There's a good chance the new coronavirus will never disappear, experts say. There are only 3 possible endings to this story.
The coronavirus that originated in Wuhan, China, has killed at least 2,800 people and infected more than 82,500. The virus has spread to 49 countries. (For the latest numbers, see Business Insider's live updates here.) According to one expert, the coronavirus outbreak is already a pandemic. Here are three ways experts think it could play out. Most likely, the virus will never fully disappear. Visit Business Insider's homepage for more stories.
The coronavirus outbreak that started in Wuhan, China, in December has killed at least 2,800 people and infected more than 82,000. According to public-health experts, there are only three possible endings to this story: The outbreak could be controlled via public-health interventions and disappear (as SARS did), a vaccine could be developed, or the coronavirus could become a permanent part of the repertoire of human viruses like the seasonal flu. That third option is the most likely, two experts told Business Insider — the new virus probably won't ever truly disappear. "The actions being taken in China — the Draconian efforts — are what happens when you're trying to catch a galloping horse that's already left the barn," Stephen Morse, an epidemiologist at Columbia University, said. Here are the three ways the outbreak could play out. Outcome 1: The outbreak never really ends
According to researchers at the World Health Organization (WHO), an average person with the new coronavirus passes it to 1.4 to 2.5 other people. The group declared the coronavirus an international public-health emergency at the end of January, when it had reached 18 countries. But it has yet to declare the outbreak a pandemic. The coronavirus has now spread to 48 other countries outside of China. So researchers like Amesh Adalja, an infectious-disease expert at the Johns Hopkins Center for Health Security, think we've passed the pandemic threshold. "I think it is a pandemic; the official declaration is not important to me," Adalja told Business Insider, adding, "we're seeing efficient, community-wide spread in multiple countries." Four other coronaviruses are endemic — meaning permanently present — in the global population. They all cause common colds, though each can cause pneumonia and death in rare instances. Because these human coronaviruses are so mild, they don't have names beyond their four-character designations: OC43, 229E, HKU1, and NL63. According to Adalja, the new coronavirus is now probably a member of the endemic coronavirus club, which means the outbreak is never really going to end. "This is going to be with us for some time — it's endemic in human populations and not going to go away without a vaccine," he said. Outcome 1a: The coronavirus never disappears but becomes seasonal
If the coronavirus becomes a permanent fixture in people, one possibility is that it winds up fluctuating with the seasons the way the flu does. In that case, it could retreat in the summer and return in the fall and winter each year. "If you look at the trajectory of the virus and how it's spreading in communities, coupled with the fact that we deal with coronaviruses every year during flu and cold season, those factors point to this coronavirus becoming a seasonal virus," Adalja said. The other four coronaviruses have seasonality too, Adalja added, so cases of the new one "may temper off as we leave spring and enter summer." The flu is seasonal because cooler temperatures help harden a protective gel-like coating that surrounds the virus while it's in the air. A stronger shell ensures it can survive long enough in the air to travel from one person to the next. The flu virus "survives better in cool, dry temperatures," Amanda Simanek, an epidemiologist at the University of Wisconsin at Milwaukee, told Insider.
Chinese president Xi Jinping and President Donald Trump have both suggested that the impending springtime warmth could stymie the coronavirus' spread in a similar way to the flu. "It may decrease in transmission frequency so that you'll be able to have time to get a vaccine scaled up by the next appearance of it," Adalja said, but he added that the virus will probably never disappear entirely. That's because the tropics don't experience seasons at all, and the northern and southern hemispheres experience seasons at opposite times. Unlike the flu, however, the coronavirus is unlikely to mutate every season, Morse said. The flu virus' genes change via a process called antigenic drift, and each small mutation gives rise to a new, closely related flu virus that our immune systems have to start fighting from scratch. (That's why flu vaccines aren't always 100% effective.) But coronaviruses, on the whole, are "somewhat less prone to mutation than flu," Morse said. Outcome 2: Through public-health interventions, the coronavirus plays itself out The coronavirus is similar to SARS in many ways: Both are coronaviruses that originated in bats, and both likely jumped from animals to people in Chinese markets. The two viruses share about 80% of their DNA. So the outcome of the new outbreak could be similar to that of SARS, too. SARS killed 774 people and infected more than 8,000 people from November 2002 to July 2003 but disappeared by 2004. Public-health experts and authorities worked hard to track down, diagnose, and isolate people with the virus to force it to "play itself out," Morse said. The spread of SARS was eventually limited via quarantines, travel restrictions, public-information campaigns, and airport screenings — the same types of interventions China, the US, and other countries are instituting now. If those efforts lead the number of people susceptible to the new coronavirus to drop below a certain threshold, Morse said, the outbreak can be contained. In that scenario, it would either disappear eventually or become like Zika or H1N1 — viruses that continue to circulate, but among far fewer people than they did at first.
However, SARS was far less contagious than the new coronavirus. SARS patients also weren't infectious until they showed symptoms, whereas people can transmit the new coronavirus even when they aren't symptomatic. What's more, people who have gotten the new coronavirus and recovered can get it again in the future, health authorities say — the body does not become immune after infection. This all makes it far more challenging to halt the coronavirus' spread. Outcome 3: Drug companies manufacture a vaccine Morse and Adalja both said a vaccine is essential if the world is to definitively control the coronavirus. The Trump administration is seeking a multibillion-dollar emergency spending package to fight the coronavirus, and at least $1 billion of that funding would be directed toward efforts to develop a vaccine, The Washington Post reported. Morse said a lot of the public-health interventions going on now are a "holding action to keep the virus from spreading in the short term until we get a vaccine." Five leading drug companies — Johnson & Johnson, Regeneron Pharmaceuticals, GlaxoSmithKline, Moderna, and Gilead Sciences — have announced plans to research and develop treatments for the new virus. Some are developing vaccines from scratch based on the coronavirus' genetic code. Others are testing existing drugs to determine whether they're effective at treating the new virus. Getting a vaccine to market has historically been an arduous, multiyear process. (The Ebola vaccine, for example, took 20 years to make.) But Moderna has already developed a vaccine and shipped it out for clinical trials in people. It will likely take another year to determine whether the vaccine is safe and effective, however.
Still, Modena's speedy vaccine-development work is "unquestionably the world indoor record," Anthony Fauci, director of the National Institutes of Health's infectious-disease division, told The Wall Street Journal. "Nothing has ever gone that fast," he added. The sooner a vaccine is created, the sooner we'll see a "sustained firewall" against the coronavirus' spread, Morse said.
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A deadly coronavirus that's sweeping China and spreading around the world has killed more than 630 people....A deadly coronavirus that's sweeping China and spreading around the world has killed more than 630 people. The current fatality rate is around 2%, but health experts predict it could ultimately be lower as more cases are reported. For the latest case total, death toll, and travel information, see Business Insider's live updates here. Visit Business Insider's homepage for more stories. More people in mainland China have now died from the coronavirus outbreak that started in December than from the eight-month SARS outbreak in the early 2000s. That SARS outbreak was considered the first pandemic of the 21st century, since it spread across 29 countries. In total, 8,000 cases were recorded and 774 people died. The new coronavirus has killed more than 630 people, infected more than 31,000, and spread across 26 countries. But it appears to be far less deadly than the SARS coronavirus. Whereas SARS had a fatality rate of 9.6% (meaning that nearly 10% of people who caught the disease died from it), the new coronavirus seems to have a fatality rate of around 2% so far, according to the World Health Organization (WHO). That number could change as more cases come to light, however. As late as last week, The New York Times reported that doctors in Wuhan — the city where the outbreak started — were still running short on test kits, which leads to delayed diagnoses. After a person has been tested, it takes about one to two days for the results to come back. Combined, these factors create a lag time between when people are infected and when cases are confirmed. "My guess is there's a delay in a lot of the reporting," Aaron Milstone, an epidemiologist at Johns Hopkins University, told Business Insider. "If people are sick and they're not getting tested, then we don't know about them." The real fatality rate could be lower The virus' fatality rate looks different depending on how you slice it. Most of the cases so far are concentrated in China's Hubei province. The fatality rate there is slightly higher than the global figure: around 2.8%. The rate in Wuhan is even higher: 4.1%. A study published recently in the Lancet found a fatality rate of 11% among 99 novel coronavirus patients with a history of exposure to the seafood market where the virus likely originated. But many unknowns remain: Around 1,500 coronavirus patients are confirmed to be in recovery worldwide, which means there are around 29,000 whose fate is uncertain. The virus is also continuing to spread. A peer-reviewed study published in The Lancet recently estimated that an infected person could pass the virus to two to three others, on average. That would mean the infected population could double every 6.4 days. The authors estimated that the true number of cases in Wuhan alone was around 75,800 as of January 25. But not all infected patients will die, of course. In fact, some health experts predict that the fatality rate could decrease as the number of cases rises. According to Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, cases being reported right now mainly represent people who are going to hospitals with severe symptoms. "There's another whole cohort that is either asymptomatic or minimally symptomatic," Fauci said at a live briefing from the Journal of the American Medical Association. "We're going to see a diminution in the overall death rate." The virus could resemble a 'pandemic flu' Estimates of the coronavirus' incubation period suggest it can last up to 14 days. During that time, carriers can be infectious even when they don't display symptoms. Patients with the virus generally have a fever and respiratory issues like coughing or difficulty breathing. The current test for the virus can only identify a case when a person is symptomatic. "We've seen people who had a detectable virus, then they didn't have a detectable virus, and then three days later they had a detectable virus," Robert Redfield, the director of the Centers for Disease Control and Prevention (CDC), said in a briefing last week. "We don't know the natural history of how this virus is secreted." Thus far, the majority of people who have died have been elderly patients or those with preexisting health problems. A recent JAMA study of found that the median age of a novel coronavirus patient is between 49 and 56 years old. But Chinese authorities have reported that 80% of the cases in China are among those ages 60 and older. The WHO reports that 14% of reported cases in China are "severe." A study published in the New England Journal of Medicine in January also speculated that "children might be less likely to become infected or, if infected, may show milder symptoms" than adults. Fauci said the new coronavirus could wind up looking more like a pandemic flu than like SARS in terms of its fatality rate. SARS and the new coronavirus share around 80% of their genetic codes, but the virus family also includes pneumonia and the common cold. The worst pandemic flu, the 1918 Spanish influenza, had about the same fatality rate as the coronavirus right now. But other pandemic flues have been less deadly, Fauci said, with fatality rates between 0.8% and 1.2%. The normal seasonal flu, he added, has a fatality rate of around 0.1%. This year's strain is even less deadly so far, with a fatality rate of 0.05%, according to the CDC. "What we're seeing now in terms of illness and deaths reflect people who started getting sick a week ago," David Weber, a professor of epidemiology at the University of North Carolina at Chapel Hill, told Business Insider. "My guess is things will change over time." Read more about the coronavirus: Everything we know about the Wuhan coronavirus outbreak The genetic code of the Wuhan coronavirus shows it's 80% similar to SARS. New research suggests a potential way to neutralize the virus. Cruise ships, detention centers, seaside resorts, and motels: Photos show how travelers are being quarantined due to the coronavirus Whistleblower doctor Li Wenliang, who was censored after sounding the alarm about the coronavirus, has died in WuhanJoin the conversation about this story »
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