Last updated 6 March 2020. 

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

However, in contrast with the common flu, COVID-19 has a far higher serious complication rate and a higher case fatality rate 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 COVID-19 and the Coronavirus Outbreak.

This information is provisional and subject to change as new data and analysis becomes available.

What is COVID-19?

The 2019 Novel Coronavirus (or 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 name prescribed by the World Health Organisation for the virus, the seventh coronavirus discovered to cause disease in humans. Among the other names encountered are the Novel Coronavirus, Novel Coronavirus 2019, Wuhan Coronavirus, nCoV19, COVID2019, COVID-19, COVID-2019, Wuhan Influenza, and the colloquial WuFlu.

In journalism and popular writing on the outbreak, it is common as a shorthand to refer to COVID-19 simply as “the coronavirus”.

How does COVID-19 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, COVID-19 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 COVID-19 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 businesswoman visiting 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 average time from infection to transmission?

The serial interval for COVID-19 (SARS-CoV-2) is around seven days.11

What is the Case Fatality Rate or Mortality Rate 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%,12 although again, this is based on data which are preliminary and evolving.

On 3 March 2020, the World Health Organization announced that around 3.4% of reported COVID-19 cases had died.13 Recall that many that get infected remain asymptomatic or do not report their symptoms to a doctor. On the other hand, as the number of cases is currently growing exponentially, the deaths-to-cases ratio will be depressed by timelag factors.

How does COVID-19 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 COVID-19 (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%”

The World Health Organization addressed this point in its 3 March 2020 media briefing:

First, COVID-19 does not transmit as efficiently as influenza, from the data we have so far. […]

The second major difference is that COVID-19 causes more severe disease than seasonal influenza.

While many people globally have built up immunity to seasonal flu strains, COVID-19 is a new virus to which no one has immunity. That means more people are susceptible to infection, and some will suffer severe disease.[…]

Third, we have vaccines and therapeutics for seasonal flu, but at the moment there is no vaccine and no specific treatment for COVID-19. However, clinical trials of therapeutics are now being done, and more than 20 vaccines are in development.[…]

And fourth, we don’t even talk about containment for seasonal flu – it’s just not possible.

14

Worldometer has an excellent discussion of how to calculate the Case Fatality Rate during an outbreak: https://www.worldometers.info/coronavirus/coronavirus-death-rate/#days

How bad will it get?

Who knows, but it has the pandemic has the potential to cause major loss of life.

One AI simulation calculated that the pandemic could claim up to 52 million lives. In another study done at the Australian National University, under a low-severity scenario there would be 15 million deaths globally and $2.4 trillion wiped off global GDP.

How can I reduce my chance of catching it?

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.15

Trevor Bedford has the following recommendations:

  • Practicing social distancing, such as limiting attendance at events with large groups of people
  • Working from home, if your job and employer allows it
  • Staying home if you are feeling ill
  • Take your temperature daily, if you develop a fever, self-isolate and call your doctor
  • Implementing good hand washing practices – it is extremely important to wash hands regularly
  • Covering coughs and sneezes in your elbow or tissue
  • Avoiding touching your eyes, nose, and mouth with unwashed hands
  • Disinfecting frequently touched surfaces, such as doorknobs
  • Beginning some preparations in anticipation of social distancing or supply chain shortages, such as ensuring you have sufficient supplies of prescription medicines and ensuring you have about a 2 week supply of food and other necessary household goods.
  • With these preparation in mind, it is important to not panic buy. Panic buying unnecessarily increases strain on supply chains and can make it difficult to ensure that everyone is able to get supplies that they need.

What can I do if I get infected, but can’t access medical care?

Dr. John Campbell, in an exclusive interview with Technical Politics, offered the following advice:

  • Sit up, or lean forward on something sitting up.
  • Breathe fresh air, keep air circulating.
  • Keep hydrated.
  • Eat, if you feel like it. Don’t eat, if you don’t.
  • Eat a healthy diet, including plenty of fruit and vegetables.
  • Get enough vitamins, particularly vitamins C and D.
  • Get good sleep.
  • Don’t get stressed.

These were not official recommendations, and may only help to mitigate the symptoms, or in some cases, to prevent infection.

Where did COVID-19 originate from?

According to official sources, the infection originated with the Huanan (Southern China) Seafood Wholesale Market, although official Chinese sources indicate that the index patient had no contact with wet market. 16

Others sources, 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”.17 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 COVID-19?

It appears as though this is likely.

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.”

At an earlier stage of the outbreak, 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 stated that they considered this to be unlikely or that those making the claims could not be sure. 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 COVID-19?

A number of journals and academic publishers are making freely available content related to COVID-19, including Cell, The Lancet, Oxford University Press Coronavirus Hub, the New England Journal of Medicine and the Elsevier Novel Coronavirus Information Center.

Dr. John Campbell has regular video updates on the medical aspects of the disease.

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

The World Health Organization maintains a live dashboard which is updated frequently.

Multiple online newspapers have Coronavirus Outbreak topic sections, including the South China Morning Post, the Straits Times, the Epoch Times, the Financial Times, the People’s Daily, CGTN and the Daily Mail.

On Technical Politics, we have a feed of our Coronavirus Outbreak-related stories.

Peak Prosperity offers daily outbreak updates, which are available on the Peak Prosperity Youtube channel.

Several organisations maintain live epidemic dashboards, including Johns Hopkins University and the excellent Worldometer.

(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. https://bedford.io/blog/ncov-cryptic-transmission/
  12. 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.
  13. https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—3-march-2020
  14. https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—3-march-2020
  15. “Frequently Asked Questions and Answers.” 2020. 2020. https://www.cdc.gov/coronavirus/2019-ncov/faq.html.
  16. 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.
  17. 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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