At the time of this writing I have encountered at least
three coronavirus conspiracy theories.
The American version goes something like this. The current pandemic
resulted from a leak from a Chinese bioweapons laboratory. The supplementary
information generally talks about how these particular bioweapons labs are not
very secure and leaks are common. The Chinese version has a human twist and it
involves a visit to China by 300 US military athletes. The suggestion is that
these athletes intentionally introduced the virus or inadvertently passed the
virus to the Chinese population. There is an Iranian version - suggesting
that the virus is basically an American bioweapon. There are various embellishments. Prominent
politicians are involved in restating these conspiracy theories. I have been
reading about bioterrorism for the past 20 years and would dismiss these
theories as being implausible from a technical perspective. From a political
perspective, it makes perfect sense to me that politicians will always try to
look for a way to deflect any responsibility. One of the most common ways to do
that is to blame an adversary - especially one that might be unpopular with the
majority of citizens.
The report of the first case of coronavirus in the US is a
rare opportunity to end all the conspiracy theories with real evidence. I do
realize that conspiracy theories are not generally refutable by facts. This post is directed at those who can
incorporate factual information into their worldview. There has been a lot
written lately about distinguishing opinion from fact, including the results of
a standardized international test suggesting that American students may have
some deficits in this area.
Detailed case report in the New England Journal of
Medicine is interesting from a number of perspectives. The patient is a 35-year-old man walked into
an urgent care in Snohomish County, Washington on January 19, 2020 the four-day
history of cough and “objective fever”. He had returned from visiting relatives
in Wuhan, China. His health history was basically unremarkable. Initial vital
signs showed a temp of 37.2°C, BP of 134/87, and pulse was 110 bpm. Restaurant
rate was 16 breaths per minute and O2 sat was 96% on room air. Initial viral screen for influenza a and B,
parainfluenza, respiratory syncytial virus, rhinovirus, adenovirus, and for
common coronaviruses was negative. The CDC was contacted and samples were
collected for 2019-nCoV. The virus was confirmed one day later.
The patient had been discharged home but after 2019-nCoV was confirmed he was admitted to an airborne isolation unit for observation. The clinical course is described in the figure below that is taken from the original paper (with permission). The symptom course before the admission date of January 20 is estimated on the diagram. I think it is instructive to note that cough preceded the development of a low-grade fever on day five of 37.9°C or 100.2°F. The patient also had fatigue nausea and vomiting before the development of fever.
Laboratory findings over the course of the illness are
presented in the original article and six blood samples did not show any marked
abnormalities. He had mild elevations of alkaline phosphatase, alanine aminotransferase,
aspartate aminotransferase, and lactate dehydrogenase. Blood tests were done
due to fevers and they showed no growth.
Chest x-ray on day 9 of the illness showed left lower lobe pneumonia
that correlated with decreased O2 sat down to 90%. At that time he was put on
supplemental oxygen. It is also treated with vancomycin and cefepime for
presumed hospital acquired pneumonia. On day 10, based on his chest x-ray, the
need for supplemental oxygen, and reports of the development of severe
pneumonia is physicians decided to treat him with an investigational drug - remdesivir.
By day 12 he was clinically improved and no longer needed supplemental oxygen.
His oxygen saturations were normal on room air. As seen in the diagram, is
always symptoms at the time were a cough and rhinorrhea.
Contrary to the conspiracy theories, this paper points out
that the Chinese researchers shared the full genetic sequence of the 2019-nCoV in
the National Institutes of Health GenBank Database
and the Global Initiative on Sharing All Influenza Data (GISAID) database.
The authors emphasize at the time of this writing that the
full spectrum of clinical disease is undetermined. Transmission dynamics are
also undetermined because the patient had not visited the seafood market in
Wuhan or had any contacts with known cases in China. They list several
complications noted in the Chinese population including acute respiratory
distress syndrome, severe pneumonia, respiratory failure, and cardiac injury.
There are several radiographs on Twitter suggestive of significant lung injury
and at least one report of myocarditis in a significant subset of patients. The
authors also point out that the patient is nonspecific symptoms prior to the
onset of pneumonia were consistent with the number of common respiratory
viruses. In differentiating this illness travel history, the decision by the
patient to seek treatment, and a coordinated effort among public health
officials led to the timely identification of the virus. I would add that this
case report also shows the clear need for clinical expertise as the illness
transforms from what appears to be a typical respiratory virus to pneumonia.
The question that needs to be asked is whether that level of expertise is
available everywhere in the country.
Addressing the threat of emerging infectious diseases
requires a public health infrastructure and cooperation across many countries
with their own political interests. Many those countries may have public health
officials that are cooperating with one another, but politicians who may decide to
use a pandemic for their own interests. With most countries engaged in
significant quarantine efforts at this time, clear cooperation among world
leaders in stopping this pandemic is urgently needed.
George Dawson, MD, DFAPA
References:
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