During the 1960s a band called the “Mothers of Invention” produced a song called, “It can’t happen here”. Among the places it couldn’t happen was Kansas. I suspect the Mothers had in mind the 1960s revolution of pot, psychedelics, and sex.
But I think of the song in a different light and this is in the shadow of the novel coronavirus (2019-nCoV). Currently we are reassured the virus is “over there” and no need to fret until it has a foothold on our continent. We are told that only a few cases have been detected, and in California, at least, the few cases were self-isolated until they were not.
But I am not reassured for multiple reasons.
First, the novel corona virus is extraordinarily infective with a currently calculated rate of transmission where one person infects an average of four or more*. Transmission is a power function of four. Assuming transmission occurs at this rate each day, after a slow start during the first few days, more than a million persons will be infected after 10 days, and more than 100 million persons after 15 days. Given this rapid rate of expansion, afflicted persons must be quickly sequestered or risk an entire population.
The application of a power function to estimate infections assumes no intervention, such as quarantine, and free interaction among population members. This does not occur in the real world because of neighborhood, geographical, physical, and social constraints, and so the rate of transmission is slowed. The more interaction is limited, the less transmission.
Second, transmission may occur through aerosol or surface contamination that enters through mouth, nose, or the eyes. That’s why hospital workers in Wuhan wear whole body suits with protection of face and eyes and follow strict protocols for decontamination.
Third, the live virus is detected in feces, so flushing a toilet in a bathroom may distribute the disease by aerosol transmission.
Fourth, persons may carry the virus and be infective to others for five or more days before showing any symptoms. The public health approach for screening MERS, SARS, H1N1, Ebola, and like pathogens by taking the temperature of potential carriers only works for carriers with a temperature. Novel coronavirus carriers may remain undetected.
Fifth, the mortality rate is currently estimated at roughly 2% of cases. The good news is that mortality is substantially lower than mortality for MERS, SARS, H1N1, and Ebola. The media commonly publishes the number of deaths from these infectious diseases alongside the number from the novel coronavirus. I believe the public finds it reassuring that the number of deaths and lethality is much less for the novel coronavirus than for the comparison pathogens. However, what the novel coronavirus lacks in lethality, it makes up for it by its transmissibility. Even with the lowball estimate of 2% mortality, if one third of Americans were to become infected, more than two million deaths would occur. In addition, approximately 20 percent of those infected would suffer serious complications that require hospitalization, without which the death rate would spiral upward. Twenty million or more Americans would need assistance. The hospital system does not have the beds or resources for such a scourge.
Sixth, the virus sometimes produces relatively minor symptoms, like those of a bad cold, for some persons. This seems like good news, but no, not really –afflicted persons may not realize that they have the novel coronavirus and return to work and social interaction. Thus, the disease becomes distributed more widely.
Seventh, the novel coronavirus constantly mutates, and new variations present new risks and complications. The virus may become less lethal or more lethal, as did the Spanish flu during the 1918-1919 epidemic.
What has happened in China can happen here. What has happened in China is that entire provinces have been isolated with restrictive travel, involuntary isolation, and standstill of industry and commerce with workers told not to report.
At present, sequestering and isolation are the only public health methods to restrain spread of the disease. China’s centralized decision-making and control permit this approach, and without doubt have greatly slowed the distribution of the disease. Imposition of strict controls may succeed for some countries, but other countries will find it impossible to restrain population movement. Restriction of movement for New York, Los Angeles, or Chicago, would be nearly impossible to enforce.
The virus is a wily enemy. The only strategy presently available to countries is to do all that is possible to screen and quarantine potential carriers to buy time. The time that is bought is precious to allow for testing and production of drugs and vaccines to counter its spread. Governments, corporations, non-profits, colleges, universities, and scientists from every country need to cooperate to make the control and eradication of the novel coronavirus an international priority. The novel coronavirus can happen here. Our well-being and the well-being of all peoples require our immediate attention, dedication, and mobilization to find a solution to this disease.
*Transmissibility estimates vary widely from roughly 2.25 to 4.28.