Guest Post by Wim Röst
Nearly all the deadly infections of the corona virus are localized in the centre of the epidemic in and near Wuhan in the province of Hubei, China. This analysis leads to two main types of contamination: 1) breathing in the virus after a nearby contaminated person coughs or sneezes and 2) contracting the virus via the fecal-oral route, due to poor hygiene, that is not washing your hands. Of these two methods, the first is very dangerous. From the point of view of epidemics, the second form is potentially as dangerous as the first one. But for most individuals that are treated well the consequence of being contaminated seems to be no more deadly than a normal flu. Even so, the danger for whole populations and even for whole continents remains huge: every infected individual, who is not properly treated, can lead to a huge and dangerous epidemic.
There is a large difference in fatality for people infected in Wuhan and the surrounding area and for people that are infected outside the province of Hubei. Nearly all deadly cases can be traced back to contamination in Wuhan, Hubei. This observation requires an explanation.
Becoming infected in Wuhan is more dangerous than becoming infected elsewhere
Outside Mainland China, the disease has resulted in death only in Hong Kong and the Philippines. Both victims traveled from Wuhan in the province of Hubei where they were infected.*
Outside of the province of Hubei (the origin of the epidemic) contamination by the virus seems to be much less deadly for individuals that were contaminated. Outside the province of Hubei there are only 14 deaths, out of a total of 563** deaths. Nearly all of that small number of deaths, in the rest of Mainland China, seem to have been infected in or near Wuhan, Hubei.
This leads to the simple conclusion that individuals that have been infected in Wuhan are at greater risk than people that are infected outside Wuhan.
The question is: why?
Types of infections
From tuberculosis we know that there are two main types: the so called ‘open tbc’ and ‘closed tbc’. Open tbc (lungs involved) is very contaminating and the consequences are far more severe.
For the Wuhan coronavirus various ways of contamination are proposed ***:
- Spread from person to person through respiratory droplets emitted by coughing or sneezing.
- Airborne – meaning: the virus is able to travel across a large room.
- The fecal-oral route. Viruses from a diarrhea can be transmitted by hands or other means to the respiratory system of the infected person.
This analysis leads to the conclusion that a fourth one should be added:
4. The fecal-manual route. A first infection in the digestive system of the first person is transmitted by ‘shaking hands’ with secondary persons that may transmit the infection to their own digestive system, causing a primary reaction like diarrhea.
Origin and spread of infections of the new corona virus
In the city of Wuhan which is the origin of the epidemic 55% of the first contaminations are proven to come from a market. In first instance the digestive systems of one or more customers of the market must have been infected by eating contaminated food, causing a diarrhea.
If the virus is first infecting the intestines of a patient the body probably has more time to activate its defense system after which a person gets protection by antibodies, constraining the severity of the contamination: “Reports point to mildly symptomatic but infectious cases of 2019-nCoV [2019 Novel Coronavirus], which were not a feature of SARS.”
Probably by the fecal-oral route, the respiratory system of one or more of the first victims, must have been reached in a second case, resulting in severe respiratory problems and in many deadly further cases.
In Wuhan contamination by respiratory droplets has been directly infecting the lungs of other victims nearby, resulting in many deaths for Wuhan and nearby. When large quantities of viruses are directly transmitted from lung to lung a totally unprepared and unprotected body gets a big problem from the very first moment: a viral load of up to 108 copies per milliliter is mentioned – 100 million viruses per milliliter.
Besides the above route the virus is transmitted via the fecal-manual route by seemingly healthy people whose digestive system has been infected but who are not aware of the type of infection or not even of becoming ill. People that are infected through the digestive route may or may not develop sickness symptoms like a diarrhea. These people themselves could not have or show problems in their respiratory system but they are still able to contaminate other people. For example, by simply shaking hands with other people with a hand with slight traces of the virus. The danger of a less than perfect hygiene (which is rather common) and more especially the hygiene in squat latrines has been mentioned in this informative article.
The fecal-manual route of contamination probably has been the case in most of the illness cases in the rest of Mainland China and in most of the secondary cases in foreign countries where corona infected people from China, not having respiratory problems, traveled to. The infection by an infected guest in the factory in Germany probably was transmitted by ‘just shaking hands’, which is what people in firms are used to doing when they meet each other.
If the above analysis is correct, in case of sickness, two types of contamination must be distinguished:
- by the fecal-manual route
- by the respiratory route
The last one is by far the most dangerous for the individual because it directly affects the fragile lung system even before the slightest resistance in the body could have been built up. Both varieties however are very contagious and can spread the virus to many people which means that both varieties have more or less the same potential in creating a dangerous epidemic.
After recognizing the ‘dangerous’ and the ‘less dangerous’ variant different ways can be followed. The ‘respiratory group’ needs 100% isolation. For the other group 100% strict hygienic prevention measures should be enough to prevent further spreading. A ‘contactless period’ is needed but further complications for the infected person are much less probable which facilitates treatment and recovery.
The Big Danger
By seemingly healthy people the disease can travel to other locations and can be spread by persons that are not showing symptoms of the disease. The spread of this highly infectious disease might already have taken place to less equipped countries. In poor countries further containing of the very contagious disease will be more difficult than in China or in other more developed countries.
New possibilities for killing the epidemic?
The fact that people develop resistance against the disease by slight infections of the digestive system possibly opens up new ways to fight the epidemic. But it is not easy to imagine how this could happen without self-contamination of the lung system of some individuals or without transmitting considerable quantities of the virus to the people in the environment – things that happen during the uncontrolled spread of the virus.
From the geographical spread of confirmed cases of the corona virus the difference between two main types of contamination is inferred.
First there is, for individuals, the less dangerous contamination that only affects the digestive system of a patient. The patient himself often develops less severe symptoms but is still able to contaminate many other people by fecal-manual transmission.
Second there is the very dangerous variant in which the respiratory system is affected.
In case of ‘lung to lung’ transmission of infections the natural defense system of infected people does not have enough time to develop natural resistance against the disease. Very soon the patient is very ill and highly contagious in the most dangerous way. It is the contamination of the respiratory system that causes most deaths.
Outside Wuhan/Hubei contamination by the fecal-manual route probably is the most common way of becoming infected. This type of infection is less problematic in its direct effects because usually only the digestive system is involved. For the affected individual the contamination usually has less severe consequences but from the point of view of contaminating other people a high risk remains. Strict hygiene is needed.
Distinguishing the two forms of contamination, eases treatment decisions. Distinguishing the two forms of transmission leads to better and more efficient policies in fighting and constraining the epidemic.
Disclaimer: The author is a geographer, not a medical specialist nor an epidemiologist. Geographical data have lead to the above analysis which may be right or may be wrong but if right this analysis will have many advantages for policies regarding the epidemic. Many lives could be saved – which has been the reason to publish this not perfect and not complete analysis.
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About the author: Wim Röst studied human geography in Utrecht, the Netherlands. The above is his personal view. He is not connected to firms or foundations nor is he funded by government(s).
Andy May was so kind to read the original text and improve the English where necessary. Thanks Andy!
A 44-year-old man who traveled from Wuhan, China, the center of the outbreak, died in the Philippines, officials said.
Hong Kong confirmed its first death from the novel coronavirus on February 4, 2020, after a 39-year-old man died after travelling to Wuhan, the capital of the central Chinese province of Hubei. (Italic added)
**Current map of Coronavirus 2019 cases in China
Some data per 2/8/2020, about 7:00 a.m. CST click on the map to see current data.
Earlier numbers in more detail (2/6/2020)
Mainland China 28,085 Total Deaths 563
Province of Hubei (inclusive the city of Wuhan):
Confirmed: 19,665 (70% of total Mainland China confirmed)
Deaths: 549 (97% of total Mainland China deaths)
Mainland China exclusive the province of Hubei:
Mainland China 28,085 – 19,665 = 8,420 = 30% of total China Mainland
Total Deaths 565 – 549 = 16 – 2 (outside of Mainland China) = 14 = 2.5% of total China Mainland
The province of Hubei has 70% of total confirmed cases and 97.5% of total deaths
To compare: the rest of Mainland China has 30% of all cases and only 2.5% of all deaths.
Many confirmed cases, no deaths: for example, the province of Zhejiang, Mainland China
Confirmed: 954 (3.4% of total of Mainland China)
Deaths: 0 (0 % of total Mainland China deaths)
***CNN: February 5 coronavirus news
6:49 a.m. ET, February 5, 2020
Cruise infections raise questions about how Wuhan coronavirus spreads
From CNN’s Joshua Berlinger in Hong Kong
The novel coronavirus is thought to spread from person to person through respiratory droplets emitted by coughing or sneezing.
There’s currently no evidence that the virus is airborne — meaning, for instance, it doesn’t travel across a large room.
Still unknown: An important factor yet to be determined, however, is whether the virus spreads via the fecal-oral route, according to Dr. John Nicholls, a clinical professor in pathology at the University of Hong Kong.
Coronavirus cruise: Norovirus — a contagious stomach bug that causes vomiting and diarrhea — and severe acute respiratory syndrome (SARS) both spread by the fecal-oral route. Norovirus is also notorious for infecting cruise passengers.
Viruses like norovirus spread so quickly on cruises because “you’ve got so many people in a crowded area and people are sharing areas, touching places,” Nicholls said.
Questions raised: The infection of at least 10 people aboard a cruise ship now quarantined in Japan is raising questions about whether the Wuhan coronavirus can spread the same way.