The following is a summary of the current status of the coronavirus outbreak (as of 2/20/20 AM).

Note: the World Health Organization has recently changed the specific virus name from 2019-nCoV to SARS-CoV-2 (“severe acute respiratory syndrome coronavirus 2”). The disease SARS-CoV-2 causes is now called “coronavirus disease 2019” (COVID-19).

  • SYMPTOMS: SARS-CoV-2 appears to cause fever and cough in nearly all cases of symptomatic COVID-19. Other symptoms are less common (diarrhea, nasal congestion, etc.) Chest x-ray usually shows pneumonia in both lungs (“bilateral pneumonia”).
  • TESTING: There is no commercially-available test for SARS-CoV-2 currently. Ill patients who are at high-risk for the disease are currently being tested at the Centers For Disease Control and Prevention. Testing at the state and local health department levels was planned to begin in mid-February but has been delayed due to test kit flaws. Please note: there are blood tests that office doctors may perform for other coronaviruses, but not yet SARS-CoV-2.
  • PREVENTION: There is no evidence, currently, that wearing masks during international travel (or during daily activities) is protective against the spread of the coronavirus (or other viral infections). Air leaks out from around the mask and your exposure risk is likely similar to not wearing the mask at all. Hand washing, on the other hand, is a more effective measure in preventing the spread of the disease.
  • CONTAGION: It is likely that people without symptoms or fever may be contagious, though researchers are not yet certain of this. One infected person is estimated to infect 2 to 3 other people, on average, during the course of his or her illness (“R0” = 2-3). Measles, one of the most contagious diseases on earth, has an R0 value of 12-18. Anything above a value of 1 can cause outbreaks or epidemics.
  • VIRUS SURVIVAL OUTSIDE HOST: It is unlikely the virus survives more than a few hours outside the body. Packages sent from abroad are therefore very unlikely to cause infection.
  • CASE DEFINITION: People who test positive for SARS-CoV-2 without having any symptoms are NOT counted as a “case” of COVID-19. This is due to inaccuracies of the test results when someone does not have symptoms. In China, “cases” are defined as having a positive test and pneumonia. Outside of China, fever + lung symptoms + a positive test = a “case.”
  • TOTAL CASES: There are over 74,000 cases diagnosed worldwide. Approximately 90% of cases are over age 30. It appears that only a small percentage of cases of COVID-19 are children.
  • CASES OUTSIDE CHINA: Several hundred cases have been diagnosed in countries outside of China. See: Updated list of affected countries
  • UNITED STATES CASES: There have been over a dozen cases diagnosed in the US. So far, there have been no confirmed cases in NYC.
  • SEVERE CASES: Around 2 cases in 10 have been classified as severe or critical disease. Most patients with severe disease are over age 60 or have significant chronic illnesses.
  • DEATHS: There have been over 2000 reported deaths due to coronavirus. Almost all deaths have occurred in China. Most deaths are in people over age 60. SARS-CoV-2 infection likely has a less than 2% (2 cases per hundred people) mortality rate. This has not yet been confirmed.
  • HEALTHCARE WORKER CASES: According to latest estimates, there are over 1,700 confirmed healthcare workers with COVID-19 in China. Healthcare workers treating patients suspected of having COVID-19 wear N-95 masks, goggles, face shields, gloves, protective foot coverings, and protective body suits.
  • TREATMENT: Antivirals to treat infection caused by SARS-CoV-2 are now under investigation in dozens of studies, mainly in China. Remdesivir has recently been shown to prevent MERS coronavirus in monkeys. (NIH Remdesivir Announcement 2/13/20). Favilavir has been approved for use in China. (Favilavir news).

The following map from the Centers For Disease Control and Prevention website shows the worldwide distribution of reported cases of SARS-CoV-2 as of 2/19/20 (Content source: WHO Coronavirus disease 2019 (COVID-19) situation report)

At our NYC Travel Clinic,  we are currently advising travelers to reschedule their trips to China and Hong Kong. The CDC recommends against all nonessential travel to China (warning level 3) but does not recommend altering travel to Hong Kong (warning level 1).  The United States and a number of other countries have now restricted entry from China. Some countries and airlines have begun restricting travel to and from Hong Kong. Anyone arriving here directly from China or who has traveled to China within the past two weeks and is not a US citizen or an immediate family member of a US citizen will be denied entry. Screening for fever and cough is ongoing at multiple airports worldwide.

At our clinic, we are not recommending wearing masks during international travel or during routine activities at this time. Again, there is no evidence this will help protect you against SARS-CoV-2.

Large cruise ships pose a particular issue for transmission, since they carry hundreds and sometimes thousands of passengers in close quarters and food is often served buffet-style. Particular attention to hand washing should be observed, regardless of cruise itinerary. Some cruise lines are barring travelers from China.

For more information regarding coronavirus, go to CDC Coronavirus Information.

Keep safe!

Julian Klapowitz, MD

By | 2020-02-20T22:41:03-05:00 January 26th, 2020|Disease, Outbreak, Travel Medicine|0 Comments

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