With the case toll rising fast, reaching nearly 10,000 on January 31, and face masks flying off store shelves, it’s no wonder questions — and fears — are swirling about 2019-nCoV, as the virus is known.
For most people in the US, though, there’s really no reason to worry. And while making sense of risks with a new, quick-spreading pathogen is tricky, infectious disease experts are helping us sort it out. Here are answers to your most burning questions about the new coronavirus and its risks.
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Coronaviruses are a large family of viruses that typically attack the respiratory system. The name comes from the Latin word corona, meaning crown, because of the spiky fringe that encircles these viruses. Most infect animals, such as bats, cats, and birds. Only seven, including 2019-nCoV, SARS, and MERS, are known to infect humans.
SARS is thought to have evolved from bats to civet cats to humans in China; MERS evolved from bats to camels to humans in the Middle East. No one knows where 2019-nCoV came from. For now, it is believed to have made the leap from animals in Wuhan, China, a city of 11 million, late last year. But researchers are still trying to suss out its precise origins.
As for symptoms: Two of the seven coronaviruses that infect humans, SARS and MERS, can cause severe pneumonia and even death in 10 and more than 30 percent of cases, respectively. But the others lead to milder symptoms, like a common cold. At the moment, we know 2019-nCoV can kill — but it’s not clear how often or how its fatality rate compares to SARS and MERS.
According to the Centers for Disease Control and Prevention, most patients right now start with a fever, cough, and shortness of breath. An early report, published in The Lancet, provided even more detailed information. It looked at a subset of the first 41 patients with confirmed 2019-nCoV in Wuhan. The most common symptoms were fever, cough, muscle pain, and fatigue; less common were headache, diarrhea, and coughing up mucus or blood. All had pneumonia and lung abnormalities on CT scans. As for the disease severity: 13 patients were admitted to an ICU, and six died. By January 22, most (68 percent) of the patients had been discharged from the hospital.
We don’t yet know how exactly 2019-nCoV spreads, but we do have a lot of data on how MERS, SARS, and other respiratory viruses move from person to person. And that’s mainly through exposure to dropletsfrom coughing or sneezing.
So when an infected person coughs or sneezes, they let out a spray, and if these droplets reach the nose, eyes, or mouth of another person, they can pass on the virus, said Jennifer Nuzzo, an infectious disease expert and senior scholar at the Johns Hopkins Center for Health Security. In rarer cases, a person might catch a respiratory disease indirectly, “via touching droplets on surfaces — and then touching mucosal membranes” in the mouth, eyes, and nose, she added. That’s why hand-washing is an important public health measure — all the time, and especially in an outbreak.
A tourist wearing a respiratory mask at the Trevi Fountain in downtown Rome on January 31, 2020. The Italian government declared a state of emergency to prevent the spread of the new coronavirus after two cases were confirmed in Rome.Filippo Monteforte/AFP via Getty Images
Both the CDC and the State Department have issued their highest-level travel alerts for China, advising Americans to avoid going to China for the moment. (These advisories are likely to change as the outbreak evolves, so keep checking them.)
And that’s not only because there’s a risk of catching this new virus. Right now, numerous airlines are canceling or scaling back flights to China, in part because of decreased demand. “I’m more concerned about the unpredictability of the [outbreak] response at this point,” said Nuzzo. “It would not be fun to go to China and get stuck there somehow. And coming back, you’ll be subject to additional screening.”
But people worried about travel should remember that these advisories focus on China, where the epidemic is currently playing out.
Of the 9,776 confirmed cases right now, 9,658 have been found in mainland China. That’s 99 percent. And more than half of those are in Hubei. “The risk of acquiring this infection outside of Hubei and, truly, outside of China is remarkably low,” said Isaac Bogoch, a professor at the University of Toronto who studies how air travel influences the dynamics outbreaks — including the new coronavirus infection.
Source: Johns Hopkins University Center for Systems Science and Engineering
People with the virus have been detected in other countries, which is the reason the WHO declared the outbreak a public health emergency. But to date, those have mainly been travelers from China. “We can count the number of people who never had exposure to Hubei or China who were infected by this virus on one or two hands,” Bogoch said. “So if people are traveling [anywhere outside of China,] your risk is close to zero percent.”
What if you have to travel and you’re seated near someone who is sick? Bogoch said that’s not even time to panic. “There has been some work looking into the risk of acquiring infectious diseases through air travel. The risk of acquiring a respiratory infection through air travel is still extraordinarily low.”
The risk does go up if you happen to be seated within two meters of a person with a respiratory infection. But even there, simple proximity doesn’t necessarily mean you’ll catch anything. Instead, the more infectious the person is, and the longer you sit near them, the higher your risk. If you’re not near the person for very long, or they’re not very infectious, the lower the risk.
People wear medical masks as a precaution against coronavirus, walking around New York, on January 30, 2020.Tayfun Coskun/Anadolu Agency via Getty Images
In the US, the risk to the public is currently deemed low. And just about every health expert Vox has spoken to has said there’s no good evidence to support the use of face masks for preventing disease in the general population.
Masks are only useful if you have a respiratory infection already and want to minimize the risk of spread to others, or if you’re working in a hospital and are in direct contact with people who have respiratory illnesses. (Plus, there are reports of runs on masks and other supplies health workers need to stay safe.)
That’s why the CDC advises against the use of masks for regular Americans. “The virus is not spreading in the general community,” Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, reasoned in a press briefing on January 30. But people are hoarding them anyway, and for the wrong reasons.
The best thing you can do to prevent all sorts of illness, said Messonnier, is “wash your hands, cover your cough, take care of yourself, and keep alert to the information that we’re providing.”
The best evidence we have that the virus can spread before a person has symptoms comes from Germany. There, four people are known to have the virus.
The outbreak was identified in Bavaria on January 27, when a German businessman was diagnosed. He had been in meetings with a female colleague who was visiting from Shanghai and had the virus but didn’t know it. The woman only began to feel symptoms — such as fever and a cough — after she left Germany, and days after meeting with the German businessman. This suggests she may have transmitted the virus to the man before knowing she was sick.
By January 28, three co-workers of the businessman were diagnosed with the virus, according to a New England Journal of Medicine case report. One had contact with the woman from Shanghai; the two others appear to have gotten the virus from the German businessman. “The fact that asymptomatic persons are potential sources of 2019-nCoV infection may warrant a reassessment of transmission dynamics of the current outbreak,” the study authors wrote.
But they also emphasized how mild the disease appeared to be among the German patients. And there’s the question of how much of a risk asymptomatic spread truly poses to public health. “Even if there have been cases of asymptomatic transmission of this infection, those will be typically rare cases, and with just about every other respiratory tract infection known to humankind, those are not the people who are driving an epidemic,” said Bogoch.
WHO Director-General Tedros Adhanom Ghebreyesus, right, with WHO Health Emergencies Program head Michael Ryan at a press conference following a WHO Emergency committee to discuss whether the new coronavirus constitutes an international health emergency, on January 30, 2020, in Geneva.Fabrice Coffrini/AFP via Getty Images
The WHO’s declaration of a “public health emergency of international concern,” or PHEIC, does not mean we are facing a deadly pandemic.
Instead, a PHEIC is a political tool the agency can use to draw attention to a serious disease threat. It’s meant to engage the global community in a coordinated outbreak response, galvanize resources, give countries guidance on how to react, and stop the disease from spreading further across borders.
The agency’s director general, Tedros Adhanom Ghebreyesus, was very clear that they sounded the alarm as a precautionary measure: The agency is concerned about the potential damage the virus could do in countries with weaker health systems, and called on the international community to help. He emphasized that the vast majority of cases are still in China, and that China has moved swiftly to get the outbreak under control.
If the disease continues to spread, however, it could turn into a pandemic: or a disease that spreads globally, with epidemics in multiple countries around the world. And that’s something health officials in the US and around the world are working to prevent. “We are preparing as if this is the next pandemic,” the CDC’s Messonnier said on January 31.
For now, the CDC and WHO are still calling this an outbreak. Very soon, health experts may determine that there are enough cases in China to call the outbreak an epidemic.
As for the question of deadliness, we don’t yet know how lethal this disease is or how easily it spreads. If you take the current number of deaths and divide it by the number of known cases, “the case fatality is 2 percent — and it’s gone down from 3 percent in the early days,” said University of Michigan’s Howard Markel, who studies outbreaks. “And if it goes really, really low, we’ll probably say — like we did in Mexico in 2009 with swine flu — that it’s something very similar, if not less deadly, than regular seasonal flu.”
So once more of these mild or asymptomatic cases are discovered, this virus could look a lot less scary.
“We live [with] and tolerate a whole lot of respiratory viruses,” said Nuzzo, “some of which are even more transmissible than the estimates people have come out with for this one — but they don’t make the headlines.” If the new coronavirus winds up looking less severe, she added, “we may be moving away from containing the virus as a goal to one of minimizing its spread.”
Two women wearing face masks on January 31, 2020, in Newcastle upon Tyne, England.Ian Forsyth/Getty Images
Some of the best research on that question comes from Bogoch and his colleagues. They’ve done great studies in the past couple of weeks on the cities most vulnerable to novel coronavirus infections. What’s the big takeaway?
It’s really East Asia and Southeast Asia that are most at risk. The researchers — from the University of Oxford, University of Toronto, and London School of Medicine and Tropical Hygiene — used 2019 data from the International Air Transport Association to find all the cities in China that received at least 100,000 airline passengers from Wuhan during February through April.
They then modeled how the disease could spread from those cities if they experienced local outbreaks. Here are 15 of the top 50 destinations that might see outbreaks (also pay attention to the IDVI — the Infectious Disease Vulnerability Index — number. It’s a measure of a country’s ability to manage an infectious disease. Scores closer to zero mean they’re less prepared.)
“By no means would anybody be surprised if there are more cases exported to Europe and the US,” said Bogoch. “But the places that are going to have the greatest volume and number of infections exported would be to East Asian and Southeast Asian centers.”
There are a few ways this outbreak could end, as my colleague Brian Resnickexplained. Perhaps public health measures — identifying cases fast, putting infected people in isolation — will stop the spread of this coronavirus. (That’s what stopped the spread of SARS in 2003.)
Because this is a zoonotic disease, which came from an animal, finding and eliminating that source would also help. Or maybe a vaccine or antiviral will be invented quickly to help curb a broader epidemic (but that’d likely take years).
Finally, there’s the possibility the virus will simply die out. “Disease outbreaks are a bit like fires,” Resnick wrote. “The virus is the flame. Susceptible people are the fuel. Eventually a fire burns itself out if it runs out of kindling. A virus outbreak will end when it stops finding susceptible people to infect.” There’s also the possibility the outbreak doesn’t end, as Nuzzo told Vox, and this simply becomes one of the diseases in circulation that commonly infects humans. How worrying that is again depends on how severe 2019nCoV turns out to be.
A SARS-like virus has sickened thousands in China, and made its way to the United States. Vox’s Julia Belluz explains what’s known and what’s next.
TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.
The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.
It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.
Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.
Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.
They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.
This report by The Canadian Press was first published Sept. 17, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”
Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.
“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.
The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.
The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”
The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.
Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.
Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.
The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.
Sanniah Jabeen, 32, Toronto
Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.
“I just wasn’t functioning like a normal human being,” Jabeen says.
Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.
“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.
Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.
“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.
Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.
She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.
“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.
She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.
Natalie Grant and her seven year-old daughter, Bowmanville, Ont.
Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.
She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.
“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.
Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.
“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.
Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.
“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.
Thelma Feldman, 89, Toronto
Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.
“I’m kind of depressed,” she says.
“It’s caused me a lot of physical and emotional pain.”
Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.
“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.
“I don’t even feel like being with people. I just sit at home.”
Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.
Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.
When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.
“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.
“I never got a call back. I never got an email”
At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.
“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”
Joseph Desmond, 50, Sydney, N.S.
Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.
His third seizure happened the next morning while walking to the nurse’s station.
In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.
“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.
When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.
“It was pretty scary. Terrifying. I honestly thought I was going to die.”
Cheryl McCombe, 63, Haliburton, Ont.
The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.
A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.
“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”
Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.
“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.
“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.
Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.
But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”
This report by The Canadian Press was first published Sept. 16, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.
Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.
In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.
The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.
Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”
Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”
This report by The Canadian Press was first published Sept. 16, 2024
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