Infectious Disease and Public Health Experts Weigh in on the Coronavirus Disease 2019

The coronavirus disease 2019, or COVID-19 – now declared as a pandemic by the World Health Organization (WHO) – has been detected in over 100 countries, areas, or territories, and has led to over 4,600 deaths. Currently, there are more than 124,000 confirmed cases worldwide. These numbers are changing daily. In order to aid the nation’s healthcare community in responding to COVID-19, the Health and Human Services has also declared a public health emergency for the United States.

According to the Centers for Disease Control and Prevention (CDC), the virus has been named “SARS-CoV-2” and the disease it causes is COVID-19. The coronaviruses are a large family of viruses that are common in many different species of animals, including camels, cattle, cats, and bats. Animal coronaviruses can rarely infect people and then spread between people, such as with MERS-CoV, SARS-CoV, and COVID-19. 

COVID-19 was first detected in Wuhan City, Hubei Province, China. The CDC also stated that early on, patients in Wuhan had some link to a large seafood and live animal market, which suggested animal-to-person spread. Chinese officials reported that sustained person-to-person spread in the community also occurred in China.

A growing number of patients have also reported not having exposure to animal markets, which indicated person-to-person spread. Person-to-person spread has been reported outside China, including in the United States and other locations. Other destinations also have an apparent community spread, which means that some people that have been infected are not sure how or where they became infected. 

Gio Baracco, M.D., an infectious disease specialist at the Miami Veterans Affairs Health System and professor at the Miller School of Medicine, engaged in a Q&A with the Department of Public Health Sciences to learn more about the respiratory disease. José Szapocznik, Ph.D., chair emeritus and professor at the Department of Public Health Sciences, also participated in the Q&A.

What steps need to be taken to contain the spread of the virus?

Dr. Baracco: The current international and United States government responses are based on containment activities. The idea was to prevent the infection from spreading outside of China through travel restrictions, quarantine of potentially exposed individuals, and early recognition and isolation of COVID-19 infected patients. This proved to be enough with SARS in 2003. However, COVID-19 seems to have expanded more widely and faster. The public health focuses now also includes mitigation strategies through non-pharmaceutical interventions, such as school closures, self-quarantine, and other social distance measures. 

Dr. Szapocznik: Each of us has to wash our hands thoroughly and frequently, and not touch our face with our hands. To prevent the spread of the new coronavirus, anyone who is suspected of having the virus needs to be isolated. All countries have to take measures to prevent the spread of the virus within their country.

What is your takeaway from the recent jump in reported cases?

Dr. Baracco: There are probably a number of factors adding to the steep epidemiological curve of COVID-19 cases coming from China and from other countries. Of course, we don’t yet know the real magnitude of the outbreak in China, and most estimates are that the actual number of cases is several-fold larger than the confirmed cases. So, there are still many unconfirmed, and thus unreported cases. As the test became more available, case ascertainment improved, and a greater proportion of cases were confirmed. Also, the case definition changed, and Chinese authorities started reporting cases that had typical clinical and radiological features, even if they had not been confirmed through laboratory testing.

What are the current unknowns about the virus?

Dr. Baracco: This is an emerging viral infection in a very rapidly developing outbreak, so there are still many unknowns. We don’t know all the details of how the virus is transmitted, the extent of the outbreak, the range of clinical manifestations, and the actual case fatality rate.

What are the symptoms of the virus?

Dr. Baracco: There have been reports of infected patients who had no symptoms at all, and on the other side of the spectrum, some people become severely ill and developed respiratory failure and died. In most cases, though, patients develop a fever, cough, congestion, which are very similar to the flu.

What are some preventative measures that individuals should take?

Dr. Baracco: The best way to protect yourself is to use common-sense generic actions, such as disinfecting your hands frequently and staying away from ill individuals. Unfortunately, there are no specific vaccines or medications that one can take to prevent this infection. 

What should you do if you believe that you might be infected?

Dr. Baracco: There are a few things that you can do if you think you are infected. If you have only mild or moderate symptoms, the best thing you can do is stay at home. Do not go to school or work. Drink plenty of fluids and lower the fever with acetaminophen or non-steroidal anti-inflammatories. Not only would a medical facility not be able to do much more for you (the treatment is purely supportive, there is no specific treatment available), but you would help prevent the spread of this infection further. If you are very sick and need medical attention, you should call the hospital ahead of your visit, so that they are prepared and can protect themselves and other patients from infection.

To prevent future outbreaks, what measures need to be taken?

Dr. Baracco: I’m not sure that future outbreaks can be prevented. Viruses like the coronavirus and influenza are widespread in nature and random mutations or genetic reassortment sometimes confer the ability to jump species and infect humans. Given the proximity of people and other animals, it is inevitable that pandemics will emerge. Early detection and early, layered, and aggressive public health interventions are key to containing and mitigating their impact.

Dr. Szapocznik: A Global Convention on Public Health Security needs to be developed, agreed to and complied with. It would require incentive or enforcement strategies. Moreover, as we say in the case of China, it is not enough to have countries agree on how to handle an emergent pathogen. Public health leaders at all levels of governance need to be trained and held accountable. 

Read more about Dr. Baracco and Dr. Szapocznik.

This Q&A was originally published on February 27, 2020 and was updated on March 12, 2020.

News@TheU: Coronavirus (COVID-19) information for the University of Miami community

The University of Miami is closely monitoring the current COVID-19 outbreak. University leaders are working closely with government and public health agencies and continue to follow guidelines from the U.S. Department of State, the Centers for Disease Control and Prevention, and the World Health Organization.

Visit News@TheU to learn more about University efforts and the Centers for Disease Control and Prevention for broader information on COVID-19.