Monday, January 27, 2020

Corona Virus Update: All questions answered

Corona Virus Update: All questions answered

Dr KK Aggarwal
President CMAAO, HCFI and past National President IMA

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.


The name of coronavirus comes from its shape, which resembles a crown or solar corona when imaged using an electron microscope.

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


People infected with these coronaviruses suffer a severe inflammatory response.

It has high mortality

In the current situation the mortality rate is 3%. The severity of illness is concerning: almost a third of patients developed acute respiratory distress syndrome requiring intensive care; six patients died; five had acute cardiac injury; and four required ventilation.

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 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 median time from onset of symptoms to first hospital admission was 7·0 days (4·0–8·0), to shortness of breath was 8·0 days (5·0–13·0), to ARDS was 9·0 days (8·0–14·0), to mechanical ventilation was 10·5 days (7·0–14·0), and to ICU admission was 10·5 days.

Its unlikely tp spread by eating sea food in India
It has been traced to snakes in China so unlikely to spread in India by eating 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 this coronavirus outbreak. However, how the virus could adapt to both the cold-blooded and warm-blooded hosts remains a mystery.

Flight Transmission

Transmission of foodborne diseases on aircraft, including cholera, shigellosis, salmonellosis, and staphylococcal food poisoning, have been well documented. Transmission of smallpox on aircraft was reported in 1965. An outbreak of influenza occurred in 1979 among passengers on a flight that had a three hours’ ground delay before takeoff. The influenza attack rate among the passengers was very high (72 %), and was attributed to the ventilation system not operating during the ground delay. Epidemiological investigations have also indicated that measles may have been transmitted aboard international flights. To date, no case of active TB has been identified as a result of exposure while on a commercial aircraft. However, there is some evidence that transmission of M. tuberculosis may occur during long (i.e. more than eight hours) flights, from an infectious source (a passenger or crew member) to other passengers or crew members.

 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.

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

Australia (4), Macau (1), Hong Kong ( 5), France(3), Japan (3), Malaysia (4), Nepal (1), Singapore (3), Taiwan (3), South Korea (3), Thailand (5), United states (3), Vietnam (2),

Is it a public health emergency

There is an emergency in China, but it has not yet become a global health emergency.

PMO Suggestions Sent

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

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