The Coronavirus: Informing Public Policy

The policy-informing facts about the coronavirus are now becoming clear.  We know the virus has been seen before in the SARS-CoV virus 2003 and MERS-CoV virus 2012.  Both of these produced entirely different results from COVID-19.  The 2003 SARS has shown 8,437 confirmed cases and 9.63% death rate; MERS produced only 2,499 confirmed cases and 34.45% death rate.  COVID-19 so far has reached 94,718 confirmed cases and 3.46% confirmed death rate.  It is likely the confirmed death rate will decline for two reasons.  There are a lot of suspected COVID-19 cases that have not been confirmed, and the death rate of latest confirmed cases indicates more timely treatment from the period of initial outbreak has lowered the death rate. 

Forget the comparisons. COVID-19 is different.  It travels much more quickly.  Nearly all cases come from micro-droplets from speech or sneezes that land on another person’s face.  Bare skin can keep the virus alive for maybe a week or more if not washed off. The virus does not survive long in the air or on surfaces such as paper and clothing.  It can last much longer on metal and plastic smooth objects:  door handles, escalator and stair banisters, shopping cart handles and the like.  Survival a little more than a week is possible.  A person that has not contracted COVID-19 will not be kept clean by wearing a face mask as the space around the nose and mouth is too loose to prevent sucking in air having micro-droplets of virus.  Face masks SHOULD be worn by persons testing positive for the virus; the purpose is to contain the carrier’s virus from reaching others.  

The incubation period of COVID-19 is so broad as to be useless information.  Officially it is from one to fourteen days between contact and first symptoms, but probably five or six will apply in a majority of circumstances.  In China, the official WHO report as of February 20 shows findings as follows.  

Transmission is largely occurring in families.  344 clusters of households were separately studied and produced from 78% to 85% confirmed transmissions among 1836 persons.  The overall transmission number was 1308 cases.  So far, COVID-19 is a uniquely new pathogen, with no pre-existing immunity in humans.  Symptoms in rank order are:  fever (87.9%), dry cough, fatigue, sputum production, shortness of breath, sore throat, headache (16.6%),

Highest risk individualsare over 60 years with underlying conditions, such as hypertension diabetes, cardiovascular, COPD and cancer. Children appear to be relatively rare cases with mild reaction.  2.4% of cases of those aged under 19 years, and 2.5% developed severe cases. Mortality increases with age, and is over 20% at age 80 and over.

Following is from the Summation of The WHO  Report. “China executed a bold approach early. On the first day of implementation there were 2478 newly confirmed cases of COVID-19 reported in China.  Two weeks later, on the final day of the WHO Mission there were 409 newly confirmed cases.  This decline is real across China.  The mission response was entirely non-pharmaceutical, a unique and unprecedented public health response.  

“Much of the global community is not yet ready, in mindset and materially, to implement the measures that have been employed to contain COVID-19 in China. These are the only measures that are currently proven to interrupt or minimize transmission chains in humans. Fundamental to these measures is extremely proactive surveillance to immediately detect cases, very rapid diagnosis and immediate case isolation, rigorous tracking and quarantine of close contacts, and an exceptionally high degree of population understanding and acceptance of these measures. 

Achieving the high quality of implementation needed to be successful with such measures requires an unusual and unprecedented speed of decision-making by top leaders, operational thoroughness by public health systems, and engagement of society.”  

A majority of the information in this essay was obtained from the Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19).  As of February 20, the schools are open and sports, theaters and other elements of community life have restarted in China.  The starting point was December 30, 2019 when a patient with pneumonia of unknown etiology was ultimately found to have died from COVID-19.                                                                                             March 6, 2020