Outbreak of
2019-nCoV constitutes a PHEIC (Public Health Emergency of International
Concern)
Person-to-person transmission in three countries
outside China, Germany, Japan 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
There are now 7711 confirmed
and 12167 suspected cases throughout the country. Of the
confirmed cases, 1370 are severe and 170 people have died. 124 people have
recovered and been discharged from hospital. There are
now 83 cases in 18 countries. Of these, only 7 had
no history of travel in China. There has been human-to-human
transmission in 3 countries outside China. One of these cases is
severe and there have been no deaths. 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.
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 %.
Global
emergency
The
Director-General ICHR has declared that the outbreak of 2019-nCoV constitutes a
PHEIC (Public Health Emergency of International Concern)
Role of CMAAO
and other country medical associations
It is expected that further
international exportation of cases may appear in any country. All countries should be prepared for
containment, including active surveillance, early detection,
isolation and case management, contact tracing and prevention of onward
spread of 2019-nCoVinfection, 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
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.
It
is unlikely to spread through seafood in India
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 is weak
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.
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 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.
The incubation period
Up to 2
weeks, according to WHO.
Symptoms
Lancet: 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 for the coronavirus. 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.
Universal
droplets precautions the answer
1.
Quarantining for two weeks of the LRTI patient
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!
Its all over in 18 countries including Australia, India,
Macau, Hong Kong, France, Japan, Malaysia, Nepal, Singapore, Taiwan, South Korea, Thailand, United
states, Vietnam with person-to-person
transmission in three countries outside China, Germany, Japan and Vietnam
i.
On 28th
Jan the German Health Ministry confirmed a 33-year-old German, had contracted
the virus from a Chinese colleague who had visited the company a week ago.
Because the incubation period is believed to be unusually long — at up to two
weeks — it is possible that the Chinese colleague had no symptoms at the time.
On her flight home on 23 Jan, the woman began to fall ill on the plane. She
sought medical treatment after landing in China and tested positive for
coronavirus. When that information was relayed back to the German company, the
33-year-old also felt like he had flu and was subsequently tested positive for
the virus too. Now, 3 more co-workers in Germany of the Chinese woman have been
tested positive for the virus too.
ii.
A Japanese man with no recent travel to China
has contracted the Wuhan virus apparently after driving tourists visiting from
Wuhan. The man in his sixties from Nara in western Japan drove two groups of
Wuhan tourists earlier in January and was hospitalised on 25 Jan with flu-like
symptoms.
iii.
A 65-year-old Chinese man had infected his son
in Vietnam. On 22 Jan, the 65-year-old was admitted to Cho Ray Hospital in Ho
Chi Minh City. He had become ill with fever on 17 Jan, a total of 4 days after
he and his wife had flown to Hanoi from Wuhan. The couple’s healthy 27-year-old
son had lived in Long An, a province 40 km southwest of Ho Chi Minh City, since
October 2019 but had not been to Wuhan or had any known contact with any person
returning from there except his parents.
On 17 Jan, he met his father in Nha Trang in
central Vietnam and shared a bedroom with his parents for 3 days in a hotel
room. On 20 Jan, a dry cough and fever developed in the son. He also reported
having had vomiting and loose stools. When the son came to Cho Ray Hospital
with his father, he already had a high fever (39°C). Both father and son were
warded and subsequently tested positive for the Wuhan virus.
Evacuation
29th Jan: 9:15 am: Charter
jet evacuating Japanese nationals from Wuhan lands in Tokyo.
There are no signs of illness among the 195 Americans who were
flown out of Wuhan, China, on a chartered flight that
landed Wednesday in Southern California, public health officials said. All
were screened for signs of the new virus — fever, cough and other respiratory
symptoms — before boarding the plane in China. One person was not permitted on
board because of a fever.
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 leave for flu patients
