How the COVID-19 Outbreak in the U.S. May Unfold in the Coming Days

There continues to be so many unknowns when it comes to the novel coronavirus. However, watching the COVID-19 outbreak unfold in China does provide a few clues into how the virus (SARS-CoV-2) behaves and how it will impact people across the globe.

Though scientists and epidemiologists are still learning more every day, a few gave Healthline insights as to how the outbreak in the United States may unfold in the near future.

The experts are:

  • Dr. Gregory C. Gray, professor at Duke University
  • Dr. Stanley Perlman, a professor at the University of Iowa
  • Amira A. Roess, PhD, a professor at George Mason University
  • Rodney Rohde, PhD, a professor at Texas State University
  • Dr. John Swartzberg, clinical professor emeritus at UC Berkeley

Here’s what they believe we can expect to learn from other countries who are dealing with the outbreak and how it will behave in America and around the world in the coming weeks.

Healthline: Does tracking past outbreaks give us any insights into how this novel coronavirus will behave? 

Rohde: Absolutely. For example, one can understand the nature or characteristic behavior of a microbe over time (seasonality, vectors, incubation times, mutation rates, etc.).

Gray: Yes, certainly it does. However, this virus is likely moving faster than any virus we have experienced before. This is due in part to more rapid transportation … [and] the long incubation, and the virus’ likely transmission before patients know that they are infected.

What makes it hard to tell how the virus may pan out as a global epidemic? 

Rohde: The difference between the terms epidemic and pandemic are often argued about between epidemiologists and public health experts. This agent is on the cusp of becoming a pandemic viral agent.  

Roess: We are working on understanding emergence and transmission of viruses. For example, we are still learning about how viruses change or mutate and what possible genetic or other markers make viruses spread and make them able to cause illness in humans.

Perlman: It is already a global epidemic in my opinion and probably a pandemic (widespread human-to-human transmission on multiple continents in multiple countries).

Swartzberg: Up until early December 2019, humans had never been infected with this virus. We do not yet have sufficient data to tell us how this virus will behave.

Does the virus itself behave differently in terms of spreading, or does our response do more to dictate how it spreads?

Roess: We are still learning about how this virus spreads and who is most likely to transmit the virus. We know from decades of experience that how we respond greatly impacts the spread of viruses.

Perlman: Both factors are important. Certainly our intervention on cruise ships influenced how the virus spread.

Swartzberg: This is a virus that spreads quite easily person-to-person. Containment strategies help but will likely be insufficient. We will also need mitigation strategies.

Where do you think the virus will be in 6 weeks, 3 months, 6 months, 1 year, and 5 years from now?

Gray: This virus is a bullet train without the constraint of train tracks. It is moving very fast in many directions at the same time. We may slow it down periodically but I think it will soon be virtually everywhere.

Rohde: I predict this virus will be a global agent in the coming year. In time, with herd immunity, it will likely settle into an endemic and seasonal virus. However, it could also disappear.

Perlman: I think that this may very well become a human infection that recurs on a period basis. I think that it is likely to recur next fall.

Swartzberg: I don’t have a crystal ball! My best guess is that it will become endemic, meaning we will be dealing with it for a long time.

Is there any way to tell if the virus will be similar in other countries based on how it spread in China?

Roess: What we know from MERS-CoV and SARS, and even Ebola, is that the quality of the healthcare system makes a big difference for how the virus spreads.

Swartzberg: The recent apparent decline in cases in China is encouraging for the rest of the world. But, China instituted draconian policies; I doubt many other countries would go that far.

What do you think will surprise the medical community most about this novel coronavirus?

Rohde: I think “we” have come to understand how critical it is to offer supportive care (ventilation, etc.) for agents that cause serious pneumonia. I hope that the medical community is not surprised by this new agent due to “lessons learned” from SARS, MERS, hantavirus, and other similar diseases that affect the pulmonary system.

Perlman: I think this virus has already surprised the medical community. The biggest surprise may be how it dies out or persists. This is really not known.

What is one of the biggest questions that medical experts still have about the novel coronavirus?

Gray: We need to identify if there is an amplifying animal reservoir. We need to learn how often and for how long infected persons share the virus before they develop signs and symptoms.

Rohde: I think most experts would like to know the answer about asymptomatic carriers — are there virus spreaders out there who are not showing symptoms?

Perlman: How does it cause infection of both the lower and upper airways? Will antiviral therapies make a difference?

Swartzberg: Understanding human’s immune response to it. This will inform how serious a problem this will be. Will people get recurrences, and will we be able to develop an effective vaccine against it?

Will a vaccine be the end of coronavirus? How far off do you think it will be till it’s readily available? 

Gray: I don’t think worldwide eradication of the virus with vaccine is likely. I think that it’s too costly and too difficult a venture to even discuss right now. I suspect some countries will be using inactivated vaccines within 12 months. I suspect the U.S. will have identified a safe and effective vaccine in 18 months.

Rohde: I would say in the 1- to 2-year timeframe in the U.S.

Roess: Twelve months is an optimistic estimate quoted by many officials.

Perlman: A vaccine may help but I doubt that it will end the epidemic. It will be months to 1 to 2 years before it is available and in widespread use, I think.

Swartzberg:The earliest a vaccine would be available would be 12 to 18 months.

What do you think the public should take seriously, and what shouldn’t they panic over?

Rohde: We are surrounded by microbes every single day of our life. Yet, we have not stopped living. Try to keep a clear head and maintain your perspective.

Perlman: Handwashing and be aware of their surroundings. Panic never helps.

Swartzberg:This is a rapidly spreading virus that can cause significant morbidity and mortality. Yet, for about 80 percent of people it is a minor event at the most.

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