29th
Jan Update Corona Virus
2019 n-CoV
behaves like SARS, has its origin from bats, spreads like large droplets and predominately
from people having lower respiratory infections
Dr KK Aggarwal
President CMAAO, HCFI and past National President IMA
29th
Jan: 5,974 confirmed cases, with 132 deaths and 103 cured
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 %.
Its not a global emergency
yet
WHO now has clarified
that the risk was "very high in China, high at the regional level and high
at the global level." WHO explained that it had stated
"incorrectly" in its previous reports that the global risk was
"moderate". The correction of the global risk assessment does not mean
that an international health emergency has been declared. This is an emergency
in China but it has not yet become a global health emergency.
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.
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
Its all over (
but all primary cases, Secondary cases only in China)
Australia, Macau, Hong Kong, France, Japan, Malaysia, Nepal, Singapore, Taiwan, South Korea, Thailand, United
states, Vietnam
Evacuation
29th Jan: 9:15 am: Charter
jet evacuating Japanese nationals from Wuhan lands in Tokyo
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
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