Coronavirus COVID-19 in the United States

Keywords:  corona virus, coronavirus, covid, covid-19

The novel Coronavirus COVID-19 appeared in China in 2019, quickly having a much more serious impact than prior evolutions of the coronavirus.  As it began to spread from Wuhan, the district in China where it originated, to other parts of China and to other countries, the world began to realize that the local epidemic could become a pandemic.  Efforts to contain the spread were varied and had mixed results, but Coronavirus eventually hit the United States and began to spread locally.  In this article, we describe what Coronavirus is, what COVID-19 is, where it originated, where it has spread, transmission rates, mortality, and efforts to contain the spread of the disease.  Because this is a constantly evolving situation, this article should be used in conjunction with developing news to fully understand the issue.    

Almost everyone in the United States is aware that there is a pandemic disease Coronavirus COVID-19, which originated in Wuhan, China and is currently spread throughout much of the world.  COVID-19 is referred to a novel coronavirus because this if the first time that this particular coronavirus has been observed in a human population.  Some people refer to it as the Chinese coronavirus, the China Wuhan coronavirus, or the Wuhan flu.  These names are somewhat misleading for two reasons.  First, the coronavirus is not the same as influenza (the flu) and the comparisons to the flu have led to dangerous disinformation about the seriousness of the pandemic.  Second, the virus is not limited to any local area and the idea that the epidemic would be contained and not become a pandemic helped delay responses in other countries.  Understanding what coronavirus is, how it is transmitted, and why COVID-19 is different from other coronaviruses are all critical to helping flatten the curve.

The coronavirus is not actually a single disease, instead the term refers to a variety of different zoonotic viruses that cause illnesses in animals and can jump from animals to humans.  The majority of coronaviruses have been relatively mild, simply causing cold-like symptoms in humans.  However, there have been other coronavirus variations such as the Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV).  There are also coronaviruses currently in the animal population that have not yet infected humans and may cause serious problems.  Most coronaviruses impact the respiratory system and produce a range of symptoms that can include fever, shortness of breath, coughing, and breathing difficulties.  More severe cases can result in kidney failure, pneumonia, and severe respiratory syndrome (WHO, 2002). 

COVID-19 is a current stain of coronaviruses that has become a pandemic around the world.  It is referred to as a novel coronaviruses because it is “new” in that it has not previously been identified in humans (FDA, 2020).   While some coronaviruses commonly circulate among humans and produce the symptoms of the common cold, this new virus does not act the same way.  In some people it is asymptomatic, but it can cause severe illness and even death in other people.  It does so by impairing breathing and can also cause failure of other internal organs.  Moreover, it is believed that there are actually two or more strains of the COVID-19 virus, which may complicate both treatment and creating a vaccine. 

Because the original cases of COVID-19 were observed in Wuhan, China, the current belief is that the animal-to-human transmission of the disease occurred in a “wet market” in Wuhan, China.  Wet markets sell both live and dead animals for human consumption.  While that idea may sound exotic to people who are used to purchasing dead and butchered meat for consumption, foods at a wet market include traditionally consumed animals like fish and poultry, as well as some more exotic food.  Wet markets are more likely to be a source of disease transmission than some other types of marketplaces because the presence of live animals makes them more difficult to keep clean; they are also usually very crowded. 

Some scientists believe that COVID-19 originated in bats.  This has led some people to the erroneous conclusion that the wet market in Wuhan was selling bats for human consumption, which reinforces some pre-existing racial stereotypes about cultural food choices.  However, the Wuhan market did not sell bats and the current working theory is that bats infected other animals, such as chickens, which were sold at the market. 

As of March 16, 2020, the following countries had confirmed COVID-19 cases: Algeria, Burkina Faso, Cameroon, Democratic Republic of Congo, Ethiopia, Gabon, Ghana, Guinea, Ivory Coast, Kenya, Mauritania, Nigeria, Senegal, South Africa, Sudan, Togo, Argentina, Bolivia, Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, French Guiana, Guadalupe, Guyana, Honduras, Jamaica, Martinique, Mexico, Panama, Paraguay, Peru, Trinidad and Tobago, United States, Afghanistan, Bahrain, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, Tunisia, and United Arab Emirates.  However, it is very important to keep in mind that this pandemic started out as a local infection in an area of China and has very quickly spread to many other countries; the expectation is that it will continue to spread.  For an up-to-date coronavirus map, visit https://www.bing.com/covid.

Because COVID-19 is new to humans, there are many unanswered questions about the disease, including the rate of transmission.  This is complicated by the fact that many people may be infected with the disease and able to transmit it to others but show no symptoms or only mild symptoms, which can make it difficult to track the total number of infected people, which is necessary to understanding transmission rates.  At this time, it is believed to be highly infectious, with each person who has the virus capable of spreading it to 2 to 4 people daily.  This supports the observed high-rate of community spread. 

In addition, it is important to note that novel viruses are often more contagious than viruses that have existed in the human population.  For example, most people have some natural immunity to common cold and flu viruses, which have been built up because of previous exposure.  Though these diseases may mutate, making reinfection possible, people may have more rapid autoimmune responses to those diseases and some people will have natural resistance.  In addition, because they are common, humans have developed vaccines for influenza.  These seasonal vaccines are based on the type of flu expected to be problematic each season and mean that a portion of the population has enhanced resistance to the disease, slowing transmission rates, even for those who did not become vaccinated.  This is referred to as “herd immunity.”  Because COVID-19 is novel, there is no herd immunity, which may be one reason for its rapid spread in impacted areas.

This is another question that is somewhat difficult to answer, in part because death rates from this current version of the coronavirus seem to depend on the population being impacted.  In addition, because there may be two or more versions of COVID-19, it is possible that some versions are more aggressive than other versions.  According to WHO, the overall death rate for COVID-19 is around 3.4% (2020).  Those most likely to die from the disease are people who are already in high-risk groups for death and other illnesses, including the elderly and people with pre-existing medical conditions, especially lung conditions.  In addition, death rates seem to vary by country, which may have to do with a number of different factors such as access to health care, testing and diagnosis, and underlying health conditions.  One of the factors complicating the determination of death rates is that some people in the population may be asymptomatic and, therefore, never tested for COVID-19.  The more testing in an area or population, the lower the death rate is likely to appear because the death rate is a calculation of people who died from the illness compared to the total population of cases of the illness. 

While the exact death rate of COVID-19 has yet to be determined, and may not be possible to be determined until the disease is either eradicated or controlled, what health experts do know is that the illness is far more deadly than seasonal colds or flus that cause similar symptoms.  While it is very popular for people to compare COVID-19 to the flu, the death rate for most seasonal influenza strains is around .1%.  This means that even conservative estimates of the death rate from COVID-19 as compared to the flu show that COVID-19 is at least an order of magnitude more deadly than the flu.   

At this time, there is no known treatment or cure for COVID-19.  While scientists are working on creating a vaccine, the realistic timeline for a new vaccine is at least 12 to 18 months, and that is even if the vaccine proves easy to create.  There are no antiviral medications that are designed to treat COVID-19, but some doctors are using antivirals that were created to treat other illnesses, such as Ebola and HIV to attempt to treat the disease.  For most people infected with the virus, the only thing to do is to wait for the virus to run its course.

However, that does not mean that there is no medical treatment for those who have severe symptoms from COVID-19.  Because it is a respiratory illness, COVID-19 impacts the ability to breath in some people. Those patients may require hospitalization and the use of a ventilator.  It can also impact other organs, so, depending on the severity of the illness, a patient may require other types of medical interventions.  In addition, people may want palliative care to help reduce symptoms, which may be as simple as pain-relievers, fever-reducers, and cough medicine. 

Because there is no treatment for the virus, the most important step that people can take is to try to prevent the spread of the virus, in the first place.  Like other respiratory illnesses, COVID-19 is spread in a variety of different ways including person-to-person contact, surface contact, and possibly even transmission through the air.  Avoiding contact with infected people and self-quarantining while infected can help reduce the spread of the virus in the community. 

Unfortunately, in the United States, there was some initial misinformation about the COVID-19 virus that may have impacted the ability to limit the spread of the disease.  Initially, the federal government did not treat COVID-19 like a serious problem, with the President and some legislators even calling it a hoax.  As a result, many American people failed to see it as a serious health concern and, even now that the federal government has declared it an emergency, continue to ignore the advice of epidemiologists and other health experts about slowing the spread of the disease.

According to most health experts, it will be almost impossible to stop the spread of COVID-19 in any area that has experienced an outbreak of the disease.  However, it is possible to slow the spread of the disease.  This is known as flattening the curve.  Flattening the curve means that the same number of people may get COVID-19 as they would under normal conditions, but that transmission rates between people will be slowed down and there will hopefully not be a spike in infected people.  This is important because the United States does not have sufficient health care resources to deal with high rates of concurrent infections.  If the demand for health care exceeds the supply, then healthcare providers will be unable to meet the medical needs of people suffering from COVID-19 or from any other illnesses during the same-time.  If the infection is spread out over time, even if the same number of people suffer from the disease over the course of a year or more, there should be adequate healthcare resources for people to access better care and have a better chance of recovery.