Coronaviruses (GAO-20-472SP)

Summary

A GAO Science & Tech Spotlight on coronaviruses, GAO-20-472SP, dated March 2020, from GAO's Science, Technology Assessment, and Analytics team. It explains that coronaviruses were not considered a major risk for humans until the SARS outbreak in 2002 and that several highly contagious outbreaks have since spread from animals to humans, most recently COVID-19 in Wuhan, China. Citing the World Health Organization, it reports over 70,000 infected and over 2,600 deaths from COVID-19, a mortality rate of approximately 3 percent. It states that as of March 2020 seven coronaviruses have been identified that can cause illness in humans.

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Science, Technology Assessment,
MARCH 2020
and Analytics
WHY THIS MATTERS
Coronaviruses can spread rapidly and cause outbreaks
with high mortality rates. They were not considered a
SCIENCE & TECH SPOTLIGHT: major risk for humans until the SARS outbreak in 2002.

CORONAVIRUSES
Since then, there have been multiple highly contagious
outbreaks originating in animals and spreading to
humans—most recently the outbreak in Wuhan, China
of Coronavirus Disease 2019 (COVID-19).

/// THE SCIENCE has seen a high infection rate, with over 70,000 infected and over 2,600
deaths—a mortality rate of approximately 3 percent as of February 24th,
What is it? While the outbreak of COVID-19 in China has brought the 2020, according to the World Health Organization (WHO). Estimates
term coronavirus into daily usage, coronaviruses can vary in severity. of the reproductive ratio, or R0, for COVID-19 have also indicated that
They can cause respiratory issues, such as pneumonia, and are believed it has the potential to spread rapidly. These estimates are tentative,
to be one cause of the common cold. According to the Centers for however, because the R0 is a complex epidemiologic measure that is
Disease Control and Prevention (CDC), most people will be infected by context-specific and affected by numerous biological, behavioral, and
a coronavirus at some point in their lifetimes. As of March 2020, seven environmental factors.
coronaviruses have been identified that can cause illness in humans.
Most infections result in mild to moderate symptoms, such as runny nose, How does it work? Coronaviruses are believed to work in similar
headache, cough, sore throat, fever, and a run-down feeling. ways. Viral particles attach themselves to specific molecules, known as
receptors, on the surface of a human or animal cell, allowing the virus to
Coronaviruses are most commonly transmitted by coughing, sneezing, enter. Once inside, the virus discards its outer coating, releasing its genetic
person-to-person contact, and touching objects that have viral particles material into the host cell. This can occur in many cells at the same time.
on them, according to CDC. The best prevention is washing hands The virus can then use the cell’s own mechanisms—for example, the
with soap and avoiding contact with people who are sick or work in mechanism to produce proteins based on genetic code—to replicate
quarantine areas. Current treatment methods are limited, and research itself. The hijacking of the cell’s functions causes the release of new viral
is being fast-tracked to develop a vaccine against existing and emerging particles and restarting the process, either in more cells of the same host
coronaviruses. or in another host that becomes infected.
Recent high-profile coronavirus outbreaks have raised new concern
because of high mortality rates relative to the coronaviruses that cause
the common cold. In addition, the severe coronaviruses can cause both
upper- and lower-respiratory-tract infections, including pneumonia.

Since 2002, there have been three severe outbreaks of respiratory
illness caused by coronaviruses, all three originating in animals. In 2002,
an outbreak of Severe Acute Respiratory Syndrome (SARS) began in
China and had a mortality rate of approximately 10 percent. In 2012, an
outbreak of Middle East Respiratory Syndrome (MERS) had a mortality
rate reported as high as 34 percent. Most recently, a December 2019
outbreak of a new coronavirus, SARS-CoV-2—which causes COVID-19—

Figure 2. Schematic of how a coronavirus infects host cells. This process is similar for all
RNA viruses, the large class to which coronaviruses belong.

Coronaviruses mutate rapidly compared to other viruses, enabling them
to adapt to new environments. Coronaviruses are ribonucleic acid (RNA)
viruses, which are more prone to random mutations than deoxyribonucleic
acid (DNA) viruses. Because DNA viruses, like chickenpox and many
others, are more stable, it is easier to create long term effective vaccines
Figure 1. Electron microscope image and schematic of coronavirus particles (Middle East against them. In contrast, RNA viruses, like flu, may regularly require new
Respiratory Syndrome Coronavirus and general coronavirus respectively).
vaccines.
GAO-20-472SP Coronaviruses
Science, Technology Assessment,
and Analytics

Generally, coronaviruses originate in animals, with the most likely origin /// OPPORTUNITIES
being bats, and can spread from animal to animal. In environments where
humans and multiple animal species mix, such as live animal markets and ■ Identification of common targets in coronaviruses to develop
farms, there is an increased likelihood that a coronavirus can mutate and vaccines against all coronaviruses.
spread into humans. The original animal vector for SARS-CoV-2 has not ■ Increased coordination by industry, academia, and government could
yet been determined.
improve awareness of treatment options for future outbreaks.
■ Advances in predictive infectious disease modelling to better inform
decisions about interventions in future outbreaks.
/// CHALLENGES

■ For rapid deployment, potential treatments need to be prepared prior
to an outbreak despite limited information and incentives.
■ Development of vaccines for RNA viruses requires frequent
evaluation and reformulation. It is complex, costly, and time
consuming.
■ Outbreak detection requires constant monitoring and coordination
among nations, which can be impeded by more closed societies.
■ Global economic consequences of such outbreaks can be serious.
According to multiple economic forecasting models, SARS cost the
global economy $30-100 billion.

Figure 3. The recent outbreaks of coronavirus-caused diseases known to infect humans /// POLICY CONTEXT AND QUESTIONS
(COVID-19 numbers are confirmed and as reported by China).
■ To what extent are surveillance and clinical data, computational
How mature is it? Several procedures, including diagnostic testing, models, and information sharing mechanisms in place to promote
are available to address coronaviruses, and are being used in the U.S. agile and effective risk management during disease outbreaks?
response. However, vaccines and therapies are not yet mature. ■ What policies and mechanisms are in place or needed to help
In the wake of the COVID-19 outbreak, Chinese researchers isolated the maintain medical supply chains during global disease outbreaks?
virus, sequenced its genome, and shared the results with the scientific /// SELECTED GAO WORK
community. The sequencing allowed CDC to develop a diagnostic test that
is now being distributed to local labs. Also, based on genetic similarities, a ■ National Biodefense Strategy: Additional Efforts Would Enhance
vaccine developed for SARS has been recommended by researchers as Likelihood of Effective Implementation GAO-20-273
a possible option for SARS-CoV-2. And researchers are drawing on the
SARS-CoV-2 genome to help determine which aspects of the coronavirus ■ Infectious Disease Threats: Funding and Performance of Key
might be used to develop a more specific vaccine against it. Preparedness and Capacity-Building Programs GAO-18-362
/// SELECTED REFERENCES
For those already infected, doctors are trying a drug originally made
to treat Ebola that also works against SARS and MERS. The first U.S. Centers for Disease Control and Prevention https://www.cdc.gov/coronavirus/index.html
patient diagnosed with COVID-19 was treated with this drug under
compassionate use (a policy allowing some use of non-approved drugs), World Health Organization https://www.who.int/health-topics/coronavirus
and additional antivirals are being tested.

GAO SUPPORT:
GAO meets congressional information needs in several ways, including by
providing oversight, insight, and foresight on science and technology issues.
GAO staff are available to brief on completed bodies of work or specific reports This document is not an audit product and is subject to revision based on continued
and answer follow-up questions. GAO also provides targeted assistance on advances in science and technology. It contains information prepared by GAO
specific science and technology topics to support congressional oversight activities to provide technical insight to legislative bodies or other external organizations.
and provide advice on legislative proposals. This document has been reviewed by the Chief Scientist of the U.S. Government
Accountability Office.
Timothy M. Persons, PhD, Chief Scientist, personst@gao.gov

Staff Acknowledgments: Karen Howard (Director), Laura Holliday (Assistant
Director), Eliot Fletcher (Analyst-in-Charge), Anika McMillon, and Ben Shouse.

GAO-20-472SP Coronaviruses

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