2019nCoV Update Health

Commission

2/6/2020

Rex Archer MD, MPH

Director of Health , KCMO

Saving Lives, Protecting People, Improving

Services

2400 Troost Ave. │ Suite 4400 │ Kansas City, MO 64108

Phone: 816.513.6252 │ KCMO.GOV │ rex.archer@kcmo.org

@RexArcherMD

Goals of Public Health Surveillance

Disease,

Infection or

Chronic Condition

Reported

to Surveillance Entity

Local Health Dept.

Used to

Influence

Public policy, local laws,

guidelines and

interventions

Public and community

response Leads

to

Prevention,

education or

diagnosis

Coronaviruses (2003)

Found in humans & animals

Associated with respiratory

diseases in humans

Readily swap genes between

virus strains

Can make sudden jumps

in their tissue and host

preferences through

random genetic mutations

Twenty Years of Communicable Disease Outbreaks*

2000 Shigella 2011 Cryptosporidium

2001 Anthrax Bioterrorism 2012 Pertussis, MERS-CoV

2002 West Nile Virus 2013 Syphilis, Chikungunya

2003 Monkey Pox, SARS-CoV 2014 Syphilis, Measles, Enterovirus 68

2004 Avian Influenza (Bird Flu) 2015 Syphilis, Shigella, Ebola

2005 Shigella, Cholera 2016 Syphilis, Zika Virus, Mumps

2006 Mumps, Tuberculosis in daycares 2017 Syphilis, Nipah Virus, Zika Virus, Mumps

2007 Extensively Drug-Resistant Tuberculosis 2018 Syphilis, Measles, Valley Fever, Foodborne Illness

2008 Syphilis 2019 Syphilis, Ebola, Legionella, Norovirus

2009 H1N1 Influenza (Swine Flu), Enterovirus 71 2020 Syphilis, 2019-nCoV

2010 Shigella

*Kansas City, MO Health Department – Either local cases of disease or preparedness activation for local response

Royals gingerly venture into SARS venue of Toronto

Exposure to infectious agent

No infection Clinical Sub-clinical

Death Carrier Immunity No immunity

Outcome

TransmissionCases Index – the first case identified

Primary – the case that brings the infection into a population

Secondary – infected by a primary case

Tertiary – infected by a secondary case

P

S

S

T

Susceptible

Immune

Sub-clinical

Clinical

ST

For the Good of the Herd

Time lines for infections

Susceptible

Susceptible

Dynamics ofinfectiousness

Dynamics of

diseaseIncubation

period

Symptomatic

period

Non-diseased

Latent

period

Infectious

period

Non-infectious

Time

Time

Reproductive number, R

A measure of the potential for transmission

The basic reproductive number, R0, the mean number of

individuals directly infected by an infectious case through

the total infectious period, when introduced to a susceptible

population

R0 = p • c • d

contacts per unit time

probability of transmission per contact

duration of infectiousness

Infection will ….. disappear, if R < 1

become endemic, if R = 1

become epidemic, if R > 1

What determines R0?

p, transmission probability per exposure – depends on the infection

HIV, p(hand shake)=0, p(transfusion)=1, p(sex)=0.001

interventions often aim at reducing p

use gloves, screene blood, condoms

c, number of contacts per time unit – relevant contact depends on

infection

same room, within sneezing distance, skin contact,

interventions often aim at reducing c

Isolation, sexual abstinence

d, duration of infectious period

may be reduced by medical interventions

How will vaccination affect R0 in a population?

How Deadly Is The Virus? The New Your Times International Sunday, February 2, 2020

Highlights of CDC’s

Guidance for

Public Health

Preparedness and

Response for SARS

“SUPERSPREADERS”

SARS

RUBELLA

MEASLES

LARYNGEAL TUBERCULOSIS

EBOLA VIRUS

Hotel M

Hong

Kong

Guangdong

Province,

China A

A

H,J

A

H,J

Hong Kong

SAR

95 HCW

>100 close contacts

United

States

1 HCW

I, L,M

I,L,M

KIreland

0 HCWK

Singapor

e

34 HCW37 close

contacts

C,D,E

C,D,E

B

B

Vietnam

37 HCW

21 close

contacts

F,G

Canada

18 HCWF,G

11 close

contacts

Effect of Travel and Missed Cases on the

SARS EpidemicSpread from Hotel M, Hong Kong

Total SARS Cases and % Healthcare

Workers by Country

0

1000

2000

3000

4000

5000

6000

China Hong Kong Taiwan Canada Singapore Vietnam

0

20

40

60

80

100To

tal N

o.

SA

RS

ca

se

s

% HCW

% H

CW

City of Kansas City, Missouri Health

Department

COMMUNITY ENGAGEMENT, POLICY,

and ACCOUNTABILITY

229

194

208

221

193202

207

168

205

175181 178

150

190

173

157

168177 176

111

99 100

7585 83

10797

82

111

98 94

10598 96

78

101 105

132

117

0

50

100

150

200

250

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Nu

mb

er

Number of deaths due to infectious disease and homicide*, KCMO 1999-2018

Infectious disease

Homicide

*Residents

Percent of communicable disease reports

requiring investigation that are investigated

22

0

20

40

60

80

100

120

19-Jan 19-Feb 19-Mar 19-Apr 19-May 19-Jun 19-Jul 19-Aug 19-Sep 19-Oct 19-Nov 19-Dec

Percent Communicable Disease Reports Investigated 2019

Percent High Priority CD Investigations Completed in 7 days (PM 24)

Percent High Priority STD Investigations Completed in 7 days (PM 23)

Percent Required Communicable Disease Investigations Completed (PM21)

Disease feedback loop

23

0

5

10

15

20

25

30

35

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020*

Number of Health Alerts Sent by Calendar Year

*2020 is through 2/3/2020