What Will It Take to Stop Coronavirus?

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A new respiratory coronavirus, 2019-nCoV, is rapidly spreading throughout China, where authorities have imposed an unprecedented travel lockdown in 16 cities with a combined population of over 50 million. Cases have also been reported in several other countries, including Australia, France, Japan, Thailand, and the United States. As of Monday night, there were nearly 4,500 confirmed cases and 107 deaths. Experts believe it likely that there are thousands more infected who have gone undetected and that it’s possible the virus is even being spread by people who do not have any symptoms. The results of a study of 41 patients hospitalized for 2019-CoV infection highlight the need for urgent action: A third required ICU-level care and 15% died.
Efforts are underway to find a vaccine, but even the most optimistic timelines suggest several months of scientific development before human clinical trials can begin. With no vaccine or treatment, the most effective way to stop 2019-nCoV’s spread is to limit transmission by identifying infected individuals as quickly as possible and isolating them for treatment before they can infect others. This strategy worked against the SARS (Severe Acute Respiratory Syndrome) epidemic in 2003. Global and national health authorities are implementing the approaches used during the SARS crisis, but, other measures also need to be taken because 2019-nCov is already widespread in China.

Similar to 2019-nCoV, SARS was a never-before-seen virus that spread to 30 countries, stirring panic and ultimately causing over 8,000 infections and 900 deaths. Because 2019-nCoV, like SARS, causes common symptoms such as a fever and coughing and can only be distinguished from more routine illnesses with laboratory testing, the same playbook used against SARS could be adapted to counter 2019-nCoV:

Contact tracing. People who have been around someone with a confirmed infection should be identified and monitored. If they develop any symptoms, they should be isolated and treated until laboratory testing can be done to determine if they have 2019-nCoV.

Screening with clinical case definition. Because there are likely many unreported cases, we need to use a clinical case definition, a checklist of symptoms and risk factors suggestive of infection, to screen people not known to be contacts of infected people but who have concerning symptoms. Because 2019-nCoV, like SARS, causes such ubiquitous symptoms, a case definition includes whether patients with these symptoms have been in an area with known transmission or around people who have. Those who screen positive should be isolated and treated until tested and, if positive, quarantined until they are no longer capable of transmitting infection.

These strategies are already being implemented. However, if it turns out that asymptomatic transmission — transmitting the disease by someone who displays no symptoms — is possible, all contacts and people who have been exposed to areas with known transmission would also need to be tested, regardless of whether they show any signs of illness. This is not currently being done.
These approaches may suffice to contain the spread of 2019-nCoV in countries, such as the United States, where there have been only a few cases (all with links to recent travel to affected parts of China) and in places yet to be affected. However, in affected parts of China where transmission is already widespread, these strategies will face major challenges in containing the spread of the virus.

Since virtually anyone living in an area of transmission could have been exposed, any of the thousands who develop a fever or a cough each day need to be isolated and treated while awaiting laboratory testing. This does not appear to be happening in the Chinese lockdown zones where hospitals, some of which cannot even test for 2019-nCoV, are overrun and patients are being turned away without being tested.

Chinese authorities are setting up screening checkpoints throughout the country. In the city of Wuhan, the epidemic’s epicenter, they are rapidly building two large hospitals with a combined total of 2,300 beds for isolating, testing, and treating 2019-nCoV; they hope to have the hospitals operational within two weeks. But 2019-nCoV may have already spread so extensively that even 2,300 beds might not be enough in a city of 11 million.

What is more, it may not be possible to establish such hospitals in every affected city or transport patients from far-flung areas to these centralized facilities. In addition, diagnosing 2019-nCoV requires specialized equipment and personnel that may be difficult to scale to test the thousands of people who need it. If people without symptoms are capable of transmitting the virus, it would be impossible to test entire city populations.
These daunting challenges could be mitigated by using additional approaches not employed during the SARS crisis:

Home-based isolation. A system could immediately be established to take test samples from patients with concerning symptoms who are not severely ill and then send them home with protective respirator masks, instructions on hand-washing to prevent the further spread of the disease, and orders to remain at home until the test results come back. If hospital beds are still limited, patients found to be positive who aren’t severely ill could remain isolated and be treated at home and be only hospitalized if their condition worsens. This approach could preserve precious hospital capacity for those who need it most and prevent people who turn out not to have the disease from being infected in hospitals while awaiting laboratory results.

Rapid diagnostics. Another measure that could prove essential is the development of rapid, “point-of-care” diagnostic tests that do not require specialized equipment or technicians and can provide results within minutes. (They are similar to the glucometers used by diabetics to monitor their blood sugar.) Such tests do not yet exist for 2019-nCoV. But they could be developed and manufactured for use within months as opposed to the year or more it would likely take to develop and test vaccines for safety.

Similar to the way U.S. hospitals use rapid-screening swabs during flu season, these tests could be widely used at hospitals, checkpoints, and even households to screen anyone who develops suspicious symptoms or, if asymptomatic transmission proves possible, used to test every person every few weeks to ensure no one is unknowingly spreading the virus. Those screened positive should still undergo laboratory testing for confirmation. If used widely, rapid tests could also uncover unknown hotspots and help determine the full extent of this epidemic.

In previous epidemics, there was hesitance by the World Health Organization (WHO) and others to use such tests because of concerns they are not as accurate as laboratory testing. For example, such tests existed during the 2013–2016 West African Ebola epidemic but may not have been deployed because, compared to laboratory testing, they were not as accurate.

However, had they been used for first-line screening with confirmatory laboratory testing done on those found positive, they could have enabled more infections to be detected quickly and drastically reduced the number of patients needing laboratory testing. One study showed that they could have reduced the extent of the epidemic by a third, and another study had even more dramatic results. Thanks to advancing technology, these tests are becoming increasingly accurate; in the case of some pathogens, they are almost as good as laboratory-based tests for detecting infection.
The 2019-nCoV epidemic is evolving by the hour. We need to move swiftly to respond to this threat.

https://hbr.org/2020/01/what-will-it-take-to-stop-coronavirus