Intervention Activities

As you know, Maricopa County Department of Public Health confirmed one case of 2019 Novel Coronavirus infection in a person from a couple of weeks ago. The person came to the Valley from Wuhan and had a mild illness that didn’t require hospitalization (a good sign). The person is still isolated at home with daily monitoring and regular testing to determine if the virus is still present in the nose and mouth.

Close contacts are being monitored daily for fever and symptoms, but so far there’s no evidence of community spread.  All the county health departments are set to contact travelers from China and provide them with monitoring instructions for 14 days after their last exposure (because Maricopa is the urban hub of the state they will be the primary spot where any action will be from travelers). Here are a few notes from Maricopa about some particulars: 

  • Maricopa County residents who have traveled to China recently and are concerned about 2019 Novel Coronavirus are supposed to call 602-747-7099;

  • Anyone with respiratory symptoms who is concerned about 2019 Novel Coronavirus should contact their healthcare provider BEFORE seeking care to avoid spread to others; and

  • Healthcare providers in Maricopa County who see patients with travel history to China in the 14 days before illness onset AND respiratory symptoms should contact Public Health at 602-747-7111

Anybody can go to the website and look at their social media (Twitter @maricopahealth and @saludmaricopa, Facebook in English and in Spanish) for local updates including: Current case counts; FAQs in English, Spanish, and Mandarin;  Detailed healthcare provider guidance; Template letter for schools to inform families about the low risk; and Actions to prevent stigmatization and bullying.

MCDPH will also continue to work with healthcare providers to facilitate testing of people who meet CDC criteria, monitor those who are risk of developing illness, and isolate those who are potentially contagious.

Editorial Remarks

So far, the evidence suggests that this new virus is easily transmitted person to person.  While the symptoms can be severe in some folks, they’re commonly quite mild (like the single AZ case). It looks like the virus can be transmitted from asymptomatic persons, which means that standard practices like screening and isolation will be of limited effectiveness as interventions over the long run (the data are still a little unclear whether asymptomatic folks are infectious).

When you put these characteristics together along with the patterns for similar illnesses- it suggests that the number of undiagnosed and unreported cases (driven by a lot of people with truly mild infection) will turn out to be at least 10 times higher than what’s currently being reported in the Chinese surveillance data. 

While 2019-nCoV currently shows ~2% mortality the denominator is likely much much larger.  In reality, mortality is likely closer to something like 0.2% or even 0.02% (because the denominator is likely much larger than what is being reported by China). 

In other words, it looks like this new virus will be a high-incidence and fairly low virulence infection. 

So, as public health professionals, we need to keep our evidence hat squarely on our heads…  and as the virus spreads across the globe (as it will likely do in the coming weeks and months) frame our intervention plans consistent with what we do for similar viruses (e.g. influenza).

Right now, with just sporadic travel cases being reported and tracked and with some uncertainty still out there about the virulence of this virus, it makes sense to conduct the interventions that are underway at our county health departments and at other levels of government.

The CDC action is now quarantining repatriated citizens for 14 days – the first time they’ve used quarantine authority since smallpox.    Interventions like that when there are a handful of contacts is of course do-able and will have essentially no societal disruption.  It will also buy valuable time- time that we will use to better characterize the etiology of the new virus. 

However, when the wave eventually hits – as it will likely do in either weeks or months – we need to think carefully and make sure that our interventions are consistent with our standardized and existing public health practice principles.  By that, I mean the kinds of interventions we conduct and encourage for influenza type illnesses.

Encouraging actual suspect cases to self-isolate is a no-brainer.  But, when the wave comes, should we invoke public health authority beyond that?

Interventions like isolation and quarantine (once the wave hits) would cause major disruptions to society and place public health in the crosshairs of needing to justify why such dramatic interventions are needed – when we don’t implement them for things like influenza.  Also, there’s a real danger to future public health authority if you “cry wolf” too soon about a disease that may turn out to be a tragedy for a few, but no big deal for the vast majority.  

Just something for the back of your mind as we do what we need to do in the coming days.  Let’s continue be cautious at first, but not over-hype it, and be prepared to back off sooner than later if the data continues to suggest that this will indeed be a high-incidence and fairly low virulence infection.