About the Wuhan Coronavirus Respiratory Syndrome

By Benny Ko, M.D.

All You Need To Know (for now)

What is a coronavirus?

A coronavirus belongs to a family of viruses that has in common proteinous
spikes on its surface, giving it the appearance of a crown or halo under
electron microscopy and for which it is named (corona: a crown). Some of
these coronaviruses are respectively responsible for the common cold, SARS
(severe acute respiratory syndrome), MERS (Middle East respiratory syndrome)
and now the Wuhan coronavirus pneumonia. The virus is abbreviated as the
2019-nCoV in scientific publications. The ‘n’ designates the Wuhan virus to
be a newly discovered member of this group.

Is the SARS coronavirus one and the same as the Wuhan coronavirus?

No, they are not, but both are closely related beta-coronaviruses of the B
lineage. Along with MERS (Middle East Respiratory Syndrome), all three
respiratory syndromes are human diseases caused by beta-coronaviruses. They
are transmitted from animal to human and such mode of disease transmission
is known as a zoonotic infection. Once a person is infected, the diseases
can also become transmittable from human to human.

How did the Wuhan coronavirus epidemic start?

By all accounts, the coronavirus began to infect people that work in or have
had visited a Wuhan wet market where live wildlife animals are sold,
including bats, other mammals, and snakes. If the SARS epidemic is a valid
counterpart to the current Wuhan one, and there is much scientific evidence
to support that, then this new coronavirus is very likely to have come from
the bat. Whereas the virus does not make the bat sick, other animals that
come into contact with it can become infected or carry it. In the SARS
case, it has been shown to have gone from the bat to the civet cat and from
the latter to infect humans.

Left to nature, the odds of a civet cat having a close encounter with a
virus-carrying bat is very small, and for the same infected civet cat to be
handled and butchered by a man is even more remote. However, this scenario
is an everyday occurrence in a wet market that also sells live wildlife
animals. Zoonotic transmission of diseases is by no means limited to the
coronaviruses, HIV is likely to have come from African chimpanzees. When
they were killed and eaten by man, the virus found a new and defenseless
host. We have all heard about the swine flu, the avian flu and so on.
Whenever live animals and humans come into close contact in a crowded and
confined space, particularly when blood and bodily fluid are present as with
butchering and unhygienic preparation, zoonotic infection is inevitable.

How to avoid being infected?

In the simplest of terms, no contact = no infection.

From there, common sense comes into play.

Presently, only a handful of cases have been reported in the U. S., almost
all these cases involved persons who have returned from a recent visit to
Wuhan. In other words, these are primary cases contracted directly in
China. There have been secondary infections reported in Japan and Germany,
meaning the primary-infected patients have passed it on to those that have
not been to Wuhan. This has not happened in the U. S. but remains a future
possibility. Therefore, at least for now, there is no reason to curtail
domestic traveling or public contact. Stay vigilant, monitor the situation
daily from a credible source such as the New York Times, South China Morning
Post or BBC news. (The electronic version of the latter two publications is
free). So far, no patient outside China has died of the disease.

If you have come in contact with someone who either has been confirmed with
the disease or known to have been exposed to a patient (both are very
unlikely scenarios if you live in the U. S.), first is report that to the
authority, such as the state board of health, or your own family physician.
You will likely be tested for exposure. If you are tested negative and
feel well, you have nothing to worry about. If you are tested negative and
develope

a flu-like illness, then you have the flu. Influenza kills many more people
annually than the Wuhan coronavirus ever will. So if you have not yet had a
flu shot, what are your reason for waiting? Unless the number of reported
cases go way up, to wear a facemask in the public for prevention will draw
you all kinds of unwanted attention. When I was still in practice, the only
occasion I would wear a facemask is when I have a cold and not wanting to
pass it on to patients or co-workers. I do not worry about the flu as I get
my flu vaccine annually without fail. I wash my hands religiously,
in-between seeing patients, before eating and needless to say, after
bathroom visits. I recommend the same habit formation if you are someone
that travels or dines out frequently. For now, do not go to China unless
you have the reason that amply justifies the risk. The situation will
settle down eventually.

What could the world expect?

Based on what has been reported in China, a few trends are becoming clear.
This new virus, though seemingly quite infectious, is not as deadly as the
SARS virus nor the MERS virus. Most patients that died from it are over
60, many also have an underlying disease or condition such as diabetes or
chronic lung disease. In China, the reported cases will continue to rise
but it will soon peak then drop. This is the general trend recorded of any
known human epidemic. From there, whether it will enter into an endemic
phase or disappears all together remains to be seen. In the case of SARS,
there has not been a case of SARS reported anywhere in the world since July
of 2003. In the case of MERS, there is an occasional cluster of cases
reported but has become much quiescent as compared to when it first
surfaced.

Where do we go from here?

The gene sequence of the new virus has been decoded in China and the data is
shared with the rest of the world. China has also welcome foreign teams of
experts to lend them a hand. The virus itself has been successfully grown
in cell culture in Australia, thus enabling new tests and hopefully drugs to
be tested for efficacy. Different scientific groups around the world,
including one team from Hong Kong, are frantically working on a vaccine to
combat this virus.

Personally, I think there is something mysterious and miraculous about the
vanished SARS. Was it something that the world’s medical communities
justifiably claim credit for its eradication?

Or was it some nature’s miracle that involves mutated genes, acquired
population immunity, or simply divine intervention? Who knows? Maybe it is
worth the scientific community to take a second look into this enigma and
see what we can learn from it.

The same has happened to the 1918-1920 Spanish flu pandemic (it had actually
started in the U. S. A. as was later determined) that killed between 50 to
100 million people worldwide, then it simply vanished.

Let us keep our fingers crossed and palms clasped that the Wuhan coronavirus
also knows when to beat a hasty retreat.

Regards,

Agnes