In a new commentary, medical experts emphasize the urgent need for strong public health leadership in the wake of the emerging coronavirus (COVID-19) pandemic.
“Appropriate concerns and not fear should play a major role in the emerging pandemic, and public health efforts should focus on public health issues, not political or economic considerations,” said Terry A. Adirim, M.D., M.P.H., M.B.A., senior associate dean for clinical affairs, chair of the Department of Integrated Medical Sciences and professor of pediatrics in Florida Atlantic University’s (FAU) Schmidt College of Medicine.
Their paper is published in the American Journal of Medicine.
“Based on the existing totality of evidence, it appears that coronavirus is comparable in communicability to influenza but with perhaps a tenfold higher case fatality rate,” said Charles H. Hennekens, M.D., Dr.P.H., first author and first Sir Richard Doll Professor in FAU’s Schmidt College of Medicine.
“The anticipated number of deaths due to coronavirus may become comparable to the most lethal epidemic of influenza in U.S. history, which occurred in 1918 when approximately 675,000 Americans died.”
In contrast, with respect to usual outbreaks of influenza, the 2018-19 flu season affected about 42.9 million Americans, of which 647,000 were hospitalized and about 61,200 died.
More than 80% of symptomatic individuals with COVID-19 will experience only mild flu-like symptoms. However, more alarmingly, approximately 15% of affected patients will become seriously ill and 5% will need critical care.
Younger and healthier people will represent a larger proportion of the population with mild to moderate symptoms. Those at greatest risk are the elderly, those with certain chronic diseases such as cardiovascular disease and lung disease, and people receiving chemotherapy or who are otherwise immunocompromised through illness or therapies.
For decades, public health officials have directed the containment of emerging pandemics, including the worldwide eradication of smallpox starting in the early to mid-1960s.
Since then, surveillance systems have increased in number with major advances in data collection, analysis, and communication. From influenza to smallpox, the establishment of systematic reporting systems and prompt action based on results have enabled public health officials to lead the charge in containing emerging pandemics.
In the new paper, the authors emphasize that public health leaders, namely, Anthony S. Fauci, M.D., director of the United States National Institute of Allergy and Infectious Diseases, who is called the “Babe Ruth” of virology, should guide the nation and other comparable world leaders through this pandemic and ensure preparedness for the challenges ahead.
Over the course of a decade spanning the tenures of U.S. presidents John F. Kennedy, Lyndon B. Johnson, Richard Nixon and Gerald Ford, using evidence-based leadership, public health officials led the U.S. and worldwide efforts that resulted in smallpox becoming the first human disease ever eradicated from the face of the earth.
At the helm of this effort were Alexander D. Langmuir, M.D., who created the Epidemic Intelligence Service (EIS) and Epidemiology Program at the U.S. Centers for Disease Control and Prevention (CDC), and Donald A. Henderson, M.D., chief of the Virus Disease Surveillance Program at the CDC in the 1960s.
“U.S. health care workers today are appropriately confused about current and future issues concerning COVID-19, an infectious disease that is caused by the severe acute respiratory syndrome coronavirus known as SARS-coV2, which is now responsible for an emerging pandemic,” said Adirim.
Adirim recently served as deputy assistant secretary of defense for health affairs at the Department of Defense and a senior medical official at the Department of Homeland Security during the 2009-H1N1 Pandemic.
“The good news is that the majority of those infected with the virus will recover, however, the most vulnerable are not projected to fare as well. It is therefore, extremely important that we all take an active role in not only protecting ourselves, but also those among us who are the most vulnerable,” said Safiya George, Ph.D., dean of FAU’s Christine E. Lynn College of Nursing, who specializes in immunology, oncology and HIV/AIDS.
“In only eight days, Florida went from 18 cases and two deaths on March 9 to 314 positive cases and seven deaths on March 18. However, these numbers are still less than 10% of the rising number of cases in New York and still much less than California and Washington. Therefore, education, social distancing, staying away from others when symptomatic and continued handwashing and vigilance remain key in minimizing transmission.”
The authors say that the staggering estimates of the potential numbers of hospitalizations could paralyze the U.S. health care delivery system. Moreover, the overcrowding of hospitals by patients with coronavirus could make it more difficult to provide care to those with life threatening conditions.
“The first case was reported in Wuhan, China on Dec. 31, 2019 and in the U.S. on Jan. 22,” said Adirim. “During that interval, containment was potentially achievable in the U.S. but required collaborative efforts such as widespread utilization of rapid testing kits available from the World Health Organization. Now, however, we must employ strategies to flatten the curve to decrease avoidable morbidity and mortality.”
By March 8, South Korea, which has a population of about one-sixth that of the U.S., had tested more than 240,000 (1 per 250) compared to the U.S., which had tested about 13,662 (3,903 from the CDC and 9,721 from public health laboratories). In both South Korea and the U.S., only about 3% of these cases tested positive for coronavirus.
Health care providers as well as the general public should also be aware that any vaccine is likely to emerge in one to two years. In addition, there is a possibility that chloroquine phosphate (a class of drugs still used to prevent and treat malaria and was formerly used to treat inflammatory arthritis) may be effective and has an acceptable safety profile against COVID-19.
Source: Florida Atlantic University