Judy Stone Senior Contributor Feb 1, 2020 - I am an Infectious
Disease specialist and author of Resilience: One Family's Story of Hope and
Triumph over Evil and of Conducting Clinical Research, the essential guide to
the topic.
The decision to impose a severe travel ban and
mandatory quarantines in response to the novel coronavirus (2019-nCoV) flies in
the face of public health recommendations, including those from the recent
Johns Hopkins Center for Health Security’s “Event 201” pandemic
preparedness exercise.
Instead, it appears to be a response to
xenophobia from the right wing, as Megan Thielkin
noted in Stat.
Information about 2019-nCoV is rapidly
changing as public health officials and scientists work feverishly to
understand it and curtail its spread.
What we have learned this week argues against
these restrictions. The biggest reason is that we now know fairly certainly
from the cases in
Germany that the virus can be spread before someone has
symptoms. In plain terms, “the cat’s out of the bag.” Millions of people have
been traveling internationally without any symptoms, or very mild ones they
didn’t recognize as significant, before the epidemic was recognized. The cases
in Germany also furthered evidence that cases can be spread by “fomites,” med
speak for an inanimate object (e.g., handles, pens, dishes).
Another new finding was detecting the virus’
genetic material (RNA) of the 2019-nCoV in stool. This doesn’t
prove that the stool is infectious, but it raises another question
as to how transmission is occurring.
Watching the Pandemic
Preparedness Exercise was enlightening. The messages from those
international experts were quite clear about travel bans being
counterproductive, potentially devastating economies. Similarly, we’ve seen
with HIV, Ebola, and other infections that punitive responses to infected
patients drives people into hiding underground, and further worsens epidemics.
On January 30, the World Health Organization
finally declared this 2019-nCov as a PHEIC (Public Health Emergency of
International Concern —pronounced phake). Dr Tedros Adhanom Ghebreyesus, WHO
Director General, emphasized that “WHO doesn’t
recommend limiting trade and movement” and that decisions should
be “evidence-based and consistent.”
Dr. Tara Kirk
Sell, Senior Scholar at Johns Hopkins Center for Preparedness
stressed that just because there is a travel ban, “no one should think that
there won’t be more cases.” It might just slow the spread a
little bit.
“Doing things out of an ‘abundance of caution’
isn’t a good idea…The risks, costs of the travel ban and some of the severe
quarantines that we are seeing around the world, those have real consequences.”
Dr. Tara Kirk Sell
Some of the immediate consequences are
economic and likely to be devastating to small businesses. There are more
lasting risks, given our reliance on
China (and India) to provide the active ingredients for many of our drugs.
I’ve been concerned about this as a national security issue for some years, as
have many others.
At the same time as the US is implementing a
travel ban for visitors to China, the administration
also expanded its travel ban to six additional Muslim majority countries.
The new coronavirus originated in China. Sell
noted, “Xenophobia, stigma… are some of the consequences that we worry about
when it comes to diseases that are associated with some foreign group.”
Dr. Sell also stressed that we need more
information about the numbers of cases and range of severity of illness to help
guide decisions. We don’t want to stir up fear because then “people are
reacting out of fear, rather than the actual consequences of the disease.”
The logistics of a quarantine are daunting,
too—you need to consider providing food, housing, meeting other special needs
to those being restricted, and consider their medical and religious needs, she
added. Implementing a quarantine “is really difficult, especially on a large
scale.”
In the meantime, what should you keep in mind
when you see the scary clickbait headlines? As of now, the 2019-nCoV appears to
require close contact and is spread primarily through droplets. Touching
contaminated surfaces is also a likely source of transmission. Influenza is
killing far more people in the US than this new virus is likely to. As Liz
Szabo noted, “Influenza has already sickened at least 13 million Americans
this winter, hospitalizing 120,000 and killing 6,600, according
to the CDC.
The best way to protect yourself from any of
these infections is to avoid people who are coughing and sneezing, and to keep
your hands away from your face so you don’t inoculate your nose, mouth, or eyes
with infected secretions. Wash your hands after touching any potentially
contaminated surface and be sure to turn off the faucet handle and open the
bathroom door using a barrier, such as a paper towel. Then use hand sanitizer.
If you wash your hands and then turn off the water with your bare hand, you
will have just recontaminated your hands. Knowing how to perform hand washing
correctly is the key to avoiding many infections.
Hopefully the travel bans, which are not
science based nor rational, will be quickly retracted. They may well worsen the
toll of this outbreak.
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