Lessons that go beyond the coronavirus outbreak

People wear protective face masks in Hong Kong. Experts say hand washing is a better way to prevent infections than wearing masks. Photo / AP

There are more useful things to do than worry. For one thing, you could wash your hands. (And did you get your flu shot?)

News of coronavirus infections is causing many people to panic.

It's unclear how widespread or deadly this illness is going to be, but for once, instead of telling you not to worry, I'm going to suggest riding that wave. Channel that fear into useful action — and find the lessons that go beyond this outbreak.

There are absolutely things we can do to protect people from infection by this novel respiratory virus, which has caused hundreds of deaths in Wuhan, China, and has spread to other countries. Some involve a societal response, but others are very simple.

Most important, wash your hands. Wash them often. Wash them for at least 20 seconds with soap and water. Wash them especially well if you're about to eat. Wash them after you've blown your nose, coughed or sneezed. Make it routine that all members of the household wash their hands when they get home.

I'm a paediatrician, and I know it can be hard to do this yourself, let alone get others to do it. So make it a game. Offer incentives. There's almost nothing that you, or your family, can do that will protect you more from infections.

Here are five steps: (1) wet your hands, (2) lather them, and then (3) scrub them for at least 20 seconds. No one ever looks at a clock, so try singing the Happy Birthday song twice, from start to finish. If you're trying to get kids to do this, come up with a funny hand-washing song to the same tune. A colleague of mine recommends singing the alphabet.

I know that 20 seconds seems like a long time. While we don't have huge randomised controlled trials to prove this is the optimal amount, research does exist to say that shorter times aren't as good at removing germs, and much longer times can actually damage the skin and can be counterproductive.

Then (4) rinse, and (5) dry. It's not that hard. If you can't wash your hands, then hand sanitiser with at least 60 per cent alcohol will work in a pinch, but it's not as good.

Don't touch your face in general, especially with unwashed hands. Don't shake hands with people who are sick. If you're sick, stay away from other people.

Clean the objects and surfaces that you touch a lot. Clean them well with cleaning sprays or wipes that will kill germs.

What's not recommended for everyone? Face masks. If you're sick, they may help prevent you from spreading the virus, but they don't do as much to help keep healthy people from getting sick.

Two likeliest scenarios for an uncontained outbreak

This is not the first coronavirus to cause worldwide concern. The 2002 outbreak known as SARS (severe acute respiratory syndrome) and the 2012 outbreak of MERS (Middle East respiratory syndrome) both originated from this same type of virus.

This new version, "2019-novel Coronavirus" or 2019-nCoV, is at the moment thought to be more infections than those two, but less likely to cause death. As of Monday, of more than 40,000 cases reported (almost all in China), more than 900 were linked to death. Many more cases are probably unreported, of course.

The best-case scenario for this outbreak would be containment. If China can pull this off, and other countries can keep those who are infected to a minimum, it's possible that we could prevent widespread infection and eradicate 2019-nCoV in humans. This is what we accomplished with SARS, so it's possible.

But as international travel becomes easier, eradication becomes harder. Should we be unable to contain the disease, and this coronavirus sticks around, it's still not necessarily cause for panic.

Medical workers treat patients in the isolated intensive care unit at a hospital in Wuhan. Photo / AP

It would be the fifth coronavirus that's endemic in humans. (SARS and MERS did not become endemic.)

A recent article by Sharon Begley in STAT News laid out the two most likely scenarios for an uncontained outbreak. The first is that 2019-nCoV winds up being like the other four endemic coronaviruses, which cause less serious coldlike illnesses. Should this happen, we'll worry for a few years as we track the rate of infections and make sure that it's not more severe than we think. But eventually we won't worry about it any more than we worry about which virus is causing our latest cold. More than a third of people infected with the other coronaviruses don't even notice they are ill.

This doesn't mean that some people don't become sicker — with pneumonia, for example — after contracting these coronaviruses. They do. But the rates of bad outcomes aren't usually high enough to make the news.

The other, more worrisome, outcome would be that 2019-nCoV becomes a more significant seasonal virus, like influenza. That would be bad. The Centers for Disease Control and Prevention estimates that the flu has already caused up to 310,000 hospitalisations this year and 10,000 to 25,000 deaths.

Where to put the worry

Time will tell if the new coronavirus ends up being less or more dangerous than the flu; we don't fully know yet how bad it is. Usually, the diseases that stick around tend to become less lethal. Only live hosts can continue to make more viruses. Influenza is also pretty devious in how it mutates its surface molecules from year to year to evade immune system detection. If 2019-nCoV is not able to do that, people's immunity to it could gradually improve.

But therein lies the paradox. The outcome that has public health officials really concerned is that 2019-nCoV will turn into something like a disease that we have a tough time making you worry about right now.

Every year physicians and public health officials try to get you to immunise yourselves against the flu, and far too many of you don't. We beg you to practice proper precautions and hygiene — and, still, tens of thousands of people die, and too few worry enough.

A nurse checks the temperature of a visitor as part of the coronavirus screening procedure at a hospital in Kuala Lumpur, Malaysia. Photo / AP

Governments and employers could help by making it easier for sick people to stay home from work. Many Americans without paid sick leave go to work despite feeling ill, and many of those work at restaurants, schools and hospitals, where disease is easily spread.

The most significant defense the United States has to prevent pandemics is a solid public health infrastructure. The public has to trust it. The system also needs to be properly prepared and have the resources to handle a widespread infection. (The system is currently stretched thin and underfunded.) It's critical to make sure there are enough medical supplies available, as well as necessities like food, to get a community through an outbreak.

Should you be worried about getting infected with viruses? Sure. Have you gotten a flu shot yet?

Channel your fears into productive behaviours. That's how you'll significantly reduce your risk from being infected with 2019-nCoV. It'll also help you from being infected with the flu. It'll even help protect you from getting a cold. Wins all around.

Written by: Aaron E. Carroll
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