A reality check on coronavirus

The novel disease is serious. But risks here remain low, says Ezekiel J. Emanuel, vice provost for global initiatives, who attended a World Health Organization meeting on the subject last week.

Since December, the emerging infectious disease known scientifically as COVID-19, the novel coronavirus, has dominated headlines, spiked anxiety, and claimed more than 2,000 lives. And while new cases are being identified around the world each day, the disease is still largely confined to China. 

Ezekial Emanuel
Ezekiel J. Emanuel

Researchers have jump-started investigations into the biology of the virus and its epidemiology, as well as efforts to treat and prevent it. To structure, prioritize, and identify funding for those efforts, the World Health Organization (WHO) convened a two-day meeting last week in Geneva to engage more than 300 world-leading scientific experts. 

Ezekiel J. Emanuel, vice provost for global initiatives and an oncologist and bioethicist, was among the participants. He spoke with Penn Today about the meeting’s focus and outcomes, how the outbreak is affecting Penn’s work globally, and what members of the Penn community should know about the outbreak.

What was the intent of the WHO meeting?

There were various different groups participating, focused on epidemiology, on therapeutics, on vaccines, and one was the ethics group of which I am a member.

With the emergence of the new coronavirus, there’s a big push to do research to understand it and to test therapeutics to treat it. We have a lot of antivirals available to us now. So we’re thinking about those and also thinking about potential vaccines that will be developed over the next three to six months. The question here is, we have this big infectious disease outbreak, how do you ethically do research, and what research do you prioritize? 

What was your own goal in attending?

I think there were two things. One is that I wanted to learn. I wanted to find out what people think about the status of the situation, how they are evaluating the danger, and what data are they looking to in the future to make assessments about the actual threat of COVID-19. There’s been a lot of, to put it frankly, hysteria around the virus, and I wanted to know, did the world’s leading experts share that feeling?

The second thing is that, given that it is very important to do research on this virus, we need to see the research conducted in an ethical manner. A lot of times when you have a novel problem, you have to spend time thinking through ethical decisions. But we’ve thought through these issues before with other outbreaks, such as Ebola. So we as the ethics groups wanted to communicate to scientists that using an ethical framework to pursue their research isn’t going to slow them down in the face of this emergency.

What was the mood like among the attendees?

People recognized that this is a serious public health problem requiring serious attention and that it could become a much more serious health issue. But, at the moment, most people are thinking that there may be a bit of an overreaction by many, maybe even our own country. If you look at the numbers dispassionately, there are just over 1,000 cases outside of China. Half of them are on that cruise ship in Japan. So, considering the world's population of more than 7 billion people, that’s not a lot.

Even in China, you've got about 74,000 cases. We know that's an underestimate of the actual number of cases, but it’s likely most of the other cases are mild. And that’s in a country with a population of 1.4 billion people. So a sense at the meeting was that we need to be a little more mathematical and rational about this. 

How is the outbreak affecting Penn’s work in China?

We’ve all spent a lot of time thinking about how to handle this at Penn. We’ve certainly had to cancel educational programs in China. Wharton has canceled a big meeting in Singapore. We are particularly focused on our students and scholars from China and the region who are suffering the impact from of all this the most. A handful of Penn students are stuck in China, but even for those who are back on campus, their families are impacted, they may be feeling ostracized, they cannot travel home for spring break, and their parents cannot come here. The University is looking into all of these issues to figure out how we can best support these folks.  It’s one reason why we made the “Stay Strong, Penn” video as a reminder to the campus to show compassion during this time. It’s definitely impacted our activities as a university, there’s no doubt about it.

How do you foresee this outbreak impacting travel and activities over the longer term, looking into the spring and summer?

Right now I have a trip planned to Taiwan in May, and I’m planning to go. If there is some big change, like we suddenly see 15,000 cases outside of China, that will certainly change people’s reactions.

The other factor here is that many of the experts are saying, well the warm weather is going to come and, just like with the flu, the coronavirus is going to go down and may move into the Southern Hemisphere. Obviously no one knows whether this is going to become an annual thing, like influenza, or if it’s going to be like SARS, which disappeared and didn’t come back. We know what the likely potential scenarios are, but we don’t know which of those potential scenarios is going to happen. Only constant monitoring is going to be able to tell us.

Are there any other big takeaways from the WHO meeting?

Something I think is important for people to be aware of is that the people who have done badly with coronavirus are usually older or have comorbidities, things like diabetes, emphysema, congestive heart failure. Healthy young people do not seem to be at very high risk; if they get it, they typically get a mild case. That's not to say there have been cases of people who are relatively young dying, like Li Wenliang, the doctor who originally reported on it. But that's an unusual case. 

In that regard it sort of behaves like the flu. A lot of us get the flu, but serious cases that cause mortality tend to be focused on the elderly and those with other chronic diseases.

In your role as vice provost for global initiatives, what would you tell students and other members of the community who might be worried about the virus?

We’re really very safe here at Penn. That’s the first thing. I wouldn’t panic. 

Second, we do have very effective and well-educated and up-to-date professionals at the Student Health Service. If students are feeling any of the usual symptoms—fever, shortness of breath, cough—contact the health service. It can’t hurt. Get the care and the reassurance you need.

Also, we have to treat our community well and not go around and think that everyone from China is a coronavirus spreader. We’ve had no cases at Penn. There hasn’t even been a case in the entire state of Pennsylvania. 

And, of course, people should always be prudent in the winter. That includes thoroughly washing your hands, avoiding touching your mouth and face, covering your sneezes and coughs, and staying home if you don’t feel well. But those things are just as important for the flu, which you’re much more likely to get, than for the coronavirus.

Ezekiel J. Emanuel is vice provost for global initiatives, chair of the Department of Medical Ethics and Health Policy, and the Diane v.S. Levy and Robert M. Levy University Professor at the Perelman School of Medicine and the Wharton School at the University of Pennsylvania.