As we move toward the end of the first week of the global Chinese Wuhan novel coronavirus (2019-nCov) outbreak, with the 2 cases in the United States, 1497 cases have been identified worldwide and 42 deaths have occurred as of evening 25 January 2020. What we can surmise, is a critical number, in epidemiology; a case fatality rate (CFR) – or case fatality risk – is the proportion of deaths within a designated population of “cases” (people with a medical condition, e.g. viral infection) over the course of the disease.
The CFR for the 2019-nCov is 2.80%. That is staggering, as the seasonal influenza CFR estimates are at around 1 to 10 deaths per 100,000 infections identified in our review, which is a mere 0.005%. This math is unreal, you are 560 times more times likely to die from the 2019-nCov than the flu; that means hundreds of millions could die from this epidemic. If half the world becomes infected, 120 million people will die. Obviously, the fatality rate is very concerning. The Centers for Disease Control and Prevention (CDC) is closely monitoring the outbreak and notes that it presents as a mild to severe respiratory illness after 5-7 days of incubation, 10-14 days of infection and can lead to very high fevers with brain involvement and death.
In the early 2000’s, previous regional outbreaks of human coronaviruses, including HCoV-OC43, are predominantly associated with mild to severe respiratory tract infections. Some just cause a simple cold and others include strains that cause the severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS). Human coronavirus infections are generally associated with upper respiratory tract infections, although it has been shown to have neuroinvasive properties, which means the brain could become infected. In studies with lab mice, human coronavirus can infect brain tissue and cause severe brain inflammation or encephalitis. The virus has also been shown to cause persistent infections in human brain tissue leading to seizures and death.
Coronaviruses are a large family of viruses that are common in many different species of animals, including camels, cattle, cats, and bats, found primarily in Africa. Rarely, animal coronaviruses can mutate and infect people and then spread between people, such as with MERS and SARS. Many of the patients in the outbreak caused by 2019-nCov in Wuhan, China reportedly have not had exposure to animals or animal markets, indicating person-to-person spread is occurring. It is postulated, person-to-person spread has occurred with MERS and SARS, and tis occurs via respiratory droplets produced when an infected person coughs or sneezes, and inhaled or absorbed by the eyes, similar to how influenza and other respiratory pathogens spread. It’s important to note that how easily a virus spreads person-to-person can vary. Some viruses are highly contagious (like measles), while other viruses are less so; currently 2019-nCov appears to be highly contagious.
To stop the spread, the president of China, Xi Jinping and the Chinese authorities have quarantined many cities and hundred of millions of people have been potentially cut off from medicine, food and water. Hundreds of patients are coming to hospitals and have been seen falling down dead where they walk or stand. For the Chinese In Wuhan, the situation looks grim. The number of confirmed cases is exploding: another 300 were announced on Saturday, while the death toll is steady at 42. Yesterday, videos flooded western social media purporting to show bodies piling up in hallways in Wuhan, with rumors that a doctor had succumbed to the virus. Those rumors have now been confirmed: A doctor who worked at a hospital in Wuhan, China, where coronavirus patients are being treated died Saturday morning, according to the Wall Street Journal. Meanwhile, a two-year-old Chinese girl has become the youngest to be diagnosed with the virus. We have to wait and see how it will play our over the next week, but epidemiologist say, in 14 days’ time, models predict the number of infected people just in Wuhan to be greater than 190,000.
Presently there is no treatment except supportive care and no vaccine. For now, the best advice is to avoid all unnecessary air travel, hospital, hotels, airports, and theaters or concert halls. Cough and sneeze into the crook of the arm, and avoid all handshakes and informal greetings with kissing, wear a mask if you are immunocompromised with HIV or cancer and in areas you could be exposed to the virus and remain vigilant.