Simon Murray, MD
According to the latest reports from the US Centers for Disease Control and Prevention (CDC), influenza (flu) has caused the deaths of 10,000-25,000 Americans, hospitalized 180,000, and sickened 19 million so far in the 2019-2020 season.
Coronavirus, on the other hand, has killed about 900 people worldwide. There have been only a handful of cases in the United States, with no deaths reported. So why is the public so panicked over this outbreak?
Novel coronavirus (2019-nCoV) has some obvious differences from the flu virus. The first difference is that we do not understand how the virus will transform itself via mutations to become more contagious in the future. The outbreak is similar to the severe acute respiratory syndrome (SARS) virus, which was initially transmitted from animals to humans and believed to have originated from civet cats and bats. Coronavirus, like the SARS virus, typically causes zoonotic infections, being transmitted from animals to humans. One way that these viruses are suspected of getting into the human population is when they are eaten as exotic foods, or taken as medicines, typically found in Asian countries like China. In many ways, the Coronavirus and SARS virus are similar.
"They likely had a common ancestor in the bat population,” Stanley Perlman, a virologist at the University of Iowa who is part of the Coronavirus Study Group, a subset of the International Committee on the Taxonomy of Viruses, told The Washington Post. “However, over time the virus mutated and may have infected other animals, and eventually mutated into a form that could be spread from 1 human to another, but we don't completely understand the process of viral transmission yet.”
The CDC believes it has identified human-to-human transmission of the novel coronavirus between a married couple in Illinois, but are not sure how it occurred. On the other hand, we clearly understand the transmission patterns of the flu. There are hundreds of zoonotic infections that have the potential to mutate into other forms capable of causing human-to-human transmission.
The second difference is that we have therapies for flu, albeit imperfect therapies, but antiviral drugs that do work to shorten the duration of the illness. Antivirals can provide prophylaxis for those at greatest risk and can treat symptoms. There are some antiviral drugs with activity against this version of coronavirus, but they have not been approved. Recently scientists in China reported that combining the antiviral drug remdesivir with chloroquine has been highly effective at killing the virus.
Third, patients infected with the flu virus generally become contagious about 1 day prior to developing symptoms, and remain infectious for another 5 days. We are not sure when patients exposed to coronavirus become infectious or how long infected patients remain contagious, so isolation strategies are difficult to develop. To be cautious, we have chosen long periods of isolation. The Chinese government has tried to isolate large populations of people to contain the virus. Entire cities have been quarantined, leading to widespread shortages of everyday goods like food, medicines, bandages, and water, triggering social panic.
The idea that large cities could be quarantined is a frightening prospect for many people and, the fact is, in today's world, it just does not work. The Chinese have built large hospitals to quarantine people who are suspected of being infectious or exposed to the virus. This has added to the public fear surrounding the disease.
The fact remains that this strain of coronavirus is not highly contagious; it behaves very similarly to other infectious viruses by targeting mainly the weak and/or immunocompromised portions of the population. For most of us, contracting coronavirus infection will lead to a flu-like syndrome, and the majority of patients will most likely survive—very similar to the majority of people who get flu.
There is a certain unspoken factor adding complexity to this outbreak: The fact that it originated in China. There is a good deal of anti-Chinese sentiment in the United States and around the world. Airlines refuse to travel to China and refuse Chines passangers, Chinese tourists are barred from entering certain countries, Western businesses have closed, and ex-pats have returned home. Some of this reflects a certain attitude of fear that the Chinese government hasn’t been honest or upfront about reporting details about the outbreak. Chinese citizens have been prohibited from traveling to some countries. I have even heard cases of Americans avoiding Asian people unless they are wearing masks out of fear that they will contract coronavirus.
All of this is, of course, absurd and, frankly, xenophobic at best—and racist at worst. The fact is, a Chinese visitor visiting the United States at this time is 10,000 times more likely to die from influenza than an American visiting China is of dying from coronavirus. In any case, wearing masks affords little protection against coronavirus since the virus is small enough to penetrate the microfibers of most masks. This strain of coronavirus appears to be far less contagious than the flu.
The fact is, influenza is an illness that is far more deadly but also far more familiar to us. The current coronavirus outbreak, which originated in China, serves as a surrogate for a good deal of xenophobia and fear of the country itself.