Coronavirus, more commonly referred to as COVID-19, is considered by many to be “the biggest global crisis since WW2.” It is also the first time the outbreak of a disease has been called a pandemic by the World Health Organization (WHO) since 2009’s H1N1 or “swine flu.” COVID-19 has become a significant concern for the medical, research, and public health communities, as they work to put an end to its rampant spread.
Although the medical community has long known there were several types of coronavirus, COVID-19 wasn’t officially recognized until December 2019. They quickly determined that it was genetically related and structurally similar to the type of coronavirus that causes sudden acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).
In an article published in the New England Journal of Medicine, the Chinese Center for Disease Control and Prevention’s, Qun Li, M. Med. and his colleagues offered a detailed epidemiologic and clinical breakdown of the initial 425 cases reported in the capital city of China’s Hubei province, Wuhan . The authors pointed out that their information did have some limitations due to real time reporting of the virus in its early stages. However, they did identify several key facts about the virus and those infected by it. The patient’s median age was 59 years old, with 56% of them being male. The elderly and anyone with a coexisting health condition were at a higher risk of morbidity and mortality. At that point, no children under the age of 15 had been diagnosed. This could be because they have a reduced risk of becoming infected or because any symptoms were so mild, they were not detected. Either situation had the potential for significant epidemiologic implications.
In the journal article, confirmed cases were required to have a pneumonia diagnosis. Using this definition, the reported fatality rate was around 2%. In a separate New England Journal of Medicine article, Guan et. Al at the Guangzhou Institute of Respiratory Disease reported 1099 cases of laboratory-confirmed COVID-19 with a 1.4% mortality rate. The 1099 patients reportedly experienced a wide range of disease severity. When you also consider that there are likely to be even more asymptomatic or minimally symptomatic cases that were never laboratory-confirmed, COVID-19’s fatality rate could be much lower than 1%. This is much more in line with severe seasonal influenza’s fatality rate of around 0.1% or pandemic influenza, like that experienced in 1957 and 1968. This is substantially lower than the fatality rate of SARS (9-10%) and MERS (36%).
In regard to containing and mitigating COVID-19, you must look at the efficiency of transmission. Currently, on average, COVID-19’s estimated basic reproduction number (R0) is 2.2, meaning that every one infected person is likely to infect 2 people. Researchers have found that to stop the spread of any outbreak, the R0 must be less than 1.0.
Li et al. reports that the mean interval of days between the onset of COVID-19 and hospitalization is 9.1 to 12.5. The long delay in the progression of severity points to the need to better understand its pathogenesis and use this information to come up with possible interventions to stop its spread.
Currently, over 90% of countries and territories, including China and the US, have instituted temporary travel bans in an effort to slow down the spread of COVID-19 . Though the number of Chinese travelers to the US had already seen a significant reduction in early 2019, this number is even lower today. While this did initially help slow the spread, COVID-19 has now been confirmed in 180 countries and territories . As of April 2, 2020, over 1,000,000 cases have been confirmed globally. The United States has 187,302 confirmed cases, while China has 82,724 . Of the cases in the United States, at least 14 were traced back to travels to China or close contact with travelers, 3 were determined to be US citizens repatriated from China, and 42 were from a cruise ship.
COVID-19 has proven how quickly and seemingly easily it can spread, resulting in major lifestyle changes in the United States, as well as other countries. This involves social distancing, the use of face masks, voluntary isolation of anyone potentially or positively infected, school closures, suspension of athletic events, and telecommuting whenever possible.
Currently, there is a concentrated effort to develop a COVID-19 vaccine. As of April 3, 2020, researchers at the University of Pittsburg School of Medicine have identified a potential vaccine that has successfully produced enough antibodies in rats to neutralize the virus . The next step of development process will involve human trials.
In addition, numerous trials are underway in an attempt to find a cure and/ or reduce the severity of the symptoms of COVID-19 . Some of the most promising involve Remdesivir (a broad-spectrum antiviral), Chloroquine and Hydroxychloroquine (antimalarial medications) and, Kevzara (used to treat moderate to severe rheumatoid arthritis and decrease lung inflammation). It’s important to note that these trials must be scientifically and ethically sound, which can take time.
Studies are also underway to create rapid test kits that may also allow at home testing.
The COVID-19 pandemic is a huge reminder that there is always the potential for emerging infectious pathogens, necessitating continuous surveillance, quick diagnosis, and substantial research to understand them and identify effective countermeasures.