2019 Novel Coronavirus Update
Updated: Mar 30, 2020
This epidemic is likely months away from peaking. At the same time, international measures for limiting the exportation of the virus appear to be slowing the spread, buying time for the development of vaccines and/or anti-viral medications.
There will continue to be new cases outside of China as all borders are porous to some extent. The challenge for public health is rapid recognition and isolation of new cases and their contacts as rapidly as possible. These sporadic new cases are not a significant reason for concern. As noted above, the issue to watch for is sustained person-to-person transmission developing beyond initial cases (1st generation) and their known direct contacts (2nd generation).
Most concerning are areas of the world, especially Africa and South America, where strong economic ties to China have been developed but have limited public health systems, including the testing ability. The World Health Organization has focused much of its resources on supporting these countries, but this still represents the greatest risk for the disease gaining a foothold outside of China. As with many viruses, this virus has demonstrated a predilection for causing severe disease in a specific subset of the population, specifically older males with other health issues, but this is a relative finding and not at all limiting. Of note, there have been relatively few severe cases in individuals under age 16.
The spread of the virus:
The 2019 novel coronavirus epidemic continues to grow dramatically in China, even if only the official statistics are believed. Importantly, however, the epidemic has not gotten a foothold outside of China. To date, only 2 cases worldwide do not have a direct 1st or 2nd generation link to Wuhan. Those cases, both in South Korea, had traveled to Singapore early in the epidemic before Singapore instituted strict containment and case tracking procedures. Internationally, the total number of these 1st and 2nd generation cases is still less than 250.
What is being done to control the virus?
Currently, the US Centers for Disease Control and Prevention (CDC) is making 2019 novel coronavirus test kits and protocols available to approximately 100 laboratories around the country. This means that suspected cases can be tested and diagnosed, or cleared on the same day. Without this capability, any suspected case would have to be isolated for multiple days, and case tracking on many eventually unproven cases could have overwhelmed the public health systems. With this new capability in place, combined with the significant reduction in movement of people to and from China, the risk for this coronavirus developing sustained person-to-person chains of transmission in this country is greatly reduced.
How it is affecting travel:
A major concern continues to be that at least some proportion of infected individuals can shed the virus with little or no upper respiratory disease symptoms. This means that simply isolating or avoiding anyone who appears ill is an inadequate protection strategy in locations with the established transmission and that illness screening of returning travelers from the region is inadequate to identify potential carriers.
Internationally, this will likely mean that significant travel restrictions related to China will remain in place for an extended period, possibly until a vaccine is available. Many countries have also instituted various types of 14- day quarantines for any arrival with recent China travel, ranging from self-quarantine and frequent checks/reports to mandatory physical quarantine in assigned locations.
We will pass along additional updates as they become available.
