Dr. John Marr is an American physician, epidemiologist, and author whose professional life has concerned outbreaks of infectious disease for over 40 years. He specializes in historical epidemics (see Backstories in Epidemiology: True Medical Mysteries). We communicated with Dr. Marr by email to get his expert opinion on the spread of Novel Coronavirus (recently named COVID-19 by the World Health Organization). He writes:

“Over forty years ago I co-authored a ‘medical thriller’ novel, The Black Death. At the time, I was the principal epidemiologist for the New York City Department of Health. I considered worst-case scenarios that might befall the city. Smallpox was on the wain, and other candidates for the White Horse of the Apocalypse seemed unlikely. But a single case of pneumonic plague, belatedly recognized, might lead to an epidemic. The novel proceeded to write itself. Now in 2020, another much worse case is unfolding,” he says. “The scenario has not yet been written.”

But the story is rapidly developing. Data from the Hong Kong Centre for Health Protection indicates that the number of cases in mainland China is 63,851 cases (as of February 13, 2020,
23:59), including 10,204 cases in serious condition and 1,380 deaths. There was an increase of 15,152 cases over a 24-hour period that the Associated Press News reports created a spike in data attributable to a new classification system being used in Hubei Province that’s meant to broaden the scope of diagnoses for the outbreak. The WHO reports that 25 countries have confirmed cases of the disease, including 15 in the US and 7 in Canada (see WHO’s 2019 n-COV Situation Dashboard below). The Centers for Disease Control and Prevention puts the number of locations affected at 28.

The CDC defines Coronaviruses as “a large family of viruses that are common in many different species of animals, including camels, cattle, cats, and bats. Rarely, animal coronaviruses can infect people and then spread between people such as with MERS, SARS, and now with 2019-nCoV.”

Cases in the United States have been confirmed by the CDC in 6 states, including Massachusetts, Illinois, Wisconsin, Washington State, California, and Arizona. Sixty-six cases are pending investigation. Hope rests on finding a vaccine for the virus, and the race for one is underway. A lab in San Diego says it’s found one, but testing it will take months.

“My own worry,” Dr. Marr says, “is that the virus, if introduced into subSaharan countries where one million Chinese workers have been commuting for decades, will become a major pandemic, just like the Black Death.”

He’s not alone. Concern of the disease spreading to Africa, where it could potentially explode due to the lack of resources there to combat it, has health officials on the continent and elsewhere on high alert. The World Health Organization has listed Zambia and 12 other African countries as high risks for potential outbreaks due to travel to and from China. So far, however, African leaders report that there’s been no sign of the virus. Indonesia, a popular destination for Chinese tourists, reports that there have been no cases there either, a dubious claim according to infectious disease experts in Australia.

Signs of Infection

WHO lists common signs of infection of Coronavirus as “respiratory symptoms, fever, cough, shortness of breath, and breathing difficulties. In more severe cases,” WHO warns, “infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.”

Stay Informed of the Latest News on Coronavirus

• World Health Organization
• Centers for Disease Control and Prevention

“My medical colleagues in Asia, ProMed-mail, and the AP give me daily updates on the coronavirus,” says Dr. Marr, “but interacting with them is difficult. Input from readers of JPHMP Direct in real time might be an additional forum to discuss the ‘What Ifs’ as the epidemic becomes a pandemic.”

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