CMAAO Update 7th February on Corona 2019
nCoV
3849 serious
cases of coronavirus in China, Mortality
in admitted cases 15%
Number of
deaths likely to cross 1000
Dr
KK Aggarwal
President
CMAAO, HCFI and Past National President IMA
Summary
Behaves like SARS with 2 % case fatality (15%
of admitted cases), time to death 14
days, time to pneumonia 9 days, 3-4
reproductive number R0, has its origin from bats, spreads like large droplets
and predominately from people having lower respiratory infections and hence
universal droplet precautions the answer.
Case Definition
1.
Fever (subjective
or confirmed)
OR signs/symptoms of lower respiratory illness (cough or shortness of
breath)
PLUS, any person, including health care workers, who has had close
contact with a laboratory-confirmed 2019-nCoV patient within 14 days of
symptom onset.
2.
[Contact means: Being within approximately
6 feet (2 meters) or within the room or care area of a 2019-nCoV case for a
prolonged period of time while not wearing recommended personal protective
equipment (gowns, gloves, NIOSH-certified disposable N95 respirator, eye
protection); close contact can include caring for, living with, visiting, or
sharing a health care waiting area or room with a 2019-nCoV case OR having
direct contact with infectious secretions of a 2019-nCoV case (e.g., being
coughed on) while not wearing recommended personal protective equipment.]
3. Fever and signs/symptoms of lower respiratory illness (cough
or shortness of breath) PLUS a history of travel from Hubei Province, China
within 14 days of symptom onset
4.
Fever and signs/symptoms
of lower respiratory illness (cough or shortness of breath) requiring
hospitalization PLUS a history of travel from mainland China within 14 days
of symptom onset.
Continue asking patients with suspected flu or
diarrhoea if they, or someone they have been in contact with, recently returned
from corona affected area. [ in US confirmed case they 2019-nCoV
RNA in a stool specimen collected on day 7 of the patient’s illness.]
Take Home Messages
Delhi Help line number:
+91-11-23978046
Virus: Single-strand,
positive-sense RNA genome ranging from 26 to 32 kilobases in length.
Type: Beta corona virus
Family: Corona
virus family. ‘corona’ means crown or the halo surrounding the sun. Heart is
considered crown and hence coronary arteries. In electron microscope, it is round
with spikes poking out from its periphery.
Link to ACE: 2019-nCoV
might be able to bind to the angiotensin-converting enzyme 2 receptor in
humans.
Origin: Wuhan,
China December 2019
Spread: 28
countries and territories
Confirmed cases: 31481
Deaths: 638
New
Cases: On Feb 5,
31 provincial-level regions on the Chinese mainland as well as the Xinjiang
Production and Construction Corps reported 3,694 (2,987 in Hubei province)
Suspected
cases on 5th : 5,328 new cases (3,230 in Hubei province)
Serous
cases on 5th : 640 new
serious cases (564 in Hubei province)
Deaths on
5th Feb: 73 (70 in Hubei province, 1 in Tianjin, 1 in
Heilongjiang province and 1 in Guizhou province)
Deaths on
6th Feb: 73
Discharged
on 5th: 261 cured (113 in Hubei province)
Freed
from medical observation on 5th: 21,365
Total
cured: 1,153
Suspected
cases: 24,702
Quarantine:
26,302
patients
Serious: 3,859 in serious condition
Close
contacts: 282,813 people
Medical
observation: 186,354
42
confirmed infections had been reported in the Hong Kong and Macao special
administrative regions and Taiwan province: 21 in Hong Kong (1 death), 10 in
Macao and 11 in Taiwan.
Three
deadly human respiratory coronaviruses viruses: Severe acute respiratory syndrome
coronavirus [SARS-CoV], Middle East respiratory syndrome coronavirus
[MERS-CoV]) and 2019-nCoV: The virus is 75 to 80% identical to the SARS-CoV
Emergency: It is
a Public Health Emergency of International Concern (mandatory to report to WHO human and animal
cases)
Kerala: state
public health emergency. Three primary cases in North, South and Central
Kerala (Kasaragod district is in north Kerala, Thrissur in central
Kerala and Alappuzha in South Kerala]. Four Karnataka
districts bordering Kerala — Kodagu, Mangaluru, Chamarajanagar and Mysuru have
been put on high alert.
Median age: 59
years (2-74 years)
Male to female ratio: 56% male
Link to Huanan Seafood Wholesale Market: 55% with
onset before January 1, 2020 and 8.6% of the subsequent cases.
Mean incubation period: 5.2
days (95% confidence interval [CI], 4.1 to 7.0), with the 95th percentile of
the distribution at 12.5 days.
Epidemic doubling time: In its
early stages, every 7.4 days. With a mean serial interval of 7.5 days (95% CI,
5.3 to 19)
Contagiousness or Basic reproductive number: 2.2 (95%
CI, 1.4 to 3.9). The reproduction number R0
or “r naught” refers to the number of additional people that an infected person
typically makes sick. An outbreak with a
reproductive number of below 1 will gradually disappear. The Ro for the common
flu is 1.3 and for SARS it was 2.0.
Comorbid conditions: 71%,
deaths in comorbid cases,
0-15 years age: Just like SARS, it mostly
does not affect children 15 years or less of age
Daily deaths: 73 deaths on 5th
(15% rise), 66 on 4th, 64 on 3rd Feb.
Anticipates: one lac already infected.
Secondary cases: Thailand, Taiwan, Germany, Vietnam, Japan, France and the United
States
Deaths outside China: Philippines
on Feb 2 (44 M) and 2nd in Hong Kong ( 39 M) on February 4
ICU need: 20% needed ICU care with 15% of them died
Fever: In all (no fever no corona)
Cough: 75% cases
Weakness or muscle ache: 50%^
Shortness of breath: 50%
TLC: low
Liver transaminase levels: raised
Case
fatality:
2%
Case
fatality in admitted cases:
15%
Time to death: 14 days
Time to pneumonia: 9 days
Origin: Bats
Mode of spread: Large
droplets and predominately from people having lower respiratory infections
Answer: Universal
droplet precautions the answer.
Incubation period: up to 2 weeks, according to
WHO. Mean 5.5 days
Transmission:
Predominantly a large droplet and contact and less so by means of
aerosols and fomites
Lab
precautions:
BSL 2 or 3
Human
to human contact period: Requires
contact of ten minutes within six feet
Virus
life span: The
virus can remain alive on any surface for 3-12 hours
Travel preferable seat: Choosing a window seat and staying lowers the risk
Travel advisory: Level 1 in all countries (Exercise
normal safety precautions), Level 2 in all affected countries and states including Kerala
( Exercise a high degree of caution), Level 3 in all countries with secondary
cases (Reconsider your need to travel) and Level 4 in China ( Do not travel). Hong
Kong has imposed 14 days quarantine on people arriving from china. The Karnataka government has ordered
that anybody arriving from the 23 coronavirus affected countries must stay in
isolation at home for 28 days. The home isolation requirement is irrespective
of the virus symptoms.
High viral load: Detection of 2019-nCoV RNA in specimens from
the upper respiratory tract with low Ct values on day 4 and day 7 of illness is
suggestive of high viral loads and potential for transmissibility. [NEJM]
Risk to other Asian countries including India: Currently,
people at risk are healthcare workers caring for 2019-nCoV patients and other
close contacts of 2019-nCoV patients. For the general public, who are unlikely
to be exposed to this virus, the immediate health risk from 2019-nCoV is
considered low at this time.
It is less likely to have the serious illness in
other countries. As patients with breathlessness are unlikely to board and patients
will mild illness or asymptomatic illness are less likely to transmit infections.
Zoonotic
but unlikely to spread through seafood: 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. 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.
Infectiousness
to humans: 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.
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. Though 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 but the same has been challenged now.
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.
No sore throat: 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.
Asymptomatic transmission: One
report of a small cluster of five cases suggested transmission from
asymptomatic individuals during the incubation period; all patients in this
cluster had mild illness. Another case got infected while using gown, but eyes
not covered. NEJM reported a transmission from asymptomatic case but the same
has been challenged.
Mass Quarantine May Spark
Irrational Fear, Anxiety, Stigma
Evacuation: Tokyo, Japan, India have evacuated their citizens trapped in
China affected areas. All 645 evacuees from
Wuhan test negative for the deadly infection in India.
Legal implications in India: Section 270 in The Indian Penal Code: 270. Malignant act likely to spread
infection of disease dangerous to life.—Whoever malignantly does any act which
is, and which he knows or has reason to believe to be, likely to spread the
infection of any disease dangerous to life, shall be punished with imprisonment
of either description for a term which may extend to two years, or with fine, or
with both.
Case
fatality of coronavirus 2%
Case
fatality of MERS
34% (2012, killed 858 people out of the 2,494 infected)
Case
fatality of SARS 10%
(Nov. 2002 - Jul. 200, originated from Beijing, spread to 29 countries, with
8,096 people infected and 774 deaths)
Case
fatality of Ebola 50%,
Case
fatality of Smallpox
30-40%
Case
fatality of Measles
10-15% developing countries
Case
fatality of Polio
2-5% children and 15-30% adults
Case
fatality of Diphtheria
5-10%
Case
fatality of Whooping cough 4%
infants < 1yr, 1% children < 4 years
Case
fatality of Swine flu <
0.1-4 %
Case
fatality of seasonal flu
0.01%.
Case
fatality of current virus in Wuhan 4.9%.
Case fatality of current virus in Hubei Province 3.1%.
Case fatality of current virus in Nationwide 2.1%.
Case fatality of current virus in other provinces 0.16%.
Number of flu deaths every year: 290,000 to 650,000 (795 to 1,781
deaths per day)
Treatment:
No proven antiviral treatment.
SARS Experience: A combination of
lopinavir and ritonavir showed promise in lab
MERS experience: Combination of
lopinavir, ritonavir and recombinant interferon beta-1b has been tried
Recreation of Virus: Scientists in Australia have reportedly recreated a lab-grown
version of coronavirus.
Chloroquine: had 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.
Thai experience: Oseltamivir along with lopinavir
and ritonavir, both HIV drugs.
Experimental drug: Rrom Gilead Sciences Inc., called remdesevir (started on 6th
Feb as a trial)
Russia and China drug: Arbidol,
an antiviral drug used in Russia and China for treating influenza, could be
combined with Darunavir, the anti-H.I.V. drug, for treating patients with the
coronavirus. {the corona virus shares some similarity to HIV virus also)
PVP-I
mouthwashes and gargles significantly reduce viral load in the
oral cavity and the oropharynx. PVP-I has high potency for viricidal activity
against hepatitis A and influenza, MERS and SARS
DCGI Approval: The
Drug Controller General of India has approved the "restricted use" of
a combination of drugs used widely for controlling HIV infection in public
health emergency for treating those affected by novel coronavirus.
Universal respiratory droplets precautions
Self-quarantining:
2
weeks
Adherence: Strict
Soap and water: Wash your hands often and for at
least 20 seconds.
Alcohol-based hand sanitizer: if soap and water is not available
Avoid touching: your eyes, nose, and mouth with
unwashed hands.
Avoid close contact: (3-6 feet) with people who are
sick with cough or breathlessness
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.
Surgical Masks: For patients
N 95 Masks: For health care providers and close contacts
Ten Common Myths
1. People receiving packages from China are not at risk of
contracting the new coronavirus as the virus does not survive long on objects,
such as letters or packages.
2. There is no evidence that companion animals/pets such as dogs or
cats can be infected with the new coronavirus. However, it is good to wash your
hands with soap and water after contact with pets. To prevent transmission of common
bacteria such as E. coli and Salmonella.
3. Pneumococcal vaccine and Haemophilus influenza type B (Hib)
vaccine, do not provide protection against the new coronavirus.
4.
Regularly rinsing the nose with
saline does not protect people from infection with the new coronavirus or
respiratory infections although it can help people recover more quickly from
the common cold.
5.
There is no evidence that using
mouthwash will protect you from infection with the new coronavirus although some
brands or mouthwash can eliminate certain microbes for a few minutes in the
saliva in your mouth.
6.
Garlic is a healthy food that
may have some antimicrobial properties, however, there is no evidence that
eating garlic protects people from the new coronavirus.
7.
Sesame oil does not kill the
new coronavirus. Chemical disinfectants that can kill the 2019-nCoV on surfaces
are bleach/chlorine-based disinfectants, either solvents, 75% ethanol,
peracetic acid and chloroform. However, they have little or no impact on the virus if you put them on
the skin or under your nose. It can even be dangerous to put these chemicals on
your skin.
8.
People of all ages can be infected by
the new coronavirus (2019-nCoV). Older people, and people with pre-existing
medical conditions (such as asthma, diabetes, heart disease) appear to be more
vulnerable to becoming severely ill with the virus. WHO advises people of
all ages to take steps to protect themselves from the virus, for example by
following good hand hygiene and good respiratory hygiene?
9.
Antibiotics do not work against
viruses, only bacteria. Hence antibiotics
should not be used as a means of prevention or treatment of new coronavirus
unless you suspect bacterial co-infection.
10. To date, there is no specific medicine recommended to prevent or
treat the new coronavirus (2019-nCoV).
Role of CMAAO and other Medical Associations
1. 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.
2. All
countries are legally required to share information with
WHO under the IHR.
3. 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.
4. All
countries should emphasise on reducing human infection, prevention of secondary
transmission and international spread.
PMO Suggestions sent
7th
January: CMAAO Alert: WHO to
monitor China's mysterious pneumonia of unknown virus outbreak
8th
Jan: CMAAO warns Asian citizens
travelling China over mystery pneumonia outbreak
10th
January: I wrote an editorial: Corona virus
strain causing pneumonia in Wuhan, China, It’s a new strain of corona virus in the
china pneumonia
13th January:
China Virus Outbreak Linked to Seafood Market:
China Virus Outbreak Linked to Seafood Market:
15th January:
First Case China Pneumonia Virus Found Outside China in Thailand
First Case China Pneumonia Virus Found Outside China in Thailand
17th January: WHO issues warning after 'mysterious' Chinese
corona virus spreads to Japan
17th Jan: India at threat of Corona. CMAAO urges travel advisory on
coronavirus: http://www.drugtodayonline.com/medical-news/nation/10379-cmaao-urges-travel-advisory-on-coronavirus.html
(18th Indian govt issues travel
advisory as China's mysterious 'Coronavirus' spread in other countries)
18th Jan:
WHO issues warning after mysterious Chinese Coronavirus spreads to
Japan [http://blogs.kkaggarwal.com/tag/who/]
18-20
Jan: Three countries meet, also discussed Corona virus
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 and neighbouring countries from
China affected areas, Time to collaborate on Nosode therapy (Exports of masks
banned on 31st January by Indian Government) Action: [ Feb 1st: Ibrahim
Mohamed Solih thanked India for the evacuation of seven Maldivian nationals
from the coronavirus-hit Chinese city of Wuhan. India evacuated 647 people]
27:
History of anti-fever drugs at airports should be taken
28:
Do research on Nosodes
29:
Closure of live markets all over the world, India should take a lead
30:
Paid flu leave, surgical mask at public places, N 95 for health care providers
31:
Respiratory hygiene advisory schools, Pan India task force to be made
1st
Feb: Disaster Budget is the need of the hour
3rd
Feb: 100 crore budget for Corona virus; Private labs to be recognised; one
dedicated corona National help line, MTNL BSNL to have a line of advisory in
their bills, isolation wards to be single rooms or two beds separated with six
feet distance, national insurance to cover cost of treatment, Sea ports to have same precautions, prize caps for masks, and
gloves, National droplet control program, clarification that import of goods is
not risky And suspend AI flights to China and Hong Kong
[Feb 4 Air India on
Tuesday suspended flight services to Hong Kong from Friday until March 28. Earlier,
Air India had cancelled its flight to Shanghai from January 31 to February 14
and on 5th Feb the Ministry of Defence is setting up 10 new laboratories across the
country, primarily to conduct research on viruses]
4th
Feb: Kerala travel advisory needed [The Union Ministry of Health and Family
Welfare issued a fresh travel advisory on Monday urging people to refrain from
visiting China]
5th Feb: PM should talk about Corona in Man Ki Baat
or a special address
6th Feb: Time to have makeshift bed policy to tackle deaths in Kota, Muzaffarpur and Corona
Confirmed Cases and Deaths by Country and Territory
(Affecting 28 countries
and territories)
Search:
Country
|
Cases
|
Deaths
|
Region
|
China
|
31,161
|
636
|
Asia
|
Japan
|
86
|
0
|
Asia
|
Singapore
|
30
|
0
|
Asia
|
Thailand
|
25
|
0
|
Asia
|
Hong Kong
|
24
|
1
|
Asia
|
South Korea
|
24
|
0
|
Asia
|
Taiwan
|
16
|
0
|
Asia
|
Australia
|
15
|
0
|
Australia/Oceania
|
Malaysia
|
14
|
0
|
Asia
|
Germany
|
13
|
0
|
Europe
|
United States
|
12
|
0
|
North America
|
Vietnam
|
12
|
0
|
Asia
|
Macao
|
10
|
0
|
Asia
|
Canada
|
7
|
0
|
North America
|
France
|
6
|
0
|
Europe
|
United Arab Emirates
|
5
|
0
|
Asia
|
Philippines
|
3
|
1
|
Asia
|
India
|
3
|
0
|
Asia
|
United Kingdom
|
3
|
0
|
Europe
|
Italy
|
3
|
0
|
Europe
|
Russia
|
2
|
0
|
Europe
|
Finland
|
1
|
0
|
Europe
|
Sweden
|
1
|
0
|
Europe
|
Sri Lanka
|
1
|
0
|
Asia
|
Cambodia
|
1
|
0
|
Asia
|
Nepal
|
1
|
0
|
Asia
|
Spain
|
1
|
0
|
Europe
|
Belgium
|
1
|
0
|
Europe
|
Total Deaths of Novel Coronavirus
(2019-nCoV)
Date
|
Total
Deaths |
Change
in Total |
Change in
Total (%) |
Feb. 6
|
638
|
73
|
13%
|
Feb. 5
|
565
|
73
|
15%
|
Feb. 4
|
492
|
66
|
15%
|
Feb. 3
|
426
|
64
|
18%
|
Feb. 2
|
362
|
58
|
19%
|
Feb. 1
|
304
|
45
|
17%
|
Jan. 31
|
259
|
46
|
22%
|
Jan. 30
|
213
|
43
|
25%
|
Jan. 29
|
170
|
38
|
29%
|
Jan. 28
|
132
|
26
|
25%
|
Jan. 27
|
106
|
26
|
33%
|
Jan. 26
|
80
|
24
|
43%
|
Jan. 25
|
56
|
15
|
37%
|
Jan. 24
|
41
|
16
|
64%
|
Jan. 23
|
25
|
8
|
47%
|
Daily Deaths of Novel Coronavirus
(2019-nCoV)
Date
|
Daily
Deaths |
Change
in Daily |
Change in
Daily (%) |
Feb. 6
|
73
|
0
|
0%
|
Feb. 5
|
73
|
7
|
11%
|
Feb. 4
|
66
|
2
|
3%
|
Feb. 3
|
64
|
6
|
10%
|
Feb. 2
|
58
|
13
|
29%
|
Feb. 1
|
45
|
-1
|
-2%
|
Jan. 31
|
46
|
3
|
7%
|
Jan. 30
|
43
|
5
|
13%
|
Jan. 29
|
38
|
12
|
46%
|
Jan. 28
|
26
|
0
|
0%
|
Jan. 27
|
26
|
2
|
8%
|
Jan. 26
|
24
|
9
|
60%
|
Jan. 25
|
15
|
-1
|
-6%
|
Jan. 24
|
16
|
8
|
100%
|
Jan. 23
|
8
|
0
|
0%
|
Total Cases of Novel Coronavirus
(2019-nCoV)
Date
|
Total
Cases |
Change
in Total |
Change in
Total (%) |
Feb. 6
|
31,439
|
3,163
|
11%
|
Feb. 5
|
28,276
|
3,723
|
15%
|
Feb. 4
|
24,553
|
3,927
|
19%
|
Feb. 3
|
20,626
|
3,239
|
19%
|
Feb. 2
|
17,387
|
2,836
|
19%
|
Feb. 1
|
14,551
|
2,603
|
22%
|
Jan. 31
|
11,948
|
2,127
|
22%
|
Jan. 30
|
9,821
|
2,005
|
26%
|
Jan. 29
|
7,816
|
1,755
|
29%
|
Jan. 28
|
6,061
|
1,482
|
32%
|
Jan. 27
|
4,579
|
1,778
|
63%
|
Jan. 26
|
2,801
|
786
|
39%
|
Jan. 25
|
2,015
|
703
|
54%
|
Jan. 24
|
1,312
|
468
|
55%
|
Jan. 23
|
844
|
265
|
46%
|
Daily Cases of Novel Coronavirus (2019-nCoV)
Date
|
Daily
Cases |
Change
in Daily |
Change in
Daily (%) |
Feb. 6
|
3,163
|
-560
|
-15%
|
Feb. 5
|
3,723
|
-204
|
-5%
|
Feb. 4
|
3,927
|
688
|
21%
|
Feb. 3
|
3,239
|
403
|
14%
|
Feb. 2
|
2,836
|
233
|
9%
|
Feb. 1
|
2,603
|
476
|
22%
|
Jan. 31
|
2,127
|
122
|
6%
|
Jan. 30
|
2,005
|
250
|
14%
|
Jan. 29
|
1,755
|
273
|
18%
|
Jan. 28
|
1,482
|
-296
|
-17%
|
Jan. 27
|
1,778
|
992
|
126%
|
Jan. 26
|
786
|
83
|
12%
|
Jan. 25
|
703
|
235
|
50%
|
Jan. 24
|
468
|
203
|
77%
|
Jan. 23
|
265
|
132
|
99%
|
No comments:
Post a Comment