by Paul Govern
Infectious diseases specialist Thomas Talbot, MD, MPH, is professor of Medicine and chief hospital epidemiologist at Vanderbilt University Medical Center. He spoke about the current novel coronavirus outbreak in China. According to the New York Times, as of Feb. 2 there were at least 17,205 cases in China and 11 confirmed cases in the United States.
Over the weekend, U.S. officials declared the virus a public health threat, prompting the State Department to issue a travel advisory urging citizens not to travel to China.
Q: How does the virus spread and how contagious is it?
From what we know so far it seems to be like other respiratory viruses — like flu and SARS and other things — spreading by respiratory droplets, so by coughing, sneezing. I think one question that’s still out there is whether people spread this virus when they don’t have symptoms. That isn’t apt to be a significant driver in the outbreaks, based on what we know about other respiratory viruses, but it’s still unknown.
Q: How serious is the virus?
That’s still not known, because at this point we’re getting the most severe case information, from people who are quite sick presenting at the hospital. The mortality rate seems to be dropping as more cases are found. What we don’t know is how many people in China have had mild illness, such as regular “colds” where they never had to seek medical care. It’s likely that those cases are not yet identified, so among the total people who get infected we can’t yet know what proportion have to go to the hospital and what proportion die of the infection. I think that will come out as we get better testing and data over the next few weeks. At this point the testing is still biased toward those who require medical care.
From what’s come out, it does seem that the people who have trouble are, in general, older adults, people having other complications, maybe underlying lung disease or heart disease. These are the same people who would potentially not do well with any respiratory virus.
Q: How likely is it that this outbreak will become a global pandemic?
I don’t think we know. We’ll have to watch and see whether there’ll be sustained human-to-human spread outside of China. We’ve had little clusters of cases that are contacts to known cases who travelled to Wuhan City — someone came from China and their immediate close contacts got it. But we haven’t seen where other areas in the world have started to note sustained spread of the virus. I think that’s reflective of the public health response: identifying people with the infection, isolating them and identifying contacts quickly. If this turns out to be spread by people who are free of symptoms, that could help determine how likely this is to become more widespread.
We should remember that we have regular coronaviruses circulating all the time that cause colds and respiratory infections. Where will this one fall on the spectrum? Right now we’re appropriately guarded because of what we’ve been hearing and seeing with the severe cases. But where will this flush out? Will we stamp it down like we did with SARS? Will it become a routine “cold” virus that people can get severely ill with? Honestly, I think only time will tell.
I will say that this time around we’ve learned a lot more, a lot quicker than with the 2003 SARS outbreak. We’re now in an age of far easier information sharing, and, unfortunately, disinformation sharing. So I think it’s really important to use information that’s trustworthy. The CDC [Centers for Disease Control and Prevention] website has information directed toward the general public and health care providers, and they’ve been consistently good in broadcasting what they’re learning and providing sound advice. The Tennessee Department of Health also has some good online resources.
Q: Beyond normal precautions against seasonal flu, should Tennesseans be observing any particular coronavirus precautions at this time?
Use the protections you’d use for any respiratory virus. I think you hit on the message right there, and it’s one we’re hearing a lot: yes, we’re watching coronavirus and we’re prepared to deal with that, but we actually have several viruses circulating around Tennessee right now that are making people very ill, and actually killing people, and that’s influenza and some of the other viruses. So follow those basic precautions that you hear all the time (and are so “boring”): wash your hands, if you’re ill don’t be around others, cover your cough. And make sure you get your flu shot —it’s still not too late! We’re still seeing some really serious, really horrible complications with people who have influenza this year, including healthy young patients who just did not do well. If you haven’t got your flu shot, that’s definitely something you should do.
Q: Should we expect a vaccine for this virus, and if so, when?
Vaccine development takes years and I don’t anticipate something quickly. So I think we go back to the 2003 SARS outbreak: what’s going to control this is going to be your basic infection prevention practices.