Public Health Officials Offer Scant Details On U.S. Coronavirus Patients
Yves here. I’ve kept the original headline to this Kaiser Health News piece even though it focuses attention away from issues that the article raises that seem more important.
It is important to protect patient privacy to the extent possible. It’s a generally accepted principle of care plus having the identity of coronavirus victims get out would be a deterrent to getting treatment. Not only could the victim be subject to hostility even after he’d recovered, but uninfected relatives and contacts could be shunned and abused, such as fired from their jobs.
However, the piece points out that where the victims have been is also being kept under wraps. This strikes me as a mistake. Given that there is some evidence that the coronovirus can survive on surfaces, it would seem prudent for the CDC to recommend cleaning measures for establishments that infected people visited in the US before being hospitalized. Again, there’s the perverse issue that members of the public would happily and unknowingly visit, say a drugstore that an infected person had stopped in before seeking care, but would shun one that had been notified by the CDC of the need for special cleaning and would presumably be safe after that.
I just happened to visit a chain drugstore and it didn’t even register until now that it was impossible to check out without putting my hands on a touchscreen (you had to accept or reject getting text messages, the prompt comes up for every friggin’ transaction). Now I am well away from any area where cases have been reported. But it’s documented that touch screens are disease vectors. And to be more graphic, feces are suspected to be a transmission path for the novel coronavirus. So consider this cause for pause:
From self-check-in, at airports to self-checkout at grocery stores, touch-screen technology is increasingly becoming an integral part of our daily lives. Touted as time saving and efficient these surfaces are touched by countless people every single day steadily collecting germs and bacteria from users. Much of the bacteria found on surfaces in public areas originates from people’s intestines, gut, nose, mouth, throat, and feces and is a result of poor hand hygiene….
o help put it into perspective the Hartsfield-Jackson International Airport in Atlanta is the busiest airport in the world handling over 2,500 flights and 275,000 passengers a day. When you think about the staggering number of people passing through the terminals every day and that 34% of Americans do not wash their hands after using the restroom, avoiding germs is an impossible task. According to research done by Insurance Quotes, the average self-check-in screen contained 253,857 colony-forming unit (CFU) that’s over 13 times more than the average of an airport water fountain button. One check-in screen recorded over 1 million CFU. In comparison, on average only 172 CFU are found on toilet seats.
Even though touchscreen technology is providing consumers with the convenience they want, it is undeniable that many touchscreens are dirty and unhygienic. Tests conducted by the Microbiology department at London Metropolitan University in 2018 found that touchscreens in McDonald’s restaurants in London and Birmingham all carried traces of feces. More often than not customers eat immediately after placing their order not stopping to wash off the germs they have just picked up.
The second basis for concern is what looks to be overconfidence of US officials in our “public health system,” as if we have one. The fact that, depending on how the study was conducted, between 44% and 64% of Americans say they skip or delay medical treatment alone says we have huge gaps in our “system”. And remember, in the early stages, the cornoavirus symptoms seem like those of a winter flu until they progress to pneumonia in severe cases.
For instance, if you go to the CDC website, you have to go three clicks from the landing page (2019 Novel Coronavirus > What You Need to Know About 2019 Novel Coronavirus > Prevention and Treatment) to find out what to do to keep from getting infected. That’s not easy to find, particularly since for two of the three clicks, you also need to scroll down the page to find further links. Or at least if the CDC thinks conveying that sort of information is important.
Perhaps much more is happening behind the scenes, but what has kept infection numbers and therefore risk in the US low so far is the (admittedly a bit late) lockdown of Wuhan and other key cities in Hubei, the halting of passenger flights to the US, and putting evacuees in quarantine.
But while the potential for transmission from China has been throttled down to close to nil, enough people left Hubei before the lockdown to allow for infection through other countries, and we may see those avenues become meaningful risks. Thailand admitted a full week ago that it can’t stop the spread of the coronavirus. Kerkala just announced that the coronavirus was a “state emergency” although it is not clear what that means.
Epidemiologists are concerned that airlines were slow to cut off flights from China to Africa. Another issue is that while passenger transportation can be shut down fairly quickly, freight is another matter. Readers have no doubt seem much gnashing of teeth over the damage the coronavirus poses to global supply chains, both due to restrictions on transport as well as restrictions on movements of people, which will have knock-on effects to production. But there’s also the disease transmission issue. China has land transport routes though Asia to the Middle East; truckers may have taken infection with them.
Needless to say, disease containment measures could have even more severe knock-on effects, as sometimes discussed in comments. From Transport Geography:
Food. Contemporary food production and distribution rely on low levels of inventory, particularly to avoid wastes of perishable products on store shelves. On average, supermarkets have between 2 to 5 days of inventory of perishable goods (dairy, produce, meat) and about 1 to 2 weeks for other goods (pasta, canned goods, etc.). It is worth underlining that these figures are for a normal and stable demand. In the case of a pandemic, available food supplies could quickly be exhausted through hoarding behavior. Such behavior is commonly observed during an acute weather event such as a hurricane where store shelves are quickly emptied. Food security is therefore defined by the ability of the transportation workers to move food from producers to the bulk-storage facilities, to the processor and lastly to the grocer.
Energy. The provision and distribution of energy are critical to the functioning of a modern economy and society. For instance, about 40% of the world’s supply of electricity is generated by burning coal (50% for the United States). Coal power plants maintain a fairly low stockpile, about 30 days, and rely on a constant supply from major coal mining regions, which tend to be far away. While a pandemic would not directly damage energy systems, many energy distribution systems could be threatened through the removal of essential personnel from the workplace for weeks or months and impaired transportation capabilities to supply power plants.
Medical supplies. A pandemic is obviously associated with a surge in the use of medical facilities, equipment and pharmaceutical products. Global drug production is controlled by a few large conglomerates that maintain a limited number of facilities at selected locations. Commonly, a single drug is produced at a single plant. If global distribution systems were impaired during a pandemic, many essential drugs would have difficulties to reach patients while limited stockpiles maintained at medical facilities would quickly run out. For instance, over 95% of all generic drugs used in the United States are made offshore, primarily in China and India. A similar pattern applies to critical medical equipment such as ventilators. Even simple respiratory masks could quickly run out. In 2017, Hurricane Maria hit Puerto Rico and substantially damaged infrastructures, particularly the power generation system. In the aftermath, a shortage of saline solutions was felt because Puerto Rico was a major supplier of these solutions to hospitals across the Americas. All these shortages are likely to result in additional deaths.
In other words, the US may continue to be lucky. But I wouldn’t bet on our ability to respond well to a real crisis.
Disclosure this week of multiple cases in the United States of a new viral infection emerging from China — including the first confirmed cases of the virus passing from person to person in this country — is fueling public concerns about how easily the deadly virus can spread.
It is also raising pointed questions about why authorities aren’t disclosing more information about the risk of exposure.
The first person-to-person case, announced Thursday, involves a man in his 60s with underlying health issues who is married to a Chicago-area woman who contracted the virus while traveling in Wuhan, China, and was diagnosed upon her return. During a news briefing, state and federal health officials said they believe the threat from the virus remains low within the United States and remained cautious about sharing details about patients and their movements.
Unlike the more detailed accounting of patients’ movements released during measles outbreaks, public health departments are not sharing precise timelines of people’s activities and locations in the days before they were diagnosed with the new coronavirus. The Centers for Disease Control and Prevention has said that while there’s a risk for everyone who comes in contact with a person with the virus, it appears minimal for those with only casual contact, such as being in the same grocery store or movie theater.
On Thursday, health officials declined to name the hospital where the infected couple are being treated, saying the patients are isolated and the risk to others in the hospital remains low. Health care workers who are caring for them and at a higher risk of contracting the virus are being monitored. Jennifer Layden, an epidemiologist with the state of Illinois, told reporters that the wife is doing well and the husband’s condition is stable.
In Orange County, California, where a traveler from Wuhan was confirmed on Jan. 25 to have the virus, Health Care Agency officials said they have received questions from concerned community members about why the agency has not released a precise timeline with the patient’s whereabouts. Jessica Good, spokesperson for the agency, said given what public health officials understand at this point about how the virus spreads, no additional precautions are recommended for the public.
“Our residents should go about their daily lives with no changes to planned activities,” Good said.
Dr. Robert Kim-Farley, an epidemiology professor with the Fielding School of Public Health at UCLA, is among the experts endorsing calm. The new coronavirus appears to be spreading through respiratory droplets, expelled by a sneeze or cough, that do not remain airborne for long and would require close contact for transmission, Kim-Farley said. Given that, he said, publishing a list of locations infected patients had visited would unnecessarily stigmatize businesses and public places.
“There’s no reason to stigmatize a place if there’s no public health action to be taken,” he said.
But he also noted that public health officials could quickly shift strategies pending key developments; for example, if they find the viral particles can remain airborne for long periods, similar to the highly contagious measles virus.
Not everyone agrees with the cautious approach. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said that if public health officials have found that patients were in public spaces, they should make that information public. “There is every reason to inform people if they were exposed.”
Most of the people confirmed to have caught the coronavirus outside of China are believed to have had prolonged contact with people who picked it up in China, like the man in Illinois. But the medical community’s understanding of the virus is still evolving, and the CDC emphasized its recommendations may change.
The Chinese National Health Commission minister has reported that the virus appears capable of being transmitted by an infected person without symptoms. On Thursday, German researchers documented such a case involving German workers who contracted the virus while attending a workshop with a female colleague who had recently been in China, according to news reports.
On Friday, citing the new research and expanded outbreak in China, the CDC took the rare step of ordering a two-week quarantine for 195 Americans flown back to the U.S. from Wuhan by the State Department. The federal government later expanded that quarantine to all Americans who have been in Hubei Province, where Wuhan is located, during the last 14 days. Additionally, all foreign nationals who have traveled in China in the past 14 days will temporarily be prevented from entering the U.S., with the exception of immediate family members of U.S. citizens and permanent residents. Those measures took effect on Sunday at 5 p.m. ET.
While the CDC has cautioned against panic in the U.S., it has expressed concern about the situation in China, where more than 17,000 people have tested positive for the disease and more than 360 have died. The majority of people infected are experiencing mild cases of illness that resemble the flu or a bad cold. But more serious cases can result in pneumonia and respiratory failure.
Despite unprecedented travel restrictions in China, which have prevented the movement of tens of millions of people, the virus has spread to every major city, and the number of cases is sure to grow substantially.
The risk that large outbreaks could spring up in other countries, including the U.S., is also real. The World Health Organization declared the virus a global health emergency on Thursday, precisely because of that risk, WHO Director-General Tedros Adhanom Ghebreyesus said during a news conference. There likely will be more cases confirmed in the U.S., and it is likely that people in close contact with those patients could contract the disease, said Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the CDC.
Still, the risk to the American public remains low, officials stressed. That’s partly because public health departments around the country are on high alert and preparing for additional cases.
“We have a really good public health system that’s really good at detecting disease,” said Anne Rimoin, an epidemiologist and director of UCLA’s Center for Global and Immigrant Health. “We’ve been preparing for this kind of a thing.”
The CDC is reminding the public to take the usual precautions during flu season: Wash hands regularly; cover your mouth when you cough; avoid touching your eyes, nose and mouth with unwashed hands; and avoid contact with people who are sick.
Local health departments also are monitoring close contacts of people who have tested positive for the virus, and sometimes running diagnostic tests even when they have no symptoms.
Despite these assurances, rumors are circulating broadly via text and social media, particularly in Chinese immigrant communities, about people who recently traveled to China and might be infected.
Los Angeles resident Rachel Lee Morales, who was born in China, is anxious because her young daughter is in China with her grandparents to celebrate the new year. Morales is closely following news on the epidemic and has seen messages on social media making unverified claims about people who have recently traveled to Wuhan, including sharing their address and where their children attend school.
“Information gets spread so widely these days, and it could seriously hurt people’s lives,” Morales said. “I don’t want anyone to get into trouble because of this.”