#healthcare  #publicpolicy  #statistics  
Issue 60
February 2, 2020
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The 2019-nCoV, known as the Wuhan Virus is a coronavirus, one of a group of viruses that originate in animals. Coronaviruses are not typically passed from animals to humans but occasionally the virus mutates and humans can become susceptible. An infected human can communicate the virus to other people.

There are seven (known) human coronaviruses. Four strains: HCoV-229E, -eL63, -OC43, and -HKU1 are always percolating among us. These typically cause common colds. Sometimes, a more severe coronavirus can cause pneumonia and on rare instances, can prove deadly.

The Wuhan coronavirus is the third known strain of human coronavirus that can cause acute symptoms. The other two are SARS-Cov better known as SARS (severe acute respiratory syndrome) and MERS-Cov better known as MERS, (Middle East respiratory syndrome, or camel flu).

SARS:

The SARS virus originated in Yunnan province, in Southern China. The initial outbreak occurred in late 2002 / early 2003. Most likely, SARS was initially communicated from a bat to a wild animal, possibly a civet. The virus then mutated and humans became vulnerable. Although Chinese authorities at first covered up the SARS outbreak, which of course contributed it to spreading, in total only ~8,000 people became infected. The vast majority of cases were contained to China and Hong Kong. Of those, ~10% succumbed to the disease. There were 27 reported SARS cases in the United States; nobody perished.

MERS:

Bats are believed to be carriers of the MERS virus but camels are suspected as being the agent that passes this particular coronavirus on to humans. While MERS is rare - only ~2,000 people worldwide are known to have contracted it - it is particularly lethal. ~40% of people who acquire it, die. Most MERS cases have been concentrated in Saudi Arabia and South Korea. There have been two reported cases of MERS in the US, both patients survived.

The Wuhan Coronavirus:

The Wuhan coronavirus originated in the Chinese city of Wuhan, in Hubei province, located between Chengdu to the west and Shanghai to the east. Specifically, the virus has been traced to a (since closed) wild animal market in Wuhan. Most likely, an infected civet hosting the disease passed it on to a human who in turn infected other unsuspecting peoples. Thus far, the vast majority of Wuhan virus patients are concentrated in mainland China.

The timing of the Wuhan outbreak is particularly suboptimal, the dangers magnified by the lunar New Year, a time period in which many rural migrants travel on the nation's network of bullet trains and buses to reunite with family; each passenger a potential host of, and agent to pass on, the Wuhan virus.

The Wuhan coronavirus is contagious when an infected person is symptomatic. Many new patients are healthcare workers who treated the initial batch of infected people without donning proper protective gear. Asymptomatic transmission (people who are infected but do not have noticeable symptoms) might be possible during the incubation period (~2 weeks). Travelers deemed high risk are being quarantined to help mitigate that threat. What is not yet clear is if Wuhan is transmitted via casual contact or from close or more intimate interaction. Furthermore, “Both SARS and MERS had ‘superspreaders’-patients with unusually high viral loads, who are exceptionally infectious. In South Korea in 2015 a patient with MERS infected 81 people during a 58-hour stay at a hospital emergency room.” It is unknown if any Wuhan patients share similar properties.

As of this writing, there have been ~10,000 reported cases of the disease, though it is spreading expeditiously. However, “modelling by Gabriel Leung and Joseph Wu at the University of Hong Kong suggests as of January 25th that the number of infections in Wuhan was closer to 44,000 (with a range of 20,000-78,000).”

Symptoms of the Wuhan virus include but are not limited to: fever, breathing difficulties, cough, body aches, diarrhea, pneumonia, kidney failure and in rare cases, death. Wuhan is fairly contagious but fortunately – at least thus far – not particularly deadly. To date ~200 patients have died which translates into a relatively low ~2% mortality rate. And the vast majority of people who have perished had previously compromised immune systems. However, all this could change. The disease could mutate into a more lethal form.

Currently, there are no approved treatments to combat the virus. Certain existing antiviral drugs including those effective at treating HIV might be effective; those compounds are already being tested in China. While a search for a vaccine has begun, experts believe that even in a best-case scenario, a commercially available vaccine is at least 6 months away.

How widespread the Wuhan epidemic gets is fiendishly difficult to predict but is certainly dependent on the following factors including but not limited to:

1) Does Wuhan mutate into a more deadly and easily communicated virus?

2) An effective public policy and coordinated global effort to contain it.

Unlike their sub-optimal reaction to the SARS virus when lawmakers covered up the disease (some local authorities did downplay Wuhan too), Chinese officials reacted swiftly. Policymakers ordered the quarantine not only of Wuhan, home to 11 million people, but to the entire province of Hubei. To understand and appreciate the magnitude of this order, imagine the population of France - ~60 million people - on lock down. Moreover, authorities have ordered two new hospitals to be erected in Wuhan in just 10 days. Indeed, while many people question the heavy hand of China’s one-party system, and some have questioned the logic, ethics and cleanliness of Chinese wild animal markets (“breeding” ground for coronaviruses), few question the speed at which the communist party can order and enact public policy. Time will dictate how effective the largest forced quarantine of human kind will be.

International Travel

Though primarily concentrated in mainland China, as of this writing the Wuhan coronavirus has now spread to 16 countries. This is not surprising. Bear in mind, when SARS reared its ugly head at the beginning of the millennia, China was much less intertwined in the global economy. In 2003, China represented ~4% of world GDP, compared to 16% now. “Bloomberg ranks Wuhan 13th out of 2,000 Chinese cities for its role in supply chains. One local company, Yangtze Optical Fibre and Cable, is the biggest maker of the wires that carry data around the planet.” The province of Hubei generates ~5% of China’s gross domestic product (GDP). And “the city of Wuhan is a major logistics and transportation hub.” The aforementioned serve as effective ingredients to facilitate the spread of this virus.

Misplaced Fear?

On Thursday, January 30, 2020, The Centers for Disease Control and Prevention (CDC) confirmed the 6th case of Wuhan in the United States and announced the first instance of person-to-person transmission of the virus. The transmission occurred in Illinois.

The Wuhan coronavirus has provoked an unusually high level of anxiety. Stories abound in the press about a potential worldwide epidemic. In America, where the instance of the virus is statistically about nil, it is a topic of conversation at work and around the dinner table. People are routinely wearing surgical masks in public and taking other precautionary measures. This is certainly not a bad thing. But might the American public’s reaction to the Wuhan virus be disproportionate to the threat, and misplaced in general?

Consider the following, already this flu season, over 19 million Americans contracted the flu, 180,000 have been hospitalized and over 8,000 died, including 60 children. The mortality rate for influenza in the United States is about 1 death per every 1,000 instances or .1%; low but certainly not nil. In fact, in a typical year ~200,000 Americans are hospitalized and about 25,000 people die from the flu. Last year the flu was particularly nasty, claiming the lives of 80,000 Americans. Unlike the Wuhan virus that has no known cure or vaccine, even though a flu vaccine exists, over 50% of American’s decline to get inoculated. A commonly stated reason why is the misplaced fear that the flu vaccine can cause the virus. This is categorically untrue and medically impossible, (the reasons why go well beyond the scope of this article.)

The flu vaccine is prepared months before the onset of flu season. Sometimes there is a “mismatch” between the vaccine and which strain of the flu happens to be most prevalent in a given year. However, it is indisputable that regardless of what type of strain happens to present itself most often, the flu vaccine helps, at least at the margins.

If we consider the epidemiological modelling by Mr. Leung and Mr. Wu whom conclude that the number of Wuhan virus infections is actually closer to 44,000 and combine that with the current death toll of ~200, a data driven argument can be made that the Wuhan coronavirus’ mortality rate is not 2%, but rather ~.1%, about the same as the flu in the United States. Despite all this, while one will find an occasional article in the mainstream press, the flu is certainly not typically front and center on peoples’ minds.

If you have not already done so, roll up your sleeve, remove your surgical mask and tell your healthcare provider that you would like a flu shot.