Stanley Perlman, M.D., Ph.D., an American Academy of Microbiology fellow, an ASM member and professor at the University of Iowa, talks about the outbreak of a novel coronavirus, COVID-19.



Feb. 28, 2020

What is the significance of community transmission, and does this mean we should be more vigilant?

Absolutely, we need to be vigilant. Community transmission means that it readily spreads from person-to-person even outside of healthcare settings.

Is this truly a public health emergency, especially compared with other outbreaks in the past?​ 

As the number of cases continue to increase, public health authorities will need to enact measures to decrease spread. We have not had an infection in the past in which the population was highly susceptible and mortality was 2-3%.

What is the status on a treatment and/or vaccine?

Specific anti-SARS-CoV-2 treatments and vaccines are not available and will not be for at least a few months.

Feb. 4, 2020

Is there any indication that those who have had another coronavirus (SARS, MERS or even the cold-causing CoVs) would have natural immunity to COVID-19?

No, those who have had SARS infection might have some protection but this is completely unknown.

What does the higher rate of cases and lower number of reported deaths indicate about this disease versus other coronaviruses?

It shows that the virus is more easily transmissible and fortunately is much less likely to cause severe disease. This probably occurs because so many COVID-19 cases involve the upper airways and less so the lungs.

Is this outbreak considered a “pandemic”? What are the “requirements” to be classified as a pandemic?

A pandemic is world wide with a large number of infections everywhere. This virus is epidemic and may become pandemic.

Jan. 28, 2020

What is a coronavirus? How does it compare to other types of viruses (like the common cold or flu)?

Cold and flu and coronaviruses are all RNA viruses (rather than DNA). Coronaviruses contain the largest genomic RNA in terms of any virus. We don’t know yet if/how this novel virus is different from other human pathogenic coronaviruses, like SARS-CoV and MERS-CoV.
 
In the past, coronaviruses were studied primarily in domestic and companion animals, until the first outbreak (SARS) in 2003. While we don’t know if this novel virus is different from SARS-CoV and MERS-CoV, it does seem to behave more like SARS-CoV. All 3 cause severe human respiratory disease and have higher rates of mortality than the influenza or other respiratory viruses.

Why is human-to-human transmission significant?

A lot of diseases don’t reach a broader audience or get as much attention because many viruses go from animals to people but are not transmitted to other humans (e.g. EEE). If a virus can spread from human to human, then to be infected, a person doesn’t need to be around the zoonotic source that caused the initial infection. Efficient human-to-human spread is a major concern because no one is immune to this new coronavirus.

Do we know the source of the outbreak?

This virus is 95% the same as a virus already identified in bats. SARS-CoV was a bat virus that likely had an intermediate host and MERS-CoV crosses from camels to infect humans. It’s likely this new coronavirus originated in bats. 
 
It is important to know an outbreak source because then one can stop transmission to humans. Elimination of exposure to bats, for example, would minimize new bat-to-human transmission.

What is the importance of early testing for COVID-19​ infection?

The earlier we test for coronavirus infection, the faster someone can be isolated and given the appropriate therapy. Proper precautions will prevent transmission to others. 

What can we learn from the genetic sequence of the virus?

By studying the genetic sequence of the virus, we can determine what proteins it uses, how it replicates and what makes the virus unique. This information will allow us to design antiviral solutions and develop animal models. It is important to follow its epidemiology; for instance: does the virus change over time or become more virulent or efficient? We need people on the ground so they can collect specimens and we can get useful clinical samples. 

What is the appropriate level of caution we should use?

This is a hard question to address. We are seeing more cases at an earlier time in the epidemic than was true with SARS and MERS. More casual persons are being affected, as opposed to health care workers or those in close contact with infected patients. One has to be cautious and aware of their surroundings: wash your hands and stay home if you feel ill.