2019 Novel Coronavirus: Thirty Days In

Countries Reporting Cases - Credit CDC

#14,772

Exactly 30 days ago, at around 3am, I awoke to find a head's up text message from Sharon Sanders alerting me to a puzzling post on FluTracker's forum, regarding 27 Cases of `Atypical Viral Pneumonia' Reported In Wuhan, Hubei. 

Within hours, more news began to emerge, including:

China: Hubei Provincial Health Committee Statement On `Unidentified' Pneumonia In Wuhan

Hong Kong & Taiwan Take Notice Of Unidentified Pneumonia Outbreak In Wuhan

Although the numbers were small, and authorities in China were downplaying the notion of human-to-human spread, this had all of the earmarks of something bigger.  Two weeks ago, we were still at just 41 confirmed cases (see ECDC Rapid Risk Assessment On Novel Coronavirus), but by a week later, those numbers had jumped 10 fold.

Fast forward another week, and the number of confirmed cases is now more than 200 times greater, and more than 20 countries outside of China have reported cases.  

The official numbers we are getting from China likely under-represent the total number of infected.  Tens of thousands have reportedly been seen in fever clinics, but were deemed not sick enough to be hospitalized - or no beds were available - and were sent home without testing.

While many of those cases were probably influenza, or other common respiratory viruses, the real number of novel coronavirus cases and deaths is anyone's guess. But they are likely much greater than has been reported. 

Yesterday, the World Health Organization declared the outbreak a PHEIC - a Public Health Emergency of International Concern, and while 99% of all known cases have occurred in China, there is a very real risk of this becoming a global public health crisis.

Last night, the United States Department of State took the extraordinary step of issuing a Level 4 - DO NOT TRAVEL - warning for all of China. 

The good news is we know what kind of virus we are dealing with, and diagnostic tests have been developed, and are becoming more widely available.  It appears that most people who contract this virus develop only mild or moderate illness, and can recover without major medical intervention. 

The less-than-good-news is that some percentage (and we don't know what that number is) of those infected can go on to develop serious, even fatal illness.  Prospects for a vaccine in anything less than a year (probably longer), are slim, and there are no identified therapeutics (beyond supportive care) approved for this virus. 

Right now, we don't know if this virus goes on to spark a pandemic, fades away entirely like SARS, or over time becomes an endemic, low-level respiratory threat along side the myriad of adenoviruses, rhinoviruses, seasonal flu, and other viral illnesses that circulate every winter.

There is also the possibility that - like MERS-CoV - there is an active animal host in China (or now, conceivably anywhere the virus travels in the world), that can harbor, and continually re-seed the virus back into the human population.

While genetically similar to both SARS and MERS-CoV, this 2019-nCoV has - in just a month - exceeded the total number of SARS cases generated in 6 months.  And unlike MERS - which has seen most of its big outbreaks in hospital settings - this virus is spreading efficiently in the community.

The remarkable, albeit draconian, measures taken by China to try to quell this epidemic - including quarantining 50+ million people - suggest that this is not an easy foe to control. The growing evidence for asymptomatic transmission of the virus only complicates the picture.

While developed countries, like the United States, Canada, much of Europe, Japan, and Australia are better equipped to deal with an emerging viral threat like 2019-nCoV, the biggest threat looms for those countries with underdeveloped public health systems, which may be quickly overwhelmed.

A lot has happened over the past 30 days, and there is certainly more to come.   

Much of what we've seen aligns with some of the pandemic tabletop exercise scenarios we've seen over the past decade (see JHCHS Pandemic Table Top Exercise (EVENT 201) Videos Now Available Online), and with dire predictions by global health agencies:

WHO/World Bank GPMB Pandemic Report : `A World At Risk'
WHO: On The Inevitability Of The Next Pandemic

World Bank: The World Ill-Prepared For A Pandemic

While no one can predict where this current outbreak will lead us - and there are still opportunities to mitigate the global impact of this epidemic - one thing is pretty obvious.

We live in an age of emerging and reemerging infectious diseases (see The Third Epidemiological Transition (Revisited)), and this won't be the last time we find ourselves at the brink. 

We either take pandemic preparedness seriously - and devote resources to it commensurate with the risk - or we will forever be playing catch up whenever nature's laboratory decides to throw us a curve ball.

And next time, we may not have a month's lead time to prepare.