Why Nepal must watch Coronavirus, but not panic

The worldwide spread of the Wuhan coronavirus as of 31 January 2020.

The ongoing outbreak of the 2019 novel coronavirus in China, also called the Wuhan coronavirus, has now affected at least 17 countries. Approximately 6,000 cases have been reported with the majority being diagnosed in China.

The total fatalities have crossed 130, a majority of them in the Hubei Province in which Wuhan is located. Nepal has reported its first confirmed case: of a student studying in China who had been visiting Nepal when diagnosed.

Read also: A Nepali in Beijing during coronavirus scare, Rastraraj Bhandari

Viruses of the coronavirus family have historically caused diseases of the respiratory tract in human populations worldwide. Recent outbreaks included the Severe Acute Respiratory Syndrome (SARS) in 2002 and the Middle Eastern Respiratory Syndrome (MERS) in 2012. Both affected thousands of people and were fatal in some cases.

SARS killed 10% of infected individuals while MERS was fatal in 37% of the infected population. The current fatality rate due to the Wuhan Coronavirus is 2.2%. If we are to describe this statistic in reverse, about 98 percent of those infected with this virus do not die.

The question then is, why is there so much concern regarding this outbreak, given the relatively low mortality rate in comparison to previous coronavirus outbreaks?

The first reason is that the Wuhan coronavirus is ‘novel’. This term is used in viral epidemiology to indicate a new strain, one which has not been detected previously in the population. Scientists therefore do not have adequate information regarding the characteristics of the virus to provide evidence-informed public health instructions on containment and treatment.

Second, unlike SARS and MERS, this virus has an incubation period of up to 14 days and asymptomatic infected individuals can transmit the disease to others during that time. Even infected individuals who show improvement can continue to transmit the virus.

The R0 (pronounced ‘r naught’) value of this virus is estimated at 3, meaning that an infected person on average will transmit to three other persons. This is considered a high infectivity number, but still lower than that of SARS or MERS.

The Chinese authorities have put in place strict measures in Wuhan to try to contain the spread of the virus. However, this may not be enough as many infected individuals might have already traveled out of town by the time the measures were put in.

                                              Photos: BIKRAM RAI

Wuhan has a population of 10 million, and many had begun to travel in advance of the Chinese New Year this week. Experts at Imperial College London have estimated infected population numbers to be already at around at 100,000.

We can therefore expect more cases around the world as infected individuals travel and transmit the disease. However, once again, the question emerges of what the reported fatalities so far are among this large number of infected individuals. Could it be that the virus is spreading but not causing too many deaths?

Nepal has seen regular outbreaks of respiratory diseases including seasonal influenza, ‘avian influenza’ and ‘swine flu’. The Nepali media often reports cases of ‘unknown viral disease’. The Nepal government had established screening centres for the coronavirus at airport and border checkpoints even before the first infected person was diagnosed in Tibet on Monday.

The National Public Health Laboratory is working with private hospitals and laboratories to provide timely and accurate diagnostics of the Wuhan coronavirus with technical support from the World Health Organization (WHO).

Cases are being referred to Sukraraj Tropical Infectious Diseases Hospital as the focal center and the Epidemiology and Disease Control Division is monitoring signs of possible outbreaks in country. The Ministry of Health and Population has directed all private hospitals around country to have ventilator supported ICUs to be on standby should those be required.

The state mechanism appears to have learnt from weaknesses is showed during the SARS and H1N1 (swine flu) outbreaks of the past. However, accurate clinical diagnosis of this disease is going to be a challenge given the likelihood of infected individuals arriving at checkpoints showing no symptoms and because individuals infected with other viruses like influenza or other weaker strains may show similar symptoms as those infected by the Wuhan coronavirus.

Screening is the only way of identifying the maximum number of cases entering the country and preventing those from infecting the population. There have been no further coronavirus infection cases reported in Nepal since 25 January. The first case, reported on that day, is so far the only one.

Global media reporting of this outbreak has focused on fatality rather than recovery, and appears to have failed to notice that the WHO, with its expertise and access to data, has not yet declared the Wuhan coronavirus outbreak a public health emergency.

The experience of having made the ‘premature and hasty’ decision to term the 2009 influenza A (H1N1) – or swine flu – outbreak a pandemic still being fresh, this time WHO has decided to monitor the situation closely before making any decision in this regard.

The WHO has focused on China as a priority for action while observing rest of the world. This does not mean we can be complacent, as the threat of the virus mutating into a more severe form is real. However, it also does not help to panic. We need to look at the numbers, listen to experts in the field and move ahead accordingly.

Sameer M Dixit is a public health research scientist at the Centre for Molecular Dynamics Nepal.