New England Journal of Medicine
February 20, 2020 Vol. 382 No. 8
A Novel Coronavirus Emerging in China — Key Questions for Impact Assessment
Vincent J. Munster, Ph.D., Marion Koopmans, D.V.M., Neeltje van Doremalen, Ph.D., Debby van Riel, Ph.D., and Emmie de Wit, Ph.D.
… We currently do not know where 2019-nCoV falls on the scale of human-to-human transmissibility. But it is safe to assume that if this virus transmits efficiently, its seemingly lower pathogenicity as compared with SARS, possibly combined with super-spreader events in specific cases, could allow large-scale spread. In this manner, a virus that poses a low health threat on the individual level can pose a high risk on the population level, with the potential to cause disruptions of global public health systems and economic losses. This possibility warrants the current aggressive response aimed at tracing and diagnosing every infected patient and thereby breaking the transmission chain of 2019-nCoV.
Epidemiologic information on the pathogenicity and transmissibility of this virus obtained by means of molecular detection and serosurveillance is needed to fill in the details in the surveillance pyramid and guide the response to this outbreak. Moreover, the propensity of novel coronaviruses to spread in health care centers indicates a need for peripheral health care facilities to be on standby to identify potential cases as well. In addition, increased preparedness is needed at animal markets and other animal facilities, while the possible source of this emerging virus is being investigated. If we are proactive in these ways, perhaps we will never have to discover the true epidemic or pandemic potential of 2019-nCoV.