Dr. Robert Siegel: Coronavirus epidemic could be contained in months – Global pandemic unlikely

No one knows for sure how long the Wuhan coronavirus epidemic in China will last and how seriously it will impact other countries, but there are encouraging signs that suggest the epidemic will be contained in several months.

As of Saturday, China reported 811 deaths from the epidemic and said more than 37,000 people have become ill from the coronavirus. The coronavirus death toll now exceeds the  774 deaths caused by the SARS (Severe Acute Respiratory Syndrome) virus in over two dozen nations in 2002 and 2003.

The U.S. Embassy in China confirmed Friday night that a 60-year-old American who was stricken with the coronavirus in China has died, becoming the first U.S. citizen killed by the virus.

In the short term, it’s safe to predict the epidemic will grow before its shrinks. The sad truth is that there will be more cases in China, including more deaths. There will also be more international cases. It is likely that more countries will be involved and that more cases will trickle into the U.S. from travelers.

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The most encouraging news comes from looking at the rate of increase in the epidemic – the shape of the epidemic curve. It appears that a turning point (the so-called “inflection point”) has already been reached. This is the place where the curve starts to flatten out, signaling that control may be in sight.

But like the battle against a fire on its way to containment, it is critical to keep the epidemic from gaining a stronghold in a new continent.

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For example, as of Thursday there was an 11 percent daily increase in the number of cases. But this rate of increase is less than the day before and much less than a week earlier.

This drop has occurred even though the level of scrutiny for new cases of the disease has increased.

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Fortunately, the great awareness of the epidemic, the careful epidemiology, and the aggressive containment steps now being taken in China and elsewhere are all likely to greatly slow the spread of infection over what it would have been without these measures.

Many respiratory viral infections such as influenza tend to decline in spring. While this is still wishful thinking in the case of Wuhan coronavirus, such a decrease was seen with the SARS virus in 2003. That is our best predictor of what will happen in the current outbreak.

Long-term predictions are the hardest. A number of possible outcomes may be seen. In the best case, the virus may be contained and never seen again or only appear after long intervals of time. This is what was seen with SARS.

A second possibility is that the Wuhan coronavirus will be contained, but reemerge frequently as is seen with MERS (Middle East Respiratory Syndrome) or with Ebola.

Because containment is likely in the next few months, these two scenarios are certainly the most probable.

A third possibility is that the coronavirus may not be contained, but will remain as an ongoing source of human infection as we have seen with Zika and West Nile viruses.

And a fourth – and worst-case – possibility is that the coronavirus will not be contained and will run rampant across the Earth, as was the case with the 1918-1919 influenza pandemic. While fear mongers may focus on this scenario, it is very unlikely to come to pass based on what we have seen to date.

In planning for the future, the short-term horizon for the battle against the coronavirus should be focused on: surveillance and containment; treating infected individuals; greatly increasing the availability of diagnostic tests in every populated region of the world, including traditionally underserved regions; and facilitating international cooperation and communication regarding the virus.

It is critical to keep the virus from establishing a stronghold in other regions of the world and becoming a pandemic as defined by the World Health Organization. Education is important in all time horizons.

In the short-term, education is needed to do the following: convince exposed individuals – including certain international travelers and their direct contacts – to recognize their risk and seek out help; assist health care providers to make informed decisions and protect themselves and others; and calm the fears of those who are not at risk, because unfounded fear can use up limited health care resources and may have other negative impacts on containing the epidemic.

In the mid-term, research studies need to be carried out to determine the extent of silent infection and thus the true death rates for the Wuhan coronavirus. We need to determine how effective available antiviral medications are in treating people stricken with the virus.

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We also need to study how prevalent Wuhan coronavirus is in bats and snakes and determine if there are additional animal reservoirs that may pose a threat from human interactions with wildlife.

Studies may help us to determine if the Wuhan coronavirus entered the human population once and then spread extensively, or whether many people actually contracted the virus from animal sources.

It is important to know if there was a specific mutation that facilitated the jump of the coronavirus to humans and if the virus has continued to evolve now that it has adapted to its new human hosts.

These mid-term goals all need to be initiated immediately so that they can be completed in the coming months.                      

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Long-term goals include the development of vaccines to protect people against the Wuhan coronavirus; the development of better anti-coronavirus drugs to treat people already infected; detailed studies on the nature of the virus as well as the human immune response to the virus; and improvements in the public health infrastructure and communications. All these goals can help us to contain coronaviruses and other potential pathogens before they can emerge as epidemics.

While panic is a natural response to a new infectious threat, panic is rarely productive. An attentive, informed response is the best hope for containing the Wuhan coronavirus and saving lives.

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