An Update on COVID-19 - (Novel Coronavirus) Presented by: Kenneth Bird, MD MPH Interim County Health Officer Merced County Department of Public ...
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An Update on COVID-19
(Novel Coronavirus)
Presented by: STRIVING FOR EXCELLENCE
Kenneth Bird, MD MPH
Interim County Health Officer
Merced County Department of Public Health
Tuesday, March 10, 2020
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What is Coronavirus?
• RNA virus that mutates easily • MERS CoV in 2012 (and ongoing)
• Largest genome of RNA viruses o Endemic to the Arabian Peninsula
• Infect wide range of hosts o WHO: 2,499 lab-confirmed cases in 27
countries w/ 861 deaths
including mammals & birds • Case-fatality rate ~34%
• 7 strains known to infect o In Saudi Arabia alone: 1831 cases and
humans 787 deaths
o 4 of these circulate regularly and
cause the common cold • SARS CoV in 2002-2003
• COVID-19 is a novel STRIVING
virus that is o Infected >8,000 people w/ 774 deaths
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of concern because of the lack in 32 countries in 2002-2003
of herd immunity • Case fatality rate ~9-10%
o Identified 12/2019 o HCWs accounted for 20% of all cases
o Many “Super Spreading” events
o Outbreak ended through use of
containment and mitigation strategies
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What is Coronavirus?
• A zoonotic disease that
can spread between
animals and humans
• The animal reservoir for
COVID-19 is unknown
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Sources:
1. Source: Timothy Sheahan, University of North Carolina STRIVING FOR EXCELLENCE
2. https://www.wsj.com/articles/what-we-know-about-the-wuhan-virus-11579716128
Wuhan, China
o 11M people
o Major transportation hub
o Earliest hospitalized case had
onset December 1, 2019
o Wet market likely source
o Case series of first 41
hospitalized: 13 had no contact to
market*
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*Huang et al. Clinical features of patients with FORcoronavirus
2019 novel EXCELLENCEin Wuhan, China. Lancet. 2020.
COVID-19 Numbers
• Globally, more than109,000 cases and 3809 deaths
• In the United States, 423 cases and 19 deaths. Of the cases:
o 72 are travel-related
o 29 person-to-person transmission
o 322 cases remain under investigation
• In California, 114 confirmed cases. Of the cases:
o 24 repatriated from high risk areas
o 37 travel related
o 23 person to person
o 14 community transmission
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o 16 under investigation
• In Merced County, there are no confirmed cases.
• Among neighboring counties, there are 36 active cases (one recovery and one death) reported
in Santa Clara County, one active case in Madera County, one active case in Fresno County,
and two active cases in San Benito County.
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Current data on COVID-19: Infectiousness
• Probably about as infectious as SARS.
• More infectious than seasonal influenza.
• Incubation period, which is the avg. amount of time it
takes from exposure to symptoms is most likely 2-14
days (CDC) which is similar to SARS incubation period.
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STRIVING FOR EXCELLENCECurrent data on COVID-19: Severity
• Case Fatality Rate: between 2-4% in Hubei province
o Lower than SARS (9-10%) or MERS (~34%)
o Higher than seasonal influenza (0.1%-0.2% among symptomatic
cases)
• https://www.cdc.gov/flu/about/burden/past-seasons.html
o Possibly similar to 1918 pandemic influenza (2-3%)
• Taubenberger et al. EID. 2006
• Study of 72,000 COVID-19 cases in China; of ~45K (62%) lab-
confirmed: STRIVING FOR EXCELLENCE
o 2.3% fatal (Severity: 81% mild disease; 14% severe disease; 5%
critically ill)
• Fatality higher among those with preexisting conditions: 10.5% CVD; 7.3% DM; 6.3% chronic
respiratory disease; 6% HTN; 5.6% cancer
• Fatality higher among elderly: 14.8% among >80y; 8% among 70-79y Wu et al. JAMA 2020
o Age: Only 2% of cases wereCurrent data on COVID-19: Symptoms
• Fever, cough, shortness of breath (Influenza-Like Illness)
• GI symptoms occasionally reported
• Some confirmed cases have not had any symptoms
• Asymptomatic transmission highly probable
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STRIVING FOR EXCELLENCETesting Criteria
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https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.htmlTesting (cont.)
• Public Health Labs (PHLs) are currently still the only labs
offering testing, however capacity is expanding to
commercial laboratory availability.
o Due to capacity restraints, PHLs are not testing/prioritizing cases
that do not meet criteria
o Commercial labs may perform provider recommended tests on
patients who do not meet criteria.
STRIVING Guidelines are in development.
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STRIVING FOR EXCELLENCEContainment & Mitigation
Isolate the Quarantine the Reduce social
sick exposed mixing
• Restrict transit
o Trains, busses, ferries
o Some airlines have suspended flights to affected areas
o Border crossings closed
o Visas and entrance restricted
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• Closure of:
o Public transit
o Schools (China, Japan, Iran)
o Major store chains
o Major companies (Google, Apple, Airbnb, Amazon, FB, MS…)
• Canceling of public events
o Lunar New Year and other festivals
STRIVING FOR EXCELLENCEControl Measures in the U.S.
• Travel notices:
o Level 3 (Avoid Nonessential Travel): China, Iran, Italy, and South
Korea
o Level 2 (Practice Enhanced Precautions): Japan
o Level 1 (Watch and Practice Usual Precautions): Hong Kong
• Airports:
o Passenger screening at 11 airports (where all flights from China are
being directed) STRIVING FOR EXCELLENCE
o Among travelers from China, entry limited to U.S. citizens and
permanent residents; screened for fever, cough, SOB at arrival
• Isolation & quarantine
• Contact tracing
STRIVING FOR EXCELLENCEPersonal Prevention
• Influenza vaccination
• Avoid close contact with ill persons
• Practice respiratory etiquette
• Wash hands frequently with soap and water
• Clean Environmental Surfaces
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• Avoid touching eyes, nose, mouth with unwashed hands
• Avoid shaking hands
• Stay home when ill
• Evaluate travel plans
STRIVING FOR EXCELLENCERole of the Public Health Department
• Department Operations Center opened since1/27/2020
• Central coordination of:
o Information flow (unified messaging)
o Guidance (Healthcare providers, First Responders, Schools,
protective equipment, persons under self-quarantine)
o Testing (24/7 staff coordination for specimen collection, testing
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approval, facilitation FOR EXCELLENCE
with Public Health Labs)
o Reporting to state/federal government
o Monitoring (returning travelers and Persons Under Investigation)
with 24/7 capability developed within the Department.
o Investigation – in the case of a positive case
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Local Emergency Responses to COVID-19
• As of Monday, 3/9/2020, the following counties have
issued declarations of local health emergencies:
o Alameda, Butte, Imperial, Los Angeles, Mendocino, Marin,
Monterey, Nevada, Orange, Placer, Sacramento, San Benito, San
Diego, City and County of San Francisco, Santa Clara, Santa Cruz,
Solano, Sonoma, and Yolo
• Declaring a local health emergency allows the County to:
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o Seek and utilize mutual aid
o Potentially obtain reimbursement
o Effectively respond to COVID-19, and
o Ensure the County has the required resources and tools at their
disposal.
STRIVING FOR EXCELLENCEIn Conclusion
• Again, at this time there are no cases of COVID-19 in Merced County
o 16 individuals at risk due to travel have been monitored through successful
self-isolation
• Community transmission will become the more likely mode of
transmission.
• A vaccine is currently being developed and currently in clinical trials.
Likely unavailable during this outbreak period.
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• Therapeutics being investigated (remdesivir), similar to Tamiflu used
during H1N1.
• One individual has tested positive in both Madera and Fresno
Counties (had been under quarantine due to exposure on a cruise
ship)
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