February 10, 2020
Two weeks ago, the World Health Organization (WHO) declared the current novel coronavirus epidemic a global health emergency. Last week, UTHealth experts convened with regional experts, including Dr. David Persse, Health Authority for the Houston Health Department; Dr. Umair Shah, executive director of Harris County Public Health; and Dr. Philip Keiser, Galveston County Local Health Authority, at the UTHealth School of Public Health for a panel discussion moderated by Dr. Bob Emery, vice president of Safety, Health, Environment and Risk Management, on this dynamic public health concern.
Here, two of those panelists, Dr. Luis Ostrosky and Dr. Cesar Arias, professors of internal medicine, provide the latest information on this new disease.
What constitutes a pandemic, and what is the concern about this coronavirus?
A pandemic implies the transmission of an infectious agent, in this case a virus, in multiple countries across the world. This strain of coronavirus is particularly concerning. Because this is a novel virus, the population at large is not immune to the pathogen, with the potential for massive spread. Scientists and public health officials are still learning about this new agent– the epidemiology of infection and disease, including viral spread, disease burden, and associated illness severity and death rate. Potential estimates are that this virus may be less lethal than SARS (10 percent mortality rate) and MERS (30 percent mortality rate). Thus far, it appears that 2109-nCoV has a mortality rate of ~2 percent, but it is too early to be certain. A concern is that the virus appears to be more easily transmissible than either SARS or MERS, prior serious coronavirus infections. To date, the WHO has confirmed 40,787 cases, with 910 deaths, with the vast majority of the cases in China and thus far only 12 cases in the United States.
How should this virus change behavior in Houston?
To date, there have been no cases in Houston and no evidence of local transmission. We need thoughtful preparation, including awareness of those who may have been exposed through travel to China or other affected countries, or through contact with a known case. If we had transmission, we would need to focus on the isolation of cases, contact tracing and surveillance, and on enforcing cough etiquette and hand hygiene, which are the best ways to prevent spread.
How are the medical school and its affiliated clinical operations prepared for this novel coronavirus?
We have been sending health alerts to all of our clinical faculty, staff, and students with the latest situational reports and clinical guidance from CDC and WHO. We also have been working with our clinics in implementing signage to identify patients and alerting them to wear masks, if they have a potential exposure. We are working with the triage center to identify patients before they come into our clinics to bring them in safely or to direct them to an ER, if needed. We are working with our hospital colleagues to create common procedures to triage, diagnose, and treat patients and to protect healthcare workers. We are in close contact with the city and county health departments, getting updates on those who need to be tested.
Who is doing the testing on suspected patients?
Currently the test is done by CDC. However, CDC is working to move testing to state and city health departments. We have procedures for sending tests to the appropriate laboratory.
How effective are face masks in protecting against viruses?
Not very effective. This virus is spread via droplets, which can travel a maximum distance of 6 feet. Masks would be very effective if you were within 6 feet of a person but would have to be coupled with a face shield and gloves, as well as rigorous hand hygiene. The CDC discourages routine face masks, which are not necessary at this point and would not be very effective.
What should clinicians be looking out for?
A “person of interest” would be someone with recent travel to China (returning within the last 14 days) who has both fever AND respiratory symptoms (such as cough and shortness of breath). We would also be concerned about a person who has had contact with a known coronavirus patient and also presents with fever OR respiratory symptoms. It is important to be aware of patients who have traveled to China within the last 14 days who may be accessing health care for other non-infectious reasons, as we need to take special precautions when evaluating them, and they are advised to be under voluntary quarantine.
How close are we to a vaccine for this virus?
Multiple academic and pharmaceutical groups had already been working on a vaccine for other coronaviruses; they are adapting that work to this specific strain. Phase 1 trials are expected to start within the next 3 months. It is remarkable that we have the technology to go into clinical trials within 3 months of an outbreak being detected.
What is the role of antiviral agents in the treatment and control of disease?
Based on a recently published case (NEJM, Jan 31, 2020), a randomized, controlled trial of the antiviral drug remdesivir is underway. This drug is a novel nucleotide analogue prodrug that has been shown in pre-clinical animal models to improve pulmonary function and reduce lung viral loads and severe lung pathology when used against Middle East respiratory syndrome coronavirus (MERS-CoV) (Nat Commun. 2020 Jan 10;11(1):222. doi: 10.1038/s41467-019-13940-6). Other antivirals such lopinavir and ritonavir (primarily used to treat HIV) also have been shown to have some activity in vitro against coronaviruses and have been used sporadically in some infected patients in China.
What are the restrictions for those at UTHealth concerning travel?
The current requirement is for trainees, faculty, and staff who have recently traveled to China to contact Student Health Services or Employee Health Services immediately for an assessment. Employees will be placed on paid leave for 14 days from the date when they returned to the United States. The CDC and State Department recommend avoiding all nonessential travel to China at this time.
A reminder about flu.
Sometimes in the midst of a new and scary epidemic, we forget about “old diseases” that are known causes of severe disease and death. This is flu season. According to CDC estimates, in this year’s flu season, which started on September 29, there have been at least 22 million cases of the illness in the United States, 210,000 hospitalizations, and 12,000 deaths—a reminder that the flu can be a deadly disease and the importance of annual flu vaccination. I hope all of you have been vaccinated this year.
For more information:
2019 Novel Coronavirus – Important Information for Clinicians
2019 Novel Coronavirus – NEJM
Johns Hopkins real-time coronavirus map
Clinical resources coronavirus
UT Physicians FAQ
The Urgent Questions Scientists Are Asking About Coronavirus
The coronavirus outbreak should bring out the best in humanity