Novel Coronavirus outbreak, update part 2

Some additonal information, as new data and interpretations are emerging as rapidly as (or even faster than) the virus. In case of an outbreak, one of the most wanted  numbers is the R_0, defined as the average number of secondary cases resulting from an infected subject surrounded by susceptibles only, and in the absence of infection control measures. If R_0 is <1, you most probably won’t hear of it, as the disease dies out. If R0>1 there is a chance that an outbreak becomes big, as it will grow as long as there are sufficient susceptible subjects around. The goal of infection control is to bring down an R_0 bigger than 1 to an effective number <1, and keep it there.

As it is a new virus, the whole global population is susceptible. I trust many research groups around the globe are searching internet for epi data to fit their models and to estimate R_0. The first report I saw appeared today and comes from the UK. Published on biomedRXiv, so it did not yet undergo peer review. As it is Friday night, I just quote some statements from the abstract. Data were used until “21 January to estimate key epidemiological measures, and to predict the possible course of the epidemic, as the potential impact of travel restrictions into and from Wuhan.” And their estimate is:

R_0 = 3.8 (95% CI ,3.6-4.0)

If so, indeed the globe is at igh risk for a pandemic. It also indicates “that 72-75% of transmissions must be prevented by control measures for infections to stop increasing.”, i.e. to bring down R_0 to <1.

They also “estimate that only 5.1% (95%CI, 4.8-5.5) of infections in Wuhan are identified, and by 21 January a total of 11,341 people (prediction interval, 9,217-14,245) had been infected in Wuhan since the start of the year.”

Naturally, all predictions are difficult, many uncertainties remain and “findings are critically dependent on the assumptions underpinning our model, and the timing and reporting of confirmed cases, and there is considerable uncertainty associated with the outbreak at this early stage.”

So, what will determine, if this R_0 turns out to be correct, if it can be controlled. A vaccin will do, but will probably be too late. Till then isolation infectious subjects will be key. But whom to isolate? The good news of SARS was that transmission only occurred after onset of symptoms. So immediate isolation at symptom onset probably worked. If the opposite occurs (transmission before symptoms, as in influenza) it might be unstoppable. Eagerly awaiting data on this aspect.

The dramatic measures taken by the Chinese government today and the 1000-bed hospital to build in 10 days, makes me think that we may not know everything yet and, thus, that these estimates might not be that unrealistic. Interesting times.

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