The novel coronavirus has definitely spread beyond China. While at first, many cases seemed to be linked to people who had travelled to China and brought the illness home with them, over the last few days many countries have reported spikes in local cases of COVID-19.
This could signal a shift in the outbreak and means that containment strategies might not be enough anymore, experts say.
As of Tuesday, Iran was reporting 95 cases of COVID-19. Many of these people likely caught the disease at home in Iran.
Travellers who had visited Iran have also exported the virus to countries in the Middle East, like Iraq, Kuwait, Bahrain, Oman and Afghanistan.
A recent Canadian case was also linked to Iran.
Italy has also had a spike in COVID-19 cases, with 229 reported infections and seven deaths. Italian authorities have effectively placed 10 towns in the Lombardy region under quarantine and cancelled Venice’s annual carnival.
The virus has also hit South Korea hard, with authorities there reporting 893 COVID-19 cases on Tuesday, many of which were transmitted through church groups.
“Certainly in the last three days we’ve started to see more and more cases outside of China and especially a lot of local transmission outside of China,” Dr. Isaac Bogoch, an infectious disease specialist at Toronto General Hospital, told Global News on Sunday.
“The leaders in the World Health Organization have really talked about this closing window of opportunity to contain the virus in China. But it appears that if this window truly is closing, it’s almost nearly closed or it has closed, because we’re starting to see a lot of infections outside of China.”
“I think what this means is that it is not possible to control this virus,” said Dr. Allison McGeer, an infectious diseases specialist at the Sinai Health System in Toronto.
Evidence is growing that the virus has several characteristics that make it hard to contain, she said. These characteristics include the possibility that it can be transmitted when a person is showing few symptoms or even none at all.
If someone is visibly sick, she said, you can identify them and quarantine them and track down who they have been in contact with.
“But if you have to identify people who are not ill at all and put them in quarantine, that’s much more difficult to do.”
This virus also seems to be transmitted fairly easily. “This is a virus that we’ve seen now has been transmitted in meetings with co-workers, in Germany and Singapore, to taxi drivers, to people who work in shops, to tour guides,” she said.
“Those are people, yes you come close to them, but it’s very different from how much contact you have with people who are members of your family.”
Not everyone thinks that containment is a lost cause, though.
While he acknowledged that the new cases in Iran, South Korea and Italy were concerning, WHO director-general Dr. Tedros Adhanom Ghebreyesus said Monday that countries should still work on containing the virus.
“The key message that should give all countries hope, courage and confidence is that this virus can be contained,” he said.
That doesn’t mean that the world can’t also prepare for the worst, he said.
“It’s not either-or. We must focus on containment, while doing everything we can to prepare for a potential pandemic.”
Dr. Susy Hota, medical director of infection prevention and control at the University Health Network in Toronto, said that right now the outbreak is in an “awkward phase” and could go either way.
“I don’t think we should give up on containment strategy,” she said. “Be we also have to think ahead, like what if this does continue to spread to other areas?
“Let’s shift our response to be a little bit different and more about mitigation as well.”
Right now, she said, doctors are using travel history to help identify possible COVID-19 cases — a strategy that won’t work nearly as well if there are many “hot spots” around the world, or if cases get transmitted within Canada.
“The approach becomes looking for just the symptoms and having a broader way of managing that within hospitals and in the community.”
Public health authorities, depending on the situation, could recommend cancelling large public gatherings, or closing schools, she said. Hospitals will need to properly manage patients and be prepared for an influx, with sufficient equipment and isolation capacity, she said.
While she does think that the virus is something to be concerned about, Hota doesn’t think alarm is the right response.
“What I don’t like is people calling this a deadly virus,” she said. “This perception that it’s going to kill everybody is a very harmful and damaging thing to say.
“We face other respiratory viruses every year that cause similar symptoms, similar consequences in people who are at risk for complications, and similar death rates.”
What’s unusual about this virus is that it’s new and might infect a large number of people at once, when the health system is already dealing with every other seasonal respiratory disease, she said.
“We just have to be prepared to offer the right kind of treatments for people and have that capacity in the system to care for the ill.”
— with files from Heather Yourex-West, Global News, and Reuters