Reality check: Risk from virus remains 'very low' at this point

IHS Emergency Management Coordinator Gerald Johnson, Navajo, is being “fit tested” for an N95 respirator. These masks are required for healthcare workers working with critical respiratory diseases.(Photo by Reba Benally | Phoenix Indian Medical Center)

Quindrea Yazzie

Indian Health Service prepares for the Novel Coronavirus *This story has been corrected

U.S. health officials offered a reality check Tuesday about the scary new virus from China: They're expanding screenings of international travelers and taking other precautions but for now, they insist the risk to Americans is very low.

“At this point Americans should not worry for their own safety,” Health and Human Services Secretary Alex Azar told reporters Tuesday. Still, he added, “this is a very fast-moving, constantly changing situation."

China's latest figures cover the previous 24 hours and add 26 to the number of deaths, 25 of which were in the central province of Hubei and its capital, Wuhan. The 5,974 cases on the mainland marked a rise of 1,459 from the previous day, although that rise is a smaller increase than the 1,771 new cases reported on Monday. Dozens of infections have been confirmed abroad as well.

In the U.S. so far, there are five confirmed patients, all of whom had traveled to the hardest-hit part of China — and no sign that they have spread the illness to anyone around them.

The most recent case hit Maricopa County, Arizona, where an adult from the Arizona State University community tested positive for the virus. According to county health departments the patient lives in Tempe, Arizona, but does not live in university student housing. It is not known whether the individual is a student, faculty member or on staff at the university.

Arizona State University is working closely with Maricopa County Department of Public Health to investigate any potential contacts that this individual may have exposed.  A university statement said any direct contacts will be notified. “The university remains open and classes are not cancelled,” said Executive Vice President and University Provost Mark Searle.

Additionally to the positive case in Arizona, there is one confirmed case in Washington, one in Chicago and two in California. As of January 27, there are 32 negative cases of the virus and 73 pending cases awaiting results from the CDC in the United States.

Related story: Americans pass health test after being evacuated from China

What is the virus?

Coronavirus is a large family of viruses that sicken mostly animals, but six of these cases, like SARS and MERS, are known to infect people. This new type of the coronavirus adds to the list, marking it number seven of now eight cneoronavirus types.

The symptoms begin after an incubation period of 2-14 days according to the Centers for Disease Control and Prevention. Those infected have symptoms of a fever, a cough and shortness of breath. Severity of the symptoms could lead to hospitalization and even death.

“Early on, many of the patients in the outbreak of respiratory illness caused by Coronavirus in Wuhan, China ,had some link to a large seafood and live animal market, suggesting animal-to-person spread,” the CDC reported. “However, a growing number of patients reportedly have not had exposure to animal markets, indicating person-to-person spread is occurring.”

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Wuhan, China. Google maps, screenshot.

What is being done?

Airports in Wuhan, China, are restricting outbound traffic and health screenings are now being conducted at U.S. airports. The CDC announced that at least 20 U.S. airports have also initiated health screens to seek preventative measures against the spread of the virus.

Chartered planes carrying evacuees home to Japan and the United States left Wuhan early Wednesday as other countries planned similar evacuations from areas China has shut down to try to contain the virus. The lockdown of 17 cities has trapped more than 50 million people in the most far-reaching disease control measures ever imposed.

A plane carrying Americans who had been in Wuhan left for Anchorage, Alaska, where they will be re-screened for the virus. U.S. hospitals are prepared to treat or quarantine people who may be infected. After departing Alaska, the plane is to fly to Ontario, California.

The virus has affected most of China resulting in nearly 50 million Chinese residents being quarantined. However, that has not stopped the virus from spreading to other countries, including the United States. The CDC issued a “warning-level 3” to travelers to avoid unnecessary travel to China on their website.

Although, the disease is not being spread from person-to-person the CDC recommends that getting vaccinated and taking everyday preventative actions to decrease the risk of getting sick with a respiratory disease or the flu.

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The Phoenix Indian Medical Center building in Arizona. (Photo by Quindrea Yazzie)

IHS prepares for the virus

The Indian Health Service's Phoenix Indian Medical Center has been taking the initiative to prepare for the respiratory illness.

The Indian Health Service will continue to follow normal policies and procedures for evaluation and treatment of respiratory illnesses, said Constance James, director of community relations and tribal affairs.

When asked if Indian Country should be concerned about the virus, Dr. Jennefer Kieran, director of Inpatient & Specialty Services at Phoenix Indian Medical Center, said there is a protocol set in place by the IHS leadership team along with infection control and special rooms are in place for critical respiratory illnesses.

“From a personal perspective, there has been no person-to-person contact and the risk is low, but something like this is changing rapidly,” Dr. Kieran said. The important thing to do right now is to take precautions, continuing to wash your hands and covering your cough.

“While any direct impacts of this outbreak to Indian Country are not yet known, we must be vigilant in our efforts to prevent the introduction and spread of infections among our patients and within the communities we serve,” James said.

Navajo Nation President Jonathan Nez released a statement on the virus stating, “as we continue to closely monitor the coronavirus, we caution our Navajo people and encourage them to be aware of the growing spread of the virus. This is a serious public health concern that must be shared with all people. We ask that you share information with your children, elders and others who may not have access to information via internet, television and other means.”

In Washington, flanked by the government's top infection specialists, Secretary Azar listed the biggest unanswered questions of the outbreak and tried to tamp down some of the fear and speculation provoked by China's rising toll:

—How deadly is this new virus? China's death toll has passed 100 but the first patients counted in an outbreak “are naturally the most severe cases” and “skew our understanding,” Azar cautioned. Over time, if doctors find many more people had just a mild, cold-like illness, the death rate will change.

—How easily does it spread? One way to measure that is an estimate of how many people could catch an infection from one contagious patient. Some reports have suggested that number might be between 1.5 and 3.5 for the new coronavirus, but Azar stressed it's too soon to know. For comparison, one patient with measles could spread it to 12 to 18 others, he added.

—What about silent carriers? Reports from China suggest some people may have spread the virus before showing symptoms. And Germany on Tuesday said a man with the virus near Munich never traveled to China or had close contact with anyone showing symptoms. Instead, he may have been infected by a coworker from China who briefly visited for a company training session and didn't report feeling ill until her flight home. Later authorities confirmed three additional cases from the German company, all connected to the first.

Some viruses, such as the flu, can spread before symptoms are obvious. But there's no evidence it's happened with the new virus in the U.S., where health officials are checking contacts of the sick. And epidemics are driven by the openly sick, said Dr. Anthony Fauci, infectious disease chief of the National Institutes of Health.

Still, the Centers for Disease Control and Prevention wants to send its own scientists to visit China for a first-hand look try to answer those questions. On Tuesday, the World Health Organization said it hopes to send in international experts soon.

Without a vaccine or treatments, the world is depending on tried-and-true public health steps to tamp down the outbreak — finding the infected early and isolating them to stem the spread.

In the U.S., the CDC is beefing up its checks of incoming travelers. It already had been screening for illness among passengers arriving from the epicenter of China's outbreak at five U.S. airports. But people who've visited other parts of China still may be arriving, with stops in other places first. Now, CDC is sending extra staff to other “quarantine stations” to screen arrivals at a total of 18 airports around the country and at two border crossings, in El Paso, Texas, and San Diego.

The State Department has also chartered a plane to evacuate diplomats from the U.S. Consulate in Wuhan, the city where the outbreak started, and some other Americans.

Asked if those evacuees would be quarantined, Azar said there will be doctors on the flight to check all the passengers so health officials can decide if additional steps are needed.

With an incubation period of anywhere from two to 14 days, travelers may arrive showing no symptoms. But CDC's Dr. Nancy Messonnier said the screenings are an opportunity to educate travelers that if they start feeling sick — with a fever, cough or flu-like symptoms — after returning from an outbreak zone, they should contact their doctor. That's exactly what the first U.S. patients did.

Azar said he has directed $105 million to fight the outbreak. Among the next steps, the CDC developed a test for the virus and aims to make it usable by state health departments, to speed diagnosis of suspected cases. Research also is under way to develop a vaccine or treatment.

Airport screenings were initially done in New York, Los Angeles, San Francisco, Chicago and Atlanta. That has been expanded to Anchorage, Alaska; Boston; Dallas; Detroit; El Paso, Texas; Honolulu; Houston, Miami, Minneapolis; Newark, New Jersey; Philadelphia; San Diego; Seattle; Washington, D.C. (Dulles); and San Juan, Puerto Rico.

For the latest information about 2019 Novel Coronavirus.

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Quindrea Yazzie, Navajo, is a reporter-producer at Indian Country Today’s Phoenix Bureau. Follow her on Twitter: @quindreayazzie or email her at qyazzie@indiancountrytoday.com

The Associated Press contributed to this report. Reporters Lauren Neergaard, Ricardo Alonso-Zaldivar and AP Medical Writer Mike Stobbe from New York.

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