In a recent publication in the New England Journal of Medicine, federal scientists Dr. Anthony Fauci, Dr. Clifford Lane, and Dr. Robert Redfield shared their perspectives on the coronavirus pandemic and the possibility of a coronavirus outbreak in the United States. Their ideas were framed in the context of recent epidemiological and clinical research findings based on the first 425 cases of the Coronavirus Disease 2019 (COVID-19) in Wuhan China.
Dr. Fauci is the current director of the National Institute of Allergy and Infectious Diseases (NIAID), Dr. Lane is the NIAID Deputy Director for Clinical Research and Special Projects, and Dr. Redfield is the Director of the Centers for Disease Control and Prevention (CDC).
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Citing recent research that indicates a case fatality rate of between one and two percent, the authors suggested that “the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.” Since infected individuals are currently likely to spread the virus, on average, to an additional 2.2 people, the authors stated that the outbreak would likely “continue to spread.” This is supported by recent research suggesting that the virus is abundantly present within and near the tongue and tonsils early during the disease course prior to the onset of significant symptoms.
While the temporary travel restrictions instituted by the United States, China, and other countries may have contributed to slowing the spread of the virus, the authors warned that the pandemic may continue to spread. “Given the efficiency of transmission as indicated in the current report, we should be prepared for Covid-19 to gain a foothold throughout the world, including in the United States,” stated Dr. Fauci et al.
The authors proposed that, if community spread of the virus occurs in the United States, “mitigation strategies” such as voluntary stay-cations at home and telecommuting to work or school could be used instead of containment.
While current treatment focuses on supportive care for infected individuals, research to develop a vaccine against the coronavirus is underway and alternative non-vaccine treatment strategies are also being evaluated, including pharmacologic antiviral agents, traditional medicines, and immune-boosting compounds. The authors indicated that monoclonal antibodies and intravenous hyperimmune globulin isolated from individuals that have been exposed to the virus may also be viable treatment options, and “anticipate that the first candidates will enter phase 1 trials by early spring.”
“The Covid-19 outbreak is a stark reminder of the ongoing challenge of emerging and reemerging infectious pathogens and the need for constant surveillance, prompt diagnosis, and robust research to understand the basic biology of new organisms and our susceptibilities to them, as well as to develop effective countermeasures,” the authors stated.
Fauci A, Lane C, Redfield RR. (2020) Covid-19 — Navigating the Uncharted. The New England Journal of Medicine. DOI: 10.1056/NEJMe2002387