Wednesday night, Columbia University Life hosted a panel of experts from the University to provide updates on the status of the novel coronavirus in China and what steps Columbia is taking in response.

The panel consisted of Dr. David Ho (Helen Wu Professor of Medicine, Director of the Aaron Diamond AIDS Research Center and Director of the Wu Family China Center), Dr. Wafaa el-Sadr (University Professor of Epidemiology and Medicine, Dr. Mathilde Krim-amfAR Chair of Global Health, Director of ICAP at Columbia University), Benjamin L. Liebman (Professor of Law and Director of the Center for Chinese Legal Studies at Columbia Law School), and Dr. Melanie Bernitz (Associate Vice President and Medical Director of Columbia Health).

Suzanne Goldberg, Executive Vice President for University Life, opened the conversation by addressing the bias and harassment some students of Chinese and Asian heritage have endured following the outbreak, and she reaffirmed the University’s commitment towards diversity and inclusion.

Dr. Ho began with a brief monologue, noting that this was his first month at Columbia.  The numbers, as of Wednesday night, were that about 25,000 have been infected and that 500 people have died from the virus. (As of February 7, the World Health Organization [WHO] has reported that 31,481 people have been infected and that all but one of 638 deaths have come from China.) Dr. Ho stressed that “we’ve known about coronavirus for quite some time – they cause the common cold,” but that the 2002 outbreak of Severe Acute Respiratory Syndrome (SARS) changed the perception of the coronavirus family. According to Ho, the new coronavirus (henceforth referred to as 2019-nCoV) bears a remarkable similitude to the SARS virus, with an “about 80% homologous nucleic acid level [genetic makeup] to the SARS virus, and at the protein level it’s actually about 95% identical.” SARS probably has a 3 to 4 times higher mortality rate than 2019-nCoV, though the transmission rates are probably similar and that 2019-nCoV might be slightly more contagious than the SARS virus was. (Dr. Ho stressed that we are still gathering information and that our current numbers are probably underestimating the true scope of the outbreak.) 

Thinking about possible solutions, Dr. Ho said that drug therapies are already being created, aiming to target the virus’s replication machinery. He stated that drug treatments could begin to be tested on humans in around 6 months, but he also said that it has become necessary to find a permanent solution to this particular family of coronaviruses.

Both Dr. Ho and Dr. el-Sadr, the next main speaker, emphasized that China is bearing the brunt of the outbreak and that we would do well to think about what is happening to the people in Wuhan. el-Sadr also acknowledged the work of the Chinese scientific community in combatting the virus and for their breakthroughs in learning more about it.

Dr. el-Sadr then transitioned to a more epidemiology-oriented perspective. “One of the most common questions that people always ask is how can you judge how an outbreak is going to evolve,” she said, “and how can you tell what’s happening?” She started to expand on this by talking about how the transmission methods and patterns of a pathogen are a good first step for learning about an outbreak. She laid out three main elements, the first being how long an infected person is infectious, the second being how many contacts a potential carrier of a pathogen has, and the third being the method of transmission—through blood, airborne mucus, et cetera. For 2019-nCoV, she reiterated that it is a respiratory virus that spreads through coughing and sneezing. In terms of how many people one person can infect, she explained that it depends on the ratio of infection—if one person infects, on average, one person or less, then the outbreak will eventually burn out on its own. But if one person can infect more than one person, then the outbreak will continue to spread. So far we have seen about a 1 to 1.5-2 transmission ratio, which does mean that the outbreak will probably not just burn out on its own. However, she noted that this is far from the most contagious disease we’ve seen, and that measles has around a 1 to 18 transmission ratio.

She then transitioned to what a government or public health agency can do besides boots-on-the-ground actions.  She began this segment by stating, “I think probably the one thing that I’ve learned in my career of infectious diseases and public health is the importance of communication.” She then laid out another set of three principles of effectively communicating to the public about an outbreak. The first of these was to “anchor the information with evidence,” especially to combat rumors that tend to circulate in the first stages of an outbreak. The second principle was the act of developing trust, and that announcing that there’s a problem early on and being transparent about what is happening can help foster this trust. Finally, she said that people’s concerns need to be addressed and that they should not simply be dismissed.

Professor Liebman then talked a little about the political aspects of the outbreak, such as what China’s domestic response has been and what this all may mean for US-China relations. “The Chinese political system did not cause this virus,” he stressed, “but it seems pretty clear, at least from a non-expert, that it made it worse.” He supported this statement by emphasizing that the slow initial response and cover-up probably helped the virus spread. He pointed out that what we’re seeing now – downplaying the initial outbreak then affecting a massive response once it blew up – is very similar to what happened in 2002 with SARS, and that we probably should not have been surprised that this happened again. “China remains a system in which local officials fear responsibility for their actions, and I think often are incentivized to cover up bad news”, he said. Once the centralized government got wind of what was happening, they were able to affect this response, like building hospitals in very short amounts of time and enforcing a quarantine. “But I think it’s important to recognize that once the state turns on the state of control, it’s also hard to stop it,” he noted, saying that this could explain why local authorities were reticent to release the information on what was happening.

Shifting gears to US-China relations, he started by saying that this is “the lowest point in a decade.” He said that while this could provide room for cooperation between the two countries – and that said cooperation has been happening in the more scientific spheres – but that on the “government to government level, the initial signs aren’t very good.” China has apparently been slow to let US experts in to assist, and the US has been slow to offer such assistance. The main risk, however, is that this will foster more xenophobia and “nationalist narratives” in both countries.

Dr. Melanie Bernitz finished up the monologue portion of the evening by laying out what Columbia Health is doing to support students and what they are doing to prepare for if 2019-nCoV comes to New York City. She stressed that Columbia follows the guidance of organizations like the United States Centers for Disease Control and Prevention (CDC), the US Department of Health, and the WHO. She then went through a brief summary of Columbia’s actions as more information became available throughout the month of January, including responding to the travel advice and subsequent ban and offering resources and information to students returning from China. She also noted that we are also still in the peak flu season, so “our staff are well-trained to evaluate any kind of respiratory illness,” and that they are seeing “dozens of flu every day.”

She then went through the progress of Columbia learning about the escalating travel advisories, capping with the recent elevation meaning “do not go to China.” Students who had returned from China within the past 14 days were asked to fill out a confidential form describing their recent travels. Some students were asked to “stay home and self-isolate for 14 days after their return,” and said that they had received resources and academic accommodations. As to what is happening now, Columbia is continuing to monitor the situation and to provide resources, and she stressed that no one at Columbia is currently suspected to have 2019-nCoV. In regards to wearing masks, an area that many people have asked questions about, she said that widespread mask use has not been recommended to prevent infection, and that people who do wear masks do so of their own volition – it does not mean that they have 2019-nCoV.

The floor was then opened up to questions from the audience. One asked if there was a plan for the first case in New York City, to which Dr. Bernitz emphatically responded that should that happen, the city and Columbia are ready to respond and to contain it.

Another question asked about patient recovery and what that may look like, as well as how severe the risk is for young people. Dr. Ho responded that there is a 90% or above recovery rate, and once one does recover, they are fine and at no further risk. Most mortality has been recorded in older folks (often with preexisting health conditions), but that there have been cases of younger adult mortality as well.

Finally, the topic of asymptomatic people perhaps being able to transmit the virus was touched on. There has been some information going around that a person showing no symptoms can give the virus to others, and the panel said that this originated with a German report of an asymptomatic person transmitting it. However, the person turned out to be symptomatic after all. So far, there is no firm documentation of asymptomatic transmission, and it was noted that the SARS virus behaved like this as well.

The event ended with a few messages of general hygiene one can take to prevent themselves from getting sick. (Not from 2019-nCoV, but from the flu, because, again, we are still in flu season.) It seems safe to conclude from this event that the risk of getting the flu is much, much higher than contracting 2019-nCoV, so if one feels the need to do something to prevent themselves from getting sick, they would do well to wash their hands, practice good hygiene, and go about their lives as normal. Just like every other flu season.

Oh, and it’s also not too late to get your flu shot.

The FAQ page on Columbia Health can be found here and the livestreamed video of this event can be found here for those who want to learn more. 

Image via Bwog Staff