Since the outbreak of Covid-19 Coronavirus have spread into a global threat, the world has enforced travel bans, quarantined millions, and isolated sick people to dealing with the stoppage of the virus. Recently, since Sunday, 78,000 cases have been reported in 29 countries with surges of people reporting sickness in Italy, Iran, and South Korea, along with an outbreak on a Japan cruise ship. Chances are higher that we are hurdling into a pandemic, which is this disease spreading around the world than just a week ago.
World Health Organization Director General Tedros Adhanom Ghebreyesus on Friday, stated, “Our window of opportunity [for containing the virus] is a narrowing so we need to act quickly before it closes completely.” Other health experts say new developments indicate that the containment of this virus in a low-resource setting might not be even possible anymore. “When several countries have widespread transmission, then spillover to other countries is inevitable. One cannot shut out the rest of the world,” said Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases. Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, notes, “I don’t think the answer is shutting down the world to stop this virus. It’s already out.” Since the complete stoppage of the virus is virtually impossible, health officials will have to move to the next phase to deal with it.
Lawrence Gostin, a global health law professor at Georgetown University, said, “We are at a turning point in the Covid-19 epidemic. We must prepare for the foreseeable possibility, even probability, that Covid-19 may soon become a pandemic affecting countries on virtually all continents.” As of February 23, the virus has been reported in more than 1,800 cases outside of China in 29 countries. It’s an increase of 500 cases from a week ago. Most of these new cases occur in people who haven’t traveled to China or is from an unknown source. The virus has been spread in places such as a cruise ship and prisons, spreading like wildfire, contagious and with no way to stop it.
Japan’s Diamond Princess cruise ship had to quarantine 3,600 passengers and crew after a 80 year-old man was discovered to be infected with the virus; currently it has an ongoing outbreak and has reported 634 cases—the largest outbreak outside of China. Japan’s authorities tried to contain it through quarantine but it backfired. David Fisman, University of Toronto epidemiology professor, said, “They’ve basically trapped a bunch of people in a large container with [the] virus.” Experts and health officials firmly believe that the lack of following quarantine protocols along with the highly contagiousness of the disease generated more cases of people being infected with the virus. By Feb. 18, people on the ship who tested negative were allowed to go home. On another cruise ship in Asia, the Westerdam cruise ship had dropped off a Malaysian woman, who in turn, tested positive for the virus. Again, there was a global search for all the passengers.
In other countries, there have been cases of the virus as well. South Korea has the largest reports of cases, 602 since Sunday—up 30 from Monday. Many of them are associated with a religious group belonging to the Shincheonji Church of Christ, located in Daegu. Their president, Moon Jae-In, said, “This will be a momentous time when the central government, local governments, health officials, and medical personnel and the entire people must wage an all-out, concerted response to the problem,” to the New York Times. Since Sunday, Iran has reported 28 cases, including five deaths. Cases associated with Iran has also turned up in Canada and Lebanon. The country quickly changed its story on the virus and closed down schools and universities along with some cinemas and theaters, according to Al Jazeera. Sylvie Briand, the director of infectious hazard management at the WHO, stated: “We are wondering about the potential for more cases to be exported in the coming days. We want all countries to be aware of this and to put in place detailed measures to pick up these cases as early as possible.” Osterholm critically noted that if the Covid-19 case fatality is only 2%, then it is very likely there are a few hundred more cases. Italy is the largest outbreak outside Asia with 132 cases, of which there was 2 deaths. The authorities imposed severe measures and canceled all sporting, religious, and cultural events, along with university classes. They also fined people who left or entered 11 cities in the Lombardy region, where outbreaks occurred.
Because of the developments outside China along with the latest information on the virus, it suggests that there will be a rapid rise in infections in China and around the world.
Covid-19 is highly contagious and probably has an incubation period where people infected don’t know that they are and continue to interact infecting 2 or 3 more people before they actually test positive for it—it is also more contagious than other Coronaviruses like SARS and MERS.
Stephen Morse, professor of epidemiology at Columbia University Mailman School of Public Health, told Vox, “For a virus pretty closely related to SARS, it shows very effective person-to-person transmission, something nobody really expected.” It is really evident and apparent at the outbreaks on cruise ships and Chinese prisons. At the same time, scientific studies show that the transmission of the virus is flu-like. Osterholm says, “trying to stop influenza-like transmissions is like trying to stop the wind. It’s virtually impossible” and “Containment never had a chance because of the influenza-virus-like transmission.”
Countries are mainly looking at people who travel from China. For the most part, people who are screened come from China or the Hubei Province. With all the recent events, the spread of the virus goes far beyond these types of people.
‘ “We don’t really know if there is community transmission going in other parts of the world because for the most part countries are not doing diagnostic testing on anyone but returning travelers or their close contacts, Tom Inglesby, director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health, told Vox. ‘ Although the US Centers for Disease Control and Prevention believes that the risk of the virus spreading in the US is low, they are changing perspective now and testing others who aren’t coming from China. They will use the national flue surveillance tracking infrastructure to test people who have flu symptoms across five US cities.
It takes time to determine causes and the individuals infected and the ways transmitted. Symptoms of Coronavirus are flu like and resemble viral illnesses. In cases where people think they have the flu, it might not even cross the doctors’ mind that there is the possibility of the Coronavirus, especially the ones who haven’t gone to China.
China very likely will see more cases as travel band and restrictions are lifted. They have taken drastic measures like quarantining millions and shutting down transit and travel. However, the business community has grown frustrated with the shutdowns and restrictions and is pressuring government to stop the restrictions. Osterholm: “[It’s] the most intense human social distancing effort in modern public health. What happens when all these people start to go back to work, and public transport is back, and crowing occurs? This is at best a temporary respite in the numbers of China.”
The response has been slow; many countries have only started to start testing. Even the US, with a highly-resourced health system, doesn’t have the capacity or the knowledge to deal with this pandemic. Last week, Africa finally had two of their countries, Senegal and South Africa, be able to have the lab capacity to screen and test this virus. Other countries are preparing for this global epidemic, but Africa has been thought of being a high risk to it since of its economic ties to the Chinese, with more than a million Chinese workers. Gostin says, “If the disease spreads to fragile states it would be even harder to contain. Many states are undergoing political violence or are poorly governed, such as Syria, the Democratic Republic of the Congo, Yemen, and Afghanistan. Others have weak health systems, for example in sub-Saharan Africa.”
Symptoms include abdominal pain before respiratory symptoms and that’s not what health officials are looking for. Even though it has respiratory infections, it’s been noted that abdominal symptoms like discomfort usually comes as a sign first. William Schaffner, an infectious disease expert at Vanderbilt University, says, “we may not be detecting cases that do not present in the classic way with fever and respiratory symptoms.” Models indicate that there are thousands of cases still not detected. From the imperial College London, approximates “two thirds of Covid-19 cases exported from mainland China have remained undetected worldwide, potentially resulting in multiple chains of as yet undetected human-to-human transmission outside mainland China”.
Diseases can spread far and wide. The current knowledge does not include the exact death rate and the lethalness of the disease. China’s CDC came out with a report with 72,314 patients having been infected with the Coronavirus in mainland China. Overall cases confirmed a 2.3 percent death rate and isn’t as deadly as SARS; however, the death toll among the elderly were much higher. It seems as the more cases are coming into the light, the death rate will drop, but Osterholm warns, “A 2 percent case fatality rate is 20 times higher than a bad flu year. So now, you can infect many more people than the flu and add a case fatality that is as much as 20 times higher.” (Seasonal flu death rare is 0.1 percent.)
Furthermore, even a solid health system can still be overwhelmed since the current data and analysis from China indicates 5 to 10 percent of patients need care in the ICU. Many countries don’t have the sources like beds and medical equipment to do their jobs properly and these potentially cost in the billions. Health experts advise that the containment of this virus is no longer possible and what should happen next is to reducing its transmission from spreading, and caring the sick. In preparation for this pandemic, hospitals need to follow Covid-19 protocols—health workers protected with protective equipment and face masks and countries need to implement instructions and policies on supply chains and travel/trade. Those with high-income economies like Germany, France, and the UK with strong public health systems are able to manage well and reduce to control the virus spread. However, even with that and the epidemic growing stronger around the world, even high-income countries will struggle. Osterholm: “I think we have to expect there are going to be many locations around the world that will experience what China is experiencing.”