Coronavirus keeps on

COVID-19 tests public health responses

It’s been six weeks since a new type of coronavirus, now named SARS-CoV-2 by the Coronavirus Study Group, was identified in China as the cause of an outbreak of severe, contagious respiratory disease. Once again, the world is learning just how important public health is to life as we know it, and how important it is to be prepared.

After September 11, 2001, multiple government agencies funded preparedness. But those funds were ended or cut back substantially over the ensuing years, and now, few health departments and other health agencies have the resources they need to prepare for a range of disasters.

We are experiencing a global coronavirus outbreak that has the potential for enormous health and economic consequences. Coronaviruses are a large family of viruses that are common in many different species of animals. Several known coronaviruses infect people and usually cause only mild respiratory disease, such as the common cold. However, at least two previously identified coronaviruses originating in bats – severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) – have infected and then spread between people, causing severe disease.

Many virologists have concluded that bats likely were the origin of the current outbreak, which has been named “coronavirus disease 2019” by the World Health Organization (WHO), and abbreviated COVID-19. The concerns of Dr. Li Wenliang, a Chinese physician who, early in the outbreak, tried to draw attention to the threat, were denied and dismissed by Chinese central and local government officials, cutting into valuable time for controlling the epidemic. Sadly, on Feb. 7, Dr. Li died from COVID-19. More than 1,700 health workers have been reported to be infected worldwide, likely an undercount, and at least seven have died, including Dr. Li and Dr. Liu Zhiming, president of the Wuhan Wuchang Hospital in Hubei Province, China, one of seven designated hospitals for treatment of the virus in the city of Wuhan, which is at the center of the epidemic.

According to the WHO’s website, Chinese health officials have reported many thousands (now more than 75,000) of COVID-19 cases in China, and much severe illness has been reported, including at least 2,200 deaths. Cases also have been identified in travelers to 29 other countries, including the United States, which now has 27 confirmed cases.

The virus can spread from person to person through respiratory droplets, which is why proper hygiene is so important (see below, “Do what you can to prevent infection”). We’ve heard gut-wrenching stories from China about empty streets, people unable to leave their apartments, even to get food, out-of-control situations at hospitals, shortages of health professionals, masks, ventilators, medicines, food and other supplies. I’ve talked with CEOs of global companies in this country who are having to rethink their business models, cancel global meetings in the coming weeks and months and guess when the virus might peak. According to the CDC, it might be with us well past summer. The New York Times has live updates on the outbreak and an excellent opinion piece by infectious disease expert Michael T. Osterholm, PhD, MPH, of the University of Minnesota, that describes what countries, healthcare systems and individuals can do to prepare.

A lot of activity and some expert advice

Currently, there are more questions than answers about the new coronavirus, SARS-CoV-2. However, experts at UNC-Chapel Hill, most of whom are jointly appointed in the Gillings School and the School of Medicine, are trusted sources of information on our campus, nationally and globally. (A separate post discusses why misinformation, rumors and conspiracy theories are harmful.)

Researchers, including Dr. Timothy Sheahan, in the Baric Lab – one of the first labs to get up to speed quickly on the novel Coronavirus – are attempting to understand and characterize SARS-CoV-2, as they have done with MERS-CoV, SARS-CoV and the virus that caused the 1918 influenza pandemic (@Baric_Lab on Twitter). Dr. Ralph Baric says, “Most of the research in our laboratory has used coronaviruses as models to study the genetics of RNA virus transcription, replication, persistence and cross-species transmission. We have also been using alphavirus vaccine vectors to develop novel candidate vaccines against caliciviruses.” Baric and Sheahan also are working with pharmaceutical companies to test potential agents against coronavirus.

Dr. David Weber, professor of medicine and physician epidemiologist, serves as medical director for the Statewide Program for Infection Control and Epidemiology, and medical director of Epidemiology for UNC Health Care and the Departments of Hospital Epidemiology (Infection Control) and Occupational Health. David is great at explaining infectious diseases to lay people and has advised on how to minimize and mitigate the virus’s impact (see video).

Dr. Allison Aiello, professor of epidemiology, is an expert on social distancing (staying away from people who are ill) and other techniques as a strategy for slowing the impact of viruses. Her research seeks to integrate social and biological data across the life course, including epigenetic approaches, to identify the key triggers of population in susceptibility to dementia, poor mental health, cardiometabolic, and immune/infectious disease outcomes.

The Gillings School’s Coronavirus Information Portal has helpful links to local and state resources and the CDC and WHO coronavirus disease pages.

Do what you can to prevent infection

Environmental controls can prevent or delay the spread of viruses to individuals. For most people in the United States, seasonal flu is a much greater risk than COVID-19. It’s not too late to get a flu shot. Handwashing and other etiquette recommended below to avoid coronavirus infection holds also for flu. (In the U.S., the number of seasonal influenza-related deaths is estimated by the CDC to be at least 14,000 so far in 2019-2020; including more than 90 children under 18.) Here is what the CDC says about coronavirus control in the workplace.

Emphasize staying home when sick, respiratory etiquette and hand hygiene by all employees

• Employees who have symptoms of acute respiratory illness are recommended to stay home and not come to work until they are free of fever (100.4° F [37.8° C] or greater using an oral thermometer), signs of a fever, and any other symptoms for at least 24 hours, without the use of fever-reducing or other symptom-altering medicines (e.g. cough suppressants). Employees should notify their supervisor and stay home if they are sick.
• Place posters that encourage staying home when sick, cough and sneeze etiquette, and hand hygiene at the entrance to your workplace and in other workplace areas where they are likely to be seen.
• Provide tissues and no-touch disposal receptacles for use by employees.
• Instruct employees to clean their hands often with an alcohol-based hand sanitizer that contains at least 60-95% alcohol or wash their hands with soap and water for at least 20 seconds. Soap and water should be used preferentially if hands are visibly dirty.
• Provide soap and water and alcohol-based hand rubs in the workplace. Ensure that adequate supplies are maintained. Place hand rubs in multiple locations or in conference rooms to encourage hand hygiene.
• Visit the coughing and sneezing etiquette and clean hands webpage for more information.

Perform routine environmental cleaning

• Routinely clean all frequently touched surfaces in the workplace, such as workstations, countertops, and doorknobs. Use the cleaning agents that are usually used in these areas and follow the directions on the label.
• No additional disinfection beyond routine cleaning is recommended at this time.
• Provide disposable wipes so that commonly used surfaces (for example, doorknobs, keyboards, remote controls, desks) can be wiped down by employees before each use.

Avoid stigmatizing people based on race or country of origin

I’m concerned about stigmatization of Chinese people, because some people believe all Chinese people pose a risk, something that is untrue. “To prevent stigma and discrimination in the workplace,” CDC says, “use only the guidance described above to determine risk of nCoV infection. Do not make determinations of risk based on race or country of origin and be sure to maintain confidentiality of people with confirmed coronavirus infection. There is much more to learn about the transmissibility, severity, and other features of COVID-19 and investigations are ongoing. Updates are available on CDC’s Coronavirus Disease 2019 web page.”

I’ve already heard too many stories of Chinese people being singled out and asked probing, personal questions without a rationale. There are isolated news reports of children being beaten up in the U.S., because others suspected them of being infected. That’s despicable. We should not assume that Chinese people in the United States are infected, particularly if they did not travel to China. “Treat people who exhibit symptoms, rather than targeting people for quarantine or barring them from public places simply because of the way they look,” said Erika Lee, professor of history and Asian American studies at the University of Minnesota, in the Los Angeles Times. “It’s really about using common sense and not letting fear and panic drive us to revert back to more base fear of foreigners.”
Barbara