Note: This is the sixth of a series of clinical briefs on the coronavirus outbreak. The information on this subject is continually evolving. The content within this activity serves as a historical reference to the information that was available at the time of this publication. We continue to add to the collection of activities on this subject as new information becomes available.

Clinical Context

On January 30, 2020, the WHO declared the outbreak of a novel coronavirus, first detected in China, to be a public health emergency of international concern.^[1] On January 31, 2020, US Health and Human Services Secretary Alex M. Azar II also declared a public health emergency for the United States.^[2] On February 11, 2020, the 2019 coronavirus was officially renamed COVID-19 by the WHO.^[3]

Investigations to learn more about this rapidly evolving situation are ongoing, and the CDC and other health organizations have pledged to update information as it becomes available. Amidst this legitimate data gathering, however, misinformation and false rumors are also circulating and need to be corrected.

Synopsis and Perspective

Myth vs Fact: Coronavirus Rumor Mill is Rampant With Misinformation

It is a fact that in addition to causing human suffering, the current coronavirus outbreak has sparked rumors, false alarms, and conspiracy theories. Given the incomplete and emerging data surrounding the outbreak that began in December 2019 in Wuhan, China, and the tendency of human nature to attempt to fill the void, it is perhaps not surprising that misinformation abounds.

"When there's some uncertainty about some important event, rumors develop," said Steven Taylor, PhD, a professor and clinical psychologist at the University of British Columbia in Vancouver, British Columbia, Canada. "There's been a long history of psychological research on rumors, and rumors can be regarded as a kind of improvised news that's circulated in an attempt to make sense of a situation."

Although these kinds of conspiracy rumors can appeal to our instincts, stepping back and analyzing them logically usually reveals their flaws, says Dr Taylor, who published the book The Psychology of Pandemics: Preparing for the Next Global Outbreak of Infectious Disease late last year.

According to official accounts, as of February 18, 2020, 73,332 cases of COVID-19 have been confirmed, and 1873 people have died (≈ 2.6% mortality rate).^[4]

As with many rumors, there is a kernel of truth to each of these, which makes them more believable and harder to fight, Dr Taylor said. Persons trying to replace rumors with facts are often accused by conspiracy theorists of being part of the conspiracy, and "[i]t can be very difficult to persuade them otherwise," he added.

Let’s look at some of the myths that have emerged with this recent outbreak.

Myth: COVID-19 started in the "wet market" selling live animals, seafood, and meat in Wuhan, a city in central China.

Fact: Data collection that might definitively prove the source of the outbreak source is still underway, precluding any firm conclusions as of yet; however, according to the WHO,^[5] coronaviruses are known to be zoonotic, common in many different species of animals (ie, camels, cattle, cats, and bats), with known transmission between animals and humans. As in the case of other recent coronavirus outbreaks (severe acute respiratory syndrome-related coronavirus [SARS-CoV] and Middle East respiratory syndrome-related coronavirus [MERS-CoV]), epidemiologic research showed both to have transmitted from bats.^[6] Several coronaviruses are still known to be circulating in animals that have not yet infected humans.

Early in the outbreak of respiratory illness caused by COVID-19 in Wuhan, many patients in China had some connection to the "wet market," consistent with animal-to-person transmission; however, increasing numbers of subsequent patients had no known exposure to animal markets, suggesting person-to-person spread.^[7]

Myth: The COVID-19 outbreak started with a woman who ate bat soup.

Fact : Bats are thought to be the natural reservoir for coronaviruses. Like MERS and SARS, both of which use bats as a reservoir, COVID-19 is a betacoronavirus. According to the WHO reports., ^[3] bats are rare in the markets of China but are hunted and sold to restaurants directly as a food source. Researchers’ hypothesis is that COVID-19 was likely transmitted from bats to another animal (intermediary host) and then transmitted to humans.

Chinese officials have reported sustained person-to-person transmission within China, and this has also been documented in the United States and other countries. Genetic sequences of COVID-19 from US patients are similar to those initially reported by China, consistent with a single, recent emergence of this virus from an animal reservoir. ^[8] This fact also dispels the myth that Bill Gates is responsible for the outbreak because of his donations to vaccine and drug programs.

Myth: The Chinese created a weaponized version of coronavirus and lost control of it.

Fact : There is no evidence to support this theory. A weaponized virus would more likely be derived from a virus with a higher fatality rate than that of COVID-19.

Although a recent study performed by the Beijing-sponsored south China University of Technology indicated a probability because of research on coronaviruses, there is no evidence of any connection of this laboratory with the current outbreak. Since SARS outbreaks occurred in 2002-2003 in Canada and China, both countries continued to study coronaviruses.

To facilitate detection of the virus, the full genome of COVID-19 was first reported by Chinese health authorities in the National Institutes of Health (NIH) genetic sequence database (GenBank) and in the Global Initiative on Sharing All Influenza Data (GISAID) portal. As sequencing is completed, the CDC is reporting to GenBank the full genome of the COVID-19 viruses detected in US patients.

In the United States, the CDC has grown the COVID-19 virus in cell culture to facilitate additional genetic characterization and other needed research, and this cell-grown virus was sent to NIH’s Biodefense and Emerging Infections (BEI) Resources Repository for use by the global scientific community.^[10]

Myth: Avoiding Chinese people is the best way to avoid contracting COVID-19.

Fact: Stigmatization can affect people, places, or things, and this is especially heightened during virus outbreaks (as was the case in the 2002 outbreak of SARS). It is characterized by associating a risk with something specific even though there is no evidence that the risk is greater in that group than in the general population.

To dispel the above myth, close personal contact with infected persons, regardless of race or ethnicity, is the most likely way to become infected with COVID-19, ^[11] as was the case in the first 2 documented US cases, whereby patients contracted the illness from infected family members. Tens of thousands of COVID-19 infections have now been documented in China, but other countries, including the United States, have also reported cases, with some evidence of person-to-person transmission.

The reality is that viruses affect everyone and are transmitted through close personal contact with friends or family members, rather than strangers.

"These viruses don't respect borders or nationalities or any kind of personal identity, race, or ethnicity. Everyone is at a potential risk if they are in the right social setting," said Jeanne Marrazzo, MD, director of the division of infectious diseases at the University of Alabama at Birmingham.

Current travel guidance for China issued by the CDC recommends that travelers avoid all nonessential travel to all of the country.^[12] The CDC issued this Level 3 Travel Health Notice on January 27, 2020.^[13]

The immediate health risk from COVID-19 is currently considered to be low for the general American public, who are unlikely to be exposed to COVID-19^[8]; however, the situation is rapidly evolving and potentially poses a high global public health threat worldwide and to the United States, as it has caused illness, including fatal illness, and has shown sustained person-to-person spread in and beyond China.

The CDC encourages recommended use of the influenza vaccine; daily infection precautions, such as hand hygiene and coughing/sneezing etiquette; and taking antiviral medications if prescribed.^[8] Persons who develop symptoms after close contact with someone infected with COVID-19 should contact their healthcare provider, and individuals who have the illness should follow CDC guidance on how to lower their risk for transmission to others.^[8]

Tedros Adhanom Ghebreyesus, PhD, the WHO’s director-general, advised at a recent news conference, "We're all in this together and we can only stop it together. This is the time for facts, not fear. This is the time for science, not rumors. This is the time for solidarity, not stigma."

Myth: Drinking bleach keeps the virus away.

Fact: Recently, bleach-like products have appeared on the market touting to be remedies for treating various conditions, including autism, cancer, HIV/AIDS, hepatitis, and flu. One such product is Miracle Mineral Solution. The product solution, when mixed, develops into a dangerous bleach, which has caused serious and potentially life-threatening adverse effects. The FDA has issued warnings after receiving reports of people experiencing severe vomiting, severe diarrhea, life-threatening low blood pressure as a result of dehydration, and acute liver failure associated with drinking these products.^[14]

The FDA Acting Commissioner Ned Sharpless, MD, released a statement in August 2019 denouncing these products, stating, "... Miracle Mineral Solution and similar products are not FDA-approved, and ingesting these products is the same as drinking bleach. Consumers should not use these products, and parents should not give these products to their children for any reason."^[14]

He further stated, "The FDA will continue to track those selling this dangerous product and take appropriate enforcement actions against those who attempt to evade FDA regulations and market unapproved and potentially dangerous products to the American public. Our top priority is to protect the public from products that place their health at risk, and we will send a strong and clear message that these products have the potential to cause serious harm."^[14]

From what we know concerning the COVID-19 virus, it is spread mainly from person to person, within about 6 feet, according to the CDC.^[8] It is spread through respiratory droplets produced when an infected person coughs or sneezes.^[11] These droplets can then land in the mouths or noses of people who are nearby, with possible inhalation into the lungs.^[11] For prevention, the CDC recommends daily preventive actions such as avoiding close contact with people who are sick; avoiding touching the eyes, nose and mouth; staying home when sick so as not to infect others; covering up cough or sneeze; appropriately disposing of infective tissue; cleaning and disinfecting objects and surfaces daily; wearing a face mask for persons who show symptoms of COVD-19; as well as washing hands with soap and water for at least 20 seconds (or using an alcohol-based hand sanitizer with at least 60% alcohol).^[15]

Myth: Coronavirus is transmitted from packages mailed from China.

Fact: There are no confirmed reports of this, and it is highly unlikely, according to the CDC because of the fact that the COVID-19 virus is spread through respiratory droplets. ^[11] They responded to this concern by stating on their website that currently no evidence supports transmission of COVID-19 through imported goods. In addition, there have not been any cases of COVID-19 in the United States associated with imported goods.

As healthcare professionals, using reliable and trusted sources (such as the CDC and WHO websites) is essential in providing the most updated information about virus outbreaks to alleviate patient fears and community concerns.

Highlights

• Myth: COVID-19 started in the "wet market" selling live animals in Wuhan, a city in central China.
• Fact: Data collection that might definitively prove the outbreak source is still underway, although coronaviruses are known to be zoonotic.
• SARS-CoV was transmitted from civet cats to humans, and MERS-CoV was transmitted from dromedary camels to humans.
• Several coronaviruses known to be circulating in animals have not yet infected humans.
• Early in the COVID-19 outbreak, many patients in China had some connection to the Wuhan "wet market," consistent with animal-to-person transmission, but subsequent patients had no known exposure to animal markets, suggesting person-to-person spread.
• Sustained person-to-person transmission has been reported within China, in the United States, and in other countries.
• Genetic sequences of COVID-19 from US patients resemble those initially reported by China, consistent with a single, recent emergence of this virus from an animal reservoir.
• Myth: The COVID-19 outbreak started with a woman who ate bat soup.
• Fact: Bats are likely a natural reservoir for coronaviruses, but researchers believe COVID-19 was transmitted from bats to another animal before infecting humans.
• COVID-19 is a betacoronavirus like MERS and SARS, both of which use bats as a reservoir.
• Myth: The Chinese created a weaponized version of coronavirus and lost control of it.
• Fact: No evidence supports this theory, particularly as a weaponized virus would more likely be derived from a virus with a higher fatality rate than COVID-19.
• A Wuhan laboratory studies extremely dangerous pathogens, but there is no connection of this laboratory with the current outbreak.
• Since SARS outbreaks occurred in 2002-2003 in Canada and China, both countries continued to study coronavirus.
• To facilitate COVID-19 detection, Chinese health authorities first reported its full genome in GenBank and GISAID, and the CDC is reporting to GenBank the full genome of the COVID-19 viruses from US patients.
• The CDC has grown COVID-19 in cell culture to facilitate additional genetic characterization and other needed research and has sent it to NIH’s BEI Resources Repository for use by the global scientific community.
• Myth: Avoiding Chinese people is the best way to avoid contracting COVID-19.
• Fact: Close personal contact with infected persons, regardless of race or ethnicity, is the most likely way to become infected with COVID-19.
• Tens of thousands of COVID-19 infections have now been documented in China, but the United States and other countries have also reported cases, with some evidence of person-to-person transmission.
• Travel policies implemented by the US government include suspending entry to the United States of foreign nationals who visited China within the past 14 days and measures to detect COVID-19 among persons who are allowed entry into the United States (US citizens, residents, and family) who visited China within 14 days.
• The latter group is also subject to health monitoring and possible quarantine for ≤ 14 days.
• A CDC Level 3 Travel Health Notice issued on January 27, 2020, recommended that travelers avoid all nonessential travel to all of China.
• The CDC urges clinicians to be vigilant for patients with fever and respiratory symptoms after recent travel in China and to follow infection control procedures.
• Risk for infection depends on exposure and is higher among healthcare workers for patients infected with COVID-19 and among other close contacts of patients with COVID-19.
• The immediate health risk from COVID-19 is currently considered to be low for the general American public, who are unlikely to be exposed to COVID-19.
• The CDC encourages recommended use of the influenza vaccine, daily infection precautions, and taking antiviral medications if prescribed.
• Persons who develop symptoms after close contact with someone infected with COVID-19 should contact their healthcare provider, and persons with the illness should follow CDC guidance on how to prevent transmission to others.
• Myth: Drinking bleach keeps the virus away.
• Fact: The FDA warns against this, as it can cause serious health risks and adverse events.
• Myth: Coronavirus is transmitted off packages mailed from China.
• Fact: The virus is transmitted through respiratory droplets. There are currently no confirmed reports of this, and it is highly unlikely, according to the CDC.

Clinical Implications

• Sustained person-to-person transmission of COVID-19 has been documented in China and other countries, but genetic sequencing is consistent with a single, recent emergence of this virus from an animal reservoir.
• Close personal contact with infected persons, regardless of race or ethnicity, is the most likely way to become infected with COVID-19.
• Implications for the Healthcare Team: The CDC urges clinicians to be vigilant for patients with fever and respiratory symptoms after recent travel in China and to follow infection control procedures. Using reliable and accurate sources for information will help calm fears and dispel unproven concerns.

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