Given that the coronavirus seems to be a major topic of conversation these days, we thought it would make for the perfect topic for our first edition of Pursuing Health Pearls. These are short, ideally 10-15 minute podcast episodes (although this one was a bit longer!) meant to offer succinct, high-yield info on common health concerns. You can listen to the episode in audio format, or you can read a more detailed write-up in the blog post below.
In this article, we’ll first shed some light on what coronavirus is, how it is transmitted, who is at highest risk, how we can decrease our risk, and what to do if you think you are infected. Then we’ll talk some numbers about the scope of the outbreak and try to put it into context with other major public health concerns.
It’s important to note that our understanding of the coronavirus is evolving day by day. The information in this blog post and accompanying podcast are accurate as of this writing but will likely change with time. The information presented here has been gathered primarily from the CDC and WHO, and we recommend you use these as well as your state or local health department for the most up-to-date information as the outbreak continues to evolve.
In this episode we discuss:
Coronaviruses are a large family of viruses that are common in humans and in different species of animals including camels, cattle, cats, and bats. In rare cases, animal coronaviruses can infect humans and then spread through person-to-person transmission. Some previous examples of this include SARS-CoV (discovered in 2002 in China, which causes Severe Acute Respiratory Syndrome) and MERS-CoV (discovered in 2012 in Saudi Arabia, which causes Middle East Respiratory Syndrome), both known to cause severe respiratory disease. Both of these viruses have been contained and to date, sustained global spread has been avoided.
By now you likely have heard of the novel coronavirus which has been named SARS-CoV-2. The disease it causes has been named “Coronavirus Disease 2019,” or COVID-19 for short. The origin of the virus was likely animal-to-human transmission in Wuhan, Hubei Province, China at a large seafood and live animal market. Subsequently, person-to-person transmission has been confirmed and now cases have been identified in over 100 countries around the world. On January 30th, the WHO declared the outbreak a “public health emergency of international concern.”
Symptoms of COVID-19 are similar to disease caused by other respiratory viruses. The most common symptoms include:
Other symptoms may include headache, muscle soreness, fatigue, sore throat, headache, and diarrhea. Also similar to other respiratory virus diseases, COVID-19 may range from mild disease such as a cold to severe pneumonia, respiratory failure, or septic shock resulting in death.
The coronavirus spreads from person-to-person contact, with respiratory droplets being the main mode of transmission. Contact with droplets from the mouth or nose can lead to infection. The virus may also spread through surfaces - it’s thought that touching an object that the virus is on and then touching one’s mouth, nose, or possibly eyes can also result in transmission. The highest risk for spread occurs when a person is symptomatic, and symptoms may develop anywhere from 2-14 days after exposure.
Following prevention measures recommended for other similar respiratory viruses such as colds and the flu is the best way to decrease your risk of infection with the coronavirus. These measures include:
Currently, those at greatest risk of infection include:
Those at greatest risk for developing severe symptoms from a coronavirus infection include the elderly and those with chronic medical conditions such as lung disease, heart disease, or diabetes. Individuals with these risk factors are advised to stay at home as much as possible and avoid crowds, and make sure they have access to several weeks of medications and supplies in case they need to stay home for prolonged periods of time.
Not a lot is known about the impact of the coronavirus on pregnant women, but extrapolating from what we know about other similar viruses (SARS and MERS), pregnant women may be at higher risk of developing severe symptoms if infected than the general population. There has also been increased risk of pregnancy loss with these viruses and increased risk of birth defects is seen with high fevers in the first trimester of pregnancy. Pregnant women should avoid others who are symptomatic and engage in the usual protective actions discussed above.
Currently, the CDC is recommending avoiding all nonessential travel to China, Iran, South Korea and Italy, and entry of foreign nationals from China and Iran has been suspended for the time being. Elderly adults and those with chronic medical conditions are advised to consider postponing travel to Japan as well. In other countries where the risk of transmission is more limited, usual travel precautions are in place.
If you have been in close contact with someone who has COVID-19 OR you have recently traveled to an area with ongoing community spread (China, Iran, Italy, South Korea, or Japan) AND you develop the symptoms listed above, call your doctor or notify your state or local health department right away.
If your symptoms are mild, you may be advised to stay home and be monitored virtually to avoid spreading the virus. If you have more severe symptoms, you may need to be evaluated in a healthcare facility, but you should still call your doctor first so they can be prepared to prevent the spread of infection to other patients and health care workers. The CDC recommends that those who may be infected do not leave home except for medical appointments, and a face mask should be worn before entering the medical facility.
As of March 9th, there have been 109,577 reported cases of COVID-19 globally, and 3809 deaths. This means that there is a 3.5% case fatality rate, or 3.5% of people that we know to be infected with the disease, have died. However, as it is early in our understanding of the outbreak, it is likely that there are many more people infected but we are not detecting them because they are experiencing mild symptoms. A larger number of cases would lower the death rate, so it’s possible we will see this number go down with time.
Comparing COVID-19 to two other coronaviruses, SARS and MERS, we can see that the COVID-19 outbreak is already much more widespread, although seems to have a lower death rate:
We can also compare COVID-19 to another widespread respiratory virus that we encounter each winter: influenza. As of March 9th in the US, there are a total of 423 cases of COVID-19 and 19 deaths. In comparison, there have been at least 34 million cases of influenza detected and 20,000 deaths in the US so far this year. Most of the cases of COVID-19 so far have been detected in California and Washington. So overall, the immediate risk of infection in most of the US is currently very low, and the number of people currently afflicted pales in comparison to influenza which is a viral illness that contributes to a huge amount of morbidity and mortality every year.
Comparing the spread of COVID-19 to other public health concerns, such as chronic disease, also helps to shed some light on the magnitude of the problem. Currently about 1.21 million people in the US have cardiovascular disease, and 859,000 people die each year of heart disease and stroke - that’s ⅓ of all deaths! Many of the chronic diseases we face today that ultimately lead to heart disease and stroke - hypertension, obesity, type 2 diabetes, hyperlipidemia, metabolic syndrome, fatty liver, chronic kidney disease - can be prevented and/or treated through lifestyle factors. These factors include regular activity, healthy nutrition, stress management, good sleep, and avoiding substances such as tobacco and alcohol. Although these diseases affect a huge proportion of our population, because they are slow to develop over years and decades, they don’t seem to raise the same level of concern as we currently have over COVID-19.
Given the information we have to date, it’s likely the coronavirus will continue to spread and more cases will be identified. By practicing basic respiratory infection precautions and doing our part to stay informed and take the outbreak seriously, hopefully we can work together to prevent this from becoming a global problem. Currently, the risk of transmission in most countries around the world, including the US, is very low and those who are generally healthy are expected to develop mild-moderate symptoms. Let’s also use this outbreak as a reminder that every year the flu affects and kills huge numbers of people, and if we bring the same level of concern and precautions to every flu season that we have now, we may be able to prevent unnecessary suffering and deaths each winter. Additionally, the epidemic of chronic disease we are experiencing, although much more insidious than the evolution of COVID-19 over the past several weeks, is one we have a lot of control over and a lot of potential to reverse if we can bring a similar level concern to that we have raised for the coronavirus.
Disclaimer: This post is for general information only, and does not provide medical advice. We recommend that you seek assistance from your personal physician for any health conditions or concerns.