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[NEWS IN-DEPTH] Two months into coronavirus outbreak: Infection prevention, control…

February 12, 2020


now around the world and around the
clock scientists are trying to figure out what must be done to end the global
health emergency unleashed by the new coronavirus as the outbreak accelerates
and spreads dozens of countries have deployed increasingly stringent measures
to try to contain the epidemic now almost as quickly in a Herculean effort
an international network of researchers the data and wet labs have started
gathering and analyzing data to unmask and disarm this perplexing new disease
two months into the outbreak of running more than 1,000 people killed worldwide
north of 40 thousand infected and growing the topic of our news in depth
tonight with Alice chang-myung ten doctor of internal medicine and MS Medea
woman’s hospital Alice welcome to the program now with
governments declaring mass quarantines and travel bans in effort to stop or at
least slow the spread of the world’s newest novel coronavirus
many outbreak watchers including Chinese President ping and US president all
Trump have lost hope in a bit of circulating conventional wisdom the idea
that like the seasonal flu this new corona virus will peer out when warmer
weather you know arrives how likely is that well given the natural course of
other coronaviruses it’s actually quite likely that with the warmer spring
months we will see a decrease in the number of new cases however that’s not
the goal we don’t want the disease to peter out just to reoccur next year in
the winter what we want is eradication like we got with SARS we want this to be
the the last episode that we see and so it’s not just good enough that we see a
decreased number of cases with the spring months we want complete
eradication that should be the goal now so does this resemble the most a
seasonal flu or is it the SARS or even when the largest plagues in human
history the 1918 to 1944 just discussed so seasonal in
the mortality rate is usually on average less than 1% anywhere between 0.1
percent and 2 percent when it’s more fatal with SARS the mortality rate was
about 10 percent with mers-cov it was greater than 35 percent currently the
mortality rate for n Co V is hovering around 2 percent the infectivity however
the transmissibility seems to be quite high so seasonal influenza causes about
three hundred and ninety thousand deaths due to respiratory disease per year
around the world we certainly do not want to see those kinds of numbers with
n Co V now that we briefly discussed about this during the sooner but Chinese
health officials are conflicted as to whether this virus can spread airborne
of course the latest episode in Hong Kong where dozens of the residents in
one housing complex have had to be quarantined because the virus appeared
to spread through the building’s pipes that’s very concerning and disturbing
what is the possibility of this current of virus being airborne so we certainly
cannot rule it out in a hospital setting that’s something that we’re very
concerned about because of the close contact of medical personnel with
patients and the fact that we’re doing procedures in which patients could be
coughing and and a lot of viral particles can be airborne in a very
closed situation however in the community we do not consider aerosol
transmission to be a major source of transmission we still think that
respiratory droplets are the major mode of transmission for this virus in
addition to perhaps what we call fomites and fomites are when virus is expelled
from the body it gets on your hand or another object and then within a very
short period of time another person might touch the object and it could be
transmitted that way but aerosol transmission
cannot rule it out but I don’t think it’s a major mode of transmission
now simultaneously we’re also closely watching the rest of the world for any
large sustained outbreaks that might resemble Ground Zero in ohan as of
Monday the largest concentration of infectious patients in a single location
outside of mainland China more than 130 people is on a cruise ship on the
diamond princes quarantine at Japan’s Yokohama port now what do you believe is
happening inside the diamond princess I mean what do you recommend in terms of
prevention and control measures there so I remember hearing in an interview from
one of the passengers on the trip and this was at the very beginning of when
this was breaking and he remarked that the whole point of this cruise for many
passengers was to interact with many other guests and to make friends and
certainly that was what was going on before the outbreak was detected right
now they are practicing very strict quarantine measures all of the
passengers are asked to stay inside their staterooms
they are receiving twice daily symptom checkers anyone who does develop
symptoms they are being tested and escorted off the boat so they are taking
very strict but standard I think quarantine measures for what’s going on
on cruise ships regarding infectious diseases the story of a traveling
British businessman who appears to have passed the corona virus to a Britons in
at least three countries has prompted concerns over a super spreader I mean
who could play an outsize role in transmitting the infection what is a
super spreader and how do they change an outbreak so a super spreader is a person
who has the disease who spreads the disease to a large number of patients
and this was the case for MERS Kavi infections here in Korea but also in the
Middle East there’s a concept called Arnott which is
how many new patients an infected person will spread the disease to and right now
the thought is with encode visa are not is to point to a super spreader would be
someone who spreads the infection two three four five plus patients that’s
concerning I don’t think that that’s playing a major factor yet but it’s
something that epidemiologically now since you mentioned are not which is the
base of reproductive number of this virus
the earliest estimate showed that typically every person infected by the
new current of virus passes on to 2 to 2.5 others now is it too early to know
if global health measures have reduced the number to inner to below the
critical threshold of one yeah I think a few days ago was the first day that we
saw the number of new cases reported to drop less than three thousand but then
subsequent to that the number of new cases went right back up once they are
not gets to below one that’s when we’ve turned the corner and the number of new
cases starts to subside I don’t think we’ve hit that point yet and that point
would be the tipping point that many experts have either given a timeline of
mid to end of February – as far as April and May and we really don’t know as of
yet when that tipping point will be now along with getting aggressive on the
level of severity is perhaps a figuring out the susceptibility or who is at most
risk for infection the data so far indicates that this would include older
adults and those with underlying medical conditions there are fewer reports I’ve
seen that of children becoming infected are they just not showing symptoms are
they do you think immune to it could they be silent carriers I mean this all
boils down to you know should governments you know keep
remain keep the schools close – for the rest of school year and whatnot why are
children not so susceptible to this as opposed adults we don’t have any hard
data to explain the phenomenon of fewer children being diagnosed as having this
and Kobe certainly that is the case of all the positive confirmed cases so far
a very very small minority has happened in children in pediatric in the
pediatric population we’re not sure why that is it might be similar to the
hepatitis A virus in which case if an adult gets hepatitis A they become very
very sick and so they’re more likely to go to a hospital whereas if a child gets
hepatitis A it may just be like a cold and nobody would notice so perhaps
that’s the kind of characteristic that we’re seeing with an Co V but it’s still
too early to know we don’t have any hard scientific data to explain what we’re
seeing well certainly it is positive there we’re seeing less of children from
this virus now even as the outbreak appears to keep escalating we believe
that the rapid and sometimes you know jerk OD and measures taken by health
authorities and governments have made a dent in the transmission you know Hong
Kong’s leading Public Health epidemiologists have said that other
countries should even consider a China style quarantine or controlling measures
sounding is warning that you know in the end this virus will reach 60 percent of
the world population which is quite alarming so far South Korea has gone out
to take various measures of its own what is your assessment of it so far so we
have a total of 28 confirmed cases I think that that indicates to us that the
virus is not spreading in the community we don’t see widespread you know
positive cases in the community and to that degree that some sign of success
however we can do more I think the lag time from the onset of symptoms or the
suspicion of I might be sick too when the person is actually diagnosed that
lack time really needs to be shortened and I think also education and support
for self isolation we really need to let the patient know how you know you are a
high-risk patient you need to be at home stay at home and stay away from people
and that’s actually quite hard to do for 14 days it takes a lot of support and so
information and support to help patients do that adequately I think that really
needs to happen and if that if that occurs then I think we will continue to
see containment now what kind of symptoms should we be on the lookout for
I mean what should be you know hitting the alarm bells if I feel this if I feel
this way I should really isolate myself and stay at home which what is the
biggest difference between a common cold and and this so the most common symptoms
for an cofee have been fever shortness of breath and cough there have been less
common symptoms it is headache diarrhea muscle aches and fatigue so it’s very
nonspecific I think the key is travel history hmm
and it’s not just China now we’ve had positive cases from Singapore and from
Thailand you know Koreans who have visited those
those countries and so if there’s been travel history within the last 14 days
and you’re not feeling well the Korean government is making more and more
diagnostic kits available so I think it would be wise to get tested if you have
the suspicion now lost more at least a massive information online it’s even
gotten numb w-h-o 2/4 term info demmick on this corona virus and it’s fueling
concerns much more concerned than advice to perhaps among those younger
generation those in their early to high teens and prompting excessive worry even
to a certain extent xenophobic treatment of people from different places how do
you manage this communication or a psychological channel
right so miss information is in some respects more harmful than the disease
itself I think what the Korean government has done in terms of sending
a very strong message that people who deliberately spread misinformation that
they will be punished I think that’s important I think also sending a message
of compassion this is human suffering that’s going on
human lives are being lost just because it’s not happening in my backyard
doesn’t mean that it’s any less important and then I think lastly what
we need to do is instill a strong sense of responsibility because this is an
infectious disease what goes around comes around
and so just because it’s not in my immediate vicinity now doesn’t mean that
it can’t you know encroach into my personal space so I really need to do my
part and do what’s right and I think those three things will be helpful in
helping curb sort of what you said the psychological aspect of this right as
it’s the case in most crises if we all play our roles and remain on guard
I’m sure the chances are we will defeat this new coronavirus as well thank you
dr. Alice Tanner for your valuable insights tonight you’re welcome

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