Previous outbreaks’ lessons applied
Chicago experts work to contain coronavirus, say risk lower than flu
As the world responds to the rapid spread of the novel coronavirus that originated in China, public health officials in Chicago are working to contain the United States’ first personto-person transmission — a balancing act between aggressive precautions based in science and careful consideration of the possibility of public panic.
Infectious disease experts say that while the virus, which has infected about 10,000 people in two months, mostly in China, is spreading faster than previous outbreaks of MERS and SARS — cousins to the current coronavirus — they’re using lessons learned in those investigations in hopes of another containment success story in the U.S.
And public health officials also stress that the virus, which has killed more than 300 people in China, remains a low risk to those living in Chicago, as well as across Illinois and the U.S., especially compared with the risk associated with influenza, which kills tens of thousands of Americans each year.
As of Friday, there were seven confirmed cases of the virus in the U.S., including two in Illinois: a Chicago woman in her 60s who had recently traveled back from China, where she had been caring for a sick relative; and her husband, also in his 60s, who is the first
confirmed case of personto-person transmission in the U.S. Both are in isolation in stable condition at Amita Health St. Alexius Medical Center in Hoffman Estates.
To limit the spread of the novel coronavirus beyond the two confirmed cases in Chicago, about 100 public health employees at various agencies are meticulously tracking anyone who came into contact with the couple, said Dr. Allison Arwady, commissioner of the Chicago Department of Public Health.
The department is working with several other local, state and federal agencies to monitor those who came in contact with the couple, she said, and responding on a case-by-case basis.
Public health officials have said there are 21 Illinois residents they are closely monitoring who could have the virus. Those with symptoms, which includes fever and cough, are in isolation. Arwady said Friday that number could continue to grow, and there are many others who had lower levels of contact with the couple whom public health officials are also tracking.
Each person is “tiered,” according to the level of contact, and monitored daily, Arwady said. Close contact is defined by being within 6 feet of someone infected for at least 10 minutes, she said.
They check in with public health workers daily by phone, in-person or through other means to report any new symptoms. Officials then advise them of any restrictions on a case-by-case basis, Arwady said. So far, there’s been no call to quarantine — meaning isolate someone who does not display symptoms — anyone in the Chicago area who had contact with someone exposed to the virus, or those who have traveled from China in recent weeks.
But officials continue to track developments, Arwady said, and are ready to adjust, weighing things like Friday’s decision by the Centers for Disease Control and Prevention to order a two-week quarantine for 195 people on a military base in California who had just evacuated from Wuhan, China, the epicenter of the outbreak.
A New England Journal of Medicine report released Thursday-showed evidence from Germany that the virus could have spread before those infected showed symptoms, unlike MERS or SARS transmission.
“I think we certainly are wanting to be careful with our highest risk contacts … the highest risk being a family-type, household contact,” Arwady said. “There’s the science and the art of applying the science in a way that protects the public’s health. For household contacts of confirmed cases, we will be more aggressively thinking about restricting movement. But we’re not ready to say what exactly that piece will look like.”
In some outbreaks, involving diseases that can spread even faster through limited contact, like measles, the public often hears more about where those infected have been, according to experts. But so far, the spread of this coronavirus in Chicago does not warrant that kind of response, Arwady said.
The virus does not linger in the air like measles, and the Chicago couple had limited close contact with others, she said. Certain places, such as health care settings, also allow for a careful accounting of who is exposed and for how long, as opposed to some public places.
Arwady, who also worked overseas for the CDC during MERS and Ebola outbreaks, said that while the quick spread of the virus in China is of concern, advances in science and emergency response training as well as the ability to lab test to confirm the virus in the early days of the outbreak breed confidence.
“This is the same practice we use for other communicable diseases, and it is really the best way that we have to contain illnesses,” she said, adding that she understands any public alarm, but that the outbreak is “one that we really have been preparing for.”
“And whatever comes next after (the current) coronavirus, we’ll take lessons learned,” she said. “That’s just what we do.”
Dr. Maximo Brito, infectious disease specialist and professor of medicine at the University of Illinois at Chicago, said containing an outbreak always starts with the person who first brought the disease to the area.
That web widens as public health investigators learn who that person has come into contact with and in what kind of setting, asking everyone about their symptoms, Brito said, and isolating when necessary.
“That’s easy to do when you are in a situation like here in the U.S. where you have (fewer cases than China),” he said.
The cancellation of some airlines’ flights from China, a travel ban and monitoring of passengers’ temperatures at certain airports are also typical ways to contain disease, Brito said.
Measures beyond that, such as a public detailing of everywhere those infected have been, or the wearing of masks by everyday Americans, are not necessary at this point, experts said.
Dr. Daniel Lucey, an adjunct professor at Georgetown University and a fellow with the Infectious Disease Society of America, said the novel coronavirus reminds him of the SARS outbreak, but now there are more resources and knowledge available. Lucey treated patients with SARS in Toronto during the second phase of the outbreak in 2003, and he has worked on infectious disease outbreaks in various countries almost every year since.
“Science wasn’t as good then. It’s just amazing,” Lucey said of the 2003 SARS epidemic.
But Lucey also said there were missed opportunities with the previous SARS and MERS outbreaks.
“We never developed in the U.S. or the world … a single antiviral drug for a coronavirus,” he said. “Or any other form of treatment,” like the drugs developed since the early onset of Ebola. “If we can do it there, we should be able to do it here. But we never did that in 17 years since SARS.”
Still, Lucey said, he has “a lot of optimism” when it comes to the current outbreak in the U.S., but also hopes for future advancements in coronavirus treatment.
Arwady said she’s using knowledge she’s gained from previous outbreaks, including past deployments to Saudi Arabia for the MERS outbreak and two trips to Liberia for an Ebola outbreak — all of which had varying levels of resources.
“It’s informed how I personally think about CDPH’s response to these situations,” she said.
Despite its name, there’s a mystery to public health among those who don’t work within it, Arwady said. “When people think of health, they think of health care. It’s very easy to really forget public health until you need it and just how important it is to have those systems in place.”
Arwady said Chicago teams have been training for the response they’ve delivered in recent days. That includes needing only minor tweaks to existing isolation orders and data systems for storing health information on those the department is tracking, as well as stockpiles of supplies, and collaboration among hospitals and other stakeholders.
“We never want to see these novel pathogens emerge, but when they do, they offer an opportunity to really make sure we’re exercising the preparedness,” she said.