As we watch the numbers of cases in China of the novel coronavirus increase exponentially every day, we should prepare for its arrival in our midst.

The relative geographic isolation of Hawaii may give us the impression that we can stop the virus from entering our islands through enhanced screening of people arriving at the airport. The novel coronavirus, like every other infectious disease, has an incubation period, the time between when one becomes infected to the time that one starts having symptoms.

Health authorities in China have announced that the incubation period of the novel coronavirus is typically 10 days (with a range of one to 14 days). An individual traveling during the incubation period does not feel ill, and airport screeners would find that his temperature is normal.

Furthermore, the signs and symptoms of the novel coronavirus are nonspecific. The first 41 patients, had fever (98%), dry cough (76%), and shortness of breath (55%). Any run of the mill pneumonia or severe influenza-like illness can cause fever, cough, and shortness of breath.

Identifying the patient with novel coronavirus will require close attention to the places that a traveler has been.

The likelihood that those infected with the virus will come to Hawaii increases with the sheer number of infected people there are.

The Centers for Disease Control and Prevention is closely monitoring an outbreak of respiratory illness caused by a novel (new) coronavirus first identified in Wuhan, Hubei Province, China.

CDC

The Chinese authorities imposed a quarantine on Wuhan, the city at the center of the epidemic, on Jan. 23, on the eve of the Lunar New Year holiday, scheduled for Jan. 24-30. The mayor of Wuhan noted that 5 million people (of a population of 14 million) had already left Wuhan before quarantine was imposed. Migrant workers, with longer and more difficult journeys to their home provinces, had left early.

There are already hundreds of confirmed cases in China’s international hub cities of Beijing, Shanghai, Chongqing, and Guangzhou. In these megalopolises, person-to-person transmission is occurring among many who don’t know yet that they are infected. Some of those individuals are boarding flights to all corners of the globe.

By making it illegal for all residents of cordoned off areas to leave, quarantine penalizes unexposed, uninfected people, i.e., susceptible individuals. Quarantine promotes defiance of authority. If planes, trains, and buses are suspended, people will escape through back roads.

Moreover, for those who are exposed or infected, quarantine incentivizes hiding signs and symptoms of illness. Humane public health measures must encourage access to health care.

A Potential Bioevent Disaster

In the end, how fearful should we be about this new virus? Keep in mind that it was the sickest people who first came to the attention of the health workers in Wuhan. They were the ones who needed to be hospitalized, placed on oxygen, and cared for in the ICU. Of those first 41 patients, six died, which calculates out to a 15% mortality.

But in the subsequent days less sick people were tested and found to have the novel coronavirus, too. Thus, of the first 835 patients, 25 died, i.e., a 3% mortality. The numbers are increasing day by day, so you can calculate the mortality rate yourself from today’s headlines.

Stay safe while our scientist friends come up with a vaccine.

Thus, as of Jan. 30, there were 8,235 confirmed cases and 171 deaths, for a 2% mortality (though some of the 8,235 are still sick). As more people with mild symptoms or even no symptoms at all are tested, we may find that they have been infected, too.

A 2% mortality is nothing to sneeze at, though. The Great Influenza of 1918-1919 had a less than 2.5% mortality, and between 50 to 100 million people died globally.

China’s lack of basic public health surveillance in wet markets and animals was responsible for SARS in 2003 and the current coronavirus epidemic. Heeding each and every public health requirement, no matter how unpopular or personally inconvenient, will once again win the battle.

Nothing erases your responsibility to others. Yes, we are faced with a bioevent disaster. We must approach this rationally, utilizing population-based public health principles. Stay safe while our scientist friends come up with a vaccine.

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