Common sense view of Coronavirus 2019-nCoV and other viral threats

Repeated warnings about mutant flu / other new viruses 

At a time of panic in some communities, here is a common sense view. I am writing as a physician and trends analyst who has been involved in the fight against HIV (another mutant virus) for over three decades.

Since 1987 I have been predicting the great vulnerability of our world to new mutant viruses or mutations of existing ones, in my book The Truth about AIDS, in Futurewise published in 1998, and in The Future of Almost Everything published in 2015/2019.

This has also been the position of the World Health Organisation for over two decades.

Longer term global challenge

The longer term global challenge is that coronavirus 2019-nCoV is just one of a large number of totally new agents emerging each year, the vast majority of which are relatively harmless causing combinations of aches, pains, fevers, rashes, gut problems and other symptoms. 

A small proportion of such new viruses are so lethal that they typically kill their victims before there is much opportunity for transmission, so infections tend to die out rapidly. 

But the most dangerous potentially to the global community are new viruses which have longer incubation periods, and are less likely to kill. Coronavirus is much less lethal to an average infected person than Sars was, but has already spread far more widely.

Many of these new viruses typically emerge in South East Asia, in nations like China, having jumped from animals into humans, sometimes with a mutation at the same time. 

Just one such new virus was of course HIV, which to date has killed over 40 million. 

Fortunately we have effective antivirals now against that particular virus, after years of intensive research, but it remains a major global health risk, with just under 2 million new infections a years, and many deaths linked to AIDS.

How Coronavirus 2019-nCoV may mutate further

A huge uncertainty is how this new coronavirus will evolve. All flu-type viruses tend to go on mutating - they can become more or less dangerous and more or less infectious. 

The good news is that a very common trend is for new viruses to become less lethal, as they pass through one person to another and across neighbourhoods. 

But sometimes a new virus can infect someone who is also carrying ordinary flu, and their cells get muddled about which virus to make, so that a new combination of genes happens. 

Such an event could change the virus radically in behaviour, however 2019-nCoV does seem relatively stable compared to ordinary flu or the common cold.

Ordinary flu is also a major killer

We also need to remember that normal flu kills 50,000 a year in the US, and around 75,000 across the EU, mainly older people, particularly if frail with other serious conditions.   

Doctors are used to seeing death rates three or four times normal every deacade or two, so US death rates from 2019-nCoV of - say - 150,000 would not be that far from normal year on year variations. 

I am not saying that is what is going to happen, only that we need to see things in proportion.

Vital to know % infected with no illness or very mild symptoms

Common signs of infection are fever, cough, sneezing, shortness of breath and breathing difficulties - all of course extremely common with other viruses

However, it seems that a significant number of people are becoming infected, but don't get anything more than very mild symptoms, maybe none at all. 

On the one hand, if true, this will make spread far harder to track. 

But on the other hand, it means that reported death rates may be far too high, because we are missing most of these other milder cases. 

Every person who recovers is of course carrying antibodies against the new virus, and unravelling how the body responds will lead to all kinds of treatments.

To be certain of all this, we need to be testing large numbers of people who are completely well, to see if they have any evidence of previous mild infection. 

And that can be harder than testing someone who is acutely sick.

Strict quarantine and contact tracing is vital

Some may argue that draconian measures to limit spread may not be enough to prevent, ultimately, a global pandemic. 

But even if that is the case (which is currently unknown), it is critically important to slow down spread as much as practically possible in early stages for several reasons. 

Firstly, to give time for experts to study the first cases, learn more about how it spreads, how dangerous it really is, risk factors for getting ill, and the best methods of treatment. 

Secondly, it gives time to prepare potentially very large scale responses, ramp up testing facilities, manufacture supplies, train health care workers, mobilise communities and create additional treatment facilities. 

And that also means wealthy nations giving major support to emerging nations to help with healthmessaging, community mobilisation, testing, quarantine, treatment.

Summer weather in Northern Hemisphere may help many nations 

The fact that Swine Flu is starting to spread globally in February 2020 rather than in the Autumn may help, because such viruses spread less effectively in warmer months, and most people in the world live close to the equator or in the Northern Hemisphere.

Lessons from Sars chaos 

Sars virus spread rapidly in 2003 but there were only 862 deaths and only around 8600 cases.  

Yet China faced a national crisis with thousands fleeing cities like Beijing, possibly carrying infection with them across many SARS-free areas. Normal life in some places ceased. 

After much delay the government introduce with draconian measures including quarantine for entire buildings, thousands of workers, entire hospitals, severe limitations on travel, cancellation of public holidays, huge fines for spreading false rumours and so on. 

We have seen major disruptions since with other new viruses, for example in Mexico. This time, the Chinese government have acted at great speed and with huge responses.

Our world was very fortunate in 2003 that there were no cases in nations such as DR Congo or Zimbabwe, nations with very few health care resources, and weak government structures, compared to China, which is highly organised, efficient and centrally controlled. 

A single superspreader on one plane in such a low-income nation, would have been enough to ensure that Sars became a semi-permanent health care problem across the world.

Expect more mutant viruses - urgent need for better antivirals 

As I have often said in the past, all this underlines the urgent need to develop effective antiviral medication. 

It is shocking that 60 years after the discovery of penicillin we still do not have a single antiviral that is as effective as the earliest antibiotics. 

When we do, we will have a cure for common cold, flu, polio, smallpox, viral meningitis and viral pneumonia - amongst many other conditions. Genetic engineering may be a key weapon in vaccine development.

Reducing personal risk

In the meantime, all those potentially at risk can take simple steps to stay well - helping protect you from a host of other flu-like viruses, as well as ordinary coughs and colds at the same time. 

The virus cannot cross your intact skin - but moist membranes are vulnerable eg nose, mouth, eyes (probably). 

That means washing hands regularly, not touching your face, using disinfectant hand gel in addition if you wish. 

And to state the obvious, don't spend time close up to someone who might be a carrier, particularly if they have a fever, are coughing or sneezing.

World Health Organsation Coronavirus 2019-nCoV update and infection control guidelines