Since creeping onto the international radar late last year, COVID-19, or the novel 2019 coronavirus, has spread rapidly, infecting some 75,000 people and killing over 2,000, mostly in mainland China, where it originated. But thanks in part to deeply flawed containment efforts, including in Japan and the United States, the prospect of a massive global outbreak looms.
So far, one American citizen—who was in the virus’ epicenter of Wuhan, China—has died. Yet the number of U.S. cases recently doubled with the return of at least 14 infected people from a quarantined cruise ship off the coast of Japan, and the Centers for Disease Control and Prevention (CDC) has suggested more cases will follow.
To put the emerging crisis in perspective, The Daily Beast canvassed three top public health experts with particular insight into the spread of infectious diseases. Jeremy Brown is director of the Office of Emergency Care Research at the National Institutes of Health, a physician and author of Influenza: The Hundred-Year Hunt to Cure the Deadliest Disease in History. Irwin Redlener is director of the National Center for Disaster Preparedness at Columbia University and contributor to The Daily Beast. Michael Osterholm is director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
Below, they answer some of the most burning questions about what this disease is, what it isn’t, and how bad it might get.
What is the 2019 novel coronavirus, and how “novel” is it, exactly?
Brown: COVID-19 as is it now designated by the World Health Organization is part of the family of coronaviruses. Many of you reading this have likely been infected by a coronavirus, since it is one of the many viruses that causes what we call “the common cold.” The novel virus is a different kind of coronavirus and is much more dangerous. From some early work published by a group of Chinese scientists, it is about 80 percent identical to the virus that caused SARS, and most likely originated in bats.
How does it spread, and is it more contagious than most diseases?
Brown: Coronavirus spreads in droplets that we cough or sneeze out and that others then inhale. This is also the way that other viruses that cause cold symptoms and influenza are spread. The coronaviruses prefer cold, dry conditions, which is why they are seasonal. Most of these viruses do not last long outside of a host, and so far there is no evidence that they can be spread in other ways, like touching a handrail that was also touched by an infected person.
We are still not sure how contagious COVID-19 is compared to other viruses. In public health we measure something called the R0 (pronounced R naught) which is the average number of people infected by a person with the virus. For example, the R0 for influenza is about 1.3, meaning about 13 people get the virus from every 10 who have the infection. Measles is very contagious, with an R0 of 12-18. We are still not sure what the R0 is for coronavirus, but it appears to be about 2.0, which is about the same as SARS. These are early estimates though and are likely to change as we get better data.
What are the symptoms of coronavirus, and how do they compare to the common cold or flu?
Brown: The early symptoms of COVID-19 are exactly the same as those of the common cold: congestion, headaches and perhaps a fever. Muscle aches and weakness are more often associated with influenza than with coronaviruses. That’s usually as bad as it gets. If the symptoms develop into shortness of breath, lethargy, or fevers that cannot easily be treated, then it is time to get checked out. But don’t worry about COVID-19 unless you’ve been in close contact with someone who themselves came from an area where it is endemic.
How deadly is COVID-19?
Redlener: [As of Tuesday] of about 74,000 identified cases, nearly 1,800 had died. That represents between 2 and 3 of every 100 infected individuals. However, we really don’t know the denominator, meaning we really don’t know how many people have no symptoms or mild forms of the disease. It is very likely that the actual percentage of fatalities is more akin to the typical seasonal flu, that is, no more than a very small fraction of 1 percent of infected people will succumb to the disease.
What do you do if you think you might have the coronavirus?
Redlener: If you live in the U.S. and have not recently been to Central China or in contact with someone diagnosed with COVID-19, but you have cold-like symptoms, the odds are beyond overwhelming that you, in fact, have a common cold. If you have a high fever with cold symptoms, it’s always a good idea to speak with your health care provider. You might have the regular seasonal flu.
Should people avoid crowded, public places in anticipation of the disease?
Redlener: Right now, there is no reason whatsoever to avoid crowds, wear face masks, or frighten your children. Of course, things could change, and there is so much we don’t know about the behavior of the COVID- 19 virus. But for now, do not let the explosion of paranoia and misinformation on social media change your life. And the best public health advice we can follow, whether we’re worried or not about COVID-19, is regular hand washing and making sure to get the annual flu shot.
Are masks and other things people are doing to stay healthy actually effective?
Osterholm: Using surgical masks, whether in public or being near a COVID-19 case, likely offers little protection against virus transmission. The size of airborne particles containing the virus and that are in the same shared air space near a case means the virus will find their way into the areas where the masks are not flush against the face, be breathed in, and ultimately be deposited in your respiratory tract. Only the use of an N-95 respirator, the tight-fitting face protection mask, can effectively prevent the COVID-19 virus from getting into your respiratory tract. The use of N-95 respirators should be prioritized for health-care worker and first responder use in caring for potentially infected cases.
Will there be a vaccine for coronavirus?
Osterholm: There will be candidate coronavirus vaccines used in clinical trials of infected patients to determine if they are safe and effective within weeks to months. But it will be years before such a vaccine will be licensed by the Food and Drug Administration and available for general public use.
Is the U.S. health system and national infrastructure ready for an explosion in cases here, if that happens?
Osterholm: No. We will have many of the same challenges that China is experiencing. We will have too few hospital beds needed for both COVID-19 cases and other patients with the background illnesses we would expect to see every day. In addition, there will not be nearly enough personal protective equipment (PPE) available to protect health-care workers from getting infected when caring for COVID-19 patients.
Is coronavirus already a “pandemic” or not? What does that distinction actually mean?
Osterholm: We consider an epidemic of a newly discovered disease a pandemic when it occurs in outbreaks in countries around the world. We clearly are on the verge of the COVID-19 virus causing a pandemic if we see sustained transmission of the virus in all parts of the world. We will likely know if that is the situation in the next three to four weeks.