To Your Health With Dr. Jim Morrow: Episode 26, Novel Coronavirus

To Your Health With Dr. Jim Morrow: Episode 26:  Novel Coronavirus

On this edition of “To Your Health with Dr. Jim Morrow,” Dr. Morrow discusses the 2019 Novel Coronavirus (2019-nCoV), a potentially fatal respiratory virus which originated in Wuhan, China. “To Your Health” is brought to you by Morrow Family Medicine, which brings the CARE back to healthcare.

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

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The complete show archive of “To Your Health with Dr. Jim Morrow” addresses a wide range of health and wellness topics, and can be found at www.toyourhealthradio.com.

Dr. Morrow’s Show Notes

The 2019 Novel Coronavirus

• 2019 Novel Coronavirus (2019-nCoV) is a virus (more specifically, a coronavirus) identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China.
◦ Early on, many of the patients in the outbreak in Wuhan, China reportedly had some link to a large seafood and animal market, suggesting animal-to-person spread.
◦ However, a growing number of patients reportedly have not had exposure to animal markets, indicating person-to-person spread is occurring.
◦ At this time, it’s unclear how easily or sustainably this virus is spreading between people.

How It Spreads

• Much is unknown about how 2019-nCoV, a new coronavirus, spreads.
◦ Current knowledge is largely based on what is known about similar coronaviruses.
◦ Coronaviruses are a large family of viruses that are common in many different species of animals, including camels, cattle, cats, and bats.
◦ Rarely, animal coronaviruses can infect people and then spread between people such as with MERS, SARS, and now with 2019-nCoV.
• Most often, spread from person-to-person happens among close contacts (about 6 feet).
◦Person-to-person spread is thought to occur mainly via respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza and other respiratory pathogens spread.
◦ These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.
◦ It’s currently unclear if a person can get 2019-nCoV by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes.
• Typically, with most respiratory viruses, people are thought to be most contagious when they are most symptomatic (the sickest).
• It’s important to note that how easily a virus spreads person-to-person can vary.
◦ Some viruses are highly contagious (like measles), while other viruses are less so.
◦ There is much more to learn about the transmissibility, severity, and other features associated with 2019-nCoV and investigations are ongoing.
◦ While research has just begun, scientists have estimated that each person with the new coronavirus could infect somewhere between 1.5 and 3.5 people without effective containment measures.
 That would make the virus roughly as contagious as SARS, another coronavirus that circulated in China in 2003 and was contained after it sickened 8,098 people and killed 774.

◦ Respiratory viruses like these can travel through the air, enveloped in tiny droplets that are produced when a sick person breathes, talks, coughs or sneezes.
 These droplets fall to the ground within a few feet.
 That makes the virus harder to get than pathogens like measles, chickenpox and tuberculosis, which can travel a hundred feet through the air.
 But it is easier to catch than H.I.V. or hepatitis, which spread only through direct contact with the bodily fluids of an infected person.

How far viruses travel 

• Coronaviruses can travel only about six feet from the infected person. Itʼs unknown how long they live on surfaces.
• Some other viruses, like measles, can travel up to 100 feet and stay alive on surfaces for hours.
• If each person infected with the new coronavirus infects two to three others, that may be enough to sustain and accelerate an outbreak, if nothing is done to reduce it.
• Here’s how that works.
◦If 5 people with new coronavirus each infected 2.6 others … there could be 52 people sick after 3 cycles.
 Compare that with a less contagious virus, like the seasonal flu.
 People with the flu tend to infect 1.3 other individuals, on average.
 The difference may seem small, but the result is a striking contrast:
• Only about 45 people might be infected in the same scenario.
• But the transmission numbers of any disease aren’t set in stone.
◦They can be reduced by effective public health measures, such as isolating sick people and tracking individuals they’ve had contact with.
◦ When global health authorities methodically tracked and isolated people infected with SARS in 2003, they were able to bring the average number each sick person infected down to 0.4, enough to stop the outbreak.
• So far, the number of cases outside China has been small.
 But in recent days, cases have turned up in several countries, including the United States, with people who have not visited China.
 And the number of cases within China far surpassed the rate of new SARS cases in 2003

Symptoms and Complications

• For confirmed 2019-nCoV infections, reported illnesses have ranged from people with little to no symptoms to people being severely ill and dying.
◦ Symptoms can include:
 Fever
 Cough
 Shortness of breath
• CDC believes at this time that symptoms of 2019-nCoV may appear in as few as 2 days or as long as 14 after exposure.
◦ This is based on what has been seen previously as the incubation period of MERS viruses.

How deadly is the virus?

• Itʼs hard to know yet. But the fatality rate is probably less than 3 percent, much less than SARS.
◦ This is one of the most important factors in how damaging the outbreak will be, and one of the least understood.
◦It’s tough to assess the lethality of a new virus.
 The worst cases are usually detected first, which can skew our understanding of how likely patients are to die.
 About a third of the first 41 patients reported in Wuhan had to be treated in an I.C.U., many with symptoms of fever, severe cough, shortness of breath and pneumonia.
 But people with mild cases may never visit a doctor.
 So there may be more cases than we know, and the death rate may be lower than we initially thought.
• At the same time, deaths from the virus may be underreported.
◦The Chinese cities at the center of the outbreak face a shortage of testing kits and hospital beds, and many sick people have not been able to see a doctor.
• There’s still a lot of uncertainty about what this virus is like and what it is doing.
• Early indications suggest the fatality rate for this virus is considerably less than another coronavirus, MERS, which kills about 35 percent of people who become infected, and SARS, which kills about 10 percent.
◦ All of the diseases appear to latch on to proteins on the surface of lung cells, but MERS and SARS seem to be more destructive to lung tissue.
• Among 17,000 people who were infected in China,
◦ 82 percent had mild infections,
◦ 15 percent had severe symptoms and
◦ 3 percent were classified as critical,
◦Less than 2 percent of the people with confirmed infections had died.
◦ Many of those who died were older men with underlying health problems

• Pathogens can still be very dangerous even if their fatality rate is low
◦For instance, even though influenza has a case fatality rate below one per 1,000, roughly 200,000 people end up hospitalized with the virus each year in the United States, and about 35,000 people die.

Prevention and Treatment

• There is currently no vaccine to prevent 2019-nCoV infection.
◦The best way to prevent infection is to avoid being exposed to this virus.
 However, as a reminder, CDC always recommends everyday preventive actions to help prevent the spread of respiratory viruses, including:
• Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
◦ If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol.
 Always wash hands with soap and water if hands are visibly dirty.
◦ Avoid touching your eyes, nose, and mouth with unwashed hands.
◦ Avoid close contact with people who are sick.
◦ Stay home when you are sick.
◦ Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
◦ Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.

What Should the Public Do?
• While the immediate risk of this new virus to the American public is believed to be low at this time, everyone can do their part to help us respond to this emerging public health threat:
◦ It’s currently flu and respiratory disease season and CDC recommends getting a flu vaccine, taking everyday preventive actions to help stop the spread of germs, and taking flu antivirals if prescribed.
◦ If you are a healthcare provider, be on the look-out for people who recently traveled from China and have fever and respiratory symptoms.
◦ If you are a healthcare provider caring for a 2019-nCoV patient or a public health responder, please take care of yourself and follow recommended infection control procedures.
◦ For people who have had close contact with someone infected with 2019-nCoV who develop symptoms, contact your healthcare provider, and tell them about your symptoms and your exposure to a 2019-nCoV patient.

Recently Returned Travelers from China

• To slow the spread of 2019 novel coronavirus into the United States, CDC is working with public health partners to implement new travel procedures announced in a Presidential Proclamation on Novel Coronavirus
• In summary:
◦ Foreign nationals who have visited China in the past 14 days may not enter the United States.
◦ American citizens, lawful permanent residents, and their families who have been in China in the past 14 days will be allowed to enter the United States, but will be redirected to one of 11 airports to undergo health screening.
 Depending on their health and travel history, they will have some level of restrictions on their movements for 14 days from the time they left China.
• If you are a US citizen and are traveling to the United States:
◦ Your travel will be redirected to one of 11 U.S. airports where CDC has quarantine stations.
◦ You will be asked about your health and travel.
◦ Your health will be screened for fever, cough, or trouble breathing.
 Depending on your health and travel history:
• You will have some restrictions on your movement for a period of 14 days from the time you left China.
• These actions are being taken to protect your health, the health of other travelers and the health of U.S. communities from the new coronavirus that is spreading from person-to-person in parts of China.

• Travelers who have been in Hubei Province in the past 14 days:
◦ If you have fever, cough, or trouble breathing:
 CDC staff at the airport will evaluate you for illness.
• You will be taken to a medical facility for further evaluation and care.
• You will not be able to complete your travel itinerary.
◦ If you do not have symptoms (fever, cough, trouble breathing):
 You will be placed under a federal, state or local quarantine order for a 14-day period from the time you left China.
 You may not be able to complete your travel itinerary until the 14-day period has elapsed.
• Travelers from other parts of China (outside Hubei Province) in the last 14 days:
◦ If you have fever, cough, or trouble breathing:
 CDC staff at the airport will evaluate you for illness.
 You will be taken to a medical facility for further evaluation and care.
 You may not be able to complete your travel itinerary.
• If you do not have symptoms:
◦ You will be allowed to reach your final destination.
◦ After arrival at your final destination, you will be asked to monitor your health for a period of 14 days from the time you left China.
◦ You will receive a health information card that tells you what symptoms to look for and what to do if you develop symptoms.
◦ During that time, you should stay home and limit interactions with others as much as possible.
◦ Your state or local health department will contact you for further follow up.

How effective will the response be?

• The W.H.O. has praised Chinaʼs efforts, but critics fear lockdown measures may not be enough.
◦ In addition to closing off transportation, officials shut down a market in Wuhan selling live poultry, seafood and wild animals, which was thought to be the origin of the coronavirus, and later suspended the trade of wild animals nationwide.
◦ Schools have been closed, Beijing’s Great Wall is off limits and tourist packages from China have been halted.
◦ World Health Organization officials have praised China’s aggressive response to the virus.
• But the measures have also had unintended effects.
◦ Residents in Wuhan who are unwell must walk or cycle for miles to get to hospitals.
◦ There, many complain that they are being turned away because of shortages of hospital beds, staff and supplies that have been made worse by the lockdown.
• Until recently, researchers abroad were also concerned by the fact that China was not admitting experts who could help track the virus and prevent its spread.
◦ On Thursday, the W.H.O. declared the outbreak a global health emergency, acknowledging that the disease represents a risk beyond China.
◦ The United States and Australia are temporarily denying entry to noncitizens who recently traveled to China, and several major airlines said they expect to halt direct service to mainland China for months.
◦ Other countries — including Kazakhstan, Russia and Vietnam — have temporarily restricted travel and visas. But critics fear that these measures will not be enough.

How long will it take to develop a vaccine?

• A vaccine is still a year away — at minimum.
• A coronavirus vaccine could prevent infections and stop the spread of the disease.
◦ But vaccines take time.
• After the SARS outbreak in 2003, it took researchers about 20 months to get a vaccine ready for human trials.
◦ The vaccine was never needed, because the disease was eventually contained.
◦ By the Zika outbreak in 2015, researchers had brought the vaccine development timeline down to six months.
• Now, they hope that work from past outbreaks will help cut the timeline even further.
◦ Researchers have already studied the genome of the new coronavirus and found the proteins that are crucial for infection.
◦ Scientists from the National Institutes of Health, in Australia and at least three companies are working on vaccine candidates.

Prevention and Protection for Yourself

• CDC does not recommend travelers wear masks to protect themselves from the new coronavirus.
◦ You may choose to wear a mask, but it is more important that you take the following steps.
• We recommend that everyone follow everyday prevention practices:
◦ Avoid close contact with people who are sick.
◦ Avoid touching your eyes, nose, and mouth with unwashed hands.
◦ Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
◦ If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.
◦ Stay home when you are sick.
◦ Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
◦ Clean and disinfect frequently touched objects and surfaces using a regular household cleaning

Sources:  World Health Organization (https://www.who.int) and Center for Disease Control (https://www.cdc.gov)