FACT SHEET and Q&A: A Novel Coronavirus (COVID-19)

Dr. H. Christian Hong

President of New Tokyo Medical College and a former Captain, U.S. Army Medical Department (AMEDD)

Chief Business Officer, EyeGene Inc.

Recently, we witnessed a cluster of pneumonia cases caused by a novel coronavirus-now named as COVID-19. This unusual viral infection imposed a global burden on various industries including tourism industry, air lines, retail businesses, hospitality industry etc. The spread of this viral infection is now reported in about 60 nations. For our island, the travel restriction has been effective since January. According to United Airlines “Anyone who’s traveled to mainland China since January 6, 2020 will not be allowed to enter the Federated States of Micronesia (FSM). Anyone who has been in a country with a confirmed case of the coronavirus (other than China) must stop in Guam, Hawaii or another location free from the virus for 14 days before entering the FSM.” (United Home Page, 2020)

Coronavirus has been a common causative agent for the common cold. A novel virus infection that we are witnessing today is basically due to “sub-types” of those common coronaviruses.  In detail, coronaviruses are enveloped non-segmented positive-sense RNA viruses belonging to the family Coronaviridae and it is widely distributed in humans and other mammals (Richman DD, 2016).

We hope this article will inform the Micronesian community of the emergence of this novel coronaviruses and its features in simple Q & A format.

  1. What is the route of infection? It is yet to be discovered further but scientists believe that the “droplets” from infected person’s coughing or sneezing can infect (pass through) other people.
  1. Is person-to-person transmission possible? The person-to-person transmission in family homes or hospital, and intercity spread of this novel coronavirus are possible (Chan, J. F-W., 2020)
  1. What are the clinical signs and symptoms? In the US study, subjective fever or measured temperature over 100.4 F (38 C) and cough or shortness of breath are the major signs and symptoms (Bajema, KL 2020)
  1. Can I get infected via my eyes or simple contact with skin? Coronavirus may survive longer in the air than influenza viruses. Contaminated hands with virus droplets may infect a person through the eyes and mouth. However skin is a good barrier against the virus; it is less likely that coronavirus can penetrate the skin.
  1. What is mortality rate (i.e., death rate) of COVID-19 as compared with other corona viruses such as Severe Acute Respiratory Syndrome (SARS-Cov) and Middle East Respiratory Syndrome (MERS-Cov)? The mortality rate from COVID-19 is estimated approximately 2.5% (Ji, Y. 2020). Meanwhile, worldwide fatality rate from SARS-Cov was 11% (range 7% to 27%) (Chan, KS, 2020). As we experienced, the mortality rate from MERS-Covid was much higher than that of SARS-Cov. The overall mortality rate of MERS-Cov was 29.8% (Ahmed, AE. 2017)
  1. How does the new Coronaviruses compared with flu (influenza viruses)? Between 1918-1919, the great influenza pandemic caused over one quarter of the US population infected and 675,000 Americans died (Billings, M, 2003). According to CDC estimation from 1 OCT 2019 through 22 FEB 2020, the flu has already caused an estimated 32-45 million illnesses, 14-21 million hospitalizations and 18,000-46,000 deaths (CDC 2020). Meantime the mortality rate from COVID-19 is about 2.5% while the mortality rate from influenza in the US is estimated as 0.02% (CDC, NCHS, 2017). The mortality rate for COVID-19 is higher than that of influenza.
  1. Beside the major sign and symptoms, what are other minor signs and symptoms? In addition to the major sign and symptom (i.e., fever, cough, and shortness of breath), the following signs and symptoms were reported (Huang, C., 2020): Myalgia (muscle pain) or fatigue; sputum production; headaches; and hemoptysis (coughing up of blood).
  1. Is facial mask effective to protect myself from the virus? There is no definitive cure (except for the experimental anti-HIV drug therapies) for COVID-19 at this time. A disposable facial mask may be the best option for the protection against the virus. In addition, paying attention to personal hygiene and hand sanitization is highly recommended.
  1. Is vaccine available? There is no vaccine available for protection against COVID-19
  1. Is gathering at schools, churches, restaurants dangerous? From lessons from other infected countries with COVID-19, gathering at certain places can be risky. However, there is no reported COVID-19 case in Pohnpei. Therefore, restriction on daily activities, attending schools, going to other public places and community meetings is not necessary at this point.

In conclusion, the risk of becoming infected with this new coronavirus (COVID-19) in Pohnpei is low. We would like to recommend the general public to increase the level of personal hygiene and hand sanitization (i.e., wash your hands with soap and water as often as possible) at all times. As we remember old quote from Sun Tzu“know yourself, know your enemy, and you shall win a hundred battles without loss,” we may be able to apply this quote to coronaviruses. Please remember that the best cure for COVID-19 is the prevention.

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New coronavirus...diligence, yes...panic, no!

News of more than 500 deaths caused by the new Coronavirus (2019-nCoV) has many residents of the FSM, if not panicked, at least highly concerned that the virus might arrive in this country.  Some are absolutely certain that if even one infected person arrives in the FSM the disease will wipe out the population in short order. In Pohnpei, all paper masks in retail outlets are entirely sold out.  Some have reported having witnessed stockpiling and hoarding activity out of fear that in addition to the extensive travel ban, the government will shut down inbound shipping of crucial dietary and other supplies such as fuel which powers the generators that supply power to the FSM.

Residents of the FSM can rest easy at least regarding the incoming shipping concerns. The FSM released yet another amended emergency health declaration today saying that as long as shippers abide by FSM quarantine policies, shipping will go on uninterrupted. Fishing vessels will also have to comply (see page 6).

It is absolutely vital to remain diligent and protect ourselves from the virus in every way we possibly can, both on individual levels by diligent hand washing and other recommended practices, and by country wide policies.  It is important to be diligent. It is a serious virus and it is spreading, but it is counterproductive to panic.

Sometimes just having information on what scares you can stave off hysteria and overthinking.  It certainly has helped me as I’ve lived and breathed the 2019 coronavirus crisis and FSM’s response to it.  Statistics sometimes help.

According to a tracking site provided by Johns Hopkins CSSE (Center for Systems Science and Engineering), as of this morning there have been a total of 28,353 confirmed cases of novel coronavirus (2019-nCoV) since the beginning of the outbreak in late December, 2019. Of those cases, 565 people (approximately 1.99%) of those people have died from the infection.

Of the total number of cases identified, only 265 have been in countries other than mainland China. So far, the virus has been identified in 28 countries. Of the 565 deaths, two have occurred outside mainland China, one in the Philippines and one in Hong Kong.  So far, 1,382 people have recovered after being infected. 11 of those recoveries were outside mainland China in six different countries.

The science of epidemiology which deals with the incidence, distribution, and possible control of diseases and other factors relating to health is a complicated one.  It relies heavily on Mathematics: dynamic systems and differential equations, graph theory, probability theory and more disciplines are at the heart of epidemiology. It is far too early to say how far 2019 coronavirus will spread or how devastating it will be. I’m told that since SARS and the new coronavirus are related but different viruses, drawing comparisons between the two viruses isn’t very helpful.  The Doctor who told me that didn’t make an effort to explain why. The World Health Organization draws comparisons on their website while making it clear that they are different viruses and so I will do the same.

Perhaps, at least in layman’s terms and without heavy Math, it would be helpful to know that, according to experts, while the 2019 Coronavirus spreads differently and perhaps faster than SARS did, it causes less damage. SARS had a mortality rate of approximately 10% while 2019 Coronavirus has had a 2% mortality rate.

So far, NO Pacific Island State has yet had a confirmed case of 2019 coronavirus and all are working to ensure that remains to be the case.  That’s encouraging as well.

The response of the FSM government, while intense and personally difficult for some of its residents has also been encouraging to the people of the FSM who are worried about the spread of the virus.

One professional member of the FSM task force said that each lab in the FSM now has at least one certified Biological Safety Cabinet that are each certified to meet Australian and US standards. They have a bio-safety program and all lab techs have gone through a series of bio-safety trainings and so now understand, and are able to perform risk assessments for Laboratory Acquired Infections.  Labs in Australia and in the US can evaluate samples sent from labs in the FSM and lab technicians know how to properly handle them.  FSM doesn’t have the capacity to determine whether a flu like virus is 2019-coronavirus or a common flu but personnel know how to get the answers and that’s encouraging.

Pohnpei has developed a plan of action for response to the international crisis.  It said that the SARS outbreak of 2003 that we were cautioned not to mention, led to the building of an isolation ward at the Pohnpei State Hospital.  Other states have their own action plans. That’s encouraging.

Physical quarantine sites have been identified to keep potential victims of the 2019-coronavirus away from the general populace.  That’s encouraging.

On a less encouraging note, the World Health Organization has said that older people and people with pre-existing medical conditions (such as, diabetes and heart disease) appear to be more vulnerable to becoming severely ill with the virus.  Unfortunately, the FSM has a higher number of people with diabetes and also of people with respiratory ailments.  If the virus lands here and IF it spreads here, those people might have a more difficult time fighting the virus off.

Still, vigilance is required.  Panic is not.

Bill Jaynes

Managing Editor

The Kaselehehlie Press

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