Do you think the recent coronavirus outbreak in China will become an epidemic?

Mudassir Ali
Mar 04, 2020 11:08 AM 0 Answers
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Mudassir Ali
- Mar 04, 2020 11:08 AM

Do you think the recent coronavirus outbreak in China will become an epidemic?

The evidence on human-to-human transmission is very spotty. The first report was on January 15, when a husband-and-wife pair became infected. Husband worked at the wet market that was the origin of this Coronavirus. He got sick first. Wife fell sick a couple of days later. Wife swore she never went to the wet market. It could be human-to-human transmission, but it could also be that the husband brought something infected back home to share with his wife. So it was jotted down as a “maybe”.

Conclusive evidence of human-to-human transmission came on January 20, when 13 people in Guangdong province tested positive. 11 went to Wuhan / came from Wuhan. 2 never went there but were the spouses of those who went. So this was the first confirmation of human-to-human transmission in family clusters.

Same day, a dozen neurosurgeons and nurses operated on a scheduled open-cranial brain surgery on an elderly patient in Wuhan. Intubation and whatnot. Patient was asymptomatic before the surgery, developed a fever after. More neurosurgeons rushed in to figure out what happened. And then, tested positive for Coronavirus. Bam, practically everybody in the surgery theater, a dozen of them, all got it. So now you have evidence that medical staff are particularly vulnerable, because they are exposed to aerosol and they have to do those intubation stuff.

But then, you have that guy in Japan. Guy became feverish in Wuhan on 1/3. Took a 3-hour flight to Japan on 1/6. Admitted to the hospital on 1/10. Recovered and discharged on 1/15. Met with hundreds of people, and scooped up with ~ 300 people for a 3 hour flight. That was 2 weeks ago so the incubation period is well-past. Nobody else got it.

And what about the US case? 12+ hour flight from Wuhan to the US with 300+ people. Closed air circulation. Nobody else got it. Same with the case in South Korea and in Thailand.

Compare this with measles. You’ll get measles if you just walk through a room where there was a measles patient who left the room 20 minutes before you come in. Or the seasonal flu. One kid gets it in class, half of the class goes down with him.

Back to China. Almost all positive cases are either in Wuhan, or on people who went to / came from Wuhan. To me, this specificity to Wuhan is an indication that this viral pneumonia is not very contagious, at least so far, because Wuhan is a major transit hub with a quarter million people going in-and-out DAILY. If this is very contagious, you’d have secondary centers of infection all over the place by now. But nothing so far. The Chinese authority just announced that the whole city of 10 million people are under quarantine. This maybe the best thing to do. Average incubation time for this virus is 7 days. Say you want to be on the safe side and call it 14 days. Say you have some”leakage” and double that. Some secondary but no third or fourth generation. Give it a month, you’ll be able to chute all infected individuals to isolation/treatment and clear the rest. Do this on 10 million people will be challenging, but a country like China, with its massive infrastructure and medical / public health resources, it’s manageable.

Right now, we just don’t have enough information right now to come to a conclusion. If human-to-human transmission is so inefficient, how did all these cases come about? Are people still eating wild bat soup or something (i.e., active source in Wuhan)? Also how fast is the virus mutating in human hosts

Mudassir Ali
- Mar 04, 2020 11:08 AM

The definition of “epidemic” is an unusual/unexpected increase in the number of cases of a particular disease. The definition of “outbreak” is very similar. The two used to be synonymous. “Outbreak” was considered less threatening than “epidemic” and was the preferred term in communicating with the public. In the last several decades (since I finished school), the two have been differentiated on the basis of scale – usually geographic. However there is no specific criteria and, like beauty, it is in the eye of the beholder.

I doubt any government agency will refer to the situation as an epidemic any time soon. There is certainly no reason refer to the few imported cases in the U.S. as an epidemic since infection took place elsewhere. Although many Chinese public health officials were trained or worked in the U.S., I don’t know that they use these terms or make the distinction. If this were happening in the U.S., it would probably be called an “outbreak” in communications but public health officials would be thinking “epidemic”. I know I did just that on occasion

Truth is it is a rather meaningless distinction, of significance mostly to the lay audience. I viewed things as: green light – business as usual – the usual flow of endemic cases with possibly a few late cases from a previous emergency that is dying out, you go home at the regular time and plan for the weekend; yellow light – something may be going on, a small blip in cases, an unconfirmed report of something unusual – sort of transient state that requires attention, you put some routine work on the back burner, maybe stay a bit late, make a few calls to local health care providers or neighboring health departments or send someone around to check things out. – it may go back to green or move on to the next stage; that is red light – the shit has hit the fan, people are getting sick and it is definitely unexpected, you work really late, (I know folks who have done double all-nighters – 72 hrs straight – RedBull, energy drinks and possibly something available only by prescription ), weekdays and weekend days are all the same, you move people in to help, and go into emergency mode. A few people die and you kick it up even more, When you finally do get to bed, you lay there thinking if there is something you missed or should have done until you fall asleep due to exhaustion. You wake up a few hours later, kiss the wife goodbye (if you lucky enough to go home that night – otherwise you sleep at your desk), get dressed and go back to work. You are so busy that whether the problem is an outbreak or an epidemic is the furthest thing from your mind. You did not create this mess but it is your job to clean it up.

The public health system in the U.S. and most developed countries are on yellow light right now and taking steps to keep from going into red. However, they are working like it has already.

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