Contribution of publishing community to the evolving COVID-19 epidemic
Dear Editor
As a Public Health physician I read with interest your case series on SARS-CoV-2 (1). As many of your readers may be aware a detailed descriptive exploratory analysis of 72, 314 patients has been published by the Novel Coronavirus Pneumonia Emergency Response Epidemiological Team (2). The entire publishing community including the BMJ has to be applauded for rapidly bringing the latest findings regarding this evolving epidemic to its readers including health professionals, policy makers and the public. Recent examples include the NEJM research letter on Evidence of SARS-CoV-2 infection in returning travellers (3) and the consistent detection of the novel Corona virus in saliva (4) which would be of help in updating existing control and diagnostic methods.
As health policy makers and Public Health specialists across the globe are working hard to contain the spread of the virus what they need is current up to date evidence on all aspects of this epidemic and it is heartening to see the publishing community is raising to this challenge as mentioned above.
The largest publication (2) so far provides useful and interesting findings; overall case fatality rate of 2.3% and in the over 80s it is 14.8%. The authors point out that the virus is “highly contagious” and reflect on the fact that the virus “has spread extremely rapidly from a single city to the entire country within only about 30 days. Moreover, it has achieved such far-reaching effects even in the face of extreme response measures including the complete shutdown and isolation of whole cities, cancellation of Chinese New Year celebrations, prohibition of attendance at school and work, massive mobilization of health and public health personnel as well as military medical units, and rapid construction of entire hospitals”. This large analysis also confirms nosocomial transmission and the ability of the virus to infect health care workers. The authors conclude by saying “although the epidemic appears to be in decline …….., we may yet face more challenges. Huge numbers of people will soon be returning to work and school after the extended New Year holiday. We need to prepare for a possible rebound of the COVID-19 epidemic in the coming weeks and months”. This is a call for caution for other countries to continue to be vigilant and further develop their plans to contain the virus and prevent it getting a foothold.
The NEJM letter (3) also has potential implications for containment as the authors document with evidence how a symptom-based screening process was ineffective in detecting SARS-CoV-2 infections and their discovery “that shedding of potentially infectious virus may occur in persons who have no fever and no signs or only minor signs of infection”. In this country Public Health England has to be commended for its tireless work, leadership, provision of expert advice to various sectors (5) and professionals, and for leading the country wide effort from the front in our efforts to deal with the epidemic.
Various countries are instituting control measures with the limited evidence that is currently available on the epidemiology of the virus. Recent media reports indicate that Russia has suspended issuing tourist, private, student and work visas to Chinese nationals (6) to prevent the spread of the virus and Iran (7) has become the third country in the Middle East to report cases apart from Egypt and the United Arab Emirates. It is worth pointing out that in light of the NEJM letter, policy makers may have to review their existing isolation protocols as it is very likely that more of their citizens are likely to return from areas of potential exposure (8). We all can agree with the authors of the largest case series who point out that “as an international community, we must all be responsible partners in surveillance, communication, response, research, and implementation of evidence-based public health and clinical practice”.
Dr Padmanabhan Badrinath, Consultant in Public Health Medicine & Associate Clinical Lecturer, Suffolk County Council & University of Cambridge, Ipswich, IP1 2BX badrishanthi@hotmail.com
Conflict of interest – None
Disclaimer: The views expressed here are that of the author and in no way represent the views of his employer, Suffolk County Council.
References
1. Xiao-Wei Xu, Xiao-Xin Wu, Xian-Gao Jiang et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series BMJ 2020;368:m606
2. The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team, Vital Surveillances: The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China, 2020. http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a... accessed on 19th of February, 2020
3. Hoehl S, Berger A, Kortenbusch M et al. Evidence of SARS-CoV-2 Infection in Returning Travelers from Wuhan, China. https://www.nejm.org/doi/full/10.1056/NEJMc2001899 accessed on 19th of February, 2020
Rapid Response:
Contribution of publishing community to the evolving COVID-19 epidemic
Dear Editor
As a Public Health physician I read with interest your case series on SARS-CoV-2 (1). As many of your readers may be aware a detailed descriptive exploratory analysis of 72, 314 patients has been published by the Novel Coronavirus Pneumonia Emergency Response Epidemiological Team (2). The entire publishing community including the BMJ has to be applauded for rapidly bringing the latest findings regarding this evolving epidemic to its readers including health professionals, policy makers and the public. Recent examples include the NEJM research letter on Evidence of SARS-CoV-2 infection in returning travellers (3) and the consistent detection of the novel Corona virus in saliva (4) which would be of help in updating existing control and diagnostic methods.
As health policy makers and Public Health specialists across the globe are working hard to contain the spread of the virus what they need is current up to date evidence on all aspects of this epidemic and it is heartening to see the publishing community is raising to this challenge as mentioned above.
The largest publication (2) so far provides useful and interesting findings; overall case fatality rate of 2.3% and in the over 80s it is 14.8%. The authors point out that the virus is “highly contagious” and reflect on the fact that the virus “has spread extremely rapidly from a single city to the entire country within only about 30 days. Moreover, it has achieved such far-reaching effects even in the face of extreme response measures including the complete shutdown and isolation of whole cities, cancellation of Chinese New Year celebrations, prohibition of attendance at school and work, massive mobilization of health and public health personnel as well as military medical units, and rapid construction of entire hospitals”. This large analysis also confirms nosocomial transmission and the ability of the virus to infect health care workers. The authors conclude by saying “although the epidemic appears to be in decline …….., we may yet face more challenges. Huge numbers of people will soon be returning to work and school after the extended New Year holiday. We need to prepare for a possible rebound of the COVID-19 epidemic in the coming weeks and months”. This is a call for caution for other countries to continue to be vigilant and further develop their plans to contain the virus and prevent it getting a foothold.
The NEJM letter (3) also has potential implications for containment as the authors document with evidence how a symptom-based screening process was ineffective in detecting SARS-CoV-2 infections and their discovery “that shedding of potentially infectious virus may occur in persons who have no fever and no signs or only minor signs of infection”. In this country Public Health England has to be commended for its tireless work, leadership, provision of expert advice to various sectors (5) and professionals, and for leading the country wide effort from the front in our efforts to deal with the epidemic.
Various countries are instituting control measures with the limited evidence that is currently available on the epidemiology of the virus. Recent media reports indicate that Russia has suspended issuing tourist, private, student and work visas to Chinese nationals (6) to prevent the spread of the virus and Iran (7) has become the third country in the Middle East to report cases apart from Egypt and the United Arab Emirates. It is worth pointing out that in light of the NEJM letter, policy makers may have to review their existing isolation protocols as it is very likely that more of their citizens are likely to return from areas of potential exposure (8). We all can agree with the authors of the largest case series who point out that “as an international community, we must all be responsible partners in surveillance, communication, response, research, and implementation of evidence-based public health and clinical practice”.
Dr Padmanabhan Badrinath, Consultant in Public Health Medicine & Associate Clinical Lecturer, Suffolk County Council & University of Cambridge, Ipswich, IP1 2BX badrishanthi@hotmail.com
Conflict of interest – None
Disclaimer: The views expressed here are that of the author and in no way represent the views of his employer, Suffolk County Council.
References
1. Xiao-Wei Xu, Xiao-Xin Wu, Xian-Gao Jiang et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series BMJ 2020;368:m606
2. The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team, Vital Surveillances: The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China, 2020.
http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a... accessed on 19th of February, 2020
3. Hoehl S, Berger A, Kortenbusch M et al. Evidence of SARS-CoV-2 Infection in Returning Travelers from Wuhan, China. https://www.nejm.org/doi/full/10.1056/NEJMc2001899 accessed on 19th of February, 2020
4. Kelvin Kai-Wang To, Owen Tak-Yin Tsang, Cyril Chik-Yan Yip et al. Consistent Detection of 2019 Novel Coronavirus in Saliva. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa149/573... Last accessed 19th February, 2020
5. https://www.gov.uk/government/collections/covid-19-guidance-for-non-clin... Last accessed 19th February, 2020
6. Russia Names Exceptions From the Entry Ban for Chinese. https://www.nytimes.com/aponline/2020/02/19/world/asia/ap-russia-china-o... Last accessed 19th February 2020
7. Iran report two cases of new Corona virus. https://www.nytimes.com/aponline/2020/02/19/world/middleeast/ap-ml-china... Last accessed 19th February 2020.
8. Coronavirus: Foreign Office tells Britons to stay on cruise ship. https://www.bbc.co.uk/news/uk-51555299 L
Competing interests: No competing interests