Coronavirus | A Second Opinion Podcast | Senator Bill Frist MD

Special Episode: Coronavirus Update from Senator Bill Frist, M.D.

Today, on A Second Opinion, we bring you a special episode outside of our regular Monday show schedule to provide up to date coverage on the 2019 novel coronavirus.

I’m your host, Senator Bill Frist.  There is no better example of the critical importance of bringing together policy, medicine, and innovation to address and solve the growing health epidemic of coronavirus.  This is our first in a special continuing series.

I’ll cover all you need to know about this threatening virus, including policy, health and innovation.   I’ll answer all the basic questions, including how dangerous the virus is to you and your family, where it came from and how fast it’s spreading,  what symptoms to watch out for, and how different it is from the routine seasonal  flu on the one hand and  measles on the other.

As a doctor I’ll give you my best clinical and medical Interpretation.  But I will also be directly comparing this novel coronavirus …this one known as 2019-nCoV, with a different species of coronavirus that I had direct, on-the-ground, personal experience with back in 2003 — the virus causing  Severe Acute  Respiratory Syndrome…, S A R S…  the virus known as SARS. … which caused  the first pandemic of the 21 st century.

You see, right at the  very height of the SARS pandemic in 2003, I was in China in the middle of it all … where it all started.  I was in China — as a physician-scientist and US Senator, leading a US Senate, fact finding delegation. I witnessed first hand the overt cover up by Chinese officials … the delay in reporting that led to global spread to 29 countries and to unnecessary death and collapse of regional economies. More on what I learned back then and how it colors today, a little bit later in the program.

As of Feb 7, the number of confirmed cases of this new strain of coronavirus globally was 31,424, with more than 31,000 of those in mainland China. The number of cases in China is currently growing between 11% and 15% a day.

And with more than 600 deaths in mainland China after just five weeks,  it has already surpassed the total number of SARS deaths in that country during the entire 8 months of the 2003 SARS pandemic.

A quick cautionary note. Things are moving fast and we are learning new things about  this virus and it’s impact literally every hour of every day. What we say today WILL change tomorrow. Thus Please, after this podcast, continue to monitor and  follow in real time current CDC information and recommendations which supersede anything that  I say or report today, this feb 9 2020.

So what do we know?

This strain of coronavirus is a new respiratory virus which first reported on Dec 31, just over 5 weeks ago, in Wuhan, a city of 11 million people in Central China.

Coronaviruses are actually a large family of viruses that are common in many different species of animals, including cats cattle  camels and bats.

Though rare, these animal coronaviruses can infect people, and then spread between people – as was the case with two other coronaviruses …MERS (or Middle Eastern Respiratory Syndrome), …  and SARS (Severe Acute Respiratory Syndrome).

Including this new strain, there are  seven different known  coronaviruses that can infect people and make them sick.

Common signs of  infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, a serious lung condition called  severe acute respiratory syndrome, and even death.

How big of an outbreak have we seen thus far?

The coronavirus outbreak has sickened more than 31,000 people in Asia. However, the true number of cases is almost certainly far, far larger than has been officially confirmed by lab tests, with some models putting the number of cases at 100,000 or more.

As of Feb 7,  638 people have died,… all but two in mainland China.

Globally, outside of China the World Health Organization reports 270 confirmed cases in 24 countries as of Feb 7.

Here at home In the United States, there are 12 cases confirmed … six in California, one in Washington state, one in Arizona, two in Illinois,  one in Massachusetts, and one in Wisconsin.

For purposes of comparison, the  SARS outbreak of 2002/2003 infected a total of 8,096 people worldwide.  Of these, 774 died. And, In the United States, only eight people were confirmed to have had the SARS infection, and all had traveled to other parts of the world where SARS was spreading.

So …How transmissible is the new coronavirus?

The virus probably originally emerged from an animal source but now it  is spreading from person-to-person.  Person-to-person transmission is thought to occur mainly by respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza (the typical flu)  and other respiratory pathogens spread.

Thus  the corona virus is harder to get than pathogens like measles, chickenpox and tuberculosis … these are spread more easily because they can be aerosolized and travel much further, up to a hundred feet through the air.

So how deadly is this virus?

From what we know so far, the virus appears more contagious than SARS, but thankfully less deadly.

But until we get a better handle on the data and accuracy of reporting in China,  it’s  unclear how much more contagious, and how much less deadly.

During the 2003 outbreak, the SARS virus killed about 1 in 10 people who were infected.

We have to be careful in judging lethality of the current outbreak at this eArly stage because … With any new virus, it’s tough to assess  lethality since the worst cases are usually detected first.  This can skew our understanding of how likely patients are to die.

Currently, most of the patients who have died from this new infection have been older than 60 and have had preexisting health conditions.

So how much risk is the virus to you right now?

For most Americans the risk of coronavirus infection is low. To put this in context, the CDC estimates that for the current 2019 – 2020 seasonal flu season, there have been between 12,000 – 30,000 flu deaths, and as many as 31 million flu illnesses.  Statistically You are at much greater risk of catching – and even dying from – the common seasonal flu than the coronavirus.

Where did it come from?

Researchers traced the origin of the new virus to a meat and seafood market in Wuhan China.

Of interest, a  study published in The Lancet last Wednesday, found that the virus shares the vast majority of its genetic makeup with viruses similar to SARS that originated in bats, suggesting that the 2019 novel coronavirus may have come from bats before spreading to a different intermediate animal host,  and then on to people.  But this has not been proven.

And how do we treat the patient with coronavirus?

Treatment is supportive only, meaning mainly with fluids, oxygen and nutrition.

Unfortunately, there is no specific drug  or vaccine that works against  the 2019 novel coronavirus. Scientists and industry are working feverishly to expedite new therapies.

A vaccine for this new strain of coronavirus is at least a year away.  My friend Dr. Tony Fauci, director of the National Institute of Allergy and Infectious Diseases, said, “If we don’t run into any unforeseen obstacles, we’ll be able to get a Phase 1 trial going within the next three months.” But it could still take months, and even years to conduct all the testing needed to prove a vaccine is safe and effective.

How long will the outbreak last – and how bad will it get?

The answer is, we don’t know. The SARS outbreak lasted for 8 months.  The scale of the current outbreak will depend on how transmissible the virus is – something we are still determining – and the effectiveness of the global containment response.

Is this a pandemic?

Not yet.  The World Health Organization has declared the current outbreak a global health emergency.  It is  not yet constituted as  a “pandemic”, or the worldwide spread of a new disease.  While more than two dozen nations have reported cases, there have been no confirmations across Africa or Latin America.

Has China’s response been effective?

I’d answer,  much much better than when I was in the SARS outbreak in 2003.

China has taken the unprecedented step of imposing travel restrictions on tens of millions of people living in Wuhan and nearby cities.

But the effective lockdown in China came days and days too late. Wuhan’s mayor acknowledged that five million people had left the city before the restrictions began in late January.

Chinese  authorities initially silenced doctors and others who were raising red flags about a potential new SARS-like outbreak. They downplayed the danger to the public.

All this reminds me so much of my own experience in China in 2003 with SARS.

We now know that  The first identifiable case of SARS occurred in November 2002. Yet, it was not until February 2003 … 3 months later… that the Chinese Ministry of Health notified the WHO that 305 cases of an acute respiratory syndrome of unknown etiology had occurred in Guandong Province.   But Even then, official China continued to deny that SARS was a serious problem.

At the time, I was the Senate Majority Leader and the only physician in the Senate.

That April, I led an official delegation of eight senators to China, where we investigated China’s critically slow response.

The disease had been raging there for over five months, but it wasn’t until we were half way through our interviews  in Beijing that the Chinese government fired its top health official, and began providing accurate reports on the impact of SARS on its people.

It was a positive turnabout, but the government’s initial refusal to acknowledge the danger of SARS exacerbated the impact of the disease not only in China but, indeed, around the world.  What could have been regionally contained became a global health emergency in nearly 30 countries.

Today … This time around, the Chinese government, though slow to respond initially,  has been more open and Definitive in their response, … acknowledging the “shortcomings and deficiencies” in the their initial  response to the coronavirus.

What is the response in the United States?

On January 31st, Health and Human Services Secretary Alex Azar declared a public health emergency for the entire United States.    The Centers for Disease Control and Prevention is working closely with state health departments on disease surveillance, contact tracing, and providing interim guidance for clinicians on identifying and treating coronavirus infections.

On Sunday a week ago, the U.S. government barred foreign nationals from entering the country within two weeks of visiting China, unless they are immediate family members of U.S. citizens or permanent residents.  The State Department has warned Americans against all travel to China, and is conducting more evacuation flights to bring Americans home from China. These new evacuees … along with anyone else who is allowed into the U.S. after recently being in China’s Hubei province … are being quarantined for up to two weeks.

The last time our government implemented mandatory quarantine was in the late 1960s, when it held people on the U.S.-Mexico border who lacked evidence of smallpox vaccination.

What will be the economic impact of the coronavirus?

Economists say it’s too soon to predict the full impact, but it’s clear there will be global repercussions. The Chinese economy now accounts for  17% of global GDP and it’s the largest trading partner for most of its neighbors. Those most dependent stand to be hit hardest.

Bloomberg News reported that Nike has closed about half of its company-owned stores in China, Starbucks has closed about 2,000 of its cafes, and Apple says its supply chain will be affected.

For comparison, the SARS outbreak of 2002 & 2003 inflicted the greatest blow to the Chinese economy since the Tiananmen Square killings in 1989. It caused a plunge in retail sales, a slump in demand for some Chinese exports and a near-collapse in domestic and foreign tourism.

When our senate delegation was in Beijing we were the only people occupying a 600 room hotel.

The pandemic knocked off an estimated 1 percent or more from China’s growth rate and had an estimated cost of $40 billion to the global economy. Now, with even more globally connected markets and financial systems, the impact of today’s epidemic is estimated to become even greater.

So Where should I get my trusted information each day?

The U.S. Centers for Disease Control and Preparedness is the most trusted source for Americans on this virus.

And the World Health Organization maintains current information on the spread and impact of this virus globally.

Here at A Second Opinion, we’ll also continue with special editions (in addition to our regular weekly podcast) to bring you useful, straightforward updates directly from leading health experts.

I will close today with a final thought … a sort of second opinion.

And I will do so by quoting  my friend, former CDC director Tom Frieden in his recent column for the Washington Post .  He writes: “We have successfully addressed serious public-health challenges. After the United States realized it was falling behind in biomedical research in 1998, we doubled the budget of the National Institutes of Health.

When the world faced the unprecedented devastation of HIV, we created the President’s Emergency Plan for AIDS Relief (PEPFAR) and helped turn the tide on the disease, building bridges with governments and communities around the world.

But when it comes to avoidable health crises such as severe acute respiratory syndrome (SARS), Ebola and drug-resistant organisms, the U.S. and global response has been slow, haphazard and far too limited. This coronavirus outbreak reminds us that humanity shares a common enemy: dangerous microbes. When Ebola struck between 2014 and 2016, Congress ultimately allocated $5.4 billion to control an epidemic — but the epidemic could have been nipped in the bud at almost no cost had basic systems been in place. The world needs a massive investment to protect against the next health threat.”

I agree with Tom.

Whatever happens with this coronavirus, we need much stronger public health systems, to find faster, stop sooner, and prevent .,,harms from the inevitable new infections we and our children will face in the coming years.

Every expert in the world agrees:  changes in the way we as humanity inhabit the globe, especially with accelerated mobility and   transportation advances, make the emergence of more new diseases inevitable. Constant mutation and adaptation are the survival mechanisms of the microbial world.

Now is the time to act to strengthen our safety and security by supporting early detection and control systems at home and around the world.

Thank you for tuning into this special broadcast of A Second Opinion.  Check back tomorrow for our next special edition update on the coronavirus, when we get the very latest from Dr. Jay Butler, Deputy Director for Infectious Diseases with the Centers for Disease Control and Prevention.

Also be sure to listen to our regular Monday broadcast. This week, the second in a series featuring our nation’s leading healthcare economists.