Coronavirus Update

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Latest news on 2019-nCoV

Unless you just got back from a trip to Mars, you probably know that there’s an epidemic going on in China. It appears to be viral in nature; viruses are tiny, much smaller than bacteria, and barely meet the definition of a living organism as it must enter the cells of a host to activate and reproduce.

Once it’s hijacked the cell’s machinery, however, it produces a lot of little viruses that enter the bloodstream, often killing the host cell in the process. The physical symptoms caused depend on the type of virus and the cells that are infected.

First reported December 8th in Wuhan, a city of 11 million people in Hubei province, the new virus appears to belong to the coronavirus family. Coronaviridae is a family of viruses with little projections that might remind you of a crown or the corona of the sun. The genetic material is not DNA, but RNA or ribonucleic acid.

RNA viruses generally have very high mutation rates compared to DNA viruses, which leaves the possibility of genetic mistakes more frequent. When I say “mistakes”, I mean an imperfect copy of the RNA genetic material as it reproduces. In most cases, not much happens. In some cases, it may hinder the virus but just as or more often, mutations improve the ability of the virus to succeed in some way, such as letting it multiply faster or making it harder to kill. Each person who becomes a host has the potential to become patient zero for a new, improved virus.

Several coronavirus strains have made the news this century: a couple of examples are Sudden Acute Respiratory Syndrome (SARS) in Asia and Middle East Respiratory Syndrome (MERS) in, well, the middle east, although many cases were workers of Korean descent.

SARS killed about 800 out of 8000 victims with the disease over 6 months or so. Untreated MERS infected thousands with a 35-45% death rate. So far, the new coronavirus, named 2019-nCoV, has sickened more than 6000 and killed 132 in 6 weeks, if you can believe statistics from the Chinese government. That’s a little more than a two per cent death rate.

(Note: My first full article on this new coronavirus occurred when there were only 200 cases and 9 deaths, after mentioning it on January 7th at 60 cases, 0 deaths in an article on pneumonia. There are some who believe the number of cases and, perhaps, deaths, are much higher than reported)

Two per cent doesn’t seem like much, but the death rate from the Spanish Flu 100 years ago was also a little more than two per cent. That virus went on to infect a third of the world’s population and cause 50-100 million deaths.

You may have heard that 2019-nCoV was first found in some of the live markets common in China. Some mutation may have appeared which allowed a bat, a common living source of coronavirus, to infect other animals and then humans. That’s a big step, but it doesn’t mean that same mutation will make it easy to pass from human to human. What is known, however, is that it can happen.

That depends on the R Naught number. The what? The R Naught. R with a zero down where a comma would be. “R0” tells you the average number of people in a previously infection-free area who will catch a disease from one contagious victim. If the number is 1 or less, the virus will likely peter out, but the Spanish flu infected 2-3 people from each contagious victim. So did Ebola, and measles was a lot more contagious, with numbers between 6-18. This virus in China’s R0 numbers are about estimated by Chinese authorities to be 1.5 or so, but perhaps higher.

In most cases, people exhibit mild symptoms 1-14 days after exposure, similar to a cold or mild flu, and get better after a week or so. About 1 in 5, however, get very sick, including pneumonia, breathing difficulty, and respiratory failure. There appears to be evidence that people can be contagious before they experience symptoms, not unusual for a viral infection.

Should you panic? The answer is no. Right now the coronavirus epidemic is 99% in China, and no community-wide outbreaks have occurred outside its borders. That’s good news, at least for now, because no traveler from China to the U.S. has proven to be patient zero in an outbreak here. In the U.S.

When a community has a crisis, nearby municipalities rush to help. That goes for wildfires as well as epidemics. The situation which would concern me the most is if many communities are hit and have to direct their resources to their own people and not be able to help others. We’re a long way from that right now.

That doesn’t mean that you shouldn’t have a plan of action. There’s no testing labs for the new coronavirus outside of the CDC at present, so your local family doctor probably will send you to the hospital. That’s a problem if the hospitals are already crowded. If outbreaks occur here in the US, you may have to work to keep your family safe without much help.

It’s yet unclear how bad this outbreak will get outside of China’s borders, but some simple preventive measures will be worth much more than a pound of cure (for which there is none, at present).

That means you need to use non-pharmaceutical interventions.

This includes some changes in your lifestyle in a community-wide epidemic, including:

•             Social distancing. This means staying away from large crowds,

•             Not going to work if you’re sick or a lot of people there are sick,

•             Keeping kids home from school

•             Isolating sick persons in your family from healthy ones.

Avoiding close contact with possibly sick individuals is very important, especially if you don’t have personal protection gear. Close contact is defined as being within 6 feet (2 meters) or in a closed room with a coronavirus victim without any personal protection gear. An unprotected person having direct contact with infectious secretions of a 2019-nCoV patient (for example, being coughed on) also qualifies.

The best policy is to wash hands frequently and carry hand sanitizer when touching surfaces. Close attention should be focused on avoiding touching eyes, nose, and mouth.

Masks and protective eyewear help you to avoid infection but chances are you’ll touch a lot of areas at work, school, or home that have been touched by a bunch of other people. This virus appears to be able to live on surfaces for longer than the average microbe, so work surfaces must be disinfected often.  Work surfaces, by the way, includes computers used by more than one person. Other surfaces that could get contaminated could be your shirt, pants, shoes, and more.

For masks, look for a supply of N95 masks, these are better than standard surgical masks but are NOT 100% protective. During outbreaks in your community always wear n95 masks or better if you must be outside of your home. This isn’t just an option, it’s a sign of social responsibility.

It’s not just important to have proper masks, but more importantly to know

  • How to put them on
  • How to achieve a proper fit
  • Take them off safely 

Articles on the proper procedure can be found at and in our latest book “Alton’s Antibiotics and Infectious Disease. Although the book is about antibiotics and bacterial (not viral) disease, you’ll find the donning and doffing process in a section in the back of the book. You’ll also find my thoughts on putting together an effective epidemic sick room in the book, but also at and our YouTube Channel.

Joe Alton MD

Joe Alton MD

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