Experts Hope For Best, But Fear The Worst

Even as some national health experts continue to publicly downplay the threat, there are numerous signs an outbreak of coronavirus is likely, and that means New York is a possible epicenter.

Medical experts fear an initial decision made in China to keep the outbreak under wraps may have allowed it to spread.

For whatever reason, often New York comes into play, as it did with the SARS outbreak, possibly because of the international traffic in and out of its airports. “It’s inevitable that we will have someone who is positive with coronavirus,” New York City’s health commissioner Dr. Oxiris Barbot said February 3.

On Friday February 7, President Donald Trump, who has been hands-on during the past week dealing with the issue, said through a spokesman, “The White House’s economic adviser does not expect the coronavirus in China will have a major effect on the U.S. economy.”

But Trump ordered travel restrictions into the United States from a half-dozen locations, directly overruling World Health Organization leaders who urged the limitations not be put in place.

On the same morning, President Trump praised China’s response to the virus outbreak after speaking by telephone with its leader, Xi Jinping, whom he said was leading “what will be a very successful operation.” But again, behind the scenes, the Chinese public is reportedly taking a more confrontational tone, demanding that those in power investigate the death of the doctor, Li Wenliang, who revealed the virus and its epidemic dangers after the government there tried to keep it hidden.

Powerful Side Effects

The coronavirus, (2019-nCoV), originated in Wuhan and is the cousin of the SARS virus.

The coronavirus is part a large group of viruses that are common among animals. The viruses can make people sick, usually with a mild to moderate upper respiratory tract illness, similar to a common cold. Coronavirus symptoms include a runny nose, cough, sore throat, possibly a headache and maybe a fever, which can last for a couple of days.

But strains with powerful side effects can become difficult to treat and highly contagious. Cases of pneumonia began being diagnosed in Wuhan on December 12. Official there continued to identify more cases, but it wasn’t until January 1, when a seafood market was abruptly closed, that eyebrows raised. It was a week later before authorities confirmed a unusual virus was spreading. The first death wasn’t announced until January 11.

U.S. health officials minimized the potential of a mass outbreak initially, pointing out the typical winter influenzas that sweep the country pose more of a threat.

The strategy, or at least hope, was that the coronavirus outbreak would peter out before rampaging through mainland China.

“With influenza, it’s fairly predictable: We see a fairly consistent number of individuals, sometimes higher, sometimes lower,” said Scott Weisenberg, director of NYU Langone Health’s travel medicine program. Coronavirus, on the other hand, “went from having zero cases” to a large number of cases in China and an emerging number of cases worldwide, he said. “We don’t know where it’s going.”

By February 10, the world was finding out: More than 40,000 confirmed cases of Wuhan coronavirus and over 900 deaths. The vast majority of these are in China. Cases have been reported in nearly two dozen countries or locales around the world. Six cases have been diagnosed in the U.S. — five of them among people who had recently been in the city of Wuhan, where the outbreak began in December 2019.

Travel History

At least 19 million people in the U.S. have experienced flu illnesses this season, the CDC estimates. About 180,000 people have been hospitalized so far, and an estimated 10,000 have died. Sixty-eight children have died this flu season.

The CDC issued a Clinical Action Alert on January 31 through its Clinician Outreach and Communication Activity network, which suggested health care providers should identify patients who might have been exposed and who have signs or symptoms related to 2019-nCoV infection, isolate these patients, and inform public health departments. This includes obtaining a detailed travel history for patients being evaluated with fever and lower respiratory tract illness.

By the beginning of February, 11 cases had been identified on the U.S. mainland. Nine had been exposed in Wuhan but two were believed to have contracted coronavirus in this country (Illinois and California) from a third party that may have been traveling overseas. The majority of cases are still centralized in Hubei, the Chinese province of which Wuhan is the capital, where more than 12,600 people remain hospitalized.

China’s National Health Commission said February 3 that the death rate from the virus stands at 2.1 percent nationwide. A spokeswoman for the commission said 80 percent of victims were over the age of 60 and 75 percent had some form of underlying condition.

Outside mainland China, concern is growing in Hong Kong, which has sealed off most of its border crossings. The semi-autonomous Chinese city reported its first death from the virus on February 3, as authorities also confirmed three “local infection cases,” which had not recently returned from China.

Authorities said an ongoing strike by healthcare workers has had a “serious impact on services.” Unions have demanded that the border be fully closed and extra support provided for frontline staff before they will end their walkout action — though most doctors and nurses continue to work.

Anyone who had close contact with the new cases has been placed under quarantine, Hong Kong health authorities said.

Chuang Shuk-kwan, head of the Hong Kong health authority’s communicable disease branch, told reporters February 3 the new cases showed “there could be invisible chains of infection happening within communities.”

“We are not ruling out a large spread in the future,” she said. Also under quarantine are thousands of passengers on board two cruise ships: the Diamond Princess cruise ship, currently sitting in Yokohama Bay, south of Tokyo, and a second ship, docked in Hong Kong’s Kai Tak terminal.

Ten people on board the Diamond Princess have been confirmed to have the virus, and were being taken to the hospital, as authorities waited for test results of other passengers. There are 2666 guests and 1045 crew members on board the ship, owner Princess Cruises said in a statement. Of those, 428 passengers are American, the U.S. embassy in Japan confirmed to CNN.

The ship has been held at the Japanese harbor since February 4, after the virus was detected in a Hong Kong man who had previously disembarked from the cruise.

The second ship in Hong Kong is holding more than 1800 passengers on board, after it was revealed passengers from the previous voyage became infected with the virus, according to officials speaking at Hong Kong’s Health Ministry press conference February 5.

rmurphy@indyeastend.com