Ask patients with suspected flu if they, or someone they have been in contact with,
recently returned from China
Public Health Emergency of International Concern
Person-to-person
transmission in UK, USA, Germany, Japan, Taiwan and Vietnam
2019 n-CoV behaves like SARS, has its origin from
bats, spreads like large droplets and predominately from people having lower
respiratory infections and hence universal droplet precautions the answer
Dr KK Aggarwal
President CMAAO,
HCFI and Past National President IMA
Status
As of Jan. 30, there were 8,236 confirmed cases of the
coronavirus in China and 171 deaths, with another 112 cases identified outside
of China in 21 other countries. India now has first confirmed case in Kerala in a student studying
in China.
It’s not new
Every decade a
zoonotic coronavirus crosses species to infect human populations and in this
decade, we have a virus, provisionally called 2019-nCoV, first identified in
Wuhan, China, in persons exposed to a seafood or wet market in Mid December
2019
CORONA: Crown or Coronary artery
Virus has an RNA
core and belongs to the corona virus family. ‘corona’ means crown or the halo
surrounding the sun. The arteries supplying oxygen to the heart are also called
coronary arteries, because the heart is considered the crown. In electron
microscope, it is round in shape with spikes poking out from its periphery.
The three deadly
human respiratory coronaviruses viruses so far
1.
Severe acute respiratory syndrome coronavirus
[SARS-CoV]
2.
Middle East respiratory syndrome coronavirus
[MERS-CoV])
3.
2019-nCoV: The virus is 75 to 80% identical to the
SARS-CoV
The case fatality
is lower than SARS, MERS and EBOLA
2019 nCoV mortality rate is 3% compared
to MERS 35%, SARS (out of 5327 cases) 10%, Ebola 50%, Small Pox 30-40%, Measles
10-15% developing countries, Polio 2-5% children and 15-30% adults, Diphtheria
5-10%, Whooping cough 4% infants < 1yr, 1% children < 4 years AND Swine
flu < 0.1-4 %.
Role of CMAAO and other Medical Associations
All countries should be prepared for
containment, including active surveillance, early detection,
isolation and case management, contact tracing and prevention of onward
spread of the virus and to share full data with WHO. All countries are
legally required to share information with WHO under
the IHR.
Any detection of 2019-nCoV in an animal (including
information about the species, diagnostic tests, and relevant epidemiological
information) should be reported to the World Organization for Animal
Health (OIE) as an emerging disease.
All countries should emphasise on reducing human
infection, prevention of secondary transmission and international spread.
Three is no travel or trade restriction based on
the current information available. All countries must inform
WHO about any travel measures taken. Countries are cautioned against
actions that promote stigma or discrimination, in line with the principles of
Article 3 of the IHR.
Its Zoonotic but It is unlikely to spread through seafood in India
It is closely
related to several bat coronaviruses. Bats are the primary reservoir for the
virus. SARS-CoV was transmitted to humans from exotic animals in wet markets,
whereas MERS-CoV is transmitted from camels to humans. In both cases, the
ancestral hosts were probably bats.
The virus has been traced to snakes in China,
so, it is unlikely to spread in India through sea food. Snakes often hunt for
bats in wild. Reports indicate that snakes were sold in the local seafood
market in Wuhan, raising the possibility that the 2019-nCoV might have jumped
from the host species - bats - to snakes and then to humans at the beginning of
the outbreak. However, it remains a mystery as to how the virus could adapt to
both the cold-blooded and warm-blooded hosts.
It is more
infectious to humans
Notably,
2019-nCoV grows better in primary human airway epithelial cells than in
standard tissue-culture cells, unlike SARS-CoV or MERS-CoV. It is likely that
2019-nCoV will behave more like SARS-CoV.
Human to Human
infection
Both SARS-CoV and
MERS-CoV infect intrapulmonary epithelial cells more than cells of the upper
airways. Consequently, transmission occurs primarily from patients with
recognized illness and not from patients with mild, nonspecific signs. However
NEJM has reported a case of 2019-nCoV
infection acquired outside of Asia in which transmission appears to have
occurred during the incubation period in the index patient.
It appears that
2019-nCoV uses the same cellular receptor as SARS-CoV (human
angiotensin-converting enzyme 2 [hACE2]), so transmission is
expected only after signs of lower respiratory tract disease develop.
The
paramount reason for breathless is the fact that this new virus attacks the
lungs and not just the throat. Patients so far have not presented with a sore
throat, the reason being that the 2019-nCoV launches an attack at the
intraepithelial cells of lung tissue.
It’s predominantly a large droplet
infection
Transmission of
2019-nCoV probably occurs by means of large droplets and
contact and less so by means of aerosols and fomites, on the basis of
experience with SARS-CoV and MERS-CoV. In lab we need minimum BSL 3 ( or BSL 4
facilities) to prevent transmission.
The incubation period
Up to 2 weeks, according to WHO. Mean
5.5 days
Symptoms
One-third
landed up in the intensive care unit; and as many as 15% of these succumbed to
the infection. Almost all patients presented with fever, more than two-thirds
had cough and almost 50% suffered from weakness or muscle ache. More than half
complained of shortness of breath.
2019-nCoV
not unlike other virus disease presents with low white cells and reduction in
lymphocyte count, and raised liver transaminase levels.
Most infected patients experience milder symptoms,
but about 1 in 5 people have severe illness, including pneumonia and
respiratory failure.
Drugs
There
is no proven antiviral treatment. A combination of lopinavir and ritonavir did
show some promise in patients with SARS, but this was in the lab and not in
humans. A randomised study is being done in Saudi Arabia in patients with MERS;
a combination of lopinavir, ritonavir and recombinant interferon beta-1b versus
placebo; the results are awaited.
Scientists
in Australia have reportedly recreated a lab-grown version of coronavirus. The breakthrough would help researchers around the world as
they race to develop a vaccine and detection tests.
Chloroquine, which has
potent antiviral activity against the SARS-CoV, has been shown to have similar
activity against HCoV-229E in cultured cells and against HCoV-OC43 both in
cultured cells and in a mouse model. However, there have been no studies of
efficacy in humans.
PVP-I mouthwashes and
gargles significantly reduce viral load in the oral cavity and the oropharynx.
The importance of PVP-I has been emphasised by its inclusion in the World
Health Organization’s list of essential medicines, and high potency for
virucidal activity has been observed against viruses of significant global concern,
including hepatitis A and influenza, as well as the Middle-East Respiratory
Syndrome and Sudden Acute Respiratory Syndrome coronaviruses.
Universal
droplets precautions the answer
1.
Quarantining for two weeks
2.
Timely diagnosis
3.
Strict adherence to universal precautions
·
Wash your hands often with soap and water for at least 20 seconds. If
soap and water are not available, use an alcohol-based hand sanitizer.
·
Avoid touching your eyes, nose, and mouth with unwashed hands.
·
Avoid close contact with people who are sick.
·
Stay home when you are sick.
·
Cover your cough or sneeze with a tissue, then throw the tissue in the
trash.
·
Clean and disinfect frequently touched objects and surfaces.
These are everyday
habits that can help prevent the spread of several viruses!
Travel
1. Requires contact
of ten minutes within a distance of six feet
2. The virus can
remain alive on any surface for 3-12 hours
3.
The reproduction number—R0 or “r naught”—simply refers to the
number of additional people that an infected person typically makes sick. Transmissibility
rate for the new coronavirus ranging from 2.0 to 3.1 people. That’s higher than
influenza—1.3 to 1.8—but like SARS, which has a basic reproduction number
in the 2 to 4 range. So, coronaviruses are slightly more prone to spreading
between people.
4. Choosing a
window seat and staying put clearly lowers your likelihood of encountering an
infectious disease.
Evacuation
Tokyo,
Japan, India have evacuated their citizens trapped in China afrected areas
Coronavirus:
Mass Quarantine May Spark Irrational Fear, Anxiety, Stigma
PMO Suggestions
17th Jan: India at threat of
Corona. Advisory should be issued (18th Indian govt issues travel
advisory as China's mysterious 'Coronavirus' spread in other countries)
22nd
Jan: Still not being declared to be a notifiable disease, N 95 to be included
in the list of essential drugs and prise capped, Oseltamivir,
should also be prise capped, air flights should have available air masks for
all passengers, not declaring flu like symptoms while boarding or landing
should be a punishable offence ( 23rd India advisory to airports)
24th:
Inter Ministerial Committee needs to be formed on Corona Virus ( PMO took a
meeting on 24th evening)
25th
Jan: Indian government should pay for Indians affected with the virus in China
26 Jan: Need of
National droplet Infection Control program, Policy to ban export of face masks,
policy to evacuate Indians from China affected areas, Time to
collaborate on Nosode therapy
27: Anti fever
drugs at airports should be taken
28: Do research
on Nosodes
29:
Closure of live markets
30:
Paid flu leave, mask at public places
31:
Resp hygiene advisory schools, Pan India task force
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