Since 1984, Fauci has been the director of the National Institute of allergy and infectious diseases of the United States. He is a representative of the scientific community of the United States. He has conducted in-depth research on influenza A (H1N1), AIDS, Ebola and other infectious diseases.
The three authors said novel coronavirus pneumonia may have a similar effect on human beings as the severe seasonal or pandemic influenza. In cases where the number of asymptomatic or mild cases may be several times the number of reported cases, the case fatality rate may be significantly lower than 1%, the article said.
At the end of the article, they wrote: the covid-19 epidemic clearly reminds people that infectious disease pathogens continue to emerge and challenge us. We need to carry out continuous monitoring, timely diagnosis and strong research to understand the basic biological characteristics of new pathogens, human susceptibility to them, and develop effective response measures.
Current research may judge that it is more similar to severe seasonal influenza
Like the first two outbreaks of coronavirus in the past 18 years (SARS in 2002 and 2003; mers in 2012 to date), the outbreak of covid-19 has posed a serious challenge to the public health, research and medical community.
The authors take a study published in the New England Journal of Medicine on January 29 as an example. In this study, which contains the data of transmission dynamics characteristics of 425 cases infected with 2019 ncov, researchers from China CDC, Hubei CDC, Hong Kong University and other units gave detailed clinical and epidemiological descriptions of the initially diagnosed patients from Wuhan, Hubei Province.
They noted that, as noted in the paper above, while research information is essential to inform appropriate responses to such outbreaks, there are limitations to the study as it reports on the earliest stages of evolution of emerging pathogens in real time.
Nevertheless, the report still gives some clear information about the disease. For example, the median age of the patients is 59 years old, and the incidence rate and mortality rate of the elderly and the comorbidity patients are high (similar to those of influenza), and 56% of the patients are male.
It is worth noting that no cases of children under the age of 15 were found in this study. Fauci et al. Mentioned that this is either because children are less likely to be infected - which will have an important impact on epidemiology; or because they are infected but have so little symptoms that they cannot be detected by testing, which will have a statistical impact on the total number of infections in the entire community.
The three authors also mentioned another paper. Chinas novel coronavirus disease novel coronavirus pneumonia, the leader of the National Health Protection Committee and the clinical features of the new 2019 coronavirus disease in China, was published in the new England Journal of medicine in February 28th. The estimated mortality of new crown pneumonia is 1.4%.
If we assume that the number of asymptomatic or mild cases is several times the number of reported cases, the case fatality rate may be significantly lower than 1%, said Fauci et al.
This suggests that the overall clinical outcome of covid-19 may eventually be more similar to severe seasonal influenza (case fatality rate of about 0.1%) or pandemic influenza (similar to 1957 and 1968), rather than a disease similar to SARS or mers, with case fatalities of 9% to 10% and 36%, respectively.
Fauci et al also pointed out that the transmission efficiency of any respiratory virus is of great significance for the study of strategies to contain and mitigate the outbreak. Current research shows that the basic number of new coronavirus infections (R0) is 2.2, which means that each infected person will spread the virus to another two people. The outbreak is likely to continue until the R0 figure falls below 1.0.
Recent reports also point out that in the early stages of the disease, the patients oropharyngeal virus titer is high, which also raises concerns about the increase of transmissibility in the period with the least symptoms.
It is important to ensure that research products are evaluated in a scientific and ethical manner
Fauci et al also discussed the current international travel restrictions. China, the United States and several other countries or regions have imposed temporary restrictions on travel with the aim of reducing the spread of the new disease in China and the rest of the world.
They noted a sharp decline in the number of Chinese tourists from the United States, especially from Hubei Province. At least for the time being, such restrictions may help slow the spread of the virus: as of February 26, 2020, 78191 laboratory confirmed cases have been reported in China, compared with 2918 in 37 other countries or regions around the world.
As of February 26, 2020, 14 cases involving Chinese travel or close contact with tourists have been found in the United States, 3 of which have been confirmed by American citizens repatriated from China, and 42 of which have been confirmed by American passengers repatriated from an infected cruise ship (the Diamond Princess).
However, Fauci and others also stressed that in view of the virus transmission capacity pointed out in the current report, covid-19 may break out around the world, including the United States, and we should be prepared for this.
They pointed out that in order to reduce the spread of the virus in American communities, strategies such as social isolation may need to be shifted from restrictive measures. Such strategies include isolation of patients (including voluntary isolation at home), suspension of classes, and telecommuting where possible.
The same suggestions come from vice president of Chinese Academy of engineering, President of Chinese Academy of Medical Sciences, and Academician Wang Chen, an expert in respiratory and critical medicine. In Chinese novel coronavirus pneumonia, Wang Chen and others published an online commentary on the international top medical journal TheLancet in February 24th. Novel coronavirus pneumonia was implemented in China during the process of combating the outbreak of new crown pneumonia. A series of measures to increase social distance (socialdistancing) were implemented. The combination of control holiday with home quarantine, grass-roots investigation and other measures effectively reduced the rate of disease transmission.
Wang Chen and others proposed that for countries facing the potential transmission of new coronavirus, or in the future to respond to the new outbreak of infectious diseases, we can consider using Chinas epidemic control holiday or epidemic control shutdown semester measures for reference.
Fauci et al also highlighted vaccines and drugs in their articles. At present, strong research work on the vaccine development of covid-19 is in progress. Fauci et al. Predict that the first batch of candidate drugs will enter phase 1 trials in early spring.
The current treatment methods include supportive care, and various treatment methods are being studied. Among them, the antiviral drugs are lopinavir litonavir, interferon-1 u03b2, RNA polymerase inhibitor remdesivir, chloroquine and a variety of traditional Chinese medicine products.
They also noted that, if possible, intravenous super immunoglobulins and monoclonal antibodies from rehabilitation patients may be attractive candidates for early intervention studies.
Although novel coronavirus pneumonia is very urgent, Fauci and others emphasize that even in the outbreak of epidemics, the key to advancing the field is to ensure that we are evaluating the research products scientifically and rationally.
They also mentioned that a better understanding of the pathogenesis of the disease is invaluable for our response in this unknown field. In addition, genomic studies of viruses can also describe host factors that make people susceptible to infection and disease progression.