07/03/2020

7
Mar

What You Need to Know About the Spreading Coronavirus: QuickTake

Friday, March 6, 2020 07:11 PM

By Jason Gale and John Lauerman

(Bloomberg) —

The newly identified virus that emerged late last year in the central Chinese city of Wuhan has quickly spread worldwide, with the number of infections topping 100,000. The contagiousness of the so-called coronavirus, which causes a lung illness dubbed Covid-19, has health experts worried it could become a pandemic to rival some of the most devastating in recent decades. Meanwhile, the outbreak is causing turmoil in the global economy and financial markets.

(This story updates with new infection toll and fresh details on what authorities are doing in section 10 and economic impact in section 12.)

1. What makes this virus so worrying?

It has been described as “insidious” because many infected people are well enough to go about their daily business, unwittingly spreading it to others. As of March 3, the fatality rate was about 3.4% based on globally reported cases, the World Health Organization said. Such numbers are unreliable in the early stages of an outbreak, however. Some disease-modeling experts project as many as hundreds of thousands of people are actually infected, most of whom don’t even know they have it. One study published Feb. 10 estimated a mortality rate of 1% once all cases, including those with no or only mild symptoms, are counted.

2. How does this compare with other outbreaks?

A related coronavirus killed 9.5% of patients in the 2002-2003 epidemic of severe acute respiratory syndrome, or SARS, and another known as MERS-CoV has led to death in 34% of the 2,499 cases recorded since 2012. In those outbreaks, however, the viruses didn’t transmit from one person to another as efficiently as this new one appears to do. Certainly, they didn’t spread as widely as fast. In the worst pandemic in recent history, an estimated 50 million people died in the 1918 influenza pandemic that had a case-fatality ratio of about 2% but infected as much as a third of the world’s population.

3. What does the virus do?

Symptoms begin to appear on average five to six days after infection. Infections appear to cause a mild illness lasting about two weeks in children, adolescents and younger adults in most cases, and potentially more severe disease lasting three to six weeks in older people. Frequently reported early signs are fever, dry cough, tiredness and sputum production. In severe cases, studies suggest the virus invades cells in the lower respiratory tract, causing difficulty breathing and the inflammation and congestion associated with pneumonia. In an early study, more than a quarter of hospitalized patients developed a complication known as acute respiratory distress syndrome.

4. Who’s most at risk for complications?

It appears to be the elderly and those with other serious health issues. Many of the fatalities have been in patients with underlying illnesses such as cardiovascular disease. A Chinese study of 72,000 cases found most deaths occurred in patients over 60 years old. Of all confirmed cases, 81% were mild, 14% were severe and 4.7% critical. The last pandemic, an outbreak of a new strain of H1N1 flu in 2009, infected an estimated 61 million people in the U.S. alone and may have killed as many as 575,000 people worldwide in the first year it circulated — with about 80% of them younger than 65, according to the U.S. Centers for Disease Control and Prevention

5. How do people contract it?

By coming into contact with virus-containing droplets that are emitted when an infected person coughs or sneezes, according to the WHO’s first comprehensive report on Covid-19. These droplets can be transferred directly to someone else in close proximity or via hands and surfaces. How long it survives on surfaces is still not known, but preliminary studies suggest coronaviruses may remain infectious from a few hours to a few days. Simple disinfectants kill it. There’s a theoretical risk the virus can spread through feces or fartherthrough the air in tiny particles known as aerosols. People who are still incubating the virus and show no symptoms may spread it. Health authorities are concerned about what’s known as community spread, where the virus begins circulating freely among people outside of known contacts with other patients.

6. How contagious is it?

Epidemiologists try to gauge contagiousness by estimating the number of additional people a person who is infected is likely to infect. That measurement, called a basic reproduction number or r0 (pronounced “r naught”), is one indicator of how difficult an epidemic is to control. A study of an outbreak aboard a cruise ship estimated that the r0 for Covid-19 was 2.28 during the early stages. That would make it more infectious than seasonal flu, which has an r0 of about 1.3 and killed an estimated 61,000 people in the U.S. in the 2017-18 season.

6. Could warming weather help combat it?

The viruses responsible for influenza spread more easily during cold weather because they survive longer in cold, dry air. But there’s no evidence to suggest the Covid-19 virus would be affected by weather.

7. What’s a coronavirus?

Coronaviruses are named for their crown-like shape. There’s a large family of them, responsible for diseases that range in severity from the common cold to MERS. Some transmit easily from person to person, while others do not. The WHO says that new strains emerge periodically around the globe, and several known versions are circulating in animals and haven’t infected humans.

From the black death to the coronavirus, this is what we need to think about in order to tackle pandemics. (

8. Where did it come from?

The virus emerged in early December in Wuhan, an industrial city of 11 million and capital of Hubei province. Early attention focused on a seafood market where live animals were also sold, but about a third of the first 41 cases were found to have no link to it. The viral genome is closely related to several coronaviruses found in bats. Diseases transmissible from animals to humans, sometimes referred to as zoonoses, comprise a large percentage of all newly identified infectious diseases.

9. How alarming is a new virus?

There is always concern when a new human pathogen emerges because people typically lack immunity to it and there usually aren’t specific treatments or vaccines available. Novel coronaviruses — those unseen in humans before — represent a particular concern because they have been known to spark complicated outbreaks that have sickened thousands of people, as SARS did as it swept across the globe from southern China.

10. What are authorities doing?

China’s government imposed a quarantine on Wuhan and more than a dozen other cities in the region that’s keeping some 60 million people sealed off. New hospitals were built from the ground up in days, and the production of medical equipment was ramped up. (Some makeshift centers in stadiums, hotels and office buildings have started to fold up as patients have recovered.) The WHO declared a global health emergency, a designation that can help mobilize international responses. The World Bank has allocated $12 billion in virus aid for developing economies. Many countries are denying or restrictingentry for non-citizens arriving from China and other especially affected areas. With Covid-19 showing up in more places, officials began to switch their goal from stopping its spread to preparing for it amid shortages of testing kits, face masks and other equipment. U.S. President Donald Trump appointedVice President Mike Pence to lead the federal response as local governments stepped up readiness efforts. Globally, governments are using a mix of cash handouts, tax breaks and transfers to counter the virus’s impact.

11. How are they faring?

Early praise for China’s response has ebbed. The country did not immediately release genetic information about the virus and has struggled to explain changes in the way it counts new cases. In a nation where the internet is heavily censored, there was a rare outpouring of social media fury over the death from the virus of a Chinese doctor who had waved an early red flag about the outbreak but was silenced by police. The top officials in Wuhan and Hubei were later removed from their posts. But China’s strict quarantine likely bought the rest of the world two to three weeks to prepare for the virus and averted many infections, according to the WHO.

12. What about the economy?

Reductions in travel, work-from-home orders and disruptions in supply chains have slowed economic activity, especially in China and among its many trading partners. The Organization for Economic Cooperation and Development warned that the Covid-19 crisis posed the “greatest danger” to the world economy since the financial crisis more than a decade ago. Global stock markets have been volatileand the U.S. Federal Reserve cut interest rates in its first emergency move since the 2008 financial crisis. Group of Seven finance chiefs pledged to use “all appropriate policy tools” to safeguard economic growth.

The Reference Shelf

  • Related QuickTakes on efforts to contain the virus, how it spreads, the effectiveness of travel bans, efforts to develop treatments and a vaccine, the meaning of a “pandemic,” and the reallocation of capital into haven assets.
  • The WHO’s first comprehensive report on the crisis.
  • Doubts persist about whether China’s statisticson the outbreak show the full picture.
  • The Centers for Disease Control and Prevention has a coronavirus web page, and the Journal of the American Medical Association offers advicefor clinicians.
  • Bill Gates offers proposals for combating Covid-19 in the New England Journal of Medicine.
  • A top airline doctor says forget face masks, wash your hands.
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