CDC Prepares For Local US Coronavirus Transmission

Fears over the novel coronavirus (COVID-19) have escalated in the past week, stoked by media but also troubling events such as the first reported deaths in the United States and serious efforts by the US Centers for Disease Control and Prevention (CDC) to prepare Americans for local community transmission of the virus.

The CDC’s February 25th summary of the ongoing situation took a more concerned tone than in the past, but emphasized that preparations for widespread local transmission are for a hypothetical future, rather than risk to Americans being high at present. There has only been limited local transmission thus far, though it should be noted at least 1 of the patients who died in Washington state had no travel history to Wuhan or known coronavirus contacts.

The CDC’s summary stated that the outbreak currently met 2 of 3 criteria of a pandemic.

“The fact that this disease has caused illness, including illness resulting in death, and sustained person-to-person spread is concerning. These factors meet two of the criteria of a pandemic. As community spread is detected in more and more countries, the world moves closer toward meeting the third criteria, worldwide spread of the new virus,” the CDC statement included.

While it is not yet clear how widespread COVID-19 transmission within the United States could be, the CDC summary painted a striking picture of what may happen.

“More cases are likely to be identified in the coming days, including more cases in the United States. It’s also likely that person-to-person spread will continue to occur, including in the United States. Widespread transmission of COVID-19 in the United States would translate into large numbers of people needing medical care at the same time. Schools, child care centers, workplaces, and other places for mass gatherings may experience more absenteeism. Public health and health care systems may become overloaded, with elevated rates of hospitalizations and deaths,” the CDC summary stated.

The CDC’s February 25 Morbidity and Mortality Weekly Report (MMWR) echoed these considerations.

The MMWR authors noted the possibility of school closures, cancellation of mass gatherings, and the need for remote work options to be expanded. While these measures can be disruptive economically, the authors explained, the early implementation of such measures can reduce community spread and pay off in terms of mitigating social costs down the line.

Employers should be prepared to adapt to new social realities imposed by the virus.

On the other hand, the authors clarified that it was not yet clear how effective state quarantine measures like those taken in China have been. Despite the quarantine of more than 11 million people in China, it appears public health officials around the world are preparing for a global pandemic. In contexts like the West African Ebola outbreak, efforts at implementing large scale quarantines in urban environments did not always meet scientific or human rights standards.

On the other hand, the Chinese government has cautiously suggested that cases are due to begin declining within the country's borders.

Additionally, even an increase in strain on public health resources deserving of a serious preparation should not be discussed in apocalyptic terms. Many media headlines have labeled COVID-19 the “deadly” coronavirus. Yet while cases outside of Wuhan have caused alarm, few are “deadly” thus far. It should be considered that case fatality rates are extrapolated largely from an area in which the outbreak is concentrated and health resources are particularly burdened.

In an interview conducted before the COVID-19 outbreak, Jason Gallagher, PharmD, FCCP, FIDSA, BCPS, clinical professor at Temple University College of Pharmacy and editor-in-chief of Contagion®, talked about changes in public health and society since the early 20th century in response to speculation about whether large-scale global pandemics are still possible in the 21st century.

The CDC highlighted a variety of response efforts underway which are focused on containing the spread and mitigating the impact of the virus.

These efforts include travel guidance, clinical guidance, travel restrictions on Chinese nationals, the establishment of a COVID-19 incident management system, and the activation of CDC’s Emergency Operations Center.

As of February 23rd, around 46,000 travelers had been screened at the 11 airports which all flights from China are being directed to.

The CDC also highlighted efforts including the development of a diagnostic test, the upload of the full virus genome from reported US cases, and experimentation on virus samples grown in cell cultures.

Clinicians are advised to be on the look-out for fever and respiratory symptoms in people who recently traveled from China, as well as to follow recommended infection control procedures.

Additionally, the first clinical trial for COVID-19 in the United States has launched, with the first participant coming from the previously quarantined Diamond Princess cruise ship.

Alex Azar, the secretary of the US Department of Health and Human Services signed a public health emergency declaration in late January. HHS is working with Regeneron in hopes of generating an antibody therapy, just one of several attempts underway to develop an effective COVID-19 treatment.

For the most recent counts in the COVID-19 outbreak in the United States and abroad, visit the Contagion® Outbreak Monitor.