by Richard Kessin

Of the scourges that the natural world can throw at us, a new and lethal virus is one of the most frightening.  At first we don’t know where the virus came from, what proportion of victims it will kill, how to treat it, or how far and fast it will spread. Viral epidemics seem apocalyptic and the first response is often fear, or worse, panic.  We are now in the fear stage for Wuhan coronavirus.

In 2002, the SARS virus (Severe Acute Respiratory Syndrome) epidemic was kept secret for months by Chinese authorities, giving it time to spread within China and abroad. SARS was also a coronavirus. Eventually, quarantine and public health measures suppressed it, but not before 800 people died of about 8000 diagnosed patients.  

The physician Dr. Li Wenliang, who first noticed the “pneumonia of unknown origin cases” caused by the Covid-19 coronavirus was threatened by the police in Wuhan for spreading rumors and forced to sign a confession. Time was lost, but Chinese authorities changed their approach and have been more open in efforts to study and contain the virus, perhaps realizing their mistake with SARS.  The infection has spread from Wuhan in Hubei Province, carried by people going home for the Chinese New Year. The efforts to contain the virus now depend on isolation at home and new hospitals. The response is the biggest quarantine in memory. The effect on morale, economic production and supply chains is enormous.  

Early in the infection, Chinese physicians described the treatment of the first 99 patients in Wuhan in The Lancet, a British medical journal.  Half of the patients worked in a live animal food market that was the immediate source of the epidemic, but not the original source of Covid-19, which has been traced to caves with large bat populations.  This virus is not a laboratory creation. 

Eleven of the original 99 Wuhan patients died despite great efforts to save them; most were older or smokers or had other health problems. The remaining patients have either recovered or were no longer critical at the time of the Lancet report around Jan. 30.  The virus appears to be most lethal to older people, but it has also taken a toll on medical staff, including Dr. Li Wenliang, who died in early February, aged 34.

At the beginning there was hope that human-to-human transmission would not occur, but it has. The Covid-19 virus is not as communicable as measles, or as lethal as Ebola but the statistics are nonetheless daunting. The virus has spread to most Chinese provinces and to 31 countries.  As of Feb. 4, 2020, there were 24,391 confirmed cases and 479 deaths, almost all in China. There were 1015 confirmed recoveries. By February 24 there were about 77,000 cases reported in China and several thousand deaths. The Chinese authorities are reporting a daily decline in the number of cases, but these are tentative as yet.

These statistics of infections in China are not the only story.  There have been breakout infections in Korea, Japan, Iran, and worryingly in Italy, where an unknown person introduced the virus, which has spread. Universities, schools, sporting events and whole towns have shut down in Northern Italy. Italy has borderless access to the rest of the European Union. Once the number of cases exceeds the ability of public health authorities to track contacts and isolate them, we are in a dire situation. 

The United States had 11 cases as of Feb. 4, 2020—all people who arrived from Wuhan—none have died and most have probably recovered. On Feb. 24, there  were 14 diagnosed cases, of which 12 were travel-related and two resulted from person-to-person spread. All were isolated. In addition, 36 patients have been flown home from the Diamond Princess Cruise Ship in Japan and have also been isolated. The Centers for Disease Control opposed their return, preferring that they be treated in Japan, but the State Department decided otherwise. To my knowledge, no infected person in the United States has died. To follow the epidemic, type CDC.gov/coronavirus into your browser.  The CDC is preparing for a large epidemic.

A source for sober advice is Columbia University’s Vincent Racaniello and his colleagues, who run a weekly podcast called This Week in Virology, or TWIV. They have an audience of many thousands, including virology students and researchers all over the world. The podcast is easily understandable for non-scientists. On Jan. 30, the TWIV scientists discussed the danger from Covid-19, and the general tenor was that the virus will not be the worldwide threat that WHO is worried about. Common precautions (serious hand washing with soap, masks, and avoiding groups) will help until drugs and a vaccine arrive. For the record, soap is better than hand sanitizers because it dissolves the mucous in which virus is trapped.   Vincent and others on TWIV respect the Wuhan scientists who isolated the virus from the lungs of patients and traced it to a similar virus found in cave bats. They would go to Wuhan if invited.   

On Jan. 14, soon after the virus was described, the genomic sequence of the Wuhan virus came on-line in GenBank, the website that the National Institutes of Health maintains for nucleic acid sequences.  The Wuhan virus is one of many coronaviruses, but they all have the same proteins, which means that what we have learned about other coronaviruses may apply to the Wuhan virus. 

The sequence of the viral genome is the code that the virus uses to make and assemble new virus particles. The sequence exposes points of weakness where a drug might work—there are many candidates from years of work on HIV and other viruses.  Clinical trials are reportedly underway, but may be difficult in the current overwhelming situation in China. Many labs are creating vaccines with technologies used successfully in the Ebola campaign. The first clinical trials have started in China, although I know no details.  

The medical and scientific world is organizing and has already distributed funds to create vaccines and to do other essential research.  The woeful response to the 2014 Ebola epidemic spurred international organizations to better preparation for this pandemic. We will keep you posted. 

Richard Kessin is Professor Emeritus of Pathology and Cell Biology at Columbia University’s Vagelos College of Physicians and Surgeons. This report originally appeared in The Lakeville Journal. It has been substantially updated. Email:Richard.kessin@gmail.com.