Daily Light – March 16, 2020

The FAQs: Coronavirus Explained by an Infectious Disease Expert and Pastor

Article by Dr. MIGUEL NÚÑEZ

Editors’ note: 

Along with being pastor for preaching and vision of the International Baptist Church in Santo Domingo, Dr. Miguel Núñez has practiced medicine in different capacities for more than 35 years. He is board-certified in internal medicine and in infectious diseases. He was also an assistant clinical professor of the Mount Sinai School of Medicine (1989-97) at Englewood Hospital and Medical Center in Englewood, New Jersey. For this reason, the Gospel Coalition contacted him for information related to the current outbreak of coronavirus from the medical point of view and to offer some words of pastoral wisdom.

What is the coronavirus?

Since the beginning of this year, we’ve been reading and hearing about a family of viruses known as coronaviruses. There are 69 species of this virus, seven of which can affect humans. The rest of the virus species are contracted by animals—mostly pigs, bats, and other small mammals. Its name comes from the fact that on the surface of the virus there are protrusions that correspond to proteins that the virus uses to adhere to other cells it wants to infect. 

What is the history of the coronavirus?

The medical community has known about these viruses since the 1960s. However, it wasn’t until 2002 to 2003 when the general population began to become familiar with them due to an outbreak of one of the viruses that occurred in China, eventually called SARS (Severe Acute Respiratory Syndrome). This epidemic was contained in China. According to the World Health Organization, only about 8,000 cases were reported with a mortality rate between 9.5 percent and 10 percent.

Ten years later, another strain of coronavirus emerged in Saudi Arabia, with an extremely high mortality rate of 35 percent. Fortunately, that epidemic was also contained. Unfortunately, 2,400 people were affected, of which about 800 died. This virus was called MERS (Middle East Respiratory Syndrome).

We wouldn’t hear about a similar virus until December 2019. The first reports of a respiratory syndrome emerged, once again in China, specifically in Wuhan province. The virus has been referred to as SARS Covid-2, and the disease as COVID-19 (Coronavirus disease, 2019).

There are rumors that this virus has mutated, though no mutation has been recognized by medical officials. 

How far has this virus spread?

Since then, this virus has spread to more than 115 nations. As of March 11, there are more than 126,300 cases reported in the infected countries. Of these, some 68,285 patients have fully recovered, there are about 53,382 cases considered active, and more than 4,633 people have died. Of the active cases, 89 percent seem to have minor conditions, and the rest are in severe or critical conditions.

How deadly is the new coronavirus?

The average mortality rate is around 3.4 percent. The highest mortality rate was reported in Italy, estimated at a little less than 6 percent. The lowest mortality rate was reported in South Korea, calculated to be around 0.7 percent.

It’s important to note that the mortality rate of this species of coronavirus (COVID-19) is not comparable to the two coronaviruses mentioned above. In reality, the mortality of this new epidemic will probably end up being much lower than reported, since up to 20 percent of patients remain completely asymptomatic, which means they will remain undiagnosed. If the number of cases of coronavirus increases, this increases the denominator with the consequent reduction in the percentage of mortality.

The highest-risk patients are those older than 60 and those who suffer from a chronic disease, either respiratory or another type such as diabetes mellitus or renal failure.

The mortality rate may end up being 1 percent or less, according to a published article in the New England Journal of Medicine. By way of comparison, the common flu in the United States has a mortality rate of approximately 0.1 percent. However, the CDC (Center for Disease Control) in Atlanta estimates that in the current flu season, between 20,000 and 50,000 people will die in the United States.

How is coronavirus transmitted?

Transmission occurs through small droplets of liquid from coughs or sneezes. It can also be transmitted by touching objects these droplets touched. The virus enters through mucosa in the mouth, the nasal route, or the eyes. The incubation period is estimated to be between two and 14 days. 

Many wonder how long the coronavirus can live outside the body—anywhere from several hours to several days. Viruses are microscopic organisms that live inside cells. Therefore, they’re alive as long as the cell they inhabit is alive. If the environment or surface on which the virus is located is wet, or has a high degree of humidity, they may be able to remain alive for several days. If the surface is dry, the virus may die within hours.

It’s estimated that each infected patient will transmit the virus to an average of 2.6 people. Most cases of COVID-19 have been reported in people who’ve been in contact with others who had been infected by the virus. However, in several communities there are cases where the disease appeared without any contact with someone infected.

The closer you are to the affected person, the greater your risk of being infected. It should be noted that the CDC considers “close contact” to be about six feet (1.8 meters) away from the person.

What are the symptoms of coronavirus?

As mentioned above, 20 percent of patients will never develop any symptoms. The observed symptoms are fever, cough, muscle aches, headache, vomiting, and diarrhea. These symptoms are similar to those of a flu, particularly similar to influenza.

Symptoms remain mild in 85 percent to 89 percent of cases, but 11 percent to 15 percent of cases progress to severe and critical symptoms. These patients will have respiratory distress, the development of pneumonia, and even the presentation of hypotension or septic shock.

Why is the situation alarming for many?

Globally, the alarm is due mostly to the number of infected patients, not so much by the mortality rate. The increased number of patients makes the number of deaths due to this virus potentially very high.

Potentially, millions of people would be affected by the virus by the time the epidemic ends. This could produce hundreds of thousands of deaths unless we develop a vaccine or some kind of treatment soon.

Most vaccine experts say we will not have a vaccine before the next 12 to 18 months. Multiple antivirals are being tested, but there is currently no official recommendation for any of them.

What prevention measures should we take?

We recommend frequent hand washing. For medical personnel who handle cases of coronavirus, the use of gloves, gowns, and even glasses may be necessary, depending on the procedure to be performed on the patient.

It’s also recommended that, until this epidemic is considered to be under control, we minimize physical contact with other people (examples: shaking hands, hugging, kissing, and so on).

As for travel safety, it depends on the destination. If you plan to travel to a country where the number of cases has increased, the recommendation is to not travel to that nation.

For example, this week Italy has declared a total quarantine. In fact, a few hours ago Italy closed most shops and restaurants, with the exception of pharmacies and supermarkets. The state of California suspended all meetings of more than a thousand people, and these measures are likely to be tightened in the immediate future. U.S. President Donald Trump decreed a few hours ago the suspension of all flights from Europe.

As believers, how do we need to think about it?

Without a doubt, we must be prudent and responsible, both in observing the recommended measures and also maintaining our health.  

The world population seems to be in panic. But for Christians, it’s important to emphasize that there’s no reason to experience such anxiety. Especially when we consider that the God of the heavens and the earth is the same God who controls every microbe, atom, or molecule.

This is a good time for Christians to demonstrate sanity, peace, and hope, recognizing that our lives do not depend on the entry of a micro-organism into our bodies. Instead, it depends on the God who determines the beginning and the end of our history on earth.

The apostle Paul calls us not to be anxious for anything (Phil. 4:6). We can call Christians to peace in the worst circumstances because of God’s sovereign control over his creation. 

Miguel Núñez (ThM, Southern Baptist School for Biblical Studies; DMin, Southern Baptist Theological Seminary; MD, INTEC School of Medicine) is pastor for preaching and vision Iglesia Bautista Internacional and president of Ministerios Integridad & Sabiduría in Santo Domingo, Dominican Republic, and a Council member of The Gospel Coalition and vice president of Coalición por el Evangelio. He has authored several books, including Enseñanzas que transformaron el mundo.

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