Spread of coronavirus in U.S. could close schools, shut down public gatherings, force people to work remotely

For almost two months, U.S. health officials have been able to watch the rapidly spreading new coronavirus in China, and nervously take comfort that at least we're not in Wuhan.

But on Tuesday, the Centers for Disease Control and Prevention and other health officials asked Americans to consider the once unthinkable.

"We have to get past the idea of 'is this going to be a problem or not?' This is going to play out around the world like it did in China," said Michael Osterholm, who directs the Center for Infectious Disease Research and Policy at the University of Minnesota. "There has been a real reluctance to go there, but the virus does not change its ability to cause disease by crossing a boundary."

"Disruption to everyday life may be severe," Nancy Messonnier, director of the CDC's National Center for Immunization and Respiratory Diseases, warned at a news conference Tuesday. Schools could be closed, mass public gatherings suspended and businesses forced to have employees work remotely, she said.

Messonnier said the coronavirus has caused sickness and death, and sustained person-to-person transmission. That's two of the three factors for a pandemic, she said.

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Although the World Health Organization determined Monday that the term pandemic "did not fit the facts," experts said it very soon could.

Health experts in the U.S. said the top priority should be protecting health care workers from becoming overwhelmed with patients and infected themselves.

"There are 3,000 health care workers in China who are infected," Osterholm said.

In the 2003 epidemic of SARS, another member of the coronavirus family, health care workers accounted for more than one-third of those infected, according to one study. The CDC has advised people who think they may have the virus to call their health providers first, rather than showing up at a hospital emergency room.

Stanley Perlman, a University of Iowa professor who has been studying coronaviruses for 38 years and vaccine development on and off for the last 17 years, called the response by hospitals in Wuhan "unbelievable." He worries that the U.S. is not prepared to face a similar flood of infected patients.

"To think any hospital could handle that in the U.S. would be naive," Perlman said. "They'd have to build more hospitals."

Conflicting messages

For weeks, health officials have stressed that people must come very close to someone who is infected in order to contract the new coronavirus.

"That is not the case," said Osterholm, author of the book "Deadliest Enemy: Our War Against Killer Germs."

The virus is transmitted through droplets released by coughing and sneezing, but when people cough, the size of the particles varies. Larger particles drop to the ground or onto another surface, others are much lighter and can potentially float in the air for as long as a week.

There is disagreement about the likelihood of the new coronavirus traveling through ventilation systems, a scenario that would allow the infection to spread from a person in one part of a building to a person in another. Osterholm said such a scenario is a distinct possibility.

"It's physically possible but unlikely because ventilation systems are quite long and there are lots of opportunities for the virus to settle within a duct," said Rachael M. Jones, an associate professor of family and preventive medicine at the University of Utah. 

While there has been a mounting sense of concern about the new coronavirus since its discovery in late December, Americans have found themselves pulled in opposite directions.

On the one hand were the images from China: large crowds wearing masks, doctors in protective gear resembling "moon suits" and airport screeners.

On the other were the reassurances of U.S. health officials saying few cases had shown up here (14 according to the CDC, one of them in Wisconsin), and that Americans are more at risk from flu at the moment.

The comments from health authorities Tuesday appeared to cross a threshold by urging Americans to prepare themselves for the possibility that what they have seen on television thousands of miles away may become their own reality in the coming months. 

Osterholm said he believes the World Health Organization was overly optimistic in suggesting that the virus can be contained. Although complete lockdowns of Chinese cities housing hundreds of millions of people may have slowed the virus, it is not a sustainable strategy, he said.

"That can't continue to happen," he said, "if the Chinese are going to continue to have an economy."

Osterholm said that trying to contain the new virus is much like trying to stop seasonal flu, except that "this is killing people at 20 times the rate of seasonal flu, even in a bad flu year."

Seasonal flu tends to kill fewer than one-tenth of 1% of those infected. Current estimates are that the new coronavirus is killing somewhere around 2% to 2.5%.

“I don’t believe that’s settled yet,” cautioned Janet Baseman, a professor in the department of epidemiology at the University of Washington School of Public Health.

A comparison can be drawn between coronavirus and the 1918 Spanish flu. While the fatality rates may differ — the Spanish flu killed about 2.5% of the infected — both spread through dense populations (the trenches and military camps in World War I, and a large provincial capital in modern China).

Neither approaches the fatality rates for SARS (11%), ebola (about 50%) and the H5N1 bird flu (60%).

Can it spread in advance of symptoms?

So far there is evidence that the virus can infect people for days before they experience symptoms, such as fever and difficulty breathing. The fear is that if they don't feel sick people with the infection could go out shopping and continue going to work without realizing they could be spreading the virus to others.

However, Jones, at the University of Utah, said, "There's only one report I've seen that people can spread the virus before they have symptoms. I don't know that for a fact."

Ajay K. Sethi, associate professor of Population Health Sciences at the University of Wisconsin-Madison, was more certain about the possibility.

“Right now there has been confirmed asymptomatic transmission,” he said. “We just don’t know how much of the spread is being driven by people who are asymptomatic.”

Such uncertainty is one of the problems health officials are battling in trying to balance fear and reassurance. That sense of the unknown is perhaps most acute when it comes to the lack of a treatment of the new virus. 

Perlman, at the University of Iowa, said that the search for a treatment begins with one sobering fact: "We don't understand the disease that well."

Doctors have yet to find a treatment, but even if they had one, it might not be very useful, Perlman said. "A lot of the disease occurs when people are eliminating the virus."

The problem is that our bodies harness an overwhelming immune response to the virus but cannot just switch off the response when the virus is in retreat.

Instead, the immune system continues to make molecules that destroy tissue, Perlman said.

Though SARS put a scare into governments and health authorities 17 years ago, development of a vaccine quickly became a relatively low priority.

William Haseltine, a former Harvard Medical School professor who chairs the U.S.-China Health Summit, said that in all likelihood a vaccine for SARS would also have worked for other coronaviruses.

In a previous interview with the Milwaukee Journal Sentinel he said, "We neglected to develop rapid diagnostic tests and neglected to develop and stockpile anti-coronavirus drugs, which we could have and should have done."

Both Osterholm and Perlman said that developing a vaccine is likely to take years.

In Wisconsin on Tuesday, Froedtert Hospital and Children's Wisconsin hospital released statements on their preparations for possible coronavirus cases.

“Children’s Wisconsin is always prepared to safely and effectively handle patients that come to us with a highly infectious disease such as coronavirus," the hospital said. "Our staff is trained to follow standard safety precautions for all patients and to implement additional protections for those with a highly contagious virus, including isolation protocol, the use of specialized personal protective equipment (PPE) and negative-pressure patient rooms.

"As with any highly infectious disease, the best precaution is to practice good hygiene, including washing hands thoroughly and often, and staying home if you’re feeling sick.”

Froedtert Hospital and the Medical College of Wisconsin released a statement saying they "are carefully monitoring information from the CDC and WHO about COVID-19 and the evolving situation." They said they have already instituted infection prevention and control measures "consistent with those outlined by CDC and WHO."