The ongoing outbreak of coronavirus disease 2019 (COVID-19) started in December of 2019. It has surpassed the death toll of the SARS outbreak of 2003.
Dr. Christopher McCoy, PharmD, is the Associate Director of Antimicrobial Stewardship and the Infectious Disease Residency Director at Beth Israel Deaconess Medical Center in Boston, MA.
BCC’s very own Tim McLean, Senior Editor for Life Sciences sat down with Dr. McCoy to discuss what we need to know about the coronavirus
BCC: What is a coronavirus, and specifically, what is this particular one?
Dr. McCoy: Coronavirus is not just one virus, it’s a group of viruses that have a similar structure under microscopy, notably crown like spikes, hence the name. They were first identified in the 1960’s and many people have a coronavirus infection each year, unrecognizable as anything but a common cold.
However, each time there is a new outbreak of a more pathogenic (disease causing) “novel” strain, it is called novel coronavirus or nCoV for short. Previous novel coronaviruses include SARS (Severe Acute Respiratory syndrome) CoV and MERS CoV (Middle East Respiratory Syndrome), both of which affected human populations over the few decades. This virus has now been named CoVID-19 (Corona virus disease)-2019. A commonality of each is that they spread from animals to people, and generally from animal to animal to humans through direct contact/care of a sick animal or eating the animal.
SARS was transmitted primarily through cats to humans and MERS-CoV from camels. CoVID-19 is suspected to come from bats but there is still uncertainty if it “jumped” from bats to another animal, then people. Another commonality of these viral infections are the symptoms, usually respiratory (cough, wheezing, sneezing) but can progress to more severe disease in terms of pneumonia or respiratory failure and potentially death as we’ve seen with CoVID-19.
BCC: In what ways is this virus different from, say, yearly influenza?
Dr. McCoy: Structurally it is different but symptomatically there are many similarities to an influenza like illness. Unlike influenza, there is no vaccine for coronaviruses since they seem to appear and disappear so quickly, there isn’t the time for development, research and mass production however researchers are studying ways to make this happen faster. Unlike influenza, there are no antivirals that can treat or prevent the disease although many were studied for SARS-1, and MERS and even now COVID-19, nothing appears to have the right balance of efficacy and safety. This makes the spread of the illness through respiratory droplets and close contact somewhat unstoppable without quarantines.
On the flipside, with flu, there were 14,000 deaths out of 26 million reported infections in the US alone last year versus 2,000 deaths among 75,000 reported cases of COVID in China. That sounds proportionally like a higher rate with CoVID which is true, but we don’t know whether the denominator is correct from the information coming from China.
There may be some differences in overall symptom severity as well, meaning the percentage of people infected with CoVID reporting mild symptoms may be higher than influenza but there are many variables to consider including age and comorbid diseases.
BCC: What do people need to know about this virus? Are there medicines people should be taking to prevent or treat this virus? Are there medicines being developed?
Dr. McCoy: I would say that at this point in time, from a US perspective, if you are sick with respiratory symptoms, seek care as you normally would and unless you have been traveling to China or another endemic region or exposed to someone in close proximity, you are very unlikely to have COVID-19 infection.
You should be aware that it is being taken seriously by the U.S. Centers for Disease Control and local public health officials as well as hospitals like mine. We have established checkpoints with signage at entryways, viral screening protocols for people that fit the definition of high risk that includes isolation until testing is complete. The best prevention is the same prevention for colds and flu.
- Wash your hands with soap and water throughout the day.
- Don’t touch your nose and mouth with unwashed hands.
- Avoid contact with anyone with a respiratory illness to avoid the cold or flu.
Stay home when you are sick yourself.
- Clean and disinfect items like phones and countertops if you are living with others and sick.
- If you want to apply extra precautions, try to avoid eating undercooked or raw animal products.
There are no effective medications to prevent or treat the virus at this time. Please do not take prophylactic antibiotics of any kind. Vitamin C and herbal products appear to be ineffective and the latter may be more harmful. There are some open label trials being explored with antivirals known as remdesivir (not commercially available in the US) and some combination antiviral products used for HIV, such as lopinavir-ritonavir and darunavir-cobicistat but none with overwhelming results.
There are other drugs including ribavirin, bromhexine, interferons, arbiidol and thalidomide that are also being trialed but again, the efficacy to safety profile is unknown.
BCC: What are some common incorrect pieces of “information” people are receiving (through the internet, TV, etc.), what some are calling an “infodemic?”
Dr. McCoy: I would absolutely agree that there is likely more misinformation in the media and online and this is the nature of today’s openness, the desire to exploit people into seeking false treatments and fear mongering for personal, financial or political gain.
The obsession with being internet famous is also at play. I would rely on resources such as the Centers for Disease Control websites and publications which include a wide variety of information for all types of users, from health care professionals to the lay public. Another good resource is the World Health Organization. Certainly, for medical professionals, I would trust high level journals, like the New England Journal of Medicine and reputable medical websites.
While it is interesting to hear the stories of cruise goers trapped on a ship and the spread of the virus to Japan, it’s not something that I would immediately set into panic about or perseverate on. In my opinion and in the opinion of others, it is likely that this outbreak will be self-limiting like MERS and SARS and cases will drop off with the warmer months ahead. Hot baths won’t.
Some other common pieces of misinformation are that alcohol-based wipes and gels applied to your hands will stave off the virus. Only soap and water will do that. There is a supposition that all Chinese and Asians are infected and that restaurants are a common source of spread, not true in the US. Chinese people didn’t all eat bats one day and get sick.
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