fourth of July, because we have not yet done enough testing to know with confidence how much is here already.
Dr. Robert Chip Schooley a UC San Diego infectious disease specialist and editor of the medical journal Clinical Infectious Diseases, noted that testing in the United States so far has been reserved mostly for those who have traveled to countries where COVID-19 outbreaks started months ago.
It will not be until significantly more people who have not traveled are tested that there will be a robust-enough measure of how broadly the disease has spread from person to person in communities, he said.
Dr. Robert Chip Schooley is an infectious disease specialist and senior director at UC San Diego School of Medicine.
(UCSD)
We need to be in a situation where we have a larger number of people being tested for a wider variety of symptoms and that will begin to fill in the blanks about how much virus is actually circulating, Schooley said.
But thats not to say, he added, that the data we do have indicates that the actions taken in America were an overreaction.
Every day we see more and more of these dots that are lining up to make it clear that this virus is actually pretty widespread, and we really do need to be taking these actions, Schooley said. These are not carelessly thought out things that are being done just because we can do them. Theyre being done because we need to do them.
In the past seven days, the phrase flatten the curve moved from discussions among a select group of forward-thinking epidemiologists to the common lexicon, popping up on social media as results from ongoing studies in other places began to show the power of broad, unified action designed to prevent people from passing infections to each other.
Graphs showing the slow-growing number of cases over time in Singapore and South Korea, and a reversal of the out-of-control pattern in China, arrived just as Americas numbers spiked, reaching 1,280 by Wednesday and 2,174 by Saturday, according to Johns Hopkins University.
Many quickly learned that the commonality among these nations has been significant social distancing campaigns that are able to break chains of transmission by ruthlessly canceling public events, keeping kids home from school and being relentless about spotting new cases early and isolating the infected quickly, even if it means keeping them separate from their families.
While the pace and longevity of the epidemic is an open question, everyone already knows that reaching a state of herd immunity in communities across the nation will bring its true end. Herd immunity is a hard-earned state in which a large enough percentage of a population has already established immunity to a disease that its difficult to sustain long chains of person-to-person transmissions. When many of the people an infected person encounters are already immune, outbreaks tend to stay small.
Specific pathogens require different thresholds of community immunity to harness the power of the herd, and those thresholds are based on just how infectious a virus or bacteria is. Measles, for example, requires between 93 percent to 95 percent because its highly infectious, with each case causing between 12 and 18 additional cases, according to a 2017 study from the London School of Hygiene and Tropical Medicine.
Its probably not that high for novel coronavirus, said mathematical epidemiologist Gerardo Chowell, chair of the Department of Population Health Sciences at Georgia State University in Atlanta.
Though no formal estimate has yet been adopted, Chowell, who is part of a team that has been modeling the movement of this new virus through populations in China and several other countries, said he would guess its higher than the 50 percent threshold for SARS, which is caused by a different coronavirus.
The optimal threshold, I would think, based on what weve seen so far, should be between 60 percent and 70 percent for herd immunity, Chowell said.
Communities can get there one of two ways: either lots of people get sick and recover, or a vaccine is developed that can confer immunity to people without them having to get sick. So far, experts say a vaccine is at least one year away, so its down to getting sick and recovering at the moment.
Only scientists developing vaccines are chasing the herd at the moment. The idea behind the current strategy of social distancing is to spread out the illness over a long enough period of time that those who do end up with life-threatening illnesses dont get sick all at once and overwhelm local treatment capacity.
Chowell agreed that there is just not enough testing data in the U.S. yet to say with confidence just how widespread novel coronavirus already is. So, until data collection catches up with the epidemic, its difficult to start making predictions about the end game.
But that doesnt mean that there is no way to know what the effect of significant social distancing measures, combined with aggressive public health investigation work to quickly identify and isolate those who are infected, will be.
Gerardo Chowell is a professor of mathematical epidemiology at Georgia State University.
(Georgia State University)
On Feb. 14, scientists from Georgia State, Tulane University in New Orleans and the Infectious Disease Prevention and Control Branch in Ottawa, jointly released a paper in the journal Infectious Disease Modeling that made an ambitious prediction. Based on observations of case rates in China reported from Feb. 5 through Feb. 9, the research team said that the epidemic in China had reached a saturation point due largely to the wide spectrum of social distancing measures implemented by the Chinese government.
Though there was another big jump in numbers just at the paper came out, Chinas new case rate subsequently stabilized, reaching 80,000 cases by mid-March and adding less than 1,000 more over the past two weeks, according to the Johns Hopkins Coronavirus Resource Center counts.
On Wednesday, speaking hours before President Donald Trump announced a travel ban to Europe and the NBA postponed the remainder if its season, Chowell predicted, based on the modeling he has done of China, Singapore and other countries, that the pace of the novel coronavirus epidemic in the U.S. would be persistent but likely not as dramatic as it was in China.
My best guess is it will be a smoldering outbreak in the U.S. for roughly a year and, hopefully, by then we will have a vaccine, Chowell said on Wednesday.
The breadth and scope of the social distancing recommendations put in place just a few days ago, Chowell said, do change the game. But not likely the smoldering nature of the epidemic. Social distancing will work better in some places than others, and some places, like Washington State, are already far ahead of others in terms of community spread.
Some cities are already being hit much harder than others, but, in the long run, thinking about the next 12 months or so, given the public health measures and social distancing measures that are being put in place now, I do think we should be getting toward something that looks more like the growth rate that we see Singapore or Hong Kong models, Chowell said.
Ben Lopman is an infectious disease epidemiologist at Emory University.
(Emory University)
Benjamin Lopman, professor of epidemiology at Rollins School of Public Health, Emory University, also in Atlanta, agreed that social distancing is likely to have a real impact. Such precautions helped end the 1918 flu pandemic, and cities such as St. Louis that canceled events early in the epidemic did fare better than those such as Philadelphia that stuck with their social schedules.
What we can learn from history is that cities that were very aggressive in their kind of social distancing activities, like canceling mass gatherings such as parades, were much more effective at getting that curve to flatten out, Lopman said.
While looking at how this novel coronavirus moved through populations is instructive, its important to remember that countries are not carbon copies of each other, Lopman added.
This is the same virus in every country, but its going into different populations, Lopman said. The structure of each population, and how people mix socially with each other, is different in different places. So while we can draw some lessons from what has occurred in other places, we shouldnt expect it to be exactly the same here.
Many in the public, who have seen their immediate social calendars evaporate, might be wondering about the events that are still far enough away that they havent yet been canceled. The San Diego County Fair, for example, is still scheduled to run from June 5 to July 5, and San Diegos Comic-Con International, which perennially brings more than 130,000 visitors from all over the world to the San Diego Convention Center, is still on the books from July 23 through July 26.
Will the social distancing mandates now in effect be enough to save these beloved summer celebrations? Its hard to know, because organizers for both events declined to identify the final dates by which they must make go/no go decisions. For the moment, though, a public health directive issued Thursday caps the size of gatherings at no more than 250 people. Public health officials have said that they will revisit their decision on gathering limits regularly, looking at the actual rate of coronavirus detection in the community to determine whether the caps are still necessary.
Though all three experts said they would like to get a look at additional data in the next few weeks before making any firm predictions about how quickly individual communities might be able to return to normal activity levels, they had slightly different gut feelings about where things are headed.
Lopman was the most skeptical: I think its wishful thinking that this will be gone by the summer.
Chowell was the most optimistic: I think that you would need about five or six weeks, and by the end of May, if not earlier, you should be in a position to decide whether or not Comic-Con should take place, and that, by the way, also applies to the Olympics.
Schooley leaned skeptical as well: I would personally think right now that its unlikely that they will occur. Some might, but it depends on how successful we are in shutting things down now.
Events are visible mileposts for whats being missed, but Schooley said everyone would do well to remember whats invisible. Thats the unknown and unknowable number of vulnerable people whose lives will end up being saved because they they dont get infected in the first place.
By doing what were doing, were saving peoples lives as we speak, and its really important for people to understand that, Schooley said.
Early on Saturday morning the news broke that a newborn baby had tested positive for coronavirus in a London hospital. The child is thought to be the youngest affected by the disease in the UK.
The childs mother had been admitted to hospital days before the birth with suspected pneumonia. Tests at North Middlesex hospital, in Edmonton revealed she had the coronavirus. Then, minutes after she gave birth, her baby was given a test which was also positive for Covid-19. It is not known whether the child contracted the disease in the womb or was infected during birth.
The case is striking because generally Covid-19 has had very little impact on children or young adults. The Chinese Centres for Disease Control and Prevention said its analysis, released on 11 February, of just under 45,000 cases revealed that less than 1% were under nine years old, while those aged between 10 and 19 accounted for just over 1%. By contrast, those aged between 50 and 59 made up almost 25% of the cases while those between 60 and 69 made up 19%.
The information suggests that children are less likely to be infected than adults and that is a bit of a puzzle, says Professor Jimmy Whitworth, of the London School of Hygiene & Tropical Medicine.
One suggestion put forward by researchers is that children have upper-respiratory tract illnesses most of the time. It may be that they are simply not reporting themselves as feeling ill, adds Whitworth. So they are not getting tested. It could be just a sampling issue.
Alternatively, it is possible that other human coronaviruses which are known to cause minor colds may be circulating in schools and playgrounds and these could providing a degree of cross protection against Covid-19. Or it could be something to do with social mixing, says Whitworth. We know children interact mostly with other children and adults mostly interact with adults. It is not as though the whole of society mixes randomly. So those differential mixing patterns might explain part of it.
The low numbers of Covid-19 infections among children is not the only mystery. It has been known to science for only a few months and many of its features continue to puzzle experts. One of these concerns hypertension high blood pressure. Studies of Chinese cases suggest that adults with high blood pressure are more at risk of dying from coronavirus than others.
Again scientists find it difficult to find simple explanations. It may be such individuals have other conditions that have not been recognised, says Tom Wingfield, a clinician at Liverpool School of Tropical Medicine. We know that people with hypertension are more likely to be diabetic and have impaired kidneys, for example. That could be a factor but the honest answer is that we just do not know at present.
Other puzzles about the impact of Covid-19 have simpler explanations, however. For example, there is its tendency to kill men more often than women. The infection is fatal for 4.7% of men, but just 2.8 % of women, even though the gender balance for those testing positive is roughly 50:50.
Most experts say this is explained by the fact that in China smoking is primarily a male prerogative and this has weakened mens respiratory systems and made them more vulnerable to Covid-19.
Johns Hopkins University has created an interactive map showing global coronavirus cases.
A snapshot of some key COVID-19 statistics in Berkeley and beyond as of Sunday, March 15. These numbers are likely to change often. Please review linked resources for the latest data.
Confirmed COVID-19 cases in Berkeley: 3
Confirmed cases on the UC Berkeley campus: 1
Test-confirmed community spread cases in Berkeley: 0
How many COVID-19 tests have been done in Berkeley? Unknown*
Confirmed cases in Alameda County: 15
Community spread cases in Alameda County: 2
How big is too big for gatherings most people should avoid? 50 people
What if youre 60+ or have a chronic illness? 10 people
Age at which health risks increase dramatically: 80
Population in Berkeley thats 60 or older: Nearly 20%
How far away do you need to be for social distancing: 6 feet
Outreach kits with hand sanitizer Berkeley has given out: 836
Public hand-washing stations deployed around Berkeley: 28
Bay Area cases: 234
Bay Area deaths: 3
Confirmed cases in California: 419
Deaths in California: 6
Confirmed cases in the U.S.: 3,486 in 49 states
Deaths in the U.S.: 68
Cases confirmed globally: 169,000
Death total: 6,500
People known to have recovered: 77,000
How many airlines have canceled flights?At least 15
How many states have seen school closures? 21, as well as Washington, D.C.
How much did the Dow drop since its Feb. 12 high? 28%
Number of ventilators in California: 7,600
Intensive care beds in California: 7,500
* The city of Berkeley said it does not know how many people in town have been tested for COVID-19 because those tests are done through clinicians. The city told Berkeleyside on Saturday that it only hears about positive cases and other specific cases that are brought to our attention. UC Berkeley said it could not share any information about testing: Out of concern for student privacy, we generally are not getting into details about whether individuals have been tested or have been quarantined but we will, of course, inform the campus community when and if we have a confirmed case.
Know of other great resources? Please share them in the comments. Then wash your hands!
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