UPDATE 05/12/2020: As anticipated in our original editor’s note, a lot has changed regarding this outbreak since this piece was written. One is the terms used to describe the virus and the disease it causes (SARS-CoV-2 and COVID-19, respectively). We have now updated this post to reflect proper naming protocol, which had not yet been established when this post was first created. Please see this message from The Official PLOS Blog for more about PLOS’ take on this outbreak. Refer to the CDC for the most up-to-date information about the outbreak–this post now functions more as a record of what our thinking was in early February rather than as a source of news.
Editor’s note: If you’re anything like me, you’ve been so busy that it’s been hard to keep up with the quickly changing news about the current coronavirus outbreak. But given our scientific training, it’s important for us to be accurately informed, so that we can be a resource when friends and family have questions, or speak out when media sources get their facts wrong. To that end, we at the PLOS ECR Community have joined forces to create a brief summary of this outbreak and important things to consider when discussing the issue. Please keep in mind that facts and figures are constantly changing, and may be out of date by the time you read this post. We recommend making sure other sources you read have clear references to reputable sources. –Meredith Whitaker
What is coronavirus?
Coronaviruses (CoVs) are a huge family of viruses (with the largest genome size of 26-32 kilobases in RNA viruses) which are very common in various animals and very rare in humans. CoVs are named for their corona or crown-like appearance under the microscope, as they are surrounded with pointed structures. NL63, OC43, 229E, HKU1, and SARS-CoV-2 are some of the types of CoVs that can infect humans. They are zoonotic in nature, which means they can spread from animals to humans.
What is SARS-CoV-2?
SARS-CoV-2 is totally novel to the scientific community. Experts are suspecting that snakes could be a probable source for the recent Wuhan coronavirus outbreak. There are other suspects too. Most of the infected people were reported to be regular customers or workers at the Huanan seafood wholesale market at Wuhan city.
CoV infection can be mild to severe. According to the WHO, mild infection can cause a runny nose, headache, sore throat, cough, short and difficult breathing, and fever. While other sets of CoV can cause severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). Symptoms of a severe infection include bronchitis or pneumonia, kidney failure, severe acute respiratory syndrome, and even death. Old aged people, infants, people with a weak immune system or cardiopulmonary disease are very prone to catch the infection.
In order to prevent infection, the CDC recommends covering your mouth and nose while sneezing and coughing, frequent hand washing, and proper and complete cooking of meat and eggs. Keep distance from people having a respiratory illness like sneezing, fever, runny nose and cough.
How do you diagnose a person for COVID-19?
Editor’s update 05/12/2020: Many options for testing are now available, please refer to your local health officials’ guidelines or the CDC website. We have kept our text from February as a record of diagnosis procedures at that time.
Diagnosis for COVID-19 can be conducted only at the CDC. Upon identifying a person under investigation (PUI), the State and local health departments should notify CDC’s Emergency Operations Center (EOC) to report the PUI to determine whether testing for COVID-19 at the CDC is required. The EOC works with the local/state health departments to gather, stock, and transport specimens properly to CDC.
Has anyone in the United States been infected?
Yes. The first infection with SARS-CoV-2 in the US was reported on January 21, 2020 and the first confirmed case of person-person spread with this virus in the U.S. was reported on January 30, 2020.
Are there any specific treatments for the new coronavirus?
No specific medicines are recommended to either prevent or treat COVID-19. Some specific treatments are under exploration and will be tested in clinical trials.
Are packages or goods shipped from China a source of SARS-CoV-2?
Coronaviruses generally don’t survive well on surfaces and hence the risk of transmission from products or packaging that are shipped over a period of days is minimal.
How can we place this in context with other outbreaks?
When trying to understand the scope of a viral outbreak, such as the current CoV scare, epidemiologists will assess several factors including viral transmissibility and case-fatality ratio. Transmissibility is a measure of how many new infections a single infected individual generates. If this number is greater than 1, then the viral outbreak can be considered self-sustaining unless appropriate actions are taken (i.e. quarantine or vaccine development). Case-fatality ratios are used to quantify how often those infected with a given virus die as a result. Below is a table which compares coronavirus, SARS, and the annual U.S. public flu in years 2018/2019 in terms of these parameters:
|Transmissibility Rate||Case-fatality ratio|
|Coronavirus||2.0 – 3.1||~ 3%|
|SARS||2.0 – 4.0||~ 10%|
|Annual Flu||1.3 – 1.8||~ 0.1 %|
At first glance, one may wonder why the annual flu receives so much attention on a yearly basis. That is because despite great efforts put forth by the public, the annual flu still infects a significant number of Americans; around 35.5 million last flu season. Even with the annual flu’s low case-fatality ratio this still resulted in 34,200 deaths nationwide. Now imagine a virus like coronavirus, which the public has no defense against like it does with the annual flu, reaching 35.5 million Americans. Estimations using the current case-fatality ratio would project roughly 1 million deaths. However, that number would likely be much larger given coronavirus’ higher transmissibility rate. If coronavirus were to make its way to the States before a reliable vaccine was established, it could ultimately kill more than twice as many Americans than World War II–however, this is currently highly unlikely, given the small numbers of cases here and the strength of our healthcare infrastructure. Projections like this, while important to consider seriously, can easily cause panic when shared in isolation from appropriate context.
Pitfalls of outbreak coverage in mainstream media
Mainstream media plays an imperative role while reporting a health crisis or an outbreak situation. When effectively done, the media can help raise awareness about precautions and control the spread of disease: a good example of an accurate and informative piece can be found here. But misinformation, whether from a news outlet directly or via fearmongering on social media, can cause unjustified panic, emotional distress or anxiety and can build up distrust in the government health agencies. The spread of misinformation is already happening with the current outbreak.
Mainstream media ought to be held to a higher standard, with the expectation that information shared will be accurate. Public health organizations (like the CDC in the US) need to supplement all possible information gaps to avoid any negative impact on the outbreak’s control. Although it is difficult to change journalistic routines, it would be ideal if such news articles can briefly describe or provide links to the practical or scientific reports, even if they are covering nonmedical aspects of the outbreak. Another nice example is this piece from Vox, which actively sought out opinions from epidemiologists on the subject. In the same direction, press conferences with scientists, doctors and health agencies can also maximize the exposure and accuracy of the information.
As for those of us in science, who may or may not study viruses, we can help by being knowledgeable community members–use our training to read the primary literature, know when sounding an alarm is appropriate, and call out misinformation when you see it.
Featured image: ‘Wuhan New Coronavirus is not SARS virus’ Flickr, Public domain.