What Can We Expect from Coronavirus?

The recent Coronavirus outbreak is being handled all over the world with different degrees of success, but what are the actual risks and likely dangers for Venezuela’s pummeled health system?

Photo: The Guardian, retrieved.

In December 2019, a group of patients in the Chinese city of Wuhan presented a cough, quickly developing shortness of breath and typical X-ray findings, all suggestive of a viral pneumonia. When some of their samples were analyzed, DNA from a new virus was identified. A month later, 56 million people have been quarantined by the Chinese government, and over 4,000 cases and a hundred deaths have been reported in 18 countries around four different continents. The world witnesses a pandemic in the making.

2019’s novel Coronavirus (2019-nCov) is similar to other virus in the Coronavirus family, such as the Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) viruses, which also cause pneumonia and have been responsible for important epidemic outbreaks in the last decade. Original reports linked all cases in Wuhan to a local fish and meat market, suggesting animal-to-human transmission. Nonetheless, new evidence strongly suggests that patient zero had no prior contact with the market and Chinese health authorities have recently confirmed human-to-human transmission, which severely jeopardizes containment measures.

So how bad is it?

Short answer is: no one’s really sure, but it’s potentially very bad.

This virus spreads quickly and easily, probably through saliva droplets.

Only yesterday, over 1,700 new cases were reported in China. This sudden spike suggests that patients who probably got infected during these last two weeks are just getting sick now, supporting the purposed 2-10 days incubation period reported by the World Health Organization. This virus spreads quickly and easily, probably through saliva droplets.

The “ease” with which a disease is spread can be measured by its basic reproductive number, also known as R0. Although the changing characteristics of the current situation make it hard to give an accurate number, most estimates situate the new coronavirus’ R0 around 3. That means that every infected patient could roughly infect 3 new people. It also means that, to stop the disease’s expansion, we’d have to protect at least ⅔ of the people susceptible, either by quarantine, as China is doing in a dystopian, partially effective way, or by using a yet-to-be-developed vaccine.

So far, most deaths have occurred among elderly patients, but some estimates put the fatality rate around 14%. The main problem is that we simply don’t know how many people are actually infected, with some experts claiming there could be over 100,000 infected patients in China at this point.

Mexico, Brazil, and Ecuador have already reported suspicious cases in travelers returning from China, but none of them has been yet confirmed. However, its presence in global hubs such as the United States, China, France, or Germany makes it silly to assume it won’t reach Latin America eventually.

The continent as a whole is ill-prepared to face an epidemic outbreak of any kind. There’s no need to overstate how underprepared is the crisis-stricken Venezuelan health system to deal with this new threat.

Although the presence of an alleged suspicious case in Venezuela made some fuzz in social media during the weekend, the information was quickly dismissed as fake. The real problem, though, is that no one is really sure if we’ll be able to identify cases in the country if they appear. 

The real problem, though, is that no one is really sure if we’ll be able to identify cases in the country if they appear.

So far, diagnostic tests rely mainly in real time Polymerase Chain Reaction (qPCR), a relatively expensive technique unavailable in the vast majority of Venezuelan clinical labs. In an official communication released last week, the Venezuelan Health Ministry acknowledged that the National Hygiene Institute in Caracas is the only laboratory in the country capable of confirming suspicious cases, assuring that they had “capacity to receive and analyse samples from all 24 states”.

The logistics of mobilizing and analysing samples from all over the country in a single laboratory are already hard in a normal situation, let alone in a country where basic supplies cannot be guaranteed. It’s very likely that if cases of coronavirus infection ever get to Venezuela, they’ll be underdiagnosed and confirmed only days, or maybe weeks after patients start presenting symptoms. 

The 2019-nCov’s R0 is considerably lower than that of other known diseases like measles (R0: 18-20) or diphtheria (R0: 5-7), which already demonstrated how vulnerable the Venezuelan health system is to epidemics, and Venezuelan hospitals lack the most basic infrastructure needed for quarantine and to prevent a rapid expansion among other patients or healthcare professionals. Not to mention the extra difficulties arising from a delayed laboratory confirmation. 

A plan to screen patients arriving at the Simón Bolívar Airport in Maiquetía for suggestive symptoms is expected to be launched in the coming days, but the movement of Venezuelan migrants through the Colombian and Brazilian land borders is probably a bigger threat, both to Venezuela and neighbouring countries. The massive number of people crossing daily, the existence of several illegal routes and the general precarious access to health services in the area make it practically impossible to screen patients efficiently.

The logistics of mobilizing and analysing samples from all over the country in a single laboratory are already hard in a normal situation, let alone in a country where basic supplies cannot be guaranteed.

In general, the magnitude of the Venezuelan refugee crisis, expected to become the most important in the world this year, is probably the greatest risk factor to be considered when assessing the possibilities of an epidemic coronavirus outbreak in Latin America.

As with any pandemic, the situation is changing really fast, and good news is the world seems to be adapting properly. Less than two weeks after the epidemic was first spotted, we already had a complete viral genome. Scientists from all over the world have had access to research data from peers thousands of miles away in almost real time. This allowed the U.S. Center for Disease Control to develop a diagnosis test, which is now being used to confirm cases everywhere. Vaccine trials are expected to begin in April 2020 and social media has turned into an incredibly valuable tool to monitor the situation and spread real-time updates.

At this point, it’s hard to imagine post-apocalyptic images such as those seen in Wuhan appearing elsewhere, even in Venezuela. But the threat is real, and although it will hardly be the end of the world, it’ll surely test the region’s public health strength.

Juan Carlos Gabaldón

Medical doctor from Merida, currently studying Medical Parasitology at the London School of Hygiene and Tropical Medicine