SARS-CoV-2(?): Confusing times

In just two days, the novel coronavirus was christened twice.

COVID-2019 is the official DISEASE name when you get sick with the 2019 novel coronavirus. The virus has a new name as well. It’s called SARS-CoV-2.

The Coronavirus Study Group (CSG) of the International Committee on Taxonomy of Viruses [Gorbalenya, A. “Severe acute respiratory syndrome-related coronavirus – The species and its viruses, a statement of the Coronavirus Study Group”, bioRxiv] had decided to call the virus, severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2.

The naming issues between the World Health Organization and the Coronavirus Study Group had caused a bit of chaos on this matter. As reported in Science, here’s a run down on the name christening event:

Martin Enserink, ‘A bit chaotic.’ Christening of new coronavirus and its disease name create confusion, Feb 12, 2020, 2:40PM

Unfortunately, China is reportedly objectionable to the name provided by CSG as it resisted comparisons between the current crisis and the traumatic 2002-03 coronavirus epidemic. And why the two names emerged almost simultaneously is also shrouded in mystery.

For now, in layman’s terms, SARS-CoV-2 is the name of the virus that causes COVID-2019. And you can get infected with SARS-CoV-2 and be asymptomatic or not get sick at all. But when you do get sick, then you have COVID-2019. It’s like when you get infected with the influenza virus, you can get flu…or something to that effect. [Did we really need to get more confusing than this? Seriously, there are people in media who would pounce at the discombobulated scientists and organizational groups who are leading, or misleading, the confused keyboard warrior who’s desperately trying to get a grasp of all this confusion.]

It’s not as if the “whats-in-a-name” has already caused confusion, health officials in China report more than 14,000 new cases in Hubei Province alone. The reason for the sudden surge in numbers? Changing the diagnostic criteria.

At the epicenter of the novel coronavirus outbreak are many people who are sick and yet have no access to being tested. The various hospitals in Wuhan (the largest city in Hubei Province) have been grappling on how to diagnose infections with “scarce and complicated tests that detect the virus’s genetic signature directly. Other countries, too, have had such issues.” [Roni Caryn Rabin, New York Times, 12 February 2020]

But the issue on the complicated tests and its waterloo wasn’t on China alone. On Wednesday (12 February 2020), the Center for Disease Control in the United States had announced that some of the “coronavirus testing kits sent to state laboratories around the country have flaws and do not work properly…But the failure of the kits means that states that encountered problems with the test should not use it, and would still have to depend on the CDCs central lab, which could cause several days’ delay in getting results.” [Denise Grady, New York Times, Updated 13 February 1:03am ET]

The sudden surge in cases is due to the government including now cases diagnosed in clinical settings including CT scan findings. “The change in reporting is meant to provide a more accurate view of the transmissibility of the virus. The new criteria is intended to give doctors broader discretion to diagnose patients, and more crucially, isolate patients to quickly treat them.”

Some government experts noted that the lack in testing kits in the provinces, its low accuracy of 30-40%, the slow turn around time for the test results, and the overstretched hospitals in the epicenter were enough reasons to look at the clinical diagnosis of the disease instead.

With so much at stake and muddling and befuddling this disease entity, this sudden shift in accounting has become an epidemiologists nightmare as well. How do you now accurately track the cases of SARS-CoV-2 as causing COVID-2019? Like so many diagnostic tests out there, the timing of when to actually take specimens matter. Patients may have no symptoms and yet turn out positive or other patients may be severely ill in the late stage of the infection and turn out negative.

When scientists, the medical community and governments are thrown at the epicenter of panic and chaos and become confused, providing accurate public information becomes a challenging task. Crisis management should always center on the patients who are afflicted.

The secret of crisis management is not good vs. bad. It’s preventing the bad from getting worse.

– Andy Gilman

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