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.
Name
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
Pathogenesis
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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