Coronavirus- Ask the Epidemiologist

willrod1989

Well-known member
Hello, everyone! I have seen so many people posting about the ongoing coronavirus (COVID-19) outbreak, and there seems to be quite a few questions and possible misinformation about this major public health crisis. In response to this, I would like to step in and perhaps offer some of my expertise in answering some of the questions that you might have.

First, a little bit about myself. I currently work as an epidemiologist for the California Department of Public Health, and I also teach epidemiology at Stanford University. Prior to this, I have spent several years throughout Latin America studying neglected tropical diseases, such as Yellow Fever and Chagas Disease. I have some basic background knowledge about how viruses function, but I'm not specifically a virologist. Most of my expertise involves disease transmission, vector elimination, and public health promotion. Most of my work with CDPH up until now has mostly involved tracking vaccine-preventable diseases, such as measles.

However, as the COVID-19 epidemic has really caught the public attention, I have found myself having to help out with the state's response to this growing public health threat. I would be happy to take any questions that anyone might have, and hopefully clarify this very murky situation.
 

Obreid

Power Poster
Here you go,
I’ve seen some reporting from questionable sites so I’ve simply filled them as cold soup see what happens.
It claimed that public health officials were suppressing cases in NY state. Specifically asking a local EMS group remove a FB post.
There were a few screen shots but they didn’t prove the whole story.
Are there any indications that local, state, or federal agencies curbing reporting on infections in the US?
 

willrod1989

Well-known member
Here you go,
I’ve seen some reporting from questionable sites so I’ve simply filled them as cold soup see what happens.
It claimed that public health officials were suppressing cases in NY state. Specifically asking a local EMS group remove a FB post.
There were a few screen shots but they didn’t prove the whole story.
Are there any indications that local, state, or federal agencies curbing reporting on infections in the US?
From what I'm seeing so far, that doesn't appear to be the case. At least not here in California. We've had a very robust response with tracking down any possible contacts with known positive cases, and have been monitoring them for symptoms, and sending tests to the CDC. I have seen some people reporting on social media about public health departments conducting investigations into contacts and saying "these people are infected" and such. These tend to be citizens who are spreading information about people under investigation. Whether they are actually infected or not can only be determined by a laboratory test. However, as of right now, we only have the 15 laboratory confirmed cases of COVID-19 in the United States.
 
5

545Felagund

Guest
Have we seen any sustained human to human transmission outside of Hubei province? Have we thus far prevented the start of an epidemic outside of China, or is it possible that an epidemic is still picking up steam? Is this likely to get worse before it gets better? Thanks for your answer.
 

willrod1989

Well-known member
Have we seen any sustained human to human transmission outside of Hubei province? Have we thus far prevented the start of an epidemic outside of China, or is it possible that an epidemic is still picking up steam? Is this likely to get worse before it gets better? Thanks for your answer.
Oh absolutely! The numbers, even with the limited data that we're getting, clearly shows that this virus has moved to other parts of Mainland China in a sustained manner. What the Chinese are trying to do with their draconian containment measures is to isolate people to hopefully bring the Base Reproductive (R0) number down to a point where this outbreak burns itself out naturally. The most important way to do this was to isolate the "hottest" area to prevent further seeding of infection, and to let the transmission chains die out once people have been successfully identified, isolated, and treated. As of right now, according to the data outside of Hubei Province, this appears to be working. However, I do wish to caution that this might only be limited. What happens when people start back to work, and touch something contaminated? This is actually why there are reports of the Chinese central bank burning money, to prevent re-igniting the epidemic.

Outside of Mainland China, the majority of cases that we're seeing so far, for the most part, are linked to known transmission clusters. However, there have been a few outliers, especially in Japan, that so far seem to have no link to any known cases. It's possible that perhaps one or two people might have come into contact with infected surfaces, and the transmission chain might break at that point. Right now, it's really difficult to tell if this disease will continue to gather momentum, like influenza, or slow down, like SARS.

One deciding factor, strangely enough, might be once we get a better idea on the Case Fatality Rate. If, indeed, we continue to maintain a Case Fatality Rate of 2% or higher, chances are that, while the epidemic might gather speed for a short while, it will probably quickly burn itself out. Think about it- people are terrified, draconian measures will be put into place, and people are more aware of maintaining good hygiene, wearing masks, etc. If, however, it only ends up being about as deadly as influenza (which is quite possible, given the fact that most mild cases inside China haven't been reported), people will probably begin to get complacent, thinking it's "not a big deal". This is especially true once you weigh the economic costs of major draconian infection control measures against having people who are possibly ill showing up to work, keeping the engine of economic growth chugging along.

In terms of my personal opinion? I believe that we might see some small localized outbreaks in various locations around the world before this is brought under control. The best way I can compare it would be the SARS epidemic in Toronto back in 2003. Perhaps a few hundred to a thousand people might become infected, but with the entire world paying attention, the sustained exponential growth that we saw before anyone was aware of this outbreak is probably unlikely.
 
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