Duke Kunshan University’s experts are closely monitoring the coronavirus outbreak. Here, Benjamin Anderson, an infectious disease epidemiologist and assistant professor of science and global heath, offers his analysis.
Putting the COVID-19 outbreak in context
“The World Health Organization (WHO) reports that in 2002-03 there were 8,098 probable cases of SARS-CoV (diagnostics were not available to confirm all cases), of which 774 died. The outbreak eventually subsided and no new naturally acquired cases have been identified since. From these numbers, we can calculate a mortality rate of 9.5 percent, but evidence shows the virus does not transmit human-to-human as efficiently as other known respiratory viruses. The most likely animal reservoir for SARS-CoV was identified to be civets, which prompted many countries to ban its importation.
“Fast-forward to 2012 and the first cases of MERS-CoV infection were identified. From 2012 until Jan. 15, 2020, the WHO reported 2,506 confirmed cases of MERS-CoV and 862 deaths. This corresponds to a death rate of 34 percent, but also with limited human-to-human transmission. Different from SARS-CoV, there has been sustained MERS-CoV infections since its discovery. This is likely due to human contact with dromedary camels, which were identified as a source of the virus.
“Comparing 2019-nCoV to these two similar events, we can see that while the overall death rate (currently 2.4 percent) may be lower, the transmissibility is much greater and the amount of total deaths have already surpassed that of both SARS-CoV and MERS-CoV. It is a serious situation. Initially, some have said that 2019-nCoV is not as severe because it has not caused as many total infections and deaths as influenza virus. This would be an inappropriate comparison given that 2019-nCoV is not circulating in the entire population like influenza is.”
Key lessons for COVID-19 and what needs to be done
“The most immediate lesson the scientific community can take from COVID-19 is that novel viruses that have potential to cross over from animals to human pose a major threat to global public health. There should be more resources allocated and efforts made to study the ecology of these viruses, particularly where humans and animals have contact.”
“More resources need to be allocated to studying viruses with pandemic potential in animals before they are able to transmit to people. We have a pretty good idea of what groups of viruses are of most concern and what environments we should focus on. New technologies, such as air sampling devices, give us the ability to monitor these environments non-invasively. Combined with advanced diagnostics, we can have a much better understanding of how these viruses emerge and what interventions would be most effective in reducing the risk of an outbreak. Additionally, biosecurity measures that protect people and communities from exposure to animal viruses should continue to be promoted where close contact might occur.”
“Global health systems are better equipped to cope with viral outbreaks like COVID-19 than 10 years ago primarily because of the emergence of H1N1 influenza pandemic in 2009. After that outbreak, the WHO adopted the Pandemic Influenza Preparedness (PIP) Framework with the goal ‘to improve and strengthen the sharing of influenza viruses with human pandemic potential, and to increase the access of developing countries to vaccines and other pandemic related supplies.’ Such infrastructure is important to implement a coordinated global response. The main focus has been on influenza viruses, as they have been viewed to pose the greatest risk. It seems such a framework should now be expanded to include other pathogens with pandemic potential and additional surveillance strategies considered to monitor for these pathogens in animals before they cross over to humans.”
“My research group is focusing on high-risk environments where new viruses can be transmitted between animals and humans (i.e. zoonotic), settings where there is greater contact between animals and humans. This includes live animal markets, which have been implicated in the COVID-19 outbreak. We also focus on agricultural production sites using intensive farming practices. Poultry and swine farms are of particular interest given the regular circulation of influenza A viruses among these animals and that swine farms in Mexico were implicated as the origin of the 2009 H1N1 influenza A virus.”
Prof. Ben Anderson is available for comment. He will consider requests for interviews on camera, or by phone, Skype and email on topics including COVID-19, infection disease prevention and control; infectious disease transmission; and coronaviruses.