Coronavirus and Hawai’i - My Take

I have been following the development of the 2019 Novel Coronavirus mostly through public releases from health organizations with mild interest. Events in the last few days have changed that. I’ve started researching and following the most reputable people on the topic I can find. Overall there is some legitimate cause for concern, and there is a need for better understanding of what exactly this COVID-19 is, and what has changed of the last few days. Big Picture The virus for the most part is a variant of the cold, likely crossing over from bats into humans based upon genetic similarities (Nature, Feb 7, 2020) . The virus strain is highly infectious, somewhat deadly, and is difficult to diagnose. The World Health Organization is saying 20% of cases have severe reactions which include symptoms such as shortness of breath, septic shock and mutli-organ failure (WHO, Feb 22, 2020). Up until recently the virus has primarily been contained to China, which is under history’s largest quarantine, with as many as 750 million people now living in quarantine (Foreign Policy, Feb 24, 2020). However, experts like Harvard epidemiology professor Marc Lipsitch state very carefully that; “I think the likely outcome is that it will ultimately not be containable.” (Atlantic, Feb 24, 2020) Testing for Coronavirus Even with the proper kits, COVID-19 does not seem as easy to diagnose due to the sometimes prolonged period before symptoms appear, and some percentage of asymptomatic carriers, or those that only experience only mild symptoms - all of which appear to be still infectious to some degree. Chinese scientists on Friday published the first findings from a ‘Presumed Asymptomatic Carrier Transmission of COVID-19’ (JAMA, Feb 21, 2020), which if is not an isolated incident could bring additional implications for the ongoing outbreak. There have also been many cases where someone tests negative for the virus as many as six times, before then returning a positive result once viral load accumulates (Dr. Hotez, Feb 22, 2020). Hawai’i did have a tourist couple from Japan that showed symptoms on O’ahu, and later tested positive after returning to Japan - his wife then tested positive as well (HI-DoH, Feb 16, 2020). Currently there are no confirmed cases in Hawai’i that may have spread from this exposure, even three weeks after they left the island, which is enough time for symptoms to begin to show. Hawai’i is currently monitoring 62 people placed under self-monitoring, 56 of which are on O’ahu (HI-DoH, Feb 23, 2020). Yet due to lack of adequate testing and availability, only California, Nebraska, and Illinois have the capacity to test people for the virus in state, according to the Association of Public Health Laboratories (Feb 21, 2020). New Countries Being Impacted In the last few days the amount of infections outside of China have worsened. Confirmed cases of COVID-19 now spread to nine Middle Eastern countries (Al Jazeera, Feb 24, 2020). Iran appears to be the most heavily impacted in the Middle East, with the true scale of the outbreak in the country yet unknown, and confirmed cases are likely to rise as documentation accumulates (Unnamed Tehran Doctor, Feb 24 2020). South Korea's cases have spiked in recent days, with a surge in confirmed cases. Just in the last 48 hours, there are 291 new cases confirmed, and there is a queue 11,600 people pending diagnostic tests. Quarantine is now in effect to isolated infected clusters, turning several villages into a ghost town. Italy has taken drastic actions to contain the outbreak, creating a small panic as roadblocks and quarantine zones were established. Yet health professionals still are unable to identify ‘patient zero’, the original carrier that brought the virus into the country. (NYTimes, Feb 24, 2020) World Health Organization’s Response The World Health Organization today stated that the outbreak has not reached pandemic levels, but urges medical professionals to make appropriate preparations. WHO Dr. Bruce Aylward stated today that containment is not a lost cause, though countries must take "extremely aggressive actions” to prevent the spread of the disease (NPR, Feb 24, 2020). World Health Organization Director-General Tedros Adhanom has stated that the ‘window of opportunity is narrowing on containing COVID-19’ (WHO, Feb 21, 2020), and that was before the last 48 hours influx of confirmed cases outside of China. But some things have gone really well that are worth restating: - China isolated and sequenced the genetic code of the virus quickly. - China increased transparency, making use of bioRxiv (Bio-Archive) to share data with scientists worldwide rapidly. - Quarantine in China has bought the world time to prepare, models suggest around two weeks (WHO Spokeswoman, Feb 22, 2020). - Delays improvised to stall COVID-19 infection rates might get us through flu season, which will free some health-care resources. - Previous outbreaks like H1N1, Ebola, and SARS have given practice to world response agencies. - Speed of production of candidate vaccines is much faster than historic vaccines. - CDC developed a real time Reverse Transcription-Polymerase Chain Reaction (rRT-PCR) test that can diagnose COVID-19 in respiratory samples relatively quickly (CDC, Feb 23 2020). So… What can you do? Take advantage of the time you have now to calmly plan. If you or a loved one has medications, consider stocking up on a few extra months worth. Avoid unnecessary travel, especially to areas known to have lots of cases of Coronavirus. Wash hands regularly and limit as much personal contact as possible. Storing extra food and basic supplies would be wise, especially non-perishable food. Like imagine if you had to stay home for 1-3 months. So… What is so concerning, the Flu kills plenty a year already? The mortality rate mixed with the highly infectious nature and deceptive means of infection for COVID-19 make it a spicy cocktail. Influenza has a relatively low mortality rate, even the last recognized pandemic of H1N1 only had a mortality rate of .02%. Meanwhile, estimates on the mortality rate of COVID-19 are still very hard to grasp, but are at roughly 3% currently (John Hopkins, Feb 24, 2020). With those highly at risk generally being those most likely so succumb to complications. Also, there is no vaccine for this virus. So… What are the economic ramifications to all this? We live in a tourism based economy. A sharp cutoff in visitation will have devastating results on the economy. During the 2018 eruption of Kilauea, lots of visitors cancelled trips to the Big Island and the economy suffered island wide. The risks posed to the economy by COVID-19 are uncertain, but most certainly present a danger to Hawai’i tourism, according to a new study by University of Hawai’i (UHERO, Feb 24, 2020) Globally, markets have taken a downturn Monday over news of the spread of COVID-19 outside of China, and that the virus has disrupted supply chains for businesses. It is hard to gauge the reactions, but initially the auto industry worldwide has been hit hard (Foreign Policy, Feb 18, 2020). Edits from Ryan Finlay, and help researching from the Hawaii Tracker Core team. References: (Nature, Feb 7, 2020) - https://www.nature.com/articles/d41586-020-00364-2 (WHO, Feb 22, 2020) - https://twitter.com/WHO/status/1231111663375380481 (Foreign Policy, Feb 24, 2020) - https://foreignpolicy.com/2020/02/24/xi-jinping-coronavirus-china-covid-19-quarantine/ (Atlantic, Feb 24, 2020) - https://www.theatlantic.com/health/archive/2020/02/covid-vaccine/607000/ (JAMA, Feb 21, 2020) - https://jamanetwork.com/journals/jama/fullarticle/2762028 (Dr. Hotez, Feb 22, 2020) - https://www.aljazeera.com/programmes/insidestory/2020/02/mishandling-coronavirus-response-200222190201457.html (Unnamed Tehran Doctor, Feb 24 2020) - https://twitter.com/IranMomentum/status/1232003585979961345 (NYTimes, Feb 24, 2020) - https://www.nytimes.com/2020/02/24/world/europe/24coronavirus-milan-italy.html (NPR, Feb 24, 2020) - https://www.npr.org/sections/goatsandsoda/2020/02/24/808957041/h1n1-was-the-last-pandemic-heres-why-covid-19-isn-t-yet-in-that-category (WHO, Feb 21, 2020) - https://www.youtube.com/watch?v=lLRzzcf5B2M (WHO Spokeswoman, Feb 22, 2020) - https://www.aljazeera.com/programmes/insidestory/2020/02/mishandling-coronavirus-response-200222190201457.html (CDC, Feb 23 2020) - https://www.cdc.gov/coronavirus/2019-ncov/summary.html (John Hopkins, Feb 24, 2020) - https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 (UHERO, Feb 24, 2020) - https://uhero.hawaii.edu/assets/20Q1_StateUpdate_Press.pdf (Foreign Policy, Feb 18, 2020) - https://foreignpolicy.com/2020/02/18/coronavirus-economic-impact-worldwide-supply-chain-disruptions/