Our Experts Respond to the Coronavirus Outbreak
Last week, as the Wuhan coronavirus outbreak spread rapidly across borders, the World Health Organization declared a global health emergency. As of February 4, upwards of 20,000 people have been infected in more than two dozen countries, and 427 have died, most of them in China.
As the outbreak intensifies, faculty experts at Columbia University Mailman School of Public Health have been working to understand and respond to its spread. Through numerous interviews with news media, they have informed the public and quelled fears.
Ian Lipkin, director of the Center for Infection and Immunity (CII) at Columbia Mailman School, has just returned from China where he has been advising the Chinese Center for Disease Control and Prevention and preparing a formal report for the government. He was in Guangzhou and Bejing and spoke with health officials who have worked on the outbreak in Wuhan. (He himself couldn’t visit Wuhan due to U.S. travel restrictions.) Among those Lipkin met with was Zhong Nanshan, an epidemiologist and pulmonologist who discovered SARS in 2003 and is today the lead advisor for the ongoing outbreak. The two men worked together during the SARS outbreak.
Lipkin learned that Chinese labs are falling behind in processing samples due to the rapid rise in suspected cases. The result, he said, is a situation that might produce false-positive results, inflating the count. “You can’t possibly do quality control at that rate,” he told the New York Times. Moreover, current tests are insufficient for guiding outbreak response.
“Most of our focus now is on developing diagnostic tests that can be used to determine who should be isolated, how long they should be isolated, and decisions about drugs and antibodies that can be used even now to reduce morbidity and mortality.”
— Ian Lipkin, director of the Center for Infection and Immunity
“Most of our focus now is on developing diagnostic tests that can be used to determine who should be isolated, how long they should be isolated, and decisions about drugs and antibodies that can be used even now to reduce morbidity and mortality,” Lipkin told Chinese television in an interview at the Columbia Global Center in Beijing. An antibody test, which could be available as soon as two to three weeks, will be able to detect not just people with an active infection, but those who were infected previously. CII is currently developing diagnostic tests for Wuhan coronavirus (they are not working with biological specimens of the virus).
No drug has been approved to treat Wuhan coronavirus infection. A vaccine will take six months to a year—long enough that the worst of the outbreak could be over, Lipkin said.
Comparing the new outbreak to the 2003 SARS outbreak, he says the science has made significant strides. Diagnostic advances allowed the Wuhan coronavirus—formally known as 2019-nCoV—to be identified much more quickly than was SARS. While the new coronavirus is spreading more rapidly than SARS, Lipkin believes that most cases are mild or asymptomatic—an assertion supported by new research by his Columbia Mailman colleague Jeffrey Shaman.
Understanding the Spread of the Outbreak
In a paper published online in medRxiv, a preprint server for health sciences, Shaman, who is professor of environmental health sciences and an infectious disease forecasting expert, presents an analysis of seasonal coronavirus infections. (There are four coronaviruses that at present continually circulate in humans and tend to be most prevalent in winter. They are distinct from SARS, MERS, and the Wuhan nCoV.) He and his co-author found that the majority of seasonal coronavirus infections are asymptomatic by most symptom definitions and that only 4 percent of individuals experiencing a seasonal coronavirus infection episode sought medical care for their symptoms. “These numbers indicate that a very high percentage of seasonal coronavirus infections are undocumented and provide a reference for understanding the spread of the emergent [Wuhan coronavirus outbreak],” they write.
Shaman and colleagues are currently working on a second paper in which they use a computer model to simulate the Wuhan coronavirus outbreak and estimate its epidemiological characteristics.
“Attention must be given to every element in the health system. One weakness in these interrelated components, whether locally or globally, dooms the response and jeopardizes the health and wellbeing of people.”
— Wafaa El-Sadr, director of ICAP at Columbia
One wildcard variable potentially contributing to the outbreak’s spread is elevated levels of air pollution, according to Peter Muennig, professor of health policy and management. In a letter to the New York Times, he says that airborne particulates “are small enough to pass through the lung and enter the bloodstream, causing damage to the immune system as well as other organ systems, such as the lungs.”
Most important, however, is the resiliency of clinical and public health infrastructure. Fast-moving outbreaks invariably stress health systems at every level. In Wuhan, laboratories are having a hard time keeping up with the demand for testing and hospital beds are in short supply (the city built a large hospital in under two weeks). As the outbreak spreads to less-developed countries, their public health experts are concerned that their health systems will be less able to treat patients and prevent the outbreak’s spread.“Health systems are the linchpin,” says Wafaa El-Sadr, director of ICAP at Columbia. “Attention must be given to every element in the health system. One weakness in these interrelated components, whether locally or globally, dooms the response and jeopardizes the health and wellbeing of people.”
El-Sadr was among Columbia Mailman faculty participating in a February 14 forum about the outbreak. Other faculty participating included Bob Fullilove, Jessica Justman, Julie Kornfeld, Nischay Mishra, and Wan Yang. (Click here to watch the seminar.)
Fear and Xenophobia
So far, there are 11 confirmed cases of Wuhan coronavirus in the United States; there are three suspected cases in New York City. But New Yorkers should not be alarmed, said Stephen Morse, a professor of epidemiology, since the risk of infection is minimal. “There’s no need to panic,” he told the Wall Street Journal. Those who canceled local Chinese New Year events were being prudent, he said, “especially because people will feel safer and enjoy it more later on. But it may not be essential.”
Many people in China—and some in New York, too—are choosing to wear surgical masks, although there is little high-quality scientific research to gauge the effectiveness of masks and the results are mixed, Morse told Columbia News. “Some studies suggest they may provide some benefit, but what’s out there isn’t conclusive,” he said. The best evidence suggests that face masks catch the bacteria shed in liquid droplets, splashes or sprays, and virus-containing droplets, but are less effective in filtering out fine viral particles in the air.
Irwin Redler, founder and director of the National Center for Disaster Preparedness, has also been widely quoted in the news media. Redlener, who is a professor in Health Policy and Management and Pediatrics (in the Earth Institute), has provided expertise on the national, state, and local outbreak response, and what people can do to protect themselves.
Fears over the Wuhan outbreak have also provoked irrational and hurtful behavior. As one example, some New Yorkers have decided to stop eating Chinese food. While having zero effect on their risk for contracting the coronavirus, this sort of personal boycott stigmatizes Chinese people. Xenophobia could be another side effect of the illness, Robert Fullilove, associate dean for minority and community affairs, told NBC News. And misinformation spreads faster than ever through social media and word of mouth. “I am tempted to predict that xenophobia will rise in significance to precisely the degree to which our sources of information—all of them, not just media—give us stuff to panic about.”