societal response. But governments and civil society are not
heeding these warnings, as the 2019-nCoV attests. What
we need to learn and communicate is that the zoonotic
or agricultural bridging of novel pathogens from domestic
and captive wildlife needs urgent attention, along with
attention to the human appetite for meat. This approach is
easily achieved for coronavirus threats—e.g., by substantially
reducing the trade of risky species of wild-caught animals for
food or other purposes, and a culturally sensitive ban on the
sale of these animals in wet markets. Vaccines and therapeutic
alternatives might be possible and are needed, but they are
a response, because the emerging strain is unpredictable
and a vaccine is unlikely to prevent the initial events. In
some parts of Africa, prevention of Ebola virus and future
coronavirus threats require shifts in food habits, a transition
from bushmeat being a cultural norm or primary source of
protein, and by discouraging agricultural development that
brings bats into increased contact with humans or livestock.
In the Middle East, re-evaluating and improving infection
prevention and control measures for camel farms, a recent
introduction coincident with the emergence of MERS-CoV,
would be a positive step forward.”
Even as COVID-19 continues to test the readiness and
preparedness of U.S. healthcare systems, we have had
enough brushes with pandemics in the last century to not
be surprised by the emergence of the novel coronavirus
causing the current COVID-19 outbreak.
As Pan, et al. (2020) remind us, “Human history is littered
with wars and pandemics, but the death and fear caused
by some pandemics cannot be matched by any war. The
one with the largest number of deaths in recent human
history, the Spanish flu caused by the H1N1 influenza A
virus, had infected 500 million people (almost one-third of
the world population in 1918) and killed 25 million to 50
million people. In the 21st century, human epidemics caused
by viruses have continuously appeared in the public eye.
Among them, the new infectious diseases caused by wild
animal coronavirus infections in humans have attracted the
most attention, reminding us that people should be fully
prepared to respond to a larger pandemic that may occur
at any time in the future.”
As Pan, et al. (2020) continues, “The rapid increase in the
number of 2019-nCoV cases in a short period of time has
forced society to respond quickly. At present, 2019-nCOV
is still spreading rapidly, and the origin of the new virus,
transmission modes other than saliva droplets and airborne
transmission, the window period, the contagious period after
clinical recovery, and patient prognosis are unknown – but
the efforts of all parties have begun to bear fruit.” At the
time of writing, researchers are working on vaccines and
other therapeutics to address COVID-19.
The emergence and rapid increase in cases of COVID-19
poses complex challenges to the global public health, research
and medical communities, write federal scientists from NIH’s
National Institute of Allergy and Infectious Diseases (NIAID)
and from the Centers for Disease Control and Prevention
(CDC). Their commentary appears in The New England
Journal of Medicine.
NIAID director Anthony S. Fauci, MD, NIAID deputy
director for clinical research and special projects; H. Clifford
www.healthcarehygienemagazine.com • april 2020
Lane, MD, and CDC director Robert R. What we need
Redfield, MD, shared their observations
in the context of a recently published to learn and
report on the early transmission dynam- communicate is
ics of COVID-19. The report provided
that the zoonotic or
detailed clinical and epidemiological
information about the first 425 cases to
agricultural bridging
arise in Wuhan, Hubei Province, China.
of novel pathogens
Fauci, Lane and Redfield point to the
many research efforts now underway from domestic and
to address COVID-19. These include
captive wildlife needs
numerous vaccine candidates proceed-
ing toward early-stage clinical trials as urgent attention,
well as clinical trials already underway along with attention
to test candidate therapeutics, includ-
ing an NIAID-sponsored trial of the to the human appetite
experimental antiviral drug remdesivir for meat.”
that began enrolling participants on
Feb. 21, 2020.
“The COVID-19 outbreak is a stark reminder of the
ongoing challenge of emerging and re-emerging infectious
pathogens and the need for constant surveillance, prompt
diagnosis and robust research to understand the basic biology
of new organisms and our susceptibilities to them, as well as
to develop effective countermeasures,” the authors observe.
Infection Control Measures in the Early Fight Against
COVID-19
Appropriate hospital infection control measures could
prevent nosocomial transmission of COVID-19, experts say.
Cheng, et al. (2020) sought to describe the infection control
preparedness for COVID-19) due to SARS-CoV-2 in the first
42 days after announcement of a cluster of pneumonia in
China, on Dec. 31, 2019 (day 1) in Hong Kong.
The researchers implemented a bundle approach of active
and enhanced laboratory surveillance, early airborne infection
isolation, rapid molecular diagnostic testing, and contact
tracing for healthcare workers (HCWs) with unprotected
exposure in the hospitals. Epidemiological characteristics
of confirmed cases, environmental and air samples were
collected and analyzed.
Cheng, et al. (2020) report that from day 1 to day 42, 42
(3.3 percent) of 1,275 patients fulfilling active (n=29) and
enhanced laboratory surveillance (n=13) confirmed to have
SARS-CoV-2 infection. The number of locally acquired case
significantly increased from 1 (7.7 percent) of 13 [day 22 to
day 32] to 27 (93.1 percent) of 29 confirmed case [day 33
to day 42] (p<0.001). Twenty-eight patients (66.6 percent)
came from eight family clusters. Eleven (2.7 percent) of 413
healthcare workers caring these confirmed cases were found
to have unprotected exposure requiring quarantine for 14
days. None of them was infected and nosocomial transmission
of SARS-CoV-2 was not observed. Environmental surveillance
performed in a patient with viral load of 3.3x106 copies/ml
(pooled nasopharyngeal/ throat swab) and 5.9x106 copies/ml
(saliva) respectively. SARS-CoV-2 revealed in 1 (7.7 percent)
of 13 environmental samples, but not in eight air samples
collected at a distance of 10 cm from patient’s chin with or
without wearing a surgical mask.
As the researchers observe, “The emergence of novel
coronavirus associated pneumonia posed a global threat
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