Last month, the World Health Organization (WHO) was informed of a cluster of cases of mysterious pneumonia in Wuhan, China. Two weeks later, cases surfaced in Thailand, and then in Japan.
The U.S. Centers for Disease Control and Prevention (CDC) recently announced enhanced health screenings for passengers with travel history from Wuhan at numerous major U.S. airports, including Atlanta's Hartsfield Jackson airport.
On Jan. 21, the CDC confirmed the first case of the Wuhan Coronavirus in the U.S. Detected in a patient in Washington State, officials are monitoring the patient and any known contacts out of an abundance of caution. As evidenced in the events of the past month, this outbreak is rapidly developing with early data still emerging.
Emory infectious diseases and travel medicine experts aim to educate the public in safety precautions and are often on the front lines when viral outbreaks occur. Emory's experts include the following:
Aneesh Mehta, MD, associate professor, School of Medicine; chief of infectious diseases services, Emory University Hospital
Bruce Ribner, MD, professor, School of Medicine; director, Emory Serious Communicable Diseases Unit
Colleen Kraft, MD, associate professor, School of Medicine; associate chief medical officer, Emory University Hospital
Henry Wu, MD, assistant professor, School of Medicine; director, Emory TravelWell Center
Jay Varkey, MD, associate professor, School of Medicine; hospital epidemiologist, Emory University Hospital
Marshall Lyon III, MD, associate professor, School of Medicine; director of biosafety, Emory University
Marybeth Sexton, MD, assistant professor, School of Medicine
**(Please contact Jill Wu or Janet Christenbury above to schedule a media interview with these experts.)
What is the first thing I need to know?
Most importantly good hygiene, particularly hand hygiene, can reduce the risk of many infections, including this novel coronavirus.
Additionally, our systems are better prepared to protect than ever before. Since first reports of the outbreak, public health agencies, health care systems, and clinicians in the U.S. began ensuring procedures were in place to identify people at risk for this infection, isolate them safely so they can receive proper care without risk of further transmission, and inform the appropriate authorities so a diagnosis may be established or ruled out quickly. Signage such as these from Emory Healthcare are posted and health care workers are trained to identify ill patients with relevant travel history.
How does a new virus like this emerge?
Many of these novel viruses develop in an animal host and can evolve to infect other types of animals, including humans. For Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS-CoV), two emerging human coronaviruses within the past 17 years, the viruses initially evolved in bats. Both developed the ability to infect an intermediate host , (Civet cats for SARS and camels for MERS-CoV), then evolved an ability to infect humans. Genetic changes that have led to the virus being able to jump to new species are still being researched. It is expected that a similar evolution occurred in this new coronavirus.
Why is it concerning that the virus is spread from person to person?
Humans generally have infrequent contact with the animal hosts of these virus; thus, it would be very unlikely for someone to come in contact with an infected animal. However, once the virus is able to spread from human to human, the chances that an individual will come in contact with an infected person grows rapidly. At this point, the outbreak can be propagated at a rapid pace in the area where it started. And given the increasing mobility and travel of many societies, these outbreaks can move into new regions and move across the globe quickly.
This also creates additional risk to health care workers as they care for ill patients. In order to mitigate the risk of transmission, the CDC has recommended that health care workers use Standard, Contact and Airborne Precautions with eye protection.
What are the similarities and the differences between this new virus, SARS and MERS-CoV?
Genetically, SARS and the novel 2019 coronavirus seem quite similar. Both are betacoronavirus (a genus within the family of coronaviruses) and appear to be a "B lineage" of this genus. MERS-CoV is also a betacoronavirus, but from a different lineage than the novel coronavirus. Clinically, they all start as upper respiratory tract infection, often indistinguishable from other more common respiratory tract infections. And like SARS and MERS-CoV, both can progress to cause lung infections, including pneumonias. However, there is not enough data yet to sufficiently compare the severity of diseases caused by these viruses. As the medical and scientific communities receive more data from the outbreak, we will have a better understanding of the full spectrum of disease for this new virus and how it compares to other infections such as SARS and MERS-CoV.
What has the infectious disease community done to prepare for the outbreak?
Through partnerships between the National Ebola Training and Education Center, CDC, Assistant Secretary for Preparedness and Response, state and local public health agencies, and many others, we are steadily increasing our preparedness to face novel infectious diseases threat.
The infectious diseases community, emergency medicine community and our public health partners have learned much from SARS, the 2009 H1N1 pandemic, MERS-CoV and the Ebola outbreak from 2014-2016. Importantly, we have all learned that infectious disease outbreaks can spread from remote regions to become global threats rapidly in the modern world. By deploying medical, public health and scientific resources to the primary area of these outbreaks, we can address, curtail and prevent the spread of these outbreaks. Locally in our healthcare and public health systems, we have shown that instituting strong measures of "Identify, Isolate and Inform" can significantly reduce the risk of these outbreaks affecting our communities.
