A new coronavirus virus, likely first transmitted to people from animals at a market in the Chinese city of Wuhan, is making international headlines as public health detectives work to uncover what it is, how it’s transmitted, and how deadly the virus actually is. I thought I would address these and other questions about this outbreak.
Public health officials and scientists are still learning about the Wuhan novel coronavirus, previously called 2019-nCoV but now known as COVID-19, which so far has sickened at least 34 people in the U.S. While more cases are likely in this country, people shouldn’t panic.
Here’s what we know so far about the virus.
What is a coronavirus?
Coronaviruses are a family of hundreds of viruses that can cause fever, respiratory problems, and sometimes gastrointestinal symptoms too. The 2019 novel coronavirus is one of seven members of this family known to infect humans, and the third in the past three decades to jump from animals to humans. Since emerging in China in December 2019, this new coronavirus has caused a global health emergency, sickening more than 75,000 people worldwide (74,000 in China), and so far killing 2,600 as of this writing on Feb 24, 2020. Today the number of U.S. cases reached 53—all linked to overseas travel. Europe’s biggest outbreak is in Italy. This particular 2019 novel coronavirus from Wuhan is called COVID-19 or 2019-nCoV.
The coronaviruses are of four genera (equivalent to the “Homo” in Homo habilis, Homo erectus or Homo sapiens): alpha, beta, gamma, and delta. COVID-19 is a beta species. A virus isn’t a cell; it isn’t even considered alive. It’s a nucleic acid (DNA or RNA) wrapped in a coat of proteins, some attached to sugars (glycoproteins). COVID-19 is basically a strip of RNA encased in a thin sphere of fat, bearing a crown of protein “spikes” that inspired the name “coronavirus.” The spikes are what attach the virus to its target cells in our respiratory tract and then act as conduits for injection of viral RNA into those host cells.
Wuhan is the capital of Hubei province, People’s Republic of China.
Where and how did the Wuhan novel coronavirus begin?
We’ve known about this particular virus shortly after a cluster of severe pneumonia cases were reported on New Year’s Eve 2019 in Wuhan, which is in the Hubei Province of China. On January 9, virologists and other public health researchers identified the strain as a novel coronavirus, which was tied to a specific “wet market” in the city of Wuhan where they sell fish and other live animals. Somehow, the COVID-19 virus may have started in a bat in 2013 and gotten into the population of pinecone soldierfish fish that ended up in the Wuhan Huanan Seafood Wholesale Market at the epicenter of the pandemic.
These markets have been known to transmit viruses before. For cultural reasons in the region, people want to see the specific animals they’re buying be slaughtered in front of them, so they know they’re receiving the products they paid for. That means there’s a lot of skinning of dead animals in front of shoppers and, as a result, aerosolizing of all sorts of things, which is why these crowded markets are common places for viruses to jump from animals to people. It’s actually also how SARS (severe acute respiratory syndrome), another coronavirus, started in 2002.
The pinecone soldierfish Myripristis murdjan may pass COVID-19 from bats to us.
How does the Wuhan coronavirus spread?
So far, there’s limited information about the Wuhan coronavirus, including how easy it is to spread and how dangerous it is. But we know the virus can be transmitted from person to person and it is passed by coughing and other close contact.
Close contact is a vague term. But in this case, it specifically means being within about six feet of someone for a prolonged period of time. It could also be having direct contact with infectious secretions of someone who has a case of the virus (for example: being coughed on) while not wearing personal protective equipment.
Is this coronavirus deadly?
The numbers of how many people have been diagnosed or how many have died are changing rapidly. That said, we do know that hundreds of people in China have died from this virus. Based on the information we’re seeing it’s likely less deadly than SARS, but more transmittable.
So far, cases have been reported in more than a dozen countries, including at least 15 confirmed cases in the U.S. It’s a reasonable expectation that the number will grow across the globe, due in no small part to the fact that China is a densely populated country and there was massive travel taking place for Lunar New Year celebrations that may have helped spread the virus.
What are the symptoms of the virus?
We’re still learning more about Wuhan novel coronavirus, but we know it typically causes flu-like symptoms including a fever, cough and congestion. Some patients — particularly the elderly and others with other chronic health conditions — develop a severe form of pneumonia.
Are we all at risk for catching this new coronavirus (2019-nCoV)?
Yes. No one is naturally immune to this particular virus and there’s no reason to believe anybody has antibodies that would normally protect them. The lack of previous experience with this pathogen is part of the reason why public health officials around the globe are working so hard to contain the spread of this particular coronavirus from Wuhan. When viruses come out like this that are both new (which means the population is highly susceptible) and can easily pass from person to person (a high transmission rate), they can be really dangerous — even if there’s a low percentage of people who die from them.
How severe is the sickness from the Wuhan coronavirus?
It looks like only about 20% of people who contract this novel coronavirus actually wind up needing to be hospitalized. The other 80% get what feels like a really bad cold and they recover at home. A lot of it has to do with underlying medical conditions. People who are more vulnerable to any kind of infection — because of their age or chronic health conditions — are more at risk for getting critically ill from this novel coronavirus. That said, some otherwise healthy people do seem to be getting more sick from this infection than we would expect. We don’t understand why that is or what might be different about those people.
Do patients with the Wuhan coronavirus need medical care?
About 80% of people who contract this new coronavirus will feel sick, but ultimately be just fine. It’s the other 20% who get really, really sick that is worrisome. A lot of these critically ill patients wind up needing to be hospitalized for their pneumonia-like illnesses. They typically require critical care and mechanical ventilators. Depending how many cases ultimately develop here in the U.S., providing that level of care for that many people over a number of weeks could overwhelm the nation’s health care system pretty quickly.
How do you screen patients for coronavirus infection?
For the past two months, physicians around the entire country have been receiving guidelines from the U.S. Centers for Disease Control and Prevention. We’re being told to ask any patient who has respiratory symptoms and a fever if they’ve traveled to Wuhan, China in the past two weeks or been in close contact with someone with a known or suspected case.
Patients who answer yes will immediately be given a facemask and put in an isolation room, which has negative pressure to keep airborne germs inside. Then, they’ll be tested for the specific virus. Turnaround time on those lab tests is about four days. People will need to remain in isolation until they’re cleared.
We’re also reminding everyone to make sure to wash their hands regularly and avoid touching their faces — that’s good practice any time of the year, but especially during flu season. You’re more likely to catch the flu than this coronavirus —if you were out running errands today. And if you did get the flu, like clockwork, this year’s influenza strain is going to die out in the spring, like it does every year, because it will have run its course.
The challenge with the new coronavirus from China is that we just don’t have any information to know if it will run its course before the summer and disappear, or if it will have to infect a substantial part of the population before burning out. As a country, we’re somewhat prepared for influenza. It comes every year! But we don’t know if we’re really prepared as a country for a massive coronavirus pandemic. There is no vaccine for it.
Is this new coronavirus virus airborne?
In medicine, we draw a line between things that are (1) transmitted by droplets that can travel in the air briefly in respiratory droplets and (2) things that are actually aerosolized and float around for a while. Think of droplets as small bits of liquid that you can feel and see when someone sneezes. You sneeze or cough and these droplets get on surfaces and then you touch them and get them on your hands, or they can fly right into your mouth or nose or eyes. That’s how most coronaviruses are transmitted and that’s how we think this one is too.
Aerosolized materials are different. Think of your favorite bathroom spray after you use it in the bathroom. When you go back to the bathroom later, you may still be able to smell it because it’s lingering in the air. We do not think that coronaviruses are airborne in that way.
What should you do if you think you’re infected?
If you haven’t been to the affected region or been near someone who’s been the affected region, you’re likely OK. January through March are rough months for all sorts of respiratory ailments because colds and influenza are common. That said, if you go to your doctor’s office or an emergency room, call ahead so someone can meet you outside to give you a facemask to help limit the spread of any germs.
The test to diagnose this virus is new and it’s not widely available. It’s called the “Real-Time Reverse Transcriptase (RT)-PCR Diagnostic Panel.” Because there aren’t enough tests, only people who are showing symptoms of the disease AND who are high risk for exposure can get tested. But make sure you tell your doctor of any recent travel history so they can make a decision about whether to test you.It’s also worth mentioning that people shouldn’t be worried if they go to their doctor’s office and get tested for respiratory viruses and the results say they have a coronavirus. That’s because coronavirus is the name for a whole group of viruses, including things like the common cold. Most doctors’ offices can test for normal, everyday coronaviruses. If you see test results that say you have one, you shouldn’t worry. Covid-19 hasn’t become a pandemic yet, meaning it hasn’t spread significantly beyond China. If the world acts quickly, the hope is that the outbreak won’t escalate.