Prepare, don’t panic

At a time when words like epidemic and pandemic have become commonplace, it is imperative we take a step back and think about the ongoing novel coronavirus situation. What started at a seafood market in Wuhan City, Hubei, has now spread to almost 90 countries in nearly all continents, with the majority of infections and deaths occurring in China.

Last week five more countries reported spikes in the number of new cases, and there was also an increase in deaths outside China. Daily counts tell us there have been 120,000 cases till date, yet no one reports the fact that more than half of those infected have already recovered.

A global media frenzy about the disease has thus resulted in a shortage of face masks, sanitizers and, in some countries, food and bottled water as well. People are fighting over toilet paper and sanitizers in convenience stores, somehow unaware that others must also have access to sanitation to prevent transmission.

But besides creating public health emergencies of international concern, the virus has also incited geopolitical and economic issues. Trade routes have been halted, and entire regions and nations have been put in lockdown. A larger domino effect is unfolding in multiple realms because Wuhan, the epicenter of this virus, is a major production hub in China that supplies manufactured goods across the world.

Although much still remains unknown about the coronavirus, one thing is sure: it is highly contagious. The rampant increase in cases around the world highlights vulnerability, further aggravated by frequency of travel and globalization, factors over which we have limited control.

However, in our lifetime we have dealt with H1N1, Ebola, SARS epidemics, and not to mention seasonal influenza. Knowledge gathered from each of these events is an advantage because we have the medical knowledge and technology to identify and test in matter of days or weeks. As concerned citizens of a civilized society we need to pick – do we prepare or panic?

It is human nature to be fearful of the unknown such as the current novel coronavirus. However, the ongoing mass hysteria isn’t helpful to those infected, receiving treatment or those at the forefront, i.e. health care workers and public health officials who must simultaneously deal with personal and public health.

We know the coronavirus is an extensive family of viruses that is quite commonly seen in humans and different animals. The Middle Eastern Respiratory Symptoms (MERS) and Severe Acute Respiratory Symptoms (SARS) were our most recent brushes with this virus, and transmissions from animals to humans have been well documented in the last 20 years.

The symptoms to look for are fever, cough, and shortness of breath. These symptoms may appear 2-14 days after exposure to an infected person.

In otherwise healthy adults, the symptoms could be mild, not requiring testing or treatment. In severe cases, it can lead to pneumonia and acute respiratory distress, especially among older people whose immunity has been weakened by diabetes, heart diseases, and existing respiratory issues.

Just to put things in perspective, the Chinese Center for Disease Control (CCDC) reports over 80 per cent of the infections in China were mild. Close to a fifth of all infections were considered to be moderate or severe.

The overall fatality rate (FR)[footnote] A mortality rate is a measure of the frequency of occurrence of death in a defined population during a specified interval[/footnote] stands at 2.3 per cent, although this has shown to increase with age. Comorbidity [footnote]The condition of having two or more diseases at the same time. [/footnote]with heart disease, diabetes, long term breathing diseases, blood pressure, and cancer showed higher fatality rates. This explains why people over 80 years have the highest case fatality rate (CFR) [footnote] The case-fatality rate is the proportion of persons with a particular condition (cases) who die from that condition. It is a measure of the severity of the condition [/footnote] at 14.8 per cent.

We cannot undermine the death of these individuals, yet what we also need right now is knowledge, expertise and evidence-based information to move forward to prevent more deaths.

Countries with testing capabilities are doing careful evaluations of who needs to be tested based on the severity of symptoms. In the coming days, the cases are bound to increase as we become more experienced in identification and testing.

It is also imperative we understand when to seek medical help. This is not the time to overburden the health care system by just walking up to your primary physician’s office or the nearest emergency department. If you have mild symptoms, it would be better for you to stay home as far as possible, wear masks when you do go out, and not expose yourself to others who are at higher risk.

When the virus was first identified in China, allegedly on December 31, 2019, no one really knew what path it was going to take. We have gained more information with time but, as WHO Director General Tedros Adhanom Ghebreyesus said at the Munich Security Conference on 15 February, we are simultaneously fighting an epidemic and an infodemic.

Also, where you get your information matters most at a time like this. Wikipedia, forwarded WhatsApp messages, and family friends’ homemade hand sanitizer recipes should be discarded in favour of scientific recommendations by certified health officials.

While the number of people infected and dying is alarming, we also have to bring this global event in perspective. As public health officials know, there is another virus, the seasonal flu, that is routinely killing kids and older adults. Despite knowledge, awareness of prevention methods like vaccination, and treatment, a staggering number of people die every year due to the flu.

As a public health professional I get asked a multitude of questions, some out of naïve curiosity and some out of conspiracy theories and downright racism. In my opinion, this might be the best time in history to have to deal with an epidemic of this nature as we have built an extensive library of knowledge from the various trials and errors we have experienced in the last century.

Anything new is frightening, but for now following simple actions like washing your hands, covering your mouth when you cough, staying home when sick and not exposing yourself to others are few very useful tactics to use.

People who have access to reliable, valid information have a duty to not feed the ongoing panic but point towards objective and evidence-based information so that health officials and public administration can make correct, life-saving decisions for everyone.

Instead of panicking we must stay prepared.

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Prepare, don’t panic