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Epidemiologist Says Use Caution, Not Fear, In Approaching Coronavirus

Photo of people wearing surgical masks in a crowd.
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The World Health Organization pronounced the spread of the new coronavirus a public health emergency, though no cases have been confirmed in Utah.

The coronavirus that originated in Wuhan, China, now has more than 20,000 reported cases. Flights to China have been canceled, quarantines are in place and the outbreak has been declared a public health emergency by the World Health Organization.

To make sense of what this virus is and the risk to Utahns, KUER’s Caroline Ballard turned to Dr. Andrew Pavia, chief of the division of pediatric infectious diseases at the University of Utah, who has worked in pandemic preparedness for 25 years. 

This interview has been edited for length and clarity.

Caroline Ballard: How does a coronavirus differ from something like the flu?

Andrew Pavia: Coronaviruses are a big family of viruses that mainly infect animals. And the coronaviruses we deal with routinely are four types that cause pretty mild illness most of the time. 

Influenza is different in that it can rearrange itself and change dramatically, so that we know influenza will come around in different forms every year and periodically cause pandemics. 

With coronavirus, we didn't really have it on our radar until 2003 when SARS (Severe Acute Respiratory Syndrome) appeared and then again with MERS (Middle East Respiratory Syndrome). And after two shots across the bow, we knew that coronaviruses were something we had to think about.

CB: How is this coronavirus that originated in Wuhan, China, distinguished from things like SARS and MERS?

AP: What we really care about is the differences in how it's transmitted and what kind of disease it causes. In that regard, there's both good news and bad news. 

The good news is that SARS and MERS seem to cause much more severe disease. Up to a third of people get MERS die, and 9% or 10% of those who developed SARS died. And our current estimate with this coronavirus is at 2%, but we all feel that that's going to drop because we're only counting the more severe cases. That's the good news. 

The bad news is that SARS and MERS were not terribly well-transmitted. With SARS, most of the people who developed SARS were quite ill. And so you could spot them, get them in isolation and that was eventually what brought it under control. 

The difference here is that we are seeing, we think, a lot of mild to moderate illness with people who are walking around, probably not recognized as having the virus and transmitting it.

CB: Is the United States’ healthcare infrastructure prepared for a larger outbreak of a virus or illness?

AP: That's not a simple answer. We've done a lot of preparedness work really triggered in 2001 by the anthrax attacks. 

The [Wuhan coronavirus] virus was characterized very quickly. The Centers for Disease Control and Prevention was able to develop a diagnostic test in a matter, really, of days. People are sharing data around the world, and there are a number of pathways towards making a vaccine that we wouldn't have had a few years ago. 

On the other hand, we really are not prepared to deal with a large surge of ill people. Most of our hospitals operate pretty close to full capacity. Most of our ICUs are pretty close to full all the time and our supply chains are designed for just-in-time inventory. 

We do have other strategies that can help with that. One of the things that we can do is we can slow the arrival of the virus and slow the surge. 

CB: Putting this into perspective, there are only a handful of cases in the United States right now and no confirmed cases in Utah, either. But what does risk look like for people in the state?

AP: So right now, the risk to any individual Utahn is pretty close to zero. But that's today, and things are changing rapidly.

We should make sure that people listen carefully to what we know about the disease. This is not Ebola. This is not the Andromeda Strain. It's not going to kill tens of thousands or hundreds of thousands of Americans. 

Our best guess is that it's going to be a bad respiratory illness. It’s going to look like a very bad flu for which we don't yet have a vaccine.

CB: How can public health officials and hospital officials — people who are thinking about this potential outbreak and how to contain it — balance being prepared and cautious with being paranoid or hysterical?

AP: That's the million-dollar question. [What] you want to do is to communicate to people that it's potentially serious. We should pay attention. We should put work into preparing for this sort of thing, but that it's not catastrophic. It doesn't need blazing 18-point headlines about the next great plague. 

We've never been very good at sort of walking that line, and then we, as humans, aren't very good at assessing risk. So that no matter how good a job public health does, the problem is when as we hear it, we have generally two responses: Either ‘It's all a lot of baloney and hype’ or ‘Oh my God! I'm going to die.’ And both are inappropriate responses.

Caroline Ballard hosts All Things Considered at KUER. Follow them on Twitter @cballardnews

 

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