A novel coronavirus outbreak was first documented in Wuhan, Hubei Province, China in December 2019. As of this writing, it has now been confirmed on six continents and in more than 100 countries. As the world’s health systems funnel resources into learning about, treating, and preventing infections in humans, new information is released daily. In this two-part article series, we will first provide some history on coronaviruses to put this disease outbreak in perspective, and discuss global health security and planning for pandemic response. Secondly, we will offer guidance from the best trusted sources for prevention and planning in the workplace and at home.
What are coronaviruses?
Coronaviruses are a large family of zoonotic viruses that cause illness ranging from the common cold to severe respiratory diseases. Zoonotic means these viruses are able to be transmitted from animals to humans. There are several coronaviruses known to be circulating in different animal populations that have not yet infected humans. COVID-19 is the most recent to make the jump to human infection.
Common signs of COVID-19 infection are similar to the common cold and include respiratory symptoms such as dry cough, fever, shortness of breath, and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure, and death.
The COVID-19 infection is spread from one person to others via droplets produced from the respiratory system of infected people, often during coughing or sneezing. According to current data, time from exposure to onset of symptoms is usually between two and 14 days, with an average of five days.
Recent coronavirus outbreak history
Two other recent coronavirus outbreaks have been experienced. Middle East Respiratory Syndrome (MERS-CoV) of 2012 was found to transmit from dromedary camels to humans. In 2002, Severe Acute Respiratory Syndrome (SARS-CoV) was found to transmit from civet cats to humans.
Although COVID-19 has already shown some similarities to recent coronavirus outbreaks, there are differences and we will learn much more as we deal with this one. SARS cases totaled 8,098 with a fatality rate of 11 percent as reported in 17 countries, with the majority of cases occurring in southern mainland China and Hong Kong. The fatality rate was highly dependent on the age of the patient with those under 24 least likely to die (one percent) and those over 65 most likely to die (55 percent). No cases have been reported worldwide since 2004.2
According to the World Health Organization (WHO), as of 2020, MERS cases total more than 2,500, have been reported in 21 countries, and resulted in about 860 deaths.3 The fatality rate may be much lower as those with mild symptoms are most likely undiagnosed. Only two cases have been confirmed in the United States, both in May of 2014 and both patients had recently traveled to Saudi Arabia. Most cases have occurred in the Arabian Peninsula. It is still unclear how the virus is transmitted from camels to humans. Its spread is uncommon outside of hospitals. Thus, its risk to the global population is currently deemed to be fairly low.4
Global Health Security
An international panel of experts undertook a comprehensive assessment and benchmarking of health security and response capabilities across 195 countries.5 The purpose of the project was to address risks from infectious disease outbreaks that could lead to international epidemics and pandemics and measure response capabilities for each nation. The hope was that the GHS Index would lead to quantifiable changes in national health security and improve international preparedness.
The GHS Index measured indicators across six broad categories:
- Prevention: Prevention of the emergence or release of pathogens.
- Detection and Reporting: Early detection and reporting for epidemics of potential international concern.
- Rapid Response: Rapid response to and mitigation of the spread of an epidemic.
- Health System: Sufficient and robust health system to treat the sick and protect health workers.
- Compliance with International Norms: Commitments to improving national capacity, financing plans to address gaps, and adhering to global norms.
- Risk Environment: Overall risk environment and country vulnerability to biological threats.The major GHS Index summary findings were:
- Although the United States scored an 83 out of 100 points, health security around the world is very weak and no country is adequately prepared for epidemics or pandemics. The average score was only 40.2 out of 100.
- Preparedness is very weak, and capacities have not been tested.
- Funding and budgets are inadequate.
- Training and coordination are lacking along with foundational health systems’ capacities for epidemic and pandemic response.
Unfortunately, the veracity of the GHS Index study is being borne out in real time with the COVID-19 outbreak the world is experiencing now. But there is no time to point fingers and say “I told you so.” We need to act, fast and furious.
At this writing, we are about three months into the COVID-19 outbreak. The WHO officially declared it a pandemic on March 11, 2020. Countries experiencing the greatest number of cases include China, Iran, Italy, and the Republic of Korea. Although the United States ranks eighth, currently, with under 2,000 confirmed cases, insufficient testing does not provide a clear and complete picture. Therefore, we need to take immediate and serious actions to: first, protect ourselves, family, loved ones, and others in our communities; and second, act to contain the spread by preparing our homes, workplaces, and businesses.
1 – Novel Coronavirus (COVID-19) Situation Dashboard, Centers for Disease Control and Prevention. https://experience.arcgis.com/experience/685d0ace521648f8a5beeeee1b9125cd
2- SARS (severe acute respiratory syndrome. NHS Choices. United Kingdom: National Health Service. 3 October 2014.
3 – Middle East respiratory syndrome coronavirus (MERS-CoV) – United Arab Emirates. World Health Organization. 31 January 2020.