As with MERS, SARS, and the Avian and Swine Flus before it, there is a certain amount of media hype attached to coronavirus at the moment that’s hard to disentangle from reality.

What is certain is that with the tens of thousands of confirmed cases, we can get a realistic and quite accurate picture of the case fatality rate, which at the moment appears to be around 1.5%-3.2%. The Journal of the American Medical Association (JAMA) reported 24Feb20 that the estimated Case Fatality Rate (CFR) was 2.3%, from a sample of 72,314 cases. Out of this large patient pool, what has been gleaned is that 81% of the cases were mild (meaning they didn’t result in pneumonia or mild pneumonia), 14% were classified as severe (including significant breathing problems), and 5% were critical (respiratory failure, septic shock, and/or multiple organ failure). When compared against the data we have for SARS and MERS, COVID-19 seems to be more highly transmissible, but less lethal by 5-10x. (SARS had a CFR of 9.6%; MERS has a CFR of 34.4% – compared again with coronavirus-19’s CFR of 2.3%). (see Figure 1)

Coronaviruses aren’t unprecedented, nor particularly novel. In any given year, about 10% of the seasonal colds that bring patients in to clinics and hospitals are attributed to coronaviruses. We also don’t have any evidence to suggest that typical sanitation methods will be insufficient to eliminate coronavirus COVID-19 (proper handwashing, surface disinfectants that are rated effective against coronaviridae, etc.). At the moment of publication, there have been 14 cases of the virus diagnosed in the U.S., and each case involved a patient who had recently traveled to China. Another 39 patients from the U.S. have been infected in other countries and have been quarantined and returned to the U.S. Each country across the globe is working to keep the risk of infiltration contained, and is doing so in deference to regional and international health agencies to keep up with the latest data and information to limit the exposure and spread of this virus.

What’s In A Name?
This new coronavirus has transmuted not only in through genetic shifting and drifting into a discrete new pathogen, but also in name: What began as ‘novel coronavirus’ became 2019-nCoV (for the year designated, “n” for novel, and Corona Virus; and now has settled into its moniker of “COVID-19,” which is shorthand for ‘coronavirus disease’ deriving in 2019. COVID-19 refers to the disease, and the virus itself which causes the disease is officially known as ‘severe acute respiratory syndrome coronavirus 2’ (SARS-CoV-2). This is not unprecedented nomenclature. In fact, it’s very precedented: diseases (such as measles) carry different names from their causative viruses (rubeola, in the case of measles). Diseases are named by the WHO’s International Classification of Diseases (ICD), and viruses are named by the International Committee on Taxonomy of Viruses (ICTV). Both COVID-19 and SARS-CoV-2 were officially named 11Feb20 (14 days prior to the publication of this article). The reason the virus shares the name “SARS” is because it is comparatively closely related, genetically, with the virus which caused the SARS outbreak in 2003.

Now, we are seeing that global markets are being impacted as China has been swept up in the panic, and their importation/exportation has vacillated wildly over the past few weeks. U.S. Dow Jones Industrial Average has summarily responded abruptly and unfavorably based on speculative trading fears and a never-ending news cycle.

In the 5-day run time series shown in Figure 2, the volume lost is about 2,500 points. In the U.S. and China, we have seen signals pertaining to alterations in supply chains, distribution networks, and manufacturing blips. This is likely to extend to pharmaceutical manufacturing and distribution soon, though we can get out ahead of it to limit its overall impact and risk to the patient population. It’s a difficult situation to be in within the industry when we can foresee upcoming disruptions – but good, reliable solutions are elusive. Only for the sake of optics does a pandemic response like this have any impact.

After all, one infected person coughing in proximity to any of this display of futility will re-contaminate all nearby surfaces and the volume of air aspirated by others.


Disease X
This COVID-19 strain, while not yet occupying the formal label of ‘pandemic,’ is indeed suitable to be categorized as ‘Disease X’ – which is a WHO list for prioritization of diseases and emergency responses. Though this sounds fairly terrifying, it was originally intended as a label for emerging diseases of global concern. It works like this: There are several ‘usual suspects’ on this list, including Ebola and Marburg virus diseases, Zika, and others. The “Disease X” term was just meant as a placeholder for those as-yet unseen, but anticipated, emergent pathogens.

In a nod to public opinion apparently being more valuable than science, the WHO has the following to say as to how they reference the coronavirus-19 illness:

“From a risk communications perspective, using the name SARS can have unintended consequences in terms of creating unnecessary fear for some populations…For that reason and others, WHO has begun referring to the virus as “the virus responsible for COVID-19” or “the COVID-19 virus” when communicating with the public.”²

This is not so different from several decades ago, when the public was so afraid of cancer, that there were hysterics and superstition even associating its name—so much so that large proportions of the public would only refer to it as ‘The Big ‘C’.’

We need to continue to use science, logic, and reason to staunch the spread of this—and other inevitably upcoming outbreaks. Regarding the belief in the coronavirus contrasted against the lack of belief in vaccinology, science personality Neil deGrasse Tyson recently tweeted, “I wonder what anti-vaxers would say to a Corona Virus vaccine.”

We’ve had a buzz of activity among vaccine circles in the past couple months, not only keeping up with seasonal influenza and choosing the strains for next year’s vaccine, but in looking at the nuances and difficulties in rapid response for a coronavirus vaccine. Understanding and working together to solve extant and novel diseases is what we owe to the public—even if we have perceptual and philosophical barriers to overcome (e.g., with anti-vaxxers).

Be careful out there. Limit exposure when possible. Stay away from others when febrile or ill.

Prevention still beats correction. 

Reference

1. Wu, Z. & McGoogan, J.M. (2020). Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. Journal of the American Medical Association.
2. World Health Organization. (2020). Naming the coronavirus disease (COVID-2019) and the virus that causes it. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it

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Ben Locwin
Contributing Editor
A healthcare executive, he has worked on vaccine and virology advisory boards, and has been featured recently across media outlets and podcasts discussing coronavirus and its potential or likely impact to public health and world economies.