Dr. Peter Hotez: What coronavirus means for the U.S., China and the world

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5 confirmed cases of coronavirus in the US

Both coronavirus patients in California are travelers from Wuhan, China; Los Angeles County Health Officer Dr. Muntu Davis weighs in.

The number of cases of the Novel Coronavirus (nCoV) that emerged in Wuhan in Central China is accelerating rapidly. It presently stands at more than 6,000, with at least 130 deaths. The actual number is far greater if we also consider undiagnosed patients with mild symptoms. Some estimates suggest there could be at least 100,000 people infected, most of them in the major cities of Central China. In addition, nCoV infection has spread to 18 countries, including five cases in the United States.

This virus can cause a serious lower respiratory tract infection and pneumonia. So far, most of the serious cases and deaths have been in individuals over the age of 60, especially men, and many with underlying diabetes, hypertension, and other chronic conditions.

nCoV vs. SARS

The major worry is that the nCoV will cause a global pandemic similar to what we saw with the SARS (severe acute respiratory syndrome) coronavirus in 2002-03.

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In that year, there were 8,000 cases and 800 deaths (10 percent mortality), mostly in China, but also in Toronto, Ontario. The SARS pandemic was a major global public health threat that prompted the WHO to institute new International Health Regulations. SARS also caused significant economic damage to China and Toronto and caused a loss of confidence in the leadership of China.

Will this new nCoV cause a similar pandemic? There are some important differences: The good news is that nCoV does not seem to be as lethal as SARS, although many patients in Wuhan are requiring respiratory support. The bad news is that the nCoV appears to be as contagious as SARS, or even more contagious. The Chinese Ministry of Health also indicates that this virus may be contracted from individuals not yet showing symptoms.

U.S. public health officials have questioned that statement, but we still must consider the possibility that, like measles, CoV is transmitted from individuals beginning late in the virus incubation period before symptoms begin.

What does this mean for China?

Right now, China faces a dire public health crisis. The number of reported cases is going up dramatically, and given its high transmissibility, we should anticipate that a significant percentage of the population of Wuhan and surrounding cities in Central China becomes infected with nCoV. Accordingly, China is working around the clock to build new infectious disease hospitals.

Some experts anticipate that this epidemic might continue for months. There are further concerns that nCoV could spread across China despite efforts by the Chinese leadership to quarantine cities in Central China. Beyond its health impact, nCoV will inflict significant economic damage due to lost productivity, loss of trade with Hong Kong’s due to its recent closure of transportation routes from mainland China, suspension of flights into China by major airlines, loss of external business investments, and steep declines in Asian stock markets. This will easily translate to billions of dollars in economic losses.

What does this mean for the United States?

In the U.S., there will be an increase in the number of nCoV cases over the next few weeks. However, the U.S. CDC anticipated importation of cases from Wuhan and Central China and implemented screening through international airports. For that reason, I do not believe our situation will in any way resemble what is happening in China. However, we are still in the early stages of understanding this disease, and if the claims of China’s health leadership about disease transmission during the incubation period are accurate, then we might see a larger number of cases.

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Ethiopia?

Many nations do not have the health systems infrastructure of the U.S. or Europe, making it easier for the nCoV to gain a foothold. I’m especially concerned about Sub-Saharan Africa. Through China’s Belt and Road Initiative, there are now more than 1 million Chinese people living in Africa, and flights between China and African nations are frequent. While the Belt and Road Initiative spans multiple African countries, Ethiopian Airlines routes account for approximately one-half of the China-Africa flights. We can assume Ethiopia is at special risk.

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nCoV vaccine?

For China, the high transmissibility of the nCoV virus means that it will be difficult for them to contain their epidemic without a vaccine. Through support from the National Institute of Allergy and Infectious Diseases of the U.S. National Institutes of Health (NIAID, NIH), our Texas Children’s Hospital Center for Vaccine Development at Baylor College of Medicine (co-headed by my 20-year science partner Maria Elena Bottazzi) developed and manufactured a recombinant protein receptor-binding-domain (RBD) vaccine for SARS.

Our vaccine development consortium includes University of Texas Medical Branch Galveston, the New York Blood Center, and Fudan University in Shanghai. The vaccine is relatively easy to produce and it is designed to reduce the toxicities that can occur with some respiratory virus vaccines. Now, Chinese scientists have found that the RBDs of both SARS and nCoV bind to the same host ACE2 receptor found in human lungs, and the two viruses are 80 percent similar in their genetic code. Therefore, we are exploring whether our SARS RBD might help China in combating the epidemic.

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The bottom line

The nCoV virus will inflict serious public health and economic damage in China, and there is a risk that it could gain a foothold in African countries. The virus is highly transmissible and we urgently need to accelerate a vaccine.