Coronavirus outbreak: What we know and what we don’t know

By | January 30, 2020

GAZETTE: So they’re testing widely?

LIPSITCH: The test isn’t in every hospital in China. It has to be disseminated to all those places and that takes time. So it’s quite extraordinary that we know as much as we do, but we still don’t know that much. By comparison, however, SARS broke out in November of 2002, and it didn’t come to global attention until February [2003]. So this epidemic may have started that same time in 2019 and came to light within a month or two of its start date.

GAZETTE: How big a difference does that time make, as far as the number of cases you have to deal with?

LIPSITCH: It’s much better. People are still trying to figure out the doubling time of the epidemic. Because right now, what we’re seeing is doublings of cases, sometimes even in one day, but that’s because people are getting tested, not because new cases are appearing. But whatever the doubling time is, a month is probably at least enough time for it to grow four- to 10-fold, if not more. A month is a lot of time in an epidemic.

GAZETTE: How does this virus compare to SARS as far as its death rate?

LIPSITCH: We don’t know. Of the diagnosed cases of SARS, about 10 percent of them died. By comparison, seasonal flu is about a tenth of a percent or lower. This one, we don’t know either the numerator or the denominator for that calculation. Not enough cases have been diagnosed to know how many people have been infected even to an order of magnitude. There were probably some deaths that weren’t attributed to this virus. Maybe not that many, but some, especially in places that weren’t looking for them at the time. So I think we just don’t know. It doesn’t look like it’s as bad as SARS, which is very good from one perspective, but it also means that it may be more challenging to control if the overall spectrum of illness is milder, because it’s harder to recognize and isolate cases.

GAZETTE: Is our health care system better able to deal with this than it was in the early 2000s with SARS?

LIPSITCH: I think the global epidemic response is tremendously better. It was recognized much more quickly. It was identified as this particular virus much more quickly; diagnostic tests have been faster. By comparison, we’re still in the time period where SARS hadn’t been recognized, and we now have diagnostics and the beginning of case counting. We even have people working on vaccine development, which is just extraordinarily fast. So that’s all very good. The American health care system, I think, has many of the same problems it had 10 years ago, and those haven’t changed. But the global medical research and response system is way better.

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GAZETTE: How about the Chinese health care system? Do you feel that they can handle this?

LIPSITCH: I think the Chinese system is mobilizing very quickly. They’ve done much of the important science on it. And one of the world’s best epidemiology groups is in Hong Kong. They cut their teeth on SARS and are now very avidly working on this. So there are lots of good efforts going, but I think it’s too early to tell whether it’s going to be SARS-like or milder or far more sustained.

GAZETTE: The World Health Organization declined to declare an international public health emergency. Do you agree with that?

LIPSITCH: I take them seriously and know that it’s true that they’re taking this very seriously, whether they declared a PHEIC [Public Health Emergency of International Concern] or not. I don’t have a view on the political ramifications of declaring such an outbreak or such an emergency, but they are working very hard on it.

GAZETTE: What is the most important thing for the public to know at this stage?

LIPSITCH: There’s a lot of uncertainty at this moment. People should keep listening to the reports to understand better what the implications are. As far as concrete actions, there’s very little anyone can do except practice basic hygiene — hand washing, cough and sneeze etiquette, as they call it — into your elbow to avoid aerosolizing your viruses.

GAZETTE: As far as symptoms, what should people look out for? Fevers, that kind of thing?

LIPSITCH: Fevers and coughs. Of course, those are also the symptoms of flu and other things.

Interview was edited for clarity and space.

Health & Medicine – Harvard Gazette