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Novel Coronavirus

Outbreak

A Brief Review from CMO OnDemand

The current Coronavirus outbreak, COVID-19 (Coronavirus disease, 2019) is a rapidly evolving and dynamic situation, with a significant number of unknowns and uncertainty in important areas of the science. The full impact of the outbreak and the public health implications are inherently unpredictable and have not been determined. The information which follows is intended to be a brief summary of key points regarding the current outbreak, learnings from similar past outbreaks relevant for employers, and recommendations for reliable resources on this topic for EHIR members and their colleagues. 

This document was authored by Dr. Tom Fariss and Dr. Clarion Johnson, members of the CMO OnDemand panel as well as Brock Anderson, the Executive Director of CMO OnDemand. For more information reach out to Brock@cmodemand.com or +1 (406) 581 8710.

Summary

A cluster of cases of pneumonia in people associated with a seafood market in Wuhan, Hubei Province, China, was reported by Chinese authorities on December 31, 2019. The cluster was confirmed in early January to be caused by a new coronavirus, now named COVID-19.

 

On January 30, 2020, the World Health Organization (WHO) declared a Public Health Emergency of International Concern; the following day the U.S. Department of Health and Human Services (HHS) declared a U.S. Public Health Emergency.


Since that time, significant human to human transmission has occurred, resulting in at least 72 additional affected countries and over 90,000 confirmed cases globally, as of 3/3/2020. Of the confirmed cases, close to 15% are severely ill, with a case fatality estimate from the WHO at around 3.4%. Other reputable sources in the scientific community suggest it might be much less, around 0.5-1.0%. A more accurate estimate will likely become available in the coming weeks as the CDC and other global public health organizations are preparing to deploy a much larger quantity of laboratory tests in the next few days. Please refer to these resources for updated information.

Employer learnings from previous pandemics

Reflecting on more than 100 years of combined experience as corporate medical directors, our Chief Medical Officers offer a sampling of high-level lessons learned from previous pandemics.

 

  1. Public health measures are effective, particularly when implemented early in the course of an outbreak. This includes early identification of cases, isolation, infection controls, communication, and contact tracing.
     

  2. Stay home when you are sick. Employers should reinforce and support work from home policies and encourage employees to stay away from work when actively symptomatic.
     

  3. Social distancing is effective: keep at least 6 feet from others in populated areas and from anyone who is coughing or sneezing; avoid mass gatherings during significant outbreaks of respiratory illness.
     

  4. Wash hands frequently and thoroughly, preferably with soap and water (alcohol-based hand sanitizers are a reasonable alternative), and avoid touching face, eyes, nose, or mouth before washing hands.
     

  5. Strategic planning for supply chain of essential equipment and supplies as well as business continuity planning. Pandemics always trigger a run on essential supplies such as personal protective equipment (masks, gowns, gloves, goggles), medications, and other essentials.
     

  6. Employers can help ensure quality decision-making among their leadership teams by identifying credible scientific resources for information.
     

  7. Employers, particularly those with a global footprint, can and should leverage the extensive global network of medical and science leaders with experience in pandemic situations such as COVID-19. 
     

Recommended resources for employers

The following is a sampling of recommended resources – follow embedded links to general and specific COVID-19 information 

Key considerations for employers

The CMO OnDemand Panel reflects below on the types of key questions to consider in managing response and taking action on behalf of global organizations 

 

  • What is the best way to keep senior leadership in my company apprised as to developments?

  • What is still unknown about the novel coronavirus? What are the pieces of misinformation which concern you the most?

  • Where do I turn for insights into issuing travel restrictions?

  • Under what circumstances should our employees wear a mask? 

  • What no regrets actions should I consider taking in leading my organization?

  • What is the relative risk of this situation relative to other infectious disease outbreaks?

  • When and how should I consider escalating or encouraging my organization to take urgent action depending on the evolution of the disease?

 

Should you or others in your organization need to connect with any of the CMO OnDemand panel on these or other priority questions, please reach out to Brock Anderson at brock@CMOdemand.com

About COVID-19 and Coronaviruses

Coronaviruses are well-known and typically benign human pathogens. They occur throughout the globe and cause an estimated 10-30% of upper respiratory tract infections (common colds) in adults. Infrequently, however, coronaviruses can evolve into a more highly pathogenic virus that can cause serious disease in humans. Twice in the last two decades, coronaviruses caused global outbreaks or “pandemics” of severe respiratory illness: Severe Acute Respiratory Syndrome (SARS) in 2002, and Middle East Respiratory Syndrome (MERS) in 2012. The case fatality rate for SARS was approximately 9.5% before it was determined to be effectively contained. MERS is to some degree an ongoing outbreak, but largely limited to transmission within hospitals and the majority of cases are in Saudi Arabia; the fatality rate is approximately 36%. The 2019-nCoV outbreak shares some characteristics with both of the previous coronavirus pandemics, leading to the heightened level of concern among public health officials. Whether this outbreak will result in a comparable, milder or more severe, pandemic, is uncertain. The medical and public health communities are paying particular attention to the severity and transmissibility of this pathogen, which have not been fully characterized. Hallmarks of the most serious pandemics are both high severity and high transmissibility. 

Who should be concerned?

Currently, the focus of public health efforts to contain the spread of this illness is on the following groups:
 

  • Confirmed cases of COVID-19, 99% of which are currently in China

  • Anyone who has traveled from mainland China, particularly Wuhan or the Hubei Province, in the previous 14 days

  • Close contacts with confirmed cases 

  • Health care workers caring for patients with COVID-19 infection

  • Locations where community transmission begins to occur
     

 The number of countries where some community transmission is occurring has already expanded to 28 and increasing. The U.S. has some local areas where community transmission is occurring in Washington (state), California, and Oregon.

Transmission and protection

The COVID-19 virus is thought to be transmitted through respiratory droplets, often passed from person to person by coughing or sneezing. The droplets carrying active virus enter through mouth, nose, or eyes (mucous membranes) or inhaled into the lungs. The greatest risk for transmission occurs within two meters (approximately 6 feet), which suggests the “social distancing” recommendation of staying a minimum of two meters from anyone who is coughing or appears ill. Surgical masks provide some protection from the virus and should be worn by anyone who is symptomatic and in public. Care givers or medical personnel who by necessity are in close contact with COVID-19 patients require more protection, which includes N95 or better respirators, goggles and other personal protective equipment. Viruses can remain viable and detectable for some indeterminate amount of time (hours to days) on inanimate surfaces although it is not yet known whether transmission can occur from viruses on surfaces. Although it has not been confirmed whether asymptomatic transmission is occurring, growing epidemiologic evidence suggests that it has occurred; it is still unclear how important this mechanism is in the overall spread of the outbreak. It is also unclear whether an asymptomatic person with a positive test is necessarily contagious.

Symptoms and signs of COVID-19 infection

The spectrum of illness ranges from mild (no or few symptoms) to severe and may include fever, cough, and trouble breathing or shortness of breath. It may be difficult to distinguish from other common respiratory illnesses such as colds or influenza, although high fevers may be more characteristic of COVID-19 infections. Incubation period is estimated to be 2-14 days (average is thought to be closer to five days), which has prompted a 14-day quarantine for all travelers from mainland China and other affected countries and anyone potentially exposed to a known case.

Key uncertainties and important unanswered questions

As with any outbreak of this nature, the situation is fluid and continues to evolve. There are still many unknowns regarding the biology and pathogenesis of COVID-19, although researchers are aggressively pursuing answers to these questions and will likely learn a great deal in the coming days and weeks of this outbreak.

  • What is the full spectrum of clinical disease and what proportion of cases are asymptomatic, mildly ill, seriously ill, etc.?

  • What is the true case fatality rate? How will this illness ultimately compare to previous coronavirus outbreaks (SARS, MERS)?

  • Do severe and fatal cases share identifiable characteristics, health risk factors, or demographics? Does this virus attack predominantly elderly or immunocompromised people or are relatively young and healthy people at significant risk as well?

  • What role for surfaces and inanimate objects for transmission?

  • What is the “reproductive number” or Ro, a measure of the average infectiousness of the typical case (an Ro > 1 indicates each case on average infects more than one person). 

  • How robust is the supply chain for essential equipment such as masks, gloves, gowns, goggles, and other personal protective equipment (PPE)?

  • What medications are in the pipeline or already being tested?

  • When will a vaccine be developed and ready for use?

CMO OnDemand Panel

EHIR members can now access corporate medical directors through its new CMO onDemand service. The CMO OnDemand panel consists of experienced medical directors with extensive experience leading multinational organizations including American Express, Exxon Mobil, Kimberly-Clark, Johnson & Johnson, JPMorgan Chase, Sutter Health, and the University of California.

Chief Medical Officer Panelists