Last updated 12 February 2020. 

A number of mainstream news outlets have written that we should be far less worried about the Novel Coronavirus than about seasonal flus, which according to one writer kill between 10,000 and 25,000 people in the United States alone.

However, in contrast with the common flu, the Novel Coronavirus has a far higher serious complication rate, a higher case fatality rate, and a higher level of transmissability, meaning that it has the potential to be considerably more deadly.

In order to address these concerns and allow you to make your own mind up, we have brought together answers from reputable sources to the main questions surrounding the Novel Coronavirus and the Wuhan Coronavirus outbreak.

As the outbreak is at an early stage in its development, this information is provisional and subject to change as new data and analysis becomes available.

What is the Novel Coronavirus (2019-nCoV)?

The Novel Coronavirus (2019-nCoV) was the earliest name given to what is commonly referred to as the Wuhan Coronavirus. Also belonging to this family are four viruses that cause common cold symptoms in humans (229E, OC43, NL63 and HKU1) and two coronaviruses that became well-known following epidemics in Asia and the Middle East in recent years, namely SARS and MERS.1

COVID-19 is the current World Health Organization-prescribed name for 2019-nCoV or 2019 Novel Coronavirus, the seventh coronavirus discovered to cause disease in humans. Among the other names encountered are the Novel Coronavirus, Novel Coronavirus 2019, Wuhan Coronavirus, COVID2019, COVID-19, COVID-2019, Wuhan Influenza, and the colloquial WuFlu.

In a range of popular sources, people will simply use the shorthand name, “the Coronavirus”, and sometimes people will write “corona virus” as two words, although this should be avoided in technical or journalistic contexts.

We have also noticed that it is common to refer to the outbreak as the Wuhan Coronavirus Outbreak.

For the purposes of these FAQs, we will mostly use the earliest scientific name, 2019-nCoV, and will refer to the outbreak as the Wuhan Coronavirus Outbreak, given that Wuhan is its locus.

How does 2019-nCoV spread?

It is now beyond question that human-to-human transmission is taking place. According to Qun Li et al writing in the New England Journal of Medicine, “…there is evidence that human-to-human transmission has occurred among close contacts since the middle of December 2019.”2

In common with other coronaviruses, 2019-nCoV spreads through respiratory droplets, including from coughs and sneezes, and viral RNA has been found in stool samples.

Who is most likely to get infected?

An early study of 425 of the first cases showed that the median age of the patients was 59 years, with 56% of patients being male. According to Li et al, there were “no cases in children below 15 years of age”, and they noted in the same paper that this may be to do with either children being less likely to get infected, or chilren experiencing lighter symptoms.3

What are the symptoms of a 2019-nCoV infection?

According to the Centres for Disease Control (CDC), among the common symptoms reported are cough, shortness of breath and a fever. Those infected may go from having no symptoms to in the most severe cases, dying.4

How long is the incubation period for the virus?

A non-peer-reviewed preprint authored by 37 Chinese scientists, including Chinese CDC scientists, found that the median incubation period was 3 days, but that the incubation period ranged from 0 to 24 days. 5

Based on its experience with MERS, the US CDC stated that the incubation period might vary from 2 days to 2 weeks.6

What is the rate of transmissibility for the current outbreak? ( R0)

The R0 number indicates for a particular point or period in time the average number of additional cases that a single case will generate. An epidemic might be said to be spreading while the R0 number is greater than 1. Three estimates for the current R0 of the outbreak include the following: 2.2 (NEJM, 29 January 2020)7; 2.68 (Lancet, 31 January 2020) 8; and, 3.11 (27 January 2020, medRxiv) 9.

Are presymptomatic, asymptomatic or postsymptomatic transmission possible?

Correspondence from doctors at the LMU University Hospital in Munich, Germany discussed a case where a Chinese businesswomanvisiting Germany appeared to transmitted the infection to a German business partner, during a period when she herself was asymptomatic. High readouts for the virus on the German patient following the period when he was symptomatic also suggest that postsymptomatic transmission might be possible, although this has yet to be confirmed.10

What is the Case Fatality Rate (CFR) for the current outbreak?

The present case fatality rate is unknown as there are questions about misdiagnosis, and underreporting of deaths in the Chinese data. Showing how varied case fatality rates for coronaviruses might be, SARS and MERS had CFRs of around 10% and 35% respectively.

Earliest estimates have suggested a case fatality rate of around 3%,11 although again, this is based on data which are preliminary and evolving.

How does the the Novel Coronavirus compare with the Common Flu?

Numerous stories have appeared in the press saying that we should be as concerned, if not more concerned, about the common flu than 2019-NCoV (for example, from CNBC, “The flu has already killed 10,000 across US as world frets over coronavirus“; from the International Business Times, “Coronavirus Not As Deadly As Common Flu, Expert Claims“; from Fox 17, “Doctor suggests worrying about the common flu, not coronavirus“).

Toxicologist Chris Martenson has countered this contention by arguing that the epidemiological characteristics of the Wuhan Coronavirus give it the potential to be far more deadly:

  • Flu
    • Case Fatality Rate: 0.1%
    • R0: 1.28
    • Serious Complication Rate (ICU bed requirement): <1%
  • Wuhan Coronavirus
    • Case Fatality Rate: c. 3%
    • R0: 2.5-3.5 (possibly 4.08)
    • Serious Complication Rate (ICU bed requirement): 20%

It remains to be seen how how these numbers develop as the outbreak spreads, but it is fair to say that the Chinese Government is reacting far more intensely than would be expected for a regular flu season.

How bad will it get?

Much will depend on the reaction of governments to the present outbreak.

Within China, it seems clear at this point that authorities have failed to contain the virus’s spread to Hubei province. Every region in China has now reported cases, although this varies from one case in Xizang to 33,366 cases in Hubei, as of 12 February 2020.

Major transportation hubs with extensive transport links to China are obviously at some risk, and much will depend on how quickly and successfully authorities in the relevant areas are able to get on top of early cases.

If however the R0 remains high, and local health authorities, particularly in poorer countries are swamped, there may be little to stop the spread of the disease globally, although heavy early intervention may allow parts of the world to play for time to develop a vaccine.

What can be done to prevent 2019-nCoV infection?

The CDC offers to following advice:

There is currently no vaccine to prevent 2019-nCoV infection. The best way to prevent infection is to avoid being exposed to this virus. However, as a reminder, CDC always recommends everyday preventive actions to help prevent the spread of respiratory viruses, including:

  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
  • If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Avoid close contact with people who are sick.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.12

Other sources have recommended elderberry syrup as a palliative treatment.

Where did 2019-nCoV originate from?

According to official sources, the infection originated with the Huanan (Southern China) Seafood Wholesale Market.13 Others authorities, including Senator Tom Cotton of the US Congress and Indian geopolitical journal, Great Game India have suggested that China’s only Biosafety Level-4 Laboratory, which is located in Wuhan, is a far more likely source for the present outbreak.

What’s the deal with the Wuhan BSL-4 Laboratory?

The Wuhan BSL-4 lab was the first on mainland China equipped for the highest level of biocontainment. According Richard Ebright, a molecular biologist from Rutgers University, quoted in a Nature article from 2017 (i.e. writing before the present outbreak), the SARS virus has escaped from high-level biocontainment facilities in Beijing on multiple occasions. In his view, the construction of the Wuhan laboratory might well have been a reaction to the growth in such networks in Europe and the United States, and that these are all unnecessary, and “governments will assume that such excess capacity is for the potential development of bioweapons”.14 Nature for their part have added the following prescript to this article in question: “Many stories have promoted an unverified theory that the Wuhan lab discussed in this article played a role in the coronavirus outbreak that began in December 2019. Nature knows of no evidence that this is true; scientists believe the most likely source of the coronavirus to be an animal market.”

Is it possible to be reinfected with 2019-nCoV?

At this point, expert opinion is split on the question.

Zhan Qingyuan, an expert at the China-Japan Friendship Hospital in Beijing stated at a press conference of China’s National Health Commission that he believes that patients who have recovered from the novel coronavirus still face the risk of being infected again. CGTN reported him as say that usually “certain antibodies will be produced to protect the human body after virus infections. However, some antibodies may not last that long. So those patients who have recovered still face the risk of secondary infections.”

Two experts speaking to the Daily Mail, Dr Bharat Pankhania, a medical lecturer at the University of Exeter and Dr Paul Digard, an immunologist at the University of Edinburgh have stated that they consider this unlikely. According to Dr Digard, “There are situations where [relapse] happens, but given the timing of the nCoV19 outbreak I think it’s unlikely that there is solid evidence to back this claim up.”

What are good sources of up-to-date information on 2019-nCoV?

Both The Lancet and the New England Journal of Medicine have portals specifically focused on the 2019 Novel Coronavirus.

Academic publishers, Elsevier have a Novel Coronavirus Information Center – “Elsevier’s free health and medical research on novel coronavirus (2019-nCoV)” which is regularly updated.

Dr. John Campbell has regular video updates on the medical aspects of the disease: https://www.youtube.com/user/Campbellteaching/videos

Where can I get up-to-date information on the Wuhan Coronavirus Outbreak?

The World Health Organization maintains a live dashboard which is updated frequently: https://who.maps.arcgis.com/apps/opsdashboard/index.html#/c88e37cfc43b4ed3baf977d77e4a0667

The South China Morning Post has a Coronavirus topic section: https://www.scmp.com/topics/coronavirus-outbreak

Peak Prosperity offers daily outbreak updates, which are available on the Peak Prosperity Youtube channel: https://www.youtube.com/user/ChrisMartensondotcom/videos

Wuflu.live has a website, which is updated throughout the day with new cases from official sources: https://wuflu.live/

(c) All rights reserved.

Picture by CDC/ Alissa Eckert, MS; Dan Higgins, MAM – This media comes from the Centers for Disease Control and Prevention‘s Public Health Image Library (PHIL), with identification number #23311. Public Domain, Link

Footnotes

  1. Zhu, Na, Dingyu Zhang, Wenling Wang, Xingwang Li, Bo Yang, Jingdong Song, Xiang Zhao, et al. 2020. “A Novel Coronavirus from Patients with Pneumonia in China, 2019.” New England Journal of Medicine, January. https://doi.org/10.1056/nejmoa2001017.
  2. Li, Qun, Xuhua Guan, Peng Wu, Xiaoye Wang, Lei Zhou, Yeqing Tong, Ruiqi Ren, et al. 2020. “Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia.” The New England Journal of Medicine, 10.1056/NEJMoa2001316. https://doi.org/10.1056/NEJMoa2001316.
  3. Li, Qun, Xuhua Guan, Peng Wu, Xiaoye Wang, Lei Zhou, Yeqing Tong, Ruiqi Ren, et al. 2020. “Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia.” The New England Journal of Medicine, 10.1056/NEJMoa2001316. https://doi.org/10.1056/NEJMoa2001316.
  4. “Symptoms of Novel Coronavirus (2019-NCoV).” 2020. 2020. https://www.cdc.gov/coronavirus/2019-ncov/about/symptoms.html.
  5. https://www.medrxiv.org/content/10.1101/2020.02.06.20020974v1.full.pdf
  6. “Symptoms of Novel Coronavirus (2019-NCoV).” 2020. 2020. https://www.cdc.gov/coronavirus/2019-ncov/about/symptoms.html.
  7. Li, Qun, Xuhua Guan, Peng Wu, Xiaoye Wang, Lei Zhou, Yeqing Tong, Ruiqi Ren, et al. 2020. “Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia.” The New England Journal of Medicine, 10.1056/NEJMoa2001316. https://doi.org/10.1056/NEJMoa2001316.
  8. Wu, J. T., Leung, K., & Leung, G. M. (2020). Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study. The Lancet. https://doi.org/10.1016/s0140-6736(20)30260-9
  9. Read, J. M., Bridgen, J. R., Cummings, D. A., Ho, A., & Jewell, C. P. (2020). Novel coronavirus 2019-nCoV: early estimation of epidemiological parameters and epidemic predictions. https://doi.org/10.1101/2020.01.23.20018549
  10. Rothe, Camilla, Mirjam Schunk, Peter Sothmann, Gisela Bretzel, Guenter Froeschl, Claudia Wallrauch, Thorbjörn Zimmer, et al. 2020. “Transmission of 2019-NCoV Infection from an Asymptomatic Contact in Germany.” New England Journal of Medicine, January. https://doi.org/10.1056/nejmc2001468.
  11. Wang, Chen, Peter W Horby, Frederick G Hayden, and George F Gao. 2020. “A Novel Coronavirus Outbreak of Global Health Concern.” The Lancet, January. https://doi.org/10.1016/s0140-6736(20)30185-9.
  12. “Frequently Asked Questions and Answers.” 2020. 2020. https://www.cdc.gov/coronavirus/2019-ncov/faq.html.
  13. Li, Qun, Xuhua Guan, Peng Wu, Xiaoye Wang, Lei Zhou, Yeqing Tong, Ruiqi Ren, et al. 2020. “Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia.” The New England Journal of Medicine, 10.1056/NEJMoa2001316. https://doi.org/10.1056/NEJMoa2001316.
  14. Cyranoski, David. 2017. “Inside the Chinese Lab Poised to Study World’s Most Dangerous Pathogens.” Nature 542 (7642): 399–400. https://doi.org/10.1038/nature.2017.21487.
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