On the final day of 2019, authorities in Wuhan, Hubei province, China, reported a case of pneumonia with an unknown cause to the World Health Organisations (WHO)’s China Office. As more similar cases emerged, China’s National Health Commission isolated the virus, and identified it as a novel coronavirus, known as either Wuhan coronavirus or 2019-nCoV; the genetic sequence of the virus was shared globally to support the development of diagnostic and preventative tools.
Coronaviruses cause respiratory tract illnesses, and other sub-types have caused previous outbreaks, including Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory (SARS) in 2012 to 2015 and 2003 respectively.
As of Monday 10 February, there have been over 40,000 cases globally; the virus has spread to over 20 countries, however, all but 376 cases are in mainland China. The death toll has reached 910 globally, climbing by 97 from Sunday 9 February; this means the number of deaths has exceeded the SARS outbreak.
As the number of cases and deaths continue to increase daily, Pharmaceutical Technology surveyed readers on their view of how serious a threat Wuhan coronavirus is to global health.
Results from 1,803 respondents show significant concern about the seriousness of the threat this novel coronavirus poses with 35% seeing it as an extremely serious threat, 24% as a serious threat and 22% as a significant threat. This leaves just 19% seeing Wuhan coronavirus as a relatively or very minor threat.
Declared a public health emergency
These results are not particularly surprising given, after a few days of deliberation, the WHO declared the outbreak to be a public health emergency of international concern (PHEIC) on 30 January.
In the emergency committee meeting, the members praised the commitment of the Chinese government to contain the outbreak, as well as the speed with which it shared the sequence of the virus. However, there was concern about the spread of the disease outside of China, and particularly human-to-human transmission outside of the country.
The WHO’s PHEIC statement calls on all countries to focus on “containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of 2019-nCoV infection”.
Since this announcement, individual countries have begun to make similar declarations about the significance of the threat this novel coronavirus has on public health. On 10 February, the UK Department of Health and Social Care declared that “the incidence or transmission of novel coronavirus constitutes a serious and imminent threat to public health,” however, the threat risk the virus poses to the public remains at moderate; it was increased from low on 30 January.
This came after the number of cases in the country doubled from four to eight, and is aimed to strengthen regulations relating to quarantine and the authority’s ability to forcibly isolate individuals at risk of spreading the virus to other members of the public.
Secretary of State for the Health and Social Care Matt Hancock said: “We are taking every possible step to control the outbreak of coronavirus. NHS staff and others will now be supported with additional legal powers to keep people safe across the country.
“The transmission of coronavirus would constitute a serious threat – so I am taking action to protect the public and isolate those at risk of spreading the virus.
“Clinical advice has not changed about the risk to the public, which remains moderate. We are taking a belt and braces approach to all necessary precautions to ensure public safety.
“Our infection control procedures are world leading – what I am announcing today further strengthens our response.
“The regulations have been put in place to reduce the risk of further human-to-human transmission in this country.”
One step away from a pandemic
To date, the Wuhan coronavirus outbreak has been classed as an epidemic, which means it is a localised or regional outbreak – the two deaths that have occurred outside of China have been confined to Asia.
However, the continued spread of the virus across Europe and the Americas suggest that this could turn into a pandemic, defined as the worldwide spread of a new infectious disease.
It seems that the current epidemic meets all but one criteria of a pandemic, “community-level outbreaks”, where there is sustained human-to-human transmission of the disease in various parts of the world among people who have never travelled to China.
This is starting to happen in some parts of the world. In January, both Japan and Germany reported Wuhan coronavirus cases in people who had never travelled to China, but were infected by people who had. The four new cases in the UK are believed to have been caused by infection by one man who contracted the virus while in Singapore, according to the Guardian.
WHO director-general Dr Tedros Adhanom Ghebreyesus tweeted: “There’ve been some concerning instances of onward 2019-nCoV spread from people with no travel history to China. The detection of a small number of cases may indicate more widespread transmission in other countries; in short, we may only be seeing the tip of the iceberg.”
Global sense of panic
Daily updates on the continually escalating scale of the outbreak, as well as multiple positive developments linked with pharma companies and researchers repurposing and developing drugs and vaccines against the virus, has kept the Wuhan coronavirus at the top of the news agenda for almost a month and contributed to a global sense of panic about its impact on global health.This sense of apprehension is reflected in the results of the Pharmaceutical Technology survey.
This has not been helped by some distrust of the Chinese Government’s reporting of the outbreak, which is reminiscent of the 2003 SARS outbreak, when the Chinese Government reported tried to censor press reports of the epidemic in order to underplay the seriousness of the situation.
Although there have been a significant number of deaths – some of which tragically are healthcare professionals working hard to combat the disease and prevent further spread – the death rate from the virus is only just over 5% in Wuhan, the epicentre of the outbreak. The average death rate globally is 2% and only two people have died outside China at the time of writing. There has been significant progress to date in diagnosing the virus, treating the symptoms of the condition, and preventing further spread of the disease.
It is important to remember that the 2019-nCoV outbreak is not the only PHEIC occurring at the moment. The Democratic Republic of Congo (DRC) is now over a year into an Ebola epidemic where approximately 2,200 lives have been lost from almost 3,500 cases. This epidemic may be currently confined to the DRC, but neighbouring countries are concerned about its spread across porous borders destabilised further by an ongoing civil war in the country.
In addition, despite effective tools to predict the sub-type of seasonal flu virus that will develop each year, the Centres for Disease Control estimates that between 12,000 and 16,000 people die every year from influenza every year in the US alone.