How the U.S. Is Preparing for a Major Coronavirus Outbreak

• The World Health Organization (WHO) has declared the coronavirus outbreak a public health emergency of international concern and has created a global preparedness and response plan
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• The Centers for Disease Control and Prevention (CDC) and WHO are distributing information to guide governments and businesses in how to respond to the crisis.
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• Experts say there are two critical factors that determine the effect of an epidemic: transmissibility and severity.

The novel coronavirus outbreak that originated in China is an ongoing epidemic that could go any of several ways.

So far, there’s just too little information available to make a solid prediction. But health officials are preparing for a worst case scenario, just in case.

“The issue is, we don’t know. And any sort of prediction would be ill-advised,” said Anthony Fauci, the director of the National Institute of Allergy and Infectious Disease (NIAID), at a Friday briefing by the presidential task force on coronavirus.

“You really do prepare for the worst possible scenario,” he said.

US HEALTH OFFICIALS, GOVERNMENT TAKING STRONG ACTION

On Jan. 30, the WHO declared the coronavirus outbreak a public health emergency of international concern.

It then created a global preparedness and response plan and asked for $675 million in funding from donors to last through April.

The plan includes measures to facilitate research about the virus, provide guidance, improve national readiness (especially in countries with weak health systems), and boost surveillance.

The CDC has issued federal quarantine orders to the 195 U.S. citizens repatriated to the United States on Jan. 29. The quarantine will last 14 days from when the plane left Wuhan, China.

“We are taking measures to minimize any contact. We expect confirmed infections among these and other returning travelers from Hubei province,” Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, said in a statement.

CDC LEADS THE FLIGHT

The CDC has been leading efforts to prevent an epidemic in the United States by screening travelers at airports who recently returned from Wuhan, China, or the rest of mainland China.

CDC actions include:

• Establishing a 2019-nCoV Incident Management System on Jan. 7 and activating its Emergency Operations Center on Jan. 21 to provide ongoing support.
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• On Feb. 3, posting guidance for assessing the potential risk of various exposures to the novel coronavirus and appropriately managing those people.
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• Developing a real-time reverse transcription-polymerase chain reaction (rRT-PCR) test that can diagnose coronavirus in respiratory and serum samples from patients.

The National Institutes of Health (NIH) has ramped up research, including the development of a vaccine and antiviral drugs.

American pharmaceutical companies are also working on a vaccine, although the process may be a long one.

“It is unlikely that 2019-nCoV will become a potentially life threatening public health issue in the United States. As this is a novel virus, we need to continue to monitor and assess the situation as it evolves on a daily basis,” Supriya Narasimhan, MD, infectious disease specialist with Santa Clara Valley Medical Center, told Healthline.

FACTORSTHAT DETERMINE THE EFFECT OF AN EPIDEMIC

A recent viewpoint article in JAMA explains that there are two critical factors that determine the effect of an epidemic: transmissibility and severity.

One or the other, but not both, characterized previous outbreaks.

“Neither the 2009 pandemic influenza A (H1N1) virus pandemic or the severe acute respiratory syndrome coronavirus (SARS-CoV) or the Middle East respiratory syndrome coronavirus (MERS-CoV) epidemics had the combination of both high transmissibility and severity,” the authors wrote.

Influenza A (H1N1), first diagnosed April 2009 in California, was highly transmissible but not severe.

SARS was severe but didn’t transmit easily between people, which helped health officials contain the outbreak.

MERS also appears to have high severity but low transmissibility from person to person.

According to Narasimhan, regardless of the disease, “Wearing a mask upon arrival to any healthcare facility and meticulous hand hygiene will be most effective to prevent any transmission.”

SEVERITY MAY BE UNDERESTIMATED

Experts emphasize that while the new coronavirus is more infectious than previous outbreaks of SARS or MERS, the percent of people who die from it is much lower.

“Based on current reported cases, the novel coronavirus (2019-nCoV) has infected more people than SARS or MERS. However, the percent mortality is much lower than either MERS or SARS,” Narasimhan said.

According to the JAMA article, estimates of severity are usually higher early in an epidemic, but because many people haven’t yet recovered, the death rate and severity could be underestimated.

“It’s hard to believe that just two months ago, this virus was unknown to us,” WHO Director-General Tedros Ghebreyesus said in a statement. “We don’t know the source of the outbreak, we don’t know what its natural reservoir is and we don’t properly understand its transmissibility or severity.

CONTAINMENT IS INCREASINGLY UNLIKELY, BUT MOST CASES ARE MILD

“Hidden” cases — where people with mild symptoms don’t seek medical help and so remain untested and unrecorded — combined with the highly contagious nature of the disease mean there could be “vastly more cases” than previously thought, Tom Frieden, a former director at the CDC, told The Guardian.

“It probably isn’t worth giving up, but trying to contain Wuhan coronavirus like SARS and MERS is very unlikely, just because of the number of cases and the number of [Chinese] provinces and the ease with which it is ease spreading in families. It’s a fog of war reality, which is what makes me suspect that what are seeing is the tip of the iceberg,” Frieden said.

However, “the risk to the general public remains low,” Narasimhan said. She also confirms that most identified cases are “mild and self-limited.”

The WHO has published a Strategic Preparedness and Response Plan online to guide prevention and containment efforts.

The CDC has issued guidance for businesses and employers to plan for, and respond to, the outbreak.

THE BOTTOM LINE

The novel coronavirus epidemic is a global crisis but hasn’t yet affected the United States. The government has taken strong measures, based on previous outbreaks, to prevent the virus from spreading here.

Passengers from China are being screened at U.S. airports, and citizens repatriated from the Chinese mainland are being held in quarantine for a 14-day period.

A coronavirus test is available but isn’t effective enough to catch all cases.

The CDC and WHO are distributing information to guide governments and businesses in how to respond to the crisis.

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