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3 Months : From Jan 2020 to Apr 2020
By Brianna Abbott
Amid the fast-moving, novel coronavirus outbreak emanating from China, companies, governments and schools are developing policies on the fly to try to halt the spread, creating a live global public-health experiment in containment.
In the U.S., some businesses and universities have told people who had recently returned from the epicenter of the outbreak or from mainland China to stay home for as long as two weeks after returning. The U.S. government also said on Friday that it would deny entry to foreign citizens who had traveled to China within the past 14 days and imposed a maximum two-week quarantine on Americans returning from Hubei province where the outbreak started. Major airlines, including Delta Air Lines Inc. and American Airlines Group, said they would stop all flights to mainland China, with other airlines cutting back on services. The State Department issued a "Do Not Travel" alert, the highest warning level, urging citizens not to travel to China.
Public-health experts say that the risk of infection is low in the U.S. for the general public, but precautions are warranted given how little is known about the virus, which emerged in Hubei province's capital city of Wuhan only a few weeks ago and has yet to be contained. Travel bans have limited effectiveness at this point in the outbreak and come with their own set of consequences, and public-health authorities are working to balance controlling the virus against repercussions on economics, social relationships and individual liberties.
"We're in a phase where a lot is unknown, and that makes it scary, and there might be a tendency to a strong reaction until more is learned," said Mark Mulligan, the director of NYU Langone Health's division of infectious diseases and immunology. "It's not a time for panic or overreaction but to follow the playbook."
Two-week quarantines and restrictions on returning to work are based on concerns that people may be able to spread the virus during the so-called incubation period when they are infected but not yet showing symptoms. Right now, the estimates by epidemiologists range anywhere from two days to two weeks, largely based on what scientists know about other coronaviruses. Experts are erring on the side of caution by recommending the upper end of that 14-day period for monitoring and quarantines, health experts say.
Scientists don't know the full timeline of when people are infectious. At least one report, published in the New England Journal of Medicine, describes a patient in Germany passing along the virus before developing symptoms, and a bus driver in Japan recently tested positive for the virus after driving tourists from Wuhan, none of whom had shown severe symptoms. The World Health Organization says that most of the transmission has occurred in symptomatic patients and that passing along the virus before a patient has developed symptoms is rare but possible.
Outright travel bans might have come too late to fully stop the contagion, some experts say. "At this point, the cows are out of the barn," said Michael Osterholm, director of the University of Minnesota's center for infectious disease research and policy. "To think that we're going to stop it by ending travel is not at all practical."
Global health authorities are warning countries and hospitals to prepare for containment and prevention of the virus within their borders, and encouraging them to engage in international cooperation to help countries with weaker health systems. Surveillance, tracking and monitoring, isolating sick people and even quarantining certain individuals are likely reasonable or necessary from a public health standpoint to halt the fast-spreading virus, experts say.
The novel outbreak that originated in China in December has now spread to at least 23 other countries, with over 17,000 confirmed cases and more than 300 deaths. Most of the cases and deaths have been in China. The first death outside of China, a 44-year-old man in the Philippines from Wuhan, occurred Saturday, according to the Philippine Department of Health.
Just 11 people in the U.S. have been confirmed with the virus, and all but two had recent travel history to Wuhan. Public-health authorities are intent on preventing further human-to-human spread in the U.S. and delaying the entry of the virus into the country.
The novel coronavirus doesn't appear to be as contagious as the measles or as deadly as SARS or MERS, also coronaviruses that killed 10% and roughly one-third of infected people, respectively. But it does seem fast-moving and deadlier than seasonal influenza, which has infected at least 19 million people and killed 10,000 in the U.S. so far this season, according to estimates from the Centers for Disease Control and Prevention.
In the absence of a vaccine, some public-health experts worry that the pathogen might be able to continuously circulate throughout the country, akin to a seasonal virus. The goal of the U.S. public-health response is to prevent sustained spread, according to the CDC, though the agency says it expects more cases and even human-to-human transmission.
"We either stop it now or we never stop it," said Lawrence Gostin, the director of the O'Neill Institute for National and Global Health Law at Georgetown University. "We have to be prepared for the possibility that this is going to be like the seasonal flu."
Health experts also note that some policies could go too far. More than 60% of all confirmed cases are just in Hubei province, so quarantining or banning anyone returning to the U.S. from all of mainland China is an overreach, said Mr. Gostin, who is also the director of the WHO Collaborating Center on National and Global Health Law. Airport screening or monitoring them for symptoms would have likely sufficed, he said.
Travel bans also often discourage international cooperation and have social and economic consequences that some experts say can damage the public-health response, especially if countries become more secretive about their case numbers to avoid travel and trade repercussions.
Others, however, say it makes sense that airlines would want to avoid putting their employees in danger and that countries want to protect their own citizens.
"At the start of an outbreak, there's a fog of war," said Nathan Grubaugh, an assistant professor of epidemiology at the Yale School of Public Health. "You're trying to weigh two bad choices to figure out which is worse, and I think in this case, limited travel and trade is worse."
When the WHO declared the coronavirus a public health emergency of international concern last week, officials explicitly said that the agency was against any trade and travel restrictions put on China, such as visa refusal or border closure. But the next day, the Trump administration announced its increased travel restrictions, which then got pushback from Chinese officials.
Public-health experts also expressed concern about unnecessary worry and misinformation circulating in the U.S., including discrimination and xenophobia against Chinese residents or even Asian Americans who have never been to China, said Dr. Grubaugh.
Within the U.S., public-health experts note that the virus isn't an immediate risk to the general public, and the CDC currently recommends against actions like wearing face masks.
"If you happen to walk down the street and pass someone with the virus, you're not going to catch it from them," said Robert Citronberg, an infectious-disease specialist at Advocate Health Care in Illinois. Instead, health authorities are attempting to turn fears over the novel coronavirus into action against a more immediate threat: "A lot of people who are concerned about the coronavirus haven't even gotten a flu shot," he said.
Write to Brianna Abbott at email@example.com
(END) Dow Jones Newswires
February 03, 2020 13:49 ET (18:49 GMT)
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