The coronavirus (2019-nCoV, CV in short in this article) discovered in Wuhan City of 14 million people is a new virus causing over one thousand death and spreading with RO (basic reproductive number of infectious case) greater than 2 but the scientists are closing in on precisely identifying it, discovering curing medicine and developing vaccine preventing it to become epidemic or to reoccur. The world-wide media are covering coronavirus as a sensational news with typical exaggeration, rumors, sarcastic remarks, racial prejudice, and criticisms with some good and some bad intentions. In this article, we will, report only the facts and scientific knowledge to correct fake news and to reduce fear, panic and prejudice, such as headlines discriminating Chinese people on Wall Street Journal.
First, we start with the WHO Geneva conference (Feb 6 2020,https://www.who.int/news-room/detail/06-02-2020-who-to-accelerate-research-and-innovation-for-new-coronavirus). Scientists now have identified CV as a close cousin of viruses that infect bats jumping from unconfirmed wild bats to intermediate host, possibly pangolins or other small mammals sold in Wuhan food market. Unfortunately, the rapid action of closing the Wuhan animal food market cut off the opportunity for scientists to collect more samples and observe more transmission cases to characterize more precisely what is the CV’s origin, intermediate host and incubation process. From DNA or RNA studies, the scientists now know CV’s RNA has only 80% similarity with SARS virus (2003) but has closer similarity with virus found in bats in Zhoushan (舟山 90%）and Yunan （雲南96%). The 4% difference is still a big deal since we know human DNA has 98% similarity with Ape’s DNA. However, with today’s scientific research capability, CV’s ID will soon be ascertained. We should be hopeful that cure and vaccine will come soon.
From epidemiology point of view, lethality, means of transmission and speed of spread (RO: the number of people infected from one virus carrier) are key information to estimate the impact, to devise prevention measures and to adopt a plan for handling the worst scenario. We already know that CV could have more impact on older and weaker people and nearly none on children (stronger natural immune system). From lethality data, we know fatality with early hospitalized CV patients was 15%, considering only severe cases, the fatality was as high as 30%, higher than the 10% cited for SARS in 2003 but less than 35% cited for MERS in 2012. If we include light cases of CV, the fatality drops to about 3%. If including no-symptom cases, the rate is even less.
Scientists have essentially understood the transmission means of CV through past experience and current studies of its molecular nature. Close contacts (about 6 feet) between person-to-person allow spread via respiratory droplets produced by an infected person from coughs or sneezes, making droplets to land in people's mouths or noses or eyes or possibly be inhaled into their lungs. Touching a surface or object having CV virus on it can transmit into one’s own mouth, nose, or eyes, but the virus has a short lifespan (minutes) when ambient temperature is higher than 15 degree C or the object surface was sprayed with disinfectant. Based on the initial data, the RO range of CV is 1.4-2.5 (Jan 23, 2020 estimate which is being reduced as people separation and closing of cities took effect) comparing to missiles 12-18, smallpox 3.5-7, SARS 2-5 and flu 1.2-2.4. Hence, paying attention to disinfection, wearing mask and staying away from the sick and the crowd would be quite effective to prevent being infected.
Professor of Hygiene, Robert Koch (born 12-11-1843), a German scientist, had defined a standard for infectious virus: 1. Large number in patient; 2. Can be extracted out; 3. Can put in healthy person to cause sickness; and 4. Can find them in new patient. Rule 1 and 2 have been verified for CV by scientists with electronic microscope and DNA studies. (Zhu N et al, NEJM 2020, rule 1 and 2, and Huang C et al, Lancet 2020, rule 1), Rule 3 and 4 are partially proven by mice experiment (Zhou P et al, bioRxiv, 2020). Scientists knew that SARS came from bats (origin) through civet cats (middle host) and MERS from camel (Kau B et al, J. Virol 2005 and Samir JSM et al Science 2015), thus it is hopeful that soon the carriers of 2019-nCoV will be identified. Quick closing of Wuhan animal market did help stopping the spread of virus but also cut off its middle host trail unfortunately. However, scientists do know that CV did not come directly from bats (Huang C et al, Lancet, 2020).
The public reaction to the 2019-nCoV is quite varied; a large population were influenced by mass media and also by considerable information, correct or not, real or fake, and positive or negative discussions from the Internet. There are very wide range of sentiment towards the Wuhan outbreak of Coronavirus. Among China’s close neighbors, the timely and sincere support came from Cambodia whose Prime Minister even visited Wuhan and Japan who had sent medical supplies despite of a number of Japanese citizens were diagnosed with CV on a cruise ship now being quarantined in Yokohama. The remote countries like Australia and the U.S. seemed to be far more nervous championing early drastic measures and contemplating evacuating American citizens from China and stopping all travels to China despite of WHO’s advice not to do so. The UN team did declare Wuhan as an emergency case but praised China’s effective effort in containing the spread and her efficient actions in providing medical care, including building several hospitals with thousands of beds in a matter of ten days as well as mobilizing hundreds of thousands of voluntary medical professionals nationwide to join Wuhan and Hubei Province to battle the viral disease.
Among many criticisms, few are valid or reasonable. One fair criticism is that the early action of the officials in Wuhan as well as people in the know (as Wuhan’s direct superiors or relevant health, medical and scientific professionals) are not excusable in not immediately recognizing the danger of this coronavirus. Over concern of early disclosure of information, which may cause public panic, might have delayed finding more effective measures in dealing with CV. For example, quarantining the Wuhan animal food market instead of just shut it completely down may be a smarter action allowing valuable leads to scientific research for understanding, cure and prevention of CV.
Judging from the many scientific publications by the Chinese scientists in the various prestigious international journals such as Nature, NEJM, J. of Virology, etc., one can appreciate the amount of hard work the scientific teams devoted to CV. However, in the situation of potential epidemic, possibly pandemic, disease, time and knowledge are the essence in solving the problem. The archaic publication rules of most prestigious journals - only accepting and publishing firsthand, original, complete and 'expert refereed' articles are the culprit for delaying vital information to be disseminated and shared. These rules may be useful for Nobel Prize Winner determination years down the road but they are destroying the scientific and medical community’s opportunity to share early information and work collaboratively to save the society and thousands of lives. After all, saving human lives must be more valuable than winning a Nobel Prize.