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Everything you need to know about coronavirus

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The coronavirus outbreak, centered in China, is evolving at a dizzying speed. And so is the global response. In the past 24 hours alone, Russia and Singapore have sealed their borders to China and the World Health Organization declared the outbreak a global public health emergency. Meanwhile, the US government dramatically escalated its response — issuing its highest-level travel advisory, quarantining 195 citizens evacuated from China, and temporarily banning foreign nationals who have recently been to China from coming in.

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.

 

 

 

 

Universal Images Group via Getty

 

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.

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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.

More recently, there have also been reports of people with very mild symptoms, like the four cases in southern Germany. There’s also evidence of asymptomatic cases. It’s possible that as we learn more, 2019-nCoV will look more like the flu than like SARS. That’s because infectious diseases typically look more severe when they’re first discovered, since the people showing up in hospitals tend to be the sickest. And already, the new virus appears to be less deadly than both SARS and MERS.

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.)

 

 

 

 

Oxford Journal of Travel Medicine

 

“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 Resnick explained. 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.

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Young and old more likely to face severe flu. Here’s why doctors think it happens

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Canadians have been getting sick enough with seasonal flu to land in hospital, say doctors with suggestions on who is most at risk and what it could mean for festive gatherings.

“We’re starting to now see the effect of flu on certain populations, particularly very young children and very older people, in making them sick enough that they need to come into hospital,” said Dr. Gerald Evans, chair of the division of infectious diseases at Queen’s University and Kingston Health Sciences Centre.

During the depths of the COVID-19 pandemic, air travel declined. It’s one of the suspected reasons that influenza all but disappeared, Evans said.

Flu viruses need human hosts travelling between the southern and northern hemispheres to gain a foothold during winter on both ends of the planet, according to influenza experts.

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Dr. Upton Allen, head of infectious diseases at Sick Kids Hospital, said the H3N2 strain of influenza might be associated with more severe disease than other strains. (SickKids)

For about 100 years, doctors have known that the youngest and oldest are most at risk for serious flu. Why hasn’t been nailed down, but there are a few possible reasons — including what strains were circulating when you were first exposed.

Generational effects explored

Canadian and international research on humans as well as in animal models suggest that the first strain of flu virus you’re infected with tends to prime or shape the immune system. The result is that our immune system responds best to the original type of flu infection it faced.

“That’s why we believe that older people who are mostly primed with H1N1 don’t do very well during an H3N2 year like we’re having this year,” Evans said.

Staff at pediatric hospitals like Sick Kids continue to face pressures from pandemic backlogs of surgeries. (Michael Wilson/CBC)

The 2009 H1N1 pandemic also continues to affect how younger ones do with flu.

Those aged 13 and under were probably primed to H1N1 after 2009, just as their grandparents were in their childhoods, Evans said.

If so, today’s kids could be more vulnerable to severe disease from flu now than their parents’ generation who first encountered an H3N2 strain.

Evans added it’s also thought that older people may have more severe outcomes from flu because of underlying problems such as heart disease, lung disease or treatments for cancer.

Youngest hadn’t been exposed

Another reason why young children are being hit hard by flu and RSV this year: recent pandemic public health measures meant those under two haven’t seen flu at all and preschoolers haven’t experienced it or another respiratory virus known as respiratory syncytial virus, or RSV, for a couple seasons.

“The boost of immunity they get from having had some prior exposures in the year before are missing and so they’re tending to get infected more,” Evans said.

Dr. Upton Allen, chief of infectious diseases at the Hospital for Sick Children in Toronto, pointed to a few other possibilities.

One is the strain of flu virus that’s mainly circulating. It’s officially called Influenza A H3N2, which Allen said might be associated with more severe disease.

Also, our immune system is considered weakest at the extremes of life.

“The overwhelming majority of kids who get the flu will get it mild, but some people can get it severe,” Allen said.

 

 

Health experts in Canada and the U.S. are recommending people start wearing masks again with a ‘perfect storm’ of respiratory diseases on the rise, a strain on our hospital systems and a shortage of medication. But is that enough to get us to wear masks again? Dr. Susy Hota joins About That with Andrew Chang to take us through it all.

If a child is breathing very quickly, having trouble breathing, weak, doesn’t wake up or respond then those might indicate a more severe bout. “Call 911 or go to the nearest emergency department,” Allen said.

The Public Health Agency of Canada reports fewer than five influenza-associated deaths among those aged 16 and younger for the week ending Nov. 19.

“Each year the number of deaths generally are in single digits,” for that age group in Canada, Allen said.

Doctor’s holiday flu forecast

Marie Tarrant, a professor in the nursing school at the University of British Columbia Okanagan, is concerned about the uptick in hospitalizations from flu for patients and health-care systems.

“The other side of that is just the burden that is putting on a healthcare system that has been maximally strained for the last 2 ½ years.”

A lab technician at work.
A lab technician works in the H1N1 laboratory at the British Columbia Centre for Disease Control in Vancouver in 2009. This year’s flu season started earlier than the norm. (Darryl Dyck/The Canadian Press)

People with flu, RSV and other infections have a “compounding effect” of burdening hospitals, she said. Like Canada’s National Advisory Committee on Immunization, Tarrant recommends those aged six months and older who are eligible get a flu shot.

“Flu vaccines prevent about 40 to 60 per cent of serious illness and hospitalization,” she said. “They do work.”

Evans has similar advice.

“Get your flu shot,” he said. “It’s not going to be for everybody, but it’s going to prevent a lot of people getting infected and that’s going to help of course alleviate the stresses that we’re seeing in trying to provide care to everybody.”

It’s also not too late to get a flu shot, clinicians say.

Plus, flu season started earlier than it typically does this year, which could (eventually) offer a yuletide bright spot. Evans said seasonal flu usually disappears after a period of about six weeks. Canada is now about two weeks into a surge.

“By the time the holidays come around, we should be seeing a waning down of numbers of influenza infections, if it follows the pattern that we have seen now literally for decades.”

The good news? “As long as you’re feeling OK and you don’t have signs and symptoms of a cold, I think gathering together is fine.”

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St. Joe's opens Hamilton Mountain flu, COVID and cold clinic – Hamilton Spectator

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St. Joseph's West 5th Campus has opened a flu, COVID and cold clinic.

With the cold and flu season now in full swing, St. Joseph’s Healthcare Hamilton has opened a flu, COVID and cold clinic at their West 5th (and Fennell) campus.

St. Joe’s officials say the goal of the dedicated clinic is to provide both adults and children with timely care, while reducing the number of patients visiting emergency departments for respiratory illnesses commonly seen throughout the fall and winter.

Clinic visits are by appointment only.

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See stjoes.ca/FluCOVIDCold to book an appointment.

Clinic hours are Monday to Friday 4:30 p.m. to 9 p.m., Saturday/Sunday 8 a.m. to 4 p.m.

The clinic is a collaborative effort between St. Joseph’s Healthcare Hamilton, Hamilton Health Sciences (HHS) and primary care doctors

St Joe’s official say adults and children experiencing flu, COVID or cold symptoms, who are unable to seek timely care from their family doctor or do not have a family doctor, should book an appointment if their symptoms are not improving after a few days, despite using common over-the-counter medications as indicated on the label, such as ibuprofen (Advil), acetaminophen (Tylenol), nasal rinses and cold/flu medications or if they are particularly worried about any of their symptoms.

Common symptoms include fever, cough, sore throat, runny or stuffy nose, chills, loss of taste or smell, headache, and muscle aches.

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World AIDS Day: HIV activists hopeful for end to backsliding on infections, stigma

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HIV activists are marking World AIDS Day by urging Ottawa to help stop a global backslide in progress on stemming infections and stigma.

“It’s clear to us that this government is seized of the issue, but the truth of the matter is, no movement is happening quickly enough for people with HIV living in Canada,” says Janet Butler-McPhee, who co-leads the HIV Legal Network in Toronto.

The Public Health Agency of Canada estimated that 62,790 people in Canada were living with HIV in 2020, and that 10 per cent of them didn’t know they had the virus.

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That represented a slight drop in overall cases from 2018, but an increase among the most vulnerable.

Indigenous people accounted for nearly one-fifth of new HIV infections in Canada in 2020, the data say. That year, women and people who inject drugs made up an increasing share of infections, while men who have sex with men made up a smaller share.

Advocates argue that the numbers reflect the uneven effects of the COVID-19 pandemic.

Butler-McPhee noted that the Harper and Trudeau governments both pledged funding for grassroots groups that serve people with HIV that hasn’t fully materialized, despite the added factors of a toxic drug crisis and the COVID-19 pandemic.

“You’re talking about organizations who have had to pivot pretty significantly and take on new work without funding that has been long-promised,” she said.

Meanwhile, Canada continues to trail its peers in criminalizing HIV non-disclosure. Canadians living with the virus can be prosecuted for not disclosing their status to sexual partners, even when prescription drugs make it impossible to transmit the virus.

“Criminalization can lead to the stigmatization of people living with HIV, which can often discourage individuals from being tested or seeking treatment,” the Department of Justice noted in October.

The Liberals have been promising to fix the issue since 2016, but only launched a national consultation in October. They have also asked prosecutors to avoid criminalizing people with HIV in the territories, while suggesting provinces follow suit, with mixed success.

“For the last six years, there has been a recognition by this federal government that HIV criminalization is an issue in Canada, but there has been not as much movement as we’d like to see,” said India Annamanthadoo, a lawyer with the HIV Legal Network.

Abroad, the World Health Organization reported disruptions in HIV patients accessing treatments that suppress symptoms and stop the virus from progressing to AIDS, as countries targeted their health care systems at stemming COVID-19 infections.

That’s put a dent in progress toward the United Nations sustainable development goal of ending the epidemic of HIV-AIDS by 2030.

Before the pandemic, the UN’s joint program on AIDS reported that AIDS-related deaths had gone down by 68 per cent since the peak in 2004, and by 52 per cent since 2010.

Thursday marks World AIDS Day, which the United Nations has marked every year since 1988. The disease has killed roughly 40 million people, including 650,000 in 2021.

In a report this week, the agency said inequalities will make it impossible to reach global targets, whether it’s the presence of girls and women in school or continued stigma against men who have sex with men.

Girls and women in sub-Saharan Africa aged 15 to 24 are acquiring HIV at rates three times that of males in the same age group, the agency reported.

 

Gay men and people engaged in sex work are more likely to avoid HIV testing when the country they live in criminalizes their behaviour, the agency says.

In September, Canada was praised for pledging $1.2 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria, after months of concern that Ottawa would pull back its funding.

The move came after the Liberals cancelled a ministerial address to the International AIDS Conference in Montreal this summer, a summit clouded by controversy after African delegates were refused visas.

Back home, the Canadian Aboriginal AIDS Network argues that mainstream public-awareness campaigns and access to HIV-preventing drugs are not reaching Indigenous communities, particularly women.

Trevor Stratton, an Ojibwa activist with the group, told an online panel on Wednesday that Ottawa ought to launch an inquiry into the disproportionate rates of HIV among Indigenous peoples.

“It’s a national embarrassment; when I travel internationally I am actually embarrassed to be a citizen of Canada,” he said.

&copy 2022 The Canadian Press

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