Communication, Caution Urged in Response to Coronavirus at YSPH Forum

A panel of Yale experts did their best to explain the current threat and future direction of the novel coronavirus epidemic during a forum Thursday hosted by the Yale School of Public Health. But they frequently cautioned the standing-room-only crowd that there is much about the mysterious illness that remains unknown.

Preliminary indications are that the virus is not as contagious as measles, is comparable in many ways to SARS (Severe Acute Respiratory Syndrome that resulted in 774 deaths worldwide in 2003) and is worse than the flu. But even these assessments could change as new data emerges, said moderator Saad Omer, director of the Yale Institute for Global Health and Susan Dwight Bliss Professor of Epidemiology at the Yale School of Public Health.

“You shouldn’t be walking around in a spacesuit on College Street, it’s reasonable to say that,” Omer told the gathering of some 120 students and faculty in Winslow Auditorium. “On the other hand, we don’t know the future risks of this outbreak.”

More than 30,000 people have been sickened since the virus first appeared last December and more than 600 people have died. The respiratory illness has appeared in 28 countries but is most prevalent in China. While patients with the virus have been reported in the United States, there have been no reported infections in Connecticut.

In response to the outbreak, stockpiles of protective masks have sold out in parts of China. Panelist Lisa Sanders, an associate professor at the Yale School of Medicine, said there is no evidence that wearing a face mask protects individuals from getting the virus.

The best way to prevent getting the virus, Sanders said, is to adopt the same precautions used for avoiding the flu–cough into your elbow, avoid people who have an obvious infection, self-quarantine if you have symptoms, and wash your hands–thoroughly and often.

“If people just washed their hands a little bit more that would go a long way,” said Sanders, who is also an Emmy-award winning television producer and writes the Diagnosis column for the New York Times.

Given the similarity of coronavirus to the flu, some have questioned why this particular respiratory illness is raising so much concern. Ellen Foxman, assistant professor at the Yale School of Medicine, explained that it is new to humans.

When our body fights a virus, it activates an immune response to block it and that response can be called on again should the virus return, Foxman said. Without that pre-existing defense, it is easier for a new virus to spread from person to person.

“That’s why a new virus is always cause to be alert, to be vigilant,” Foxman said. “Just because it’s new doesn’t mean it’s worse than other viruses, but there is that potential and that’s why there is reason to be vigilant about it.”

With so many uncertainties surrounding the virus, the panelists said it is vital for officials to be clear about what is known and unknown when publicly sharing information. Scientists have been quick to share information about the virus as it becomes available to aid in the international response. But that process can be problematic, particularly when findings are released before vetting.

“When you have an emerging outbreak there is uncertainty and we should acknowledge that uncertainty,” said Omer. “We certainly know a lot more about this outbreak than before, but we owe it to the public to convey what we don’t know.”

In order to avoid misinformation during an outbreak, Omer said a rapid peer review system needs to be created so that other scientists can quickly evaluate information before it is released publicly. He said universities could play an important role.

One thing that is certain is that the virus was not released from a Chinese laboratory, despite such rumors circulating on social media, said Nathan Grubaugh, an assistant professor at the Yale School of Public Health. Coronavirus most likely originated in bats. While the virus also appears to be mutating over time, that is part of its natural evolution and does not necessarily mean it is becoming more deadly, he said.

“Whether this is going to be SARS or the common old, we just can’t look at the virus’ genome and determine that,” said Grubaugh. “We don’t have enough data right now to say how bad it is going to be.”

Uncertainties surrounding transmission of the virus have led to drastic action in some areas. It was reported Thursday that a Chinese health official had ordered the city of Wuhan, where the virus first appeared, to place all infected residents in mass quarantine camps.

Yale Nursing Professor David Vlahov, who has a joint appointment in epidemiology and public health, voiced his concern that such quarantines could hinder public health efforts and have a stigmatizing effect, forcing people underground.

Gregg Gonsalves, an assistant professor at the Yale School of Public Health and co-director of Yale’s Global Health Justice Partnership, said he is particularly concerned about human rights issues as the virus spreads.

When considering quarantines, officials must use the least restrictive measures possible and not overreact, said Gonsalves, an adjunct associate professor at Yale Law School. Gonsalves is part of a legal team that is suing Connecticut for quarantines during the 2014 Ebola outbreak.

“We’re thinking about risks to the United States, but think about the thousands of Chinese patients with coronavirus whose health status is going to be put into a precarious position if they are isolated into these facilities,” said Gonsalves. "We have no idea of the quality of care that will be provided to them."

Should the virus establish a stronger foothold in the United States, Omer said he hopes the greater Yale community will respond appropriately.

“Outbreaks can bring out the best and the worst in people,” Omer said. “It is extremely important that we treat each other with dignity, respect and compassion.”

When asked what the latest scientific estimates were for the virus to peak and eventually end, the panelists said it is simply still too early to tell. Professor Albert Ko, chair of the Yale School of Public Health’s Department of Epidemiology of Microbial Diseases, said the epidemic is still growing in its “exponential phase.” Ko said he is concerned about vulnerable populations in countries that don’t have significant health care resources.

On a more positive note, Vlahov said the current crisis could be an impetus for more public health funding. But Yale School of Public Health Dean Sten Vermund said funding support for public health is always a challenge.

“It’s hard to convince policymakers to pay you to do something to prevent something from happening,” Vermund said. “It’s much more intuitive to invest in hospitals to care for the ill, then it is to invest in public health infrastructure to prevent the illness to begin with.”

A recording of Thursday’s forum can be viewed here.