After weeks of measured statements, the Centers for Disease Control and Prevention on Tuesday finally sounded what some have said was an overdue public wake-up call about a deadly and highly contagious coronavirus that is rapidly spreading around the world.
Having infected more than 81,000 people in at least 38 countries, including three continents, CDC officials are now telling Americans to expect eventual outbreaks and "community spread," in which the source of the infection is unknown. The World Health Organization has not classified the current outbreak as a global pandemic, but on a call with reporters yesterday, a doctor with the CDC used the term, which has been defined as an epidemic occurring worldwide, or over a very wide area, that includes crossing international boundaries.
“It’s not so much of a question of if this will happen any more but rather more of a question of exactly when this will happen,” said Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases during the news briefing.
Messonnier sketched out some precautions that individuals should start considering, such as social distancing and working from home, and raised the possibility of school closures, a move that would help containment but also disrupt the work lives of parents.
Given the sudden ramp-up in concern, Tuesday's CDC announcement raised questions about how cities and local communities should begin preparing for a coronavirus outbreak, especially as President Donald Trump and his administration officials downplayed the impact of the virus in the U.S. on the same day. Trump and CDC officials have announced a press conference at the White House at 6 p.m. on Wednesday to discuss the coronavirus.
As of early Wednesday morning, state and city officials have yet to come out with any additional guidelines beyond what they have already issued, but Senator Chuck Schumer is requesting $8.5 billion in emergency federal funding to combat the coronavirus, over three times higher than the $2.5 billion currently requested by the Trump administration.
There are still no confirmed cases of the coronavirus in New York state, and only seven suspected cases that were found to be negative citywide. But some scientists have raised the possibility of low-level infections that may have gone unnoticed. Complicating detection is the fact that the virus can result in mild cases which exhibit symptoms very similar to the flu or the common cold, which are both in full swing right now. But unlike the flu, it is still not clear whether the latest coronavirus will be seasonal.
So how exactly should New Yorkers start preparing themselves for the contagion officially known as COVID-19? Here are some things you should know.
Continue using smart hygiene practices, and then some, i.e. stop touching your face.
Health officials have thus far focused on basic precautions such as frequent hand-washing, covering coughs and sneezes, and staying home when sick. Dr. Stephen Morse, a professor of epidemiology at Columbia University Medical Center said those measures should continue to serve as a baseline of protective measures against the disease. "You can’ t get perfection," he said. "On the other hand, many of these things should become habitual."
The next level of preparedness is increased vigilance. While scientists are still trying to determine level of contagiousness of the disease, known as the "R naught," there is growing consensus that the COVID-19 is more contagious than SARS. There are also signs that asymptomatic people can pass on the disease, which is believed to have an incubation period of between 2 to 14 days.
"Don't touch your face or eyes," after touching surfaces that may be infected, Morse said.
For some, the advice may evoke the movie Contagion, where Kate Winslet, who plays a CDC officer, says the average person touches their face "two or three thousand times a day." While Morse could not vouch for that statistic, the film is well-regarded by scientists. Dr. W. Ian Lipkin, a preeminent virologist and "master virus hunter" served as the film's technical consultant and has said it is a realistic depiction of a pandemic.
Keep your distance and start accumulating essential supplies at home.
Since most respiratory illnesses are spread by droplets in the air that travel between 3 to 6 feet, social distancing is another recommended step, especially among those who are feeling unwell, with 6 feet being the general guideline, according to Morse. A study by China's Center for Disease Control and Prevention found that the virus can live in fecal matter, which would suggest that attention be paid when using bathrooms.
Dr. Ali Khan, the CDC's former director of the Office of Public Health Preparedness and Response, advised the public to begin stockpiling 10-14 days of basic necessities. Individuals on medication should have a few months of supply on hand. He suggested that people come up with a home emergency plan and to get CPR training. They should start checking in with their neighbors.
Additionally, Morse said New Yorkers should have their groceries delivered if possible and recommended asking delivery people to leave the items at the door so as to avoid person-to-person contact.
Employers, meanwhile, should begin reviewing and if necessary, re-evaluating their sick leave policies, as well as determining which people can work from home. Those who can telecommute should consider doing so if they begin to feel unwell or as the pandemic worsens. Routine cleaning of work spaces should also be performed. The CDC has listed some interim guidance for businesses on its website.
Personal health choices may also make a difference. In China, one factor that has not gone unnoticed is that more than half the population of men smoke. Khan advised people who smoke to stop. He and other U.S. health officials are also reminding people to get vaccinated for the flu.
Healthy people DO NOT need to wear face masks.
Shortly after the outbreak, there was a perceptible rise in New Yorkers wearing masks and there were multiple reports of pharmacies being sold out of the items. Among Asians, wearing masks is an acceptable custom, viewed as a way of avoiding breathing in "bad air" and as a considerate gesture during flu or cold seasons.
People in Flushing wearing face masks.
But the CDC does not recommend wearing a face mask for those who are not infected or sick. Morse agrees on this, saying that the literature is mixed on the efficacy of masks in preventing infection in public areas. Cheap surgical masks are especially thought to offer limited protection given their loose fit.
"I think it’s easier to get a false sense of security," he said. "A mask has to be worn properly and it's hard to do that without actual training."
Even heavy-duty masks used in hospitals, known as an N95 respirator, are difficult to wear and require users to be fit-tested.
The subway may not be the ideal way to commute during a pandemic but New Yorkers should be able to deal with it.
Past studies of germs in the city's labyrinthian subway system have found them to be plentiful but largely harmless. But amid a pandemic or even flu season, the health risk increases. Lipkin has said that he always uses a glove or other physical barrier, like the crook of an elbow, when he grasps onto poles. In any case, people should wash their hands after touching any public surfaces.
Morse said that ultimately, the decision of taking the subway depends on one's degree of risk aversion. Those who are feeling sick or have underlying conditions may want to take extra precautions. "Some of the measures, at our density are really hard to do," he said. "It becomes an individual decision."
Regardless of the coronavirus, he added, "We are not going to live as hermits."
Certain people appear to be more vulnerable to the disease.
According to an analysis of nearly 45,000 cases in China, the elderly and those with underlying health conditions have been most at risk for developing a severe form of the coronavirus. The fatality rate among those with cardiovascular disease was 10.5 percent, 7.3 percent for diabetes patients and around 6 percent for individuals with chronic respiratory disease, hypertension, or cancer. Among healthy patients, the risk of death was 1 percent. “The virus matters, but the host response matters at least as much, and probably more,” Stanley Perlman, a virologist and pediatric infectious disease specialist at the University of Iowa, told The Scientist magazine.
Another study suggested that infected men have a higher fatality rate than women, 2.8 percent compared to 1.7 percent. The same gender disparity has been observed in SARS and the Middle East Respiratory Syndrome (MERS), both forms of coronavirus. During those outbreaks, men were were also disproportionately affected. One study showed that during SARS, the death rate among men was 50 percent higher. In general, woman are believed to be better at fighting off viral infections.
Children have also generally been spared, with relatively few cases among those under nine, a pattern that was also seen in SARS and MERS. While scientists don't fully understand the reasons why, certain viruses seem to trigger milder symptoms in the very young. Early studies also suggest that the disease is not transmitted from a sick mother to the fetus.
A vaccine will likely not be developed in time to save us.
Most experts are projecting that a vaccine is still at least a year away. During the 2003 SARS outbreak, a phase 1 clinical trial of a vaccine took about 20 months. "The process of safety and efficacy testing remains a challenge," Lipkin recently told Gothamist. But he added: "I’m optimistic that we will see enhancements that shorten the timeline."
At a press conference on Tuesday, Dr. Bruce Aylward, a Canadian epidemiologist who headed a World Health Organization team to China, urged collaboration among the world's best scientists, saying that "research saves lives."
Referring to the American-led effort during World War II to develop an atomic bomb, he said, "You want a Manhattan Project on your top vaccine candidates and top therapeutics."
But even if a vaccine is not released in time for this pandemic, it could still prove useful for future outbreaks of COVID-19.
This is not the first pandemic to hit New York City—and it will won't be the last.
Beginning in April 2009, there was an outbreak of the H1N1 virus, also known as "swine flu," which eventually reached at least 74 countries. Across the United States, there were an estimated 2 million people infected and at least 4,000 deaths. One of the first and largest outbreaks was identified in a Queens high school. One hundred students at St. Francis Preparatory School in Fresh Meadows became sick and nine tested positive for the swine flu. The outbreak prompted the closure of nearly 60 schools and high absentee rates. More than 50 people in New York City died from the virus. City health officials estimated that between 750,000 to one million people were sickened in New York City.
Given the 2009 swine flu pandemic, the city and some organizations should have a road map in place to build on for the latest coronavirus outbreak, according to Morse.
"By all indication, it looks very much like a flu pandemic," he said. "But we should be less blasé about flu pandemics."
