The decision to impose a severe travel ban and mandatory quarantines in response to the novel coronavirus (2019-nCoV) flies in the face of public health recommendations, including those from the recent Johns Hopkins Center for Health Security’s “Event 201” pandemic preparedness exercise.
Instead, it appears to be a response to xenophobia from the right wing, as Megan Thielkin noted in Stat.
Information about 2019-nCoV is rapidly changing as public health officials and scientists work feverishly to understand it and curtail its spread.
What we have learned this week argues against these restrictions. The biggest reason is that we now know fairly certainly from the cases in Germany that the virus can be spread before someone has symptoms. In plain terms, “the cat’s out of the bag.” Millions of people have been traveling internationally without any symptoms, or very mild ones they didn’t recognize as significant, before the epidemic was recognized. The cases in Germany also furthered evidence that cases can be spread by “fomites,” med speak for an inanimate object (e.g., handles, pens, dishes).
Another new finding was detecting the virus’ genetic material (RNA) of the 2019-nCoV in stool. This doesn’t prove that the stool is infectious, but it raises another question as to how transmission is occurring.
Watching the Pandemic Preparedness Exercise was enlightening. The messages from those international experts were quite clear about travel bans being counterproductive, potentially devastating economies. Similarly, we’ve seen with HIV, Ebola, and other infections that punitive responses to infected patients drives people into hiding underground, and further worsens epidemics.
On January 30, the World Health Organization finally declared this 2019-nCov as a PHEIC (Public Health Emergency of International Concern —pronounced phake). Dr Tedros Adhanom Ghebreyesus, WHO Director General, emphasized that “WHO doesn’t recommend limiting trade and movement” and that decisions should be “evidence-based and consistent.”
Dr. Tara Kirk Sell, Senior Scholar at Johns Hopkins Center for Preparedness stressed that just because there is a travel ban, “no one should think that there won’t be more cases.” It might just slow the spread a little bit.
“Doing things out of an ‘abundance of caution’ isn’t a good idea…The risks, costs of the travel ban and some of the severe quarantines that we are seeing around the world, those have real consequences.”
Some of the immediate consequences are economic and likely to be devastating to small businesses. There are more lasting risks, given our reliance on China (and India) to provide the active ingredients for many of our drugs. I’ve been concerned about this as a national security issue for some years, as have many others.
At the same time as the US is implementing a travel ban for visitors to China, the administration also expanded its travel ban to six additional Muslim majority countries.
The new coronavirus originated in China. Sell noted, “Xenophobia, stigma… are some of the consequences that we worry about when it comes to diseases that are associated with some foreign group.”
Dr. Sell also stressed that we need more information about the numbers of cases and range of severity of illness to help guide decisions. We don’t want to stir up fear because then “people are reacting out of fear, rather than the actual consequences of the disease.”
The logistics of a quarantine are daunting, too—you need to consider providing food, housing, meeting other special needs to those being restricted, and consider their medical and religious needs, she added. Implementing a quarantine “is really difficult, especially on a large scale.”
In the meantime, what should you keep in mind when you see the scary clickbait headlines? As of now, the 2019-nCoV appears to require close contact and is spread primarily through droplets. Touching contaminated surfaces is also a likely source of transmission. Influenza is killing far more people in the US than this new virus is likely to. As Liz Szabo noted, “Influenza has already sickened at least 13 million Americans this winter, hospitalizing 120,000 and killing 6,600, according to the CDC.
The best way to protect yourself from any of these infections is to avoid people who are coughing and sneezing, and to keep your hands away from your face so you don’t inoculate your nose, mouth, or eyes with infected secretions. Wash your hands after touching any potentially contaminated surface and be sure to turn off the faucet handle and open the bathroom door using a barrier, such as a paper towel. Then use hand sanitizer. If you wash your hands and then turn off the water with your bare hand, you will have just recontaminated your hands. Knowing how to perform hand washing correctly is the key to avoiding many infections.
Hopefully the travel bans, which are not science based nor rational, will be quickly retracted. They may well worsen the toll of this outbreak.