CDC Warns That COVID-19 Is Likely Headed Toward Pandemic Stage, Could Affect US Schools, Businesses

Widespread local transmission of coronavirus disease 2019 (COVID-19) in the United States hasn’t happened—yet. But it’s only a matter of time until it does, the CDC said Tuesday.

In the first of 2 updates about the disease, Nancy Messonnier, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, said thus far COVID-19 meets 2 of the 3 factors needed to be classified as a pandemic: illness resulting in death and sustained person-to-person spread. Worldwide spread is the third criteria, she said.

“Ultimately, we expect we will see community spread in this country,” she said. It’s not a question of “if” anymore, she said—it’s a question of when, and how many people will have severe illness.

The outbreak has spread throughout China and to 30 other countries and territories, besides the United States. Community spread is now happening in Italy, Iran, Hong Kong, South Korea, Taiwan, and other places.

In a later briefing, HHS Secretary Alex Azar said there are 14 US cases that were detected here; 3 cases from repatriation flights from Wuhan, China; and 40 cases from American passengers evacuated from the Diamond Princess cruise ship last week.

Azar said the risk of the getting COVID-19 is still low, but that could change quickly, and officials are focusing screening and intervention at ports of entry.

However, once community transmission begins, focusing attention at entry points will be ineffective, Messonnier said.

If COVID-19 begins spreading in US localities, health officials said that “social distancing”—postponement or cancellation of mass gatherings, remote telework, school closings and dismissals, and other measures—will help to slow its transmission. In addition, Messonnier said healthcare systems may want to increase use of telehealth and can cancel elective surgeries.

She acknowledged that missed school days, or loss of income, would be disruptive for many, but said the public needs to start thinking about these things now. To that end, she has told her family their lives may be upended and she has queried her children's local school superintendent about what plans are in place if the disease becomes widespread.

At the briefing with Azar, CDC’s Principal Deputy Director, Anne Schuchat, MD, called it a “difficult and concerning time.” As of right now, patients with COVID-19 are being managed in healthcare facilities, but she said future cases will likely involve home management and isolation.

Person-to-person spread of COVID-19 appears to occur mainly by respiratory transmission, and symptoms include cough, shortness of breath, and fever. Based on past experience with Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS) coronaviruses, the CDC estimates that symptoms of COVID-19 occur within 2 to 14 days after exposure. Early information seems to suggest that older adults and persons with underlying health conditions or compromised immune systems might be at greater risk for severe illness.

The CDC reiterated that the public should still receive a flu vaccine if they haven’t yet received one. Given the similarity of symptoms, the vaccine can not only prevent influenza but also prevent possible unnecessary evaluation for COVID-19. Overall, this year’s vaccine is 45% effective at reducing medical visits for flu, and even more effective in children, the CDC said last week, at 55%.

As of the CDC’s last flu report, there have been 105 pediatric deaths from the flu, including 13 in the week ending February 15. Overall this season, the CDC estimates that there have been at least 29 million flu illnesses, 280,000 hospitalizations, and 16,000 deaths.

Worldwide, COVID-19 has caused 2462 associated deaths, with none in the United States as of Tuesday.

In other developments Tuesday, the White House sent a supplemental request to Congress to make $2.5 billion available for COVID-19 response efforts, including an emergency supplemental appropriation of $1.25 billion, and the stock market suffered its third day of losses, with the Dow Jones Industrial Average falling 3.15% to close at 27,081.36.