An inside perspective of health care and life as a physician, from Pure Family Medicine

Why Denver Shouldn't Worry About Wuhan Coronavirus, For Now...

January 29, 2020

The new coronavirus out of Wuhan, China has become big news lately - reports are popping up of cases all over the world, the CDC has issued a level 3 travel advisory for people to avoid non-essential travel to China, and misinformation has been spreading like... well, a global viral pandemic. But how worried should you be if you live in Colorado? Let's try to put this outbreak in perspective. Keep in mind, infectious outbreaks can change quickly, the info shared here is accurate as of 1/29/20.

What Factors are at Play?

What makes an infectious outbreak scary? Certainly the mortality rate is a huge concern, as is the level of contagiousness. But there are a ton of factors at play - how many people have it now, is quarantine in place and effective, how does it spread, is there any immunity to the disease, what is it's potential for mutation, etc, etc...

How Contagious is It?

In short, it's about as contagious as the common cold, and spreads the same way. When looking at a level of contagiousness we look at a R0 (R-nought) value which essentially says - how many people will one person infect with this disease. An R0 of greater than 1 means the disease will spread, an R0 of 1 means the disease is at a stable level and won't cause an outbreak, and an R0 of less than 1 means it will naturally decline. R0 doesn't tell the whole story of contagiousness, because other factors like quarantine, vaccination, and level of natural immunity will alter the R0 value, but it's a great way to compare an unfamiliar disease to diseases we already know.

R0 values for well known infectious diseases

  • Malaria - 17
  • Measles - 9
  • Pertussis (whooping cough) - 9
  • Norovirus (GI bug) - 7.8
  • Mumps - 7
  • SARS - 2.8
  • Ebola - 2.2
  • Spanish flu pandemic (of 1918) - 2.2
  • Wuhan Coronavirus - estimated around 2
  • Common cold (rhinovirus) - 2
  • Seasonal influenza - 1
  • Rotavirus (infant GI bug) - 0.9

Data from Information is Beautiful

So, every person who has it is likely to spread it to two more people, and as you can see looking at the Spanish flu numbers, it has the possibility to cause a pandemic if not taken seriously. But taking the proper precautions that number can absolutely go down - hand washing, staying home when sick, etc will all decrease how much it spreads. We still don't know if it can be spread before symptoms appear (initial data says no) which would increase this value. There is also rapid work towards a vaccine in progress should a vaccine be necessary (for example if it becomes more widespread), with phase 1 trials expected in about 3 months.

How Deadly is It?

This is tough to say, because mild cases are likely not reported, and the vast majority of cases are from China where there is a history of unreliable reporting of data like this. My suspicion is that the actual fatality rate is lower than it is currently reported. Let's look at a comparison again:

Fatality rate (per 1,000 infected patients)

  • Ebola - 500
  • SARS - 96
  • Spanish flu pandemic (of 1918) - 50
  • Wuhan coronavirus - 21
  • Measles - 8
  • Rotavirus (infant GI bug) - 6.5
  • Pertussis (whooping cough) - 6
  • Norovirus (GI bug) - 2.5
  • Malaria - 2
  • Seasonal influenza - 1
  • Mumps - 0.1
  • Common cold (rhinovirus) - 0

Data from Information is Beautiful

It is most fatal in older and immunocompromised patients, and less fatal in young, healthy individuals. There's no doubt it is more deadly than your common cold, but the other factor at play right now is...

How Widespread is It?

Not widespread at all. Reported cases in China (as of 1/29/20) are currently at just over 6,000. Reported cases in the US are 5, all in people who had just traveled from Wuhan. There was a potential case in Lakewood, but that patient tested negative. For comparison, there have been between 9 million and 45 million cases of seasonal flu each year over the last 10 years, resulting in between 12,000 and 61,000 deaths per year.

Honestly, I am impressed at the CDC's response to this so far. If this disease were to become widespread, it could become a big problem, but they are doing an excellent job of keeping this disease contained.

Putting it All Together

To sum it all up - preliminary info shows the Wuhan coronavirus to be about as infectious as the common cold, with a mortality rate (with current data) that is high enough to be a concern, if it spreads. And that is the key. and why people are taking it so seriously right now, because there is an excellent chance at preventing this from spreading.

The best comparison in recent memory can be made to the SARS outbreak of 2002-2003. There were around 8,100 confirmed cases worldwide (reminder that China did cover up a lot of those cases) and around 770 deaths, but only 29 cases in the US with no deaths. Wuhan coronavirus has already spread to a similar number of patients worldwide, but has a much lower mortality rate. Compare that to the seasonal flu which infected around 35 million patients and killed around 34,000 last year in the US alone.

So am I worried? No. Not now. I'm much more worried about the seasonal flu. Things that would make me worry would be a significant spread in the US or a mutation that changed it's level of infectiousness or mortality (no mutations detected to this point). We do need to watch the number of international cases popping up, a significant worldwide spread would make it harder and harder to contain which would raise my level of concern. Stay away from sensational headlines and get your facts from the CDC.

So, wash your hands, keep your hands away from your face and mouth, and stay home when you are sick! Keep an eye on this situation so you know if it worsens, but don't be stressed out right now by what you hear on the news!

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Rebecca Bub, DO
Rebecca Bub is a board certified family physician, the proud owner of Pure Family Medicine, and is on a mission to change the way people get health care, one patient at a time. In her spare time she enjoys chasing her three young kids around, spending time hiking and cycling, and living vicariously through her friend's social lives online.
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