www.medpagetoday.com/infectiousdisease/publichealth/84861
Gottlieb: Keep Close Eye on Coronavirus in Singapore
How disease plays out in other countries besides China could predict pandemic, says former FDA chief
"So far, in Singapore with 50 cases identified... eight are in the ICU. That's deeply concerning to me," said Gottlieb, the former FDA commissioner and now a resident fellow at the American Enterprise Institute, at a Senate Committee on Homeland Security & Governmental Affairs hearing Wednesday.
Of particular importance is how many of those infected with the virus develop severe disease, he said.
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The outbreak's advancement in Singapore during a time of warm weather (currently 80°F) is especially alarming, he said, because summer weather would ordinarily be "a backstop" against coronavirus transmission.
Gottlieb who has no formal background in public health but participated in biodefense and pandemic preparedness programs at the FDA prior to becoming commissioner said that what he's seen so far indicates that the disease may become a pandemic.
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Gottlieb said he is worried that the novel virus could reflect a "sweet spot" between being efficient enough for quick transmission, and virulent enough over a large population "that it causes a lot of death and disease."
Mortality with the novel coronavirus has been put at about 2%, but the denominator in that calculation has been China's case counts that don't include individuals with mild infections. Yet even a "case fatality rate of 0.2 or 0.5 [percent] could be catastrophic if this is highly, highly contagious and spreads around the world," Gottlieb said.
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Modeling from the U.K. suggests that for every identified case there are three or four that haven't been identified, he added.
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Gerberding warned that it may not be possible to contain the novel virus, but there should be a strong focus on slowing viral spread, by making gloves and masks available, employing "social distancing," and leveraging early school closings if necessary. During the 2014-2015 Ebola outbreak in West Africa, she and other public health experts referred to this approach as the "Swiss cheese" model because none of these practices alone could prevent spread, but when layered on each other, could create solid protection.
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One significant concern described by panelists was the lack of "surge capacity" in the U.S. healthcare system the ability to handle sudden large increases in patient loads and the absence of funding to prepare for emergencies.
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In addition, he warned of the possibility of disruptions in medical supplies in the coming months. Hubei province is a major manufacturing center for pharmaceutical ingredients, including some used in antibiotics production -- and 80% of antibiotics used in the U.S. comes from China, he testified. Medical devices also rely heavily on Chinese components, he said.
Most of the manufacturers he's spoken with have 1 to 3 months or "a little bit more inventory" on hand, Gottlieb told MedPage Today after the hearing.
Cheerful.