Saturday, January 25, 2020

What if Wuhan Coronavirus (WN-CoV) becomes endemic? If Ill, Stay Home!

It is unlikely that public health measures are going to succeed in containing the Wuhan Coronavirus. Despite placing the whole city of Wuhan in quarantine, the new disease has spread to several countries in Asia, and a case has reached Lyons.

At the moment the diagnosis is relatively easy. You have a flu-like illness and have been in Wuhan in the last 14 days? WN-CoV (2019 nCoV) must be considered. There is a diagnostic blood test available, and the patient has to be quarantined. The infection covers a range of severity from a mild cold, through sore throat and fever to severe pneumonia that needs hospital treatment. The mortality rate in China has been 2-3%, which is in the same order as the 1918 flu pandemic.

We are still learning about this disease. Assuming it cannot be contained by public health work (contacting and isolating people who may have contracted the virus from a known case), the virus will start circulating throughout the world. We do not yet know whether its infectivity will die away in summer, or whether it will just continue to circulate.

If it does circulate in the general population, we are going to have to change our illness behaviour. The rule is going to have to be - If Ill, Stay Home. Going out and about with a cold, sore throat, cough or flu-like illness will have to be treated as an antisocial practice, like drunk driving.

Note that even this will not stop viruses from circulating, since a person can pass the viruses on  for up to two weeks before symptoms appear. What If Ill, Stay Home advice does achieve though is to reduce the number of new cases, and so eases the pressure on health services. It is also likely to reduce the severity and duration of the viral illness. If you have flu, you do not feel like going to work, and if you do, apart from infecting everyone you meet, you are not going to do any useful work. You may make mistakes and you will work more slowly. If you are doing physical work, you may injure yourself.

The problem is that employers tend to frown on people who call in sick. They tend also to demand a doctors certificate. This drives up unnecessary work for GPs, and also exposes health staff and other patients to the virus. This approach is illogical, because it makes the difference between having one worker off and having a whole office out of action. Frankly, if employers think they have a malingering problem in their work force, they should employ a nurse to check up on people who are calling in sick.

So say Wuhan virus is being reported in your area and you get a cold, sore throat, cough or flu-like illness, what do you do? Stay home, and see how things develop. If is is a common virus, it will get better in somewhere between two days and two weeks. The most important thing is whether it is getting better or getting worse. If better, fine. You are likely to get better more quickly if you are resting than if you try to work.

If it is getting worse, with worsening cough, increasing fever, pain in the chest, sometimes one-sided, maybe vivid dreams, and then shortness of breath, with increasing numbers of breaths per minute, then pneumonia may be setting in, and that is when you need to call the doctor. Be ready for them to ask a lot of questions, as they may decide not to visit, but rather, to admit you to hospital.

Let's hope that WN-CoV is contained, or mutates to lose its virulence. But even if it does, If Ill, Stay Home is still the most sensible policy.


Harry Raphael said...
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DocRichard said...

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