The COVID-19 virus is on everybody’s mind these days. To help make sense of the situation, we reached out to GYA Executive Committee member Sandra Lopez-Verges (Gorgas Memorial Institute for Health Studies, Panama), who is a microbiologist/virologist.
Question: What is your position, and what does your organization do?
Sandra: I’m a Senior Health Researcher and the Head in charge of the Department of Research in Virology and Biotechnology at the Gorgas Memorial Institute of Health Studies in Panama. This is a public institution that has two main roles: one as the national laboratory of reference and one as a research institution on public health and health-related research producing data for helping the Ministry of Health make science-based decisions. This new position has allowed me to be part of the national response for preparedness and surveillance of the new coronavirus SARS-CoV-2 (COVID-19) led by the Ministry of Health, for which our department is responsible at the national level for the laboratory diagnosis of samples from suspected cases.
Q: What makes this particular coronavirus strain so concerning?
Sandra: Every time there is a new emergent virus, there is a concern because we need to learn about the virus as well as the spectrum of the disease it induces. For COVID-19, what is concerning is the fact that the transmission from human-to-human is easy, superior to the last two emergent coronaviruses SARS-CoV and MERS-CoV, and this transmission rate can even be higher in hospital settings (behaving as a nosocomial disease) and crowded spaces, creating new focus of spread.
The current lethality, calculated mainly with the cases in China, is around 2%, and it can increase around 15% in older people (more information here https://www.livescience.com/new-coronavirus-compare-with-flu.html). As pathogenesis of the disease depends on the virus as well as on the host, there are still uncertainties of how it could behave in different genetic backgrounds, if possible mutations could modify its transmission rate or the clinical spectrum, thereby becoming milder or more severe.
This virus was identified, sequenced and the diagnostic tools created in a shorter time than with previous outbreaks, thanks to open science, and the constant communication between countries has helped restrain the outbreak for a time, leaving most countries to prepare for a possible introduction of the virus. Just when China was beginning to control the outbreak, a new focus spread outside of China, which increases the risk of a pandemic. The severity of this outbreak will all depend on if countries with imported cases are prepared and capable of doing early detection and diagnosis, and treatment.
Q: Is Panama’s position a trouble spot for the spread of disease?
Sandra: Panama is a traffic and commercial hub with a wide and constant exchange of people through the Canal, and is also the main airport hub for flights between LAC countries and the rest of the world. For this reason, we are aware that we have to be particularly prepared and that our surveillance needs to be strong in all ports of entrance as well as throughout the country.
Luckily, Panama is in the forefront of respiratory surveillance in the region, always collaborating with the United States Centers for Disease Control, and the Pan American Health Organization/World Health Organization, and thanks to the surveillance network created for the 2009 H1N1 Influenza outbreak, Panama is prepared to quickly detect an imported case.
This would decrease the possibility of spread in Panama and other LAC countries that do not have direct contact with the countries that have COVID-19 circulation. We hope that, as with the SARS-CoV and MERS-CoV outbreaks, that even if we are prepared, the virus will not arrive so we would not need to test our health response.
Q: What is the regional outlook for COVID-19?
Sandra: Most of the countries in LAC have decreased exchanges with the main countries with high COVID-19 circulation and/or are monitoring travellers from these countries, as well as quarantined suspected cases. The countries of the region are always exchanging information about pathogens through PAHO, and emergent viruses through Ibero-American research networks like ViroRed (financed by CYTED). Moreover, since the beginning of the year, the countries have created a network of virologists from CELAC (Comunidad de Estados Latinamericanos y Caribeños) to exchange and comment about the measures taken by each country. This shows the positive effect of good science diplomacy, which is crucial in public health of infectious diseases.
Still, the first case in Brazil confirmed on February 25 of a person that travelled from Italy is alarming, and we hope there are not other cases in LAC countries that have not yet been detected. It is still not known if the transmission rate will be similar in tropical countries or the South American countries that are currently in summer time, and if this will help or not contains the cases in the region.
Q: What can people do to help prevent the spread of COVID-19?
Sandra: The most important thing is to avoid contact with infected cases, and if you are in a country with cases avoid crowded places and go to hospital only if needed. Wash your hands with water and soap frequently. If there is no water, use alcohol gels. It is also important to keep surfaces in public spaces clean. If you have a respiratory infection (common during winter and due to many different viruses), try to stay at home and if necessary use a surgical mask. As COVID-19 is more dangerous with older people, avoid visiting them if you are sick.
Q: Are you worried about the future spread of the virus?
Sandra: This virus has all the features that could allow it to cause a pandemic. But again, it will all depend on the measures taken in each country.
This is not the first emergent virus to cause a pandemic (more recent instances include influenza H1N1 in 2009, Chikungunya in 2005 and then 2014, and Zika in 2015). Sadly, it will also not be the last, as most factors that allow the new emergence of pathogens (climate change, deforestation, land use changes, urbanization, high population density, etc.) and their spread (increased worldwide exchange of people, animals and goods) are met.
The future spread of COVID-19 worries me for the countries that have an old population or for countries with a health system that is not strong in general. I hope that COVID-19 becomes milder and not more severe. What is also unknown is if it could cause a pandemic and then become undetectable, or on the other hand become endemic like the other four coronaviruses (HKU-1, NL-63, OC-43, 2299E) than causes the common cold.
Q: Should people take this virus into account when travelling?
Sandra: Yes, you always need to take in account outbreaks in your travel plans, especially if you are a population at risk (in the case of COVID-19, this means older than 60 years old or with underlying health conditions). Always talk to your medical doctor to confirm if you should be especially careful. The best for everyone is to avoid travelling to cities with current endemic transmission to protect yourself but also not to help the dissemination of the disease.
For a detailed map of countries affected by the outbreak: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html?fbclid=IwAR0CZMZzW_3ZCkWvGqv2vB0BZl2P7q03aJTAsxdhlxxPwC8XvJrTdJeORy8#/bda7594740fd40299423467b48e9ecf6