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This isn’t a story. This is a collection of notes and information from various trusted sites with a little commentary from me. Because San Antonio is host to 90+ evacuees from China, all in quarantine at Lackland AFB, and because one individual tested positive for COVID-19, there have been many questions. This is meant to be an easy resource to copy and paste for many common questions.

Expect this to be an evolving document.

Where did COVID-19 come from?
It’s still early days, but most likely it was a virus infecting bats that mutated and made the jump into humans. Scientists sequenced a sample from an infected patient, and found the viral genome to be most closely related to SARS-like viruses isolated from bats previously.

The deadly viruses responsible for recent outbreaks such as SARS, MERS, Ebola and Marburg have come from bats. Why? Scientists believe it is a result of the immune system of bats which is so primed to respond to infection, there is selective pressure on the virus, causing it to replicate rapidly. The rapid replication leads to mutation, which allow it to jump species.
Now, coronaviruses aren’t as rapidly mutating as influenza viruses, and once they jump into other mammals, they aren’t subject to the same selective pressure as they were in bats. But this may explain why they move from bats into humans.

It’s just the flu.

No, it’s not.

Influenza viruses and Coronaviruses belong to completely different virus families. Both cause “flu-like illness” or “ILI” which is what may cause confusion. The initial symptoms may be similar, but the viruses are very different. The case-fatality rate for seasonal flu varies, but is generally around 0.05%. The case-fatality rate for COVID-19 is still unclear, but so far around 2%. Compare SARS (14–15% but over 50% for patients over 55). Though the case-fatality rate for influenza is lower, a person in the US (and most of the northern hemisphere right now) is more likely to get flu, so the risk of severe disease related to influenza is higher than for COVID-19.

“Influenza viruses belong to the family Orthomyxoviridae and have a single-stranded segmented RNA genome. The influenza viruses are classified into types A, B, and C on the basis of their core proteins.”

“Coronaviruses are in the family Coronaviridae. They are enveloped viruses with a positive-sense single-stranded RNA genome and a nucleocapsid of helical symmetry. The genome size of coronaviruses ranges from approximately 26 to 32 kilobases, the largest for an RNA virus. Coronavirus infection can range from mild to severe.”

You can get a flu shot which is doing a reasonably good job of preventing the spread of flu strains circulating now.

They can just be treated.

“There is no specific antiviral treatment recommended for 2019-nCoV infection. People infected with 2019-nCoV should receive supportive care to help relieve symptoms. For severe cases, treatment should include care to support vital organ functions. “

Note: there are some drugs in the works in China, but none approved yet. Mostly it’s symptomatic treatment to support organ function.

Incubation Period

2–14 days. Maybe. This is based on SARS and MERS. But it could be as long as 24 days. It is normal in the early months of a novel pathogen to not have specific details. If it seems like public health experts are confused, it’s because this is biology. It doesn’t always act like we predict.

How is it transmitted?
It’s transmitted via respiratory droplets when someone coughs in close proximity (6 feet). This is different from AIRBORNE (like measle)s. It’s not clear if it can live on surfaces, but generally you need to be in close contact.

More on Airborne vs Droplet transmission

“Some diseases can be transferred by infected droplets contacting surfaces of the eye, nose, or mouth. This is referred to as droplet contact transmission. Droplets containing microorganisms can be generated when an infected person coughs, sneezes, or talks. Droplets can also be generated during certain medical procedures, such as bronchoscopy. * Droplets are too large to be airborne for long periods of time, and quickly settle out of air.”

“Droplet transmission can be reduced with the use of personal protective barriers, such as face masks and goggles. Measles and SARS are examples of diseases capable of droplet contact transmission.”

*This is why diseases like SARS often affect healthcare workers more. They are more likely to be exposed to someone with severe illness and the medical procedures are more likely to generate droplets.

“Airborne transmission refers to situations where droplet nuclei (residue from evaporated droplets) or dust particles containing microorganisms can remain suspended in air for long periods of time. These organisms must be capable of surviving for long periods of time outside the body and must be resistant to drying. Airborne transmission allows organisms to enter the upper and lower respiratory tracts. Fortunately, only a limited number of diseases are capable of airborne transmission.”

Diseases capable of airborne transmission include: Tuberculosis, Chicken pox and measles.


Can it be transmitted asymptomatically?

If a person is coughing, they can transmit it (i.e. they have symptoms). The bigger question is if they can transmit before they have symptoms (like with flu). So far, it doesn’t seem likely. There was a report in Germany that suggested a visitor from China was asymptomatic and gave it to 4 people. However, further discussions found that the individual WAS symptomatic, although symptoms were mild and the illness in all associated individuals was also mild. Is it possible to transmit asymptomatically? Maybe, but so far we have no evidence of that.

Worried about San Antonio?

These are old stories, but still accurate. San Antonio’s Emergency Response is well prepared to handle a crisis.

Can we quarantine and entire population?

In short, yes. It’s not easy and wouldn’t be done lightly, but there are laws in place that allow it. It hasn’t been done since the flu pandemic of 1918–1919. Normally, local health authorities have jurisdiction — so the local health department calls the shots. The CDC must wait for an invitation to enter a jurisdiction. But the state can step in if it deems it necessary and the federal government make a federal order. Highly unlikely, but the legal systems are in place.

Why doesn’t the city share the name of the hospital?

Because HIPAA. No, no one NEEDS to know where a patient is located.

(An individual evacuated from China to Lackland AFB was diagnosed with COVID-19 and transported to a local hospital, prompting many questions like these)

“The HIPAA Privacy regulations require health care providers and organizations, as well as their business associates, to develop and follow procedures that ensure the confidentiality and security of protected health information (PHI) when it is transferred, received, handled, or shared. This applies to all forms of PHI, including paper, oral, and electronic, etc. Furthermore, only the minimum health information necessary to conduct business is to be used or shared.”

Update: The name of the hospital was released. Presumably the patient has given permission.
Public Health communication is a fine balance of releasing the necessary information but limiting how much information goes out. Because not all information is accurate or good or necessary and can violate a patient’s rights.

ps — Thank you to WHO for NOT naming the virus after the place, even though the struggle with nomenclature is confusing people.

Dr. Rohr-Allegrini is an epidemiologist and tropical disease scientist currently working to prevent diseases through immunizations.

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