"No country is going to escape [the coronavirus]"

Dr. Amesh Adalja offers his thoughts on the coronavirus in a video here. I've transcribed his remarks in the video below.

So my name is Amesh Adalja. I'm a senior scholar at the Johns Hopkins Center for Health Security. I'm a board certified infectious disease and critical care physician based in Pittsburgh. I work on pandemic preparededness, emerging infectious disease, the intersection of infectious disease and national security, as well as hospital preparededness.

I think we are in the beginning stages of a pandemic. I think this pandemic will be mild. Maybe around the scale of the 2009 H1N1 pandemic. It will likely not cause the virus to completely disappear from the world. I think it will become something that may become seasonal until we have a vaccine. And we may deal with this coronavirus in future winter respiratory virus seasons.

The biggest thing the United States needs to do right now is move from a mentality that's tried to contain this virus to one where they're starting to work on mitigating the impact of this virus. That means shifting away from travel bans, quarantines, isolation, and moving towards preparing our healthcare systems to be able to deal with the surge of patients they may have, increasing vaccine development, increasing antiviral clinical trials, scaling up diagnostic tests, improving public health communications. That's really what we need to be doing, and not squandering precious resources on travel bans and quarantining individuals.

We've been dealing with this virus at least since November. It's been spreading in China since November, unbeknownst to anybody. So if you think that a virus that has respiratory spread efficiently through human populations doesn't get around the world very quickly, you really don't know very much about viruses. Overly restrictive testing criteria is going to limit our ability to deal with this virus, and it's also going to panic the public because now the public has been told: "Oh, now there's community spread". But we knew community spread was likely occurring, but the restrictive testing policies that were in place made it very, very hard to test individuals who didn't have a strong link to the epicenter of the outbreak. And that epicenter is going to become less and less important as we see cases spreading all over the globe.

The only way that you can tell that this is a coronavirus caused illness vs. another virus for example, like influenza, is to do the diagnostic testing. The symptoms are clinically indistinguishable. You would not be able to tell the difference between somebody who had the flu and someone who had coronavirus without doing a specific test.

This is a virus that doesn't have a specific antiviral or a vaccine for it. So at an individual level you really have to use a lot of common sense. Some of the same types of principles you use during flu season. Wash your hands a lot. Avoid sick people. If you are sick yourself, stay away from other people - stay home. Cough into your elbow. Those types of measures are the best things you can do.

Specifically now with coronavirus it's important to be tuned into what your local public health department is doing, or your state health department if you don't have a local health department, so that you know what's going on in your community and in your area. You also might want to talk to your employers or maybe the schools that your children go to and ask them what are the policies that are going to be in place so that you know about them ahead of time. For example, maybe there's a telecommuting program. Maybe there is an alternative school childcare that you may need to use. Those types of actions, to do them now, to get some information now, is much better than doing it on the fly when you have community spread of this virus.

But we do know that this is going to be all over the world. And it's going to be really be hard to avoid eventually, this virus, no matter where you go, because it's a virus that spreads efficiently in human populations. Because of that, no country is going to escape it. It's going to be like 2009 H1N1 which infected over a billion people in six months. (People have also fogotten that statistic.)

The big mystery is really the case fatality ratio. How many cases are mild vs. how many are severe or fatal. We have a very skewed sample from China because we're hearing mostly about the severe cases that end up in the hospital or healthcare facilities. We don't know about all the cases that are out in the community that have very mild symptoms - maybe just a runny nose - that aren't qualifying for testing. The biggest question is what's the denominator? How big of a population is affected by this virus? Is it already out there causing lots of mild illnesses? That will really bring down the case fatality ratio because so many people are infected it's only a small number of people that have severe disease or fatal disease.

We also want to know who's at most risk for having severe complications. We know that it's elderly people with immunocompromised conditions, other medical conditions. We want to be able to get very good clarity on that and understand who is at most risk. Especially when we get into the time when we have a vaccine and we want to prioritize who we vaccinate first, who we give antivirals to first, who needs more closer monitoring, who needs less closer monitoring. All of those questions need to be answered. And that will help when we get better diagnostic testing and more time with this virus and the clinical care of patients with this virus.