CMAAO Update 5th
February on Corona 2019 nCoV
Beware
of Common Myths: It is safe to receive a letter or a package from China.
Kerala
government declares coronavirus as state disaster: Three primary cases in North,
South and Central Kerala (Kasaragod district is in north Kerala, Thrissur
in central Kerala and Alappuzha in South Kerala]
Dr KK Aggarwal
President CMAAO,
HCFI and Past National President IMA
Beware of Myths
1. It is safe to receive
a letter or a package from China. People receiving packages from China are not
at risk of contracting the new coronavirus. Coronaviruses do 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 always a good idea to wash your hands with soap and
water after contact with pets. This protects you against various common
bacteria such as E.coli and Salmonella that can pass between pets and humans.
3. Vaccines against
pneumonia, such as pneumococcal vaccine and Haemophilus influenza type B (Hib)
vaccine, do not provide protection against the new coronavirus.
4.
There is no evidence that regularly rinsing the nose with saline
has protected people from infection with the new coronavirus. There is
some limited evidence that regularly rinsing nose with saline can help people
recover more quickly from the common cold. However, regularly rinsing the nose
has not been shown to prevent respiratory infections.
5.
There is no evidence that using mouthwash will protect you from
infection with the new coronavirus. Some brands or mouthwash can eliminate
certain microbes for a few minutes in the saliva in your mouth. However, this
does not mean they protect you from 2019-nCoV infection.
6.
There is no evidence that using mouthwash will protect you from
infection with the new coronavirus. Some brands or mouthwash can eliminate
certain microbes for a few minutes in the saliva in your mouth. However, this
does not mean they protect you from 2019-nCoV infection.
7.
Sesame oil does not
kill the new coronavirus. There are some chemical disinfectants that can kill
the 2019-nCoV on surfaces. These include 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. The new
coronavirus (2019-nCoV) is a virus and, therefore, antibiotics should not be
used as a means of prevention or treatment. However, if you are hospitalized
for the 2019-nCoV, you may receive antibiotics because bacterial co-infection
is possible.
10. To date, there is no
specific medicine recommended to prevent or treat the new coronavirus
(2019-nCoV). However, those infected with the virus should receive appropriate care
to relieve and treat symptoms, and those with severe illness should receive
optimized supportive care. Some specific treatments are under investigation,
and will be tested through clinical trials. WHO is helping to accelerate
research and development efforts with a range or partners.
Summary
Continue
asking patients with suspected flu or diarrhoea if they, or someone they have
been in contact with, recently returned from corona affected area.
Corona is a Public Health
Emergency of International Concern (mandatory
to report to WHO human and animal cases) as person-to-person transmission in
UK, USA, Germany, Japan, Taiwan and Vietnam and two deaths, one in the
Philippines on Feb 2 (44 M) and 2nd in Hong Kong ( 39 M) on February outside of mainland China.
The virus behaves like SARS with 2 % case fatality
(15% of admitted cases), time to death
14 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.
Status
The Novel Coronavirus
(2019-nCoV) originating from Wuhan, China, has now spread to 28
countries and territories worldwide, with 24552 confirmed
cases and 492 deaths (median age45,
range 2-74, predominately males 71%, deaths more in comorbid cases, Just like SARS, it mostly do not affect
children 15 years or less of age). 64 deaths on 3rd feb.
Anticipates one lac already infected.
Countries and territories that have
confirmed cases: Thailand, Japan, Hong Kong, Singapore, Taiwan, Australia,
Malaysia, Macau, Russia, France, the United States, South Korea, Germany, the
United Arab Emirates, Canada, Britain, Vietnam, Italy, India, the Philippines,
Nepal, Cambodia, Sri Lanka, Finland, Sweden and Spain.
Cases recorded in Thailand, Taiwan,
Germany, Vietnam, Japan, France and the United States involved patients who had
not to 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 in Mid December 2019
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 virus
2019-nCoV is sufficiently divergent from SARS-CoV to be
considered a new human-infecting betacoronavirus. Structural analysis suggests
that 2019-nCoV might be able to bind to the angiotensin-converting enzyme 2
receptor in humans. It is a single-strand, positive-sense RNA genome ranging
from 26 to 32 kilobases in length.
The case fatality is lower than SARS, MERS and EBOLA
2019
nCoV mortality rate is 2% ( earlier thought to be 3%) compared to MERS 34%,
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 %.
Once the province Hubei (where the epicenter Wuhan is situated)
is removed from the calculation, the national (China) mortality rate drops to
0.3%. Within the Hubei province, the mortality rate is about 1% when excluding
the city of Wuhan (where it is 5.5%).
The case fatality rate with seasonal flu is less than 0.01% (1
death per every 10,000 cases)[8].
Role of CMAAO
and other Medical Associations
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. 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 but It is unlikely to spread
through seafood in India
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, 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
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. However 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.
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.
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.
It’s predominantly 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. In lab we need minimum BSL
3 ( or BSL 4 facilities) to prevent transmission.
The incubation period
Up to 2
weeks, according to WHO. Mean 5.5 days
Symptoms
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.
|
Clinical features
|
|
Epidemiologic risk
|
|
Fever* 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-confirmedΔ◊ 2019-nCoV
patient within 14 days of
symptom onset
|
|
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
|
|
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
|
nCoV: novel coronavirus; CDC: United States Centers
for Disease Control and Prevention; NIOSH: National Institute for Occupational
Safety and Health.
* Fever may be subjective or confirmed.
¶ CDC definition of close contact (any of following):
§ 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.
§ Having direct contact
with infectious secretions of a 2019-nCoV case (eg, being coughed on) while not
wearing recommended personal protective equipment.
Δ Documentation of laboratory
confirmation of 2019-nCoV may not be possible for travelers or persons caring
for patients in other countries.
◊ This category also includes any
member of a cluster of patients with severe acute lower respiratory illness
(eg, pneumonia, acute respiratory distress syndrome) of unknown etiology in
whom 2019-nCoV is being considered that requires hospitalization. Such persons
should be evaluated in consultation with state and local health departments
regardless of travel history.
Drugs
There is no proven antiviral
treatment. 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.
Chloroquine, which has 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. However, there
have been no studies of efficacy in humans.
Thai doctors have used oseltamivir along with lopinavir
and ritonavir, both HIV drugs. An experimental drug from Gilead Sciences Inc.,
called remdesevir, has encouraging results.
PVP-I mouthwashes and gargles significantly reduce viral load in the oral
cavity and the oropharynx. The importance of PVP-I has been emphasised by its
inclusion in the World Health Organization’s list of essential medicines, and
high potency for virucidal activity has been observed against viruses of
significant global concern, including hepatitis A and influenza, as well as the
Middle-East Respiratory Syndrome and Sudden Acute Respiratory Syndrome
coronaviruses.
Universal droplets precautions the answer
1.
Quarantining for two weeks
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!
Travel
1. Requires contact
of ten minutes within a distance of six feet
2. The virus can
remain alive on any surface for 3-12 hours
3.
Choosing a window seat and staying put clearly lowers your likelihood of
encountering an infectious disease.
Contagiousness
The reproduction number—R0
or “r naught”—simply refers to the number of additional people that an infected
person typically makes sick.
A more recent study is indicating a Ro as high as 4.08. This
value substantially exceeds WHO's estimate (made on Jan. 23) of between 1.4 and
2.5], and is also higher than recent estimates between 3.6 and 4.0
and between 2.24 to 3.58 . Preliminary studies had estimated Ro to be
between 1.5 and 3.5. Based on these numbers, on average every
case of the Novel Coronavirus would create 3 to 4 new cases. 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.
Evacuation
Tokyo, Japan, India have evacuated
their citizens trapped in China afrected areas
Coronavirus: Mass Quarantine May Spark Irrational Fear, Anxiety, Stigma
Comparisons:
- Every
year an estimated 290,000 to 650,000 people die in the world due to
complications from seasonal influenza (flu) viruses. This figure
corresponds to 795 to 1,781 deaths per day due to the seasonal flu.
- SARS
(Nov. 2002 - Jul. 2003): was a coronavirus that originated from Beijing,
China, spread to 29 countries, with 8,096 people infected and 774 deaths
(with a fatality rate of 9.6%). Considering that SARS ended up infecting
5,237 people in mainland China, Wuhan Coronavirus surpassed SARS on
January 29, 2020, when Chinese officials confirmed 5,974 cases of the
novel coronavirus (2019-nCoV). One day later, on January 30, 2020 the
novel coronavirus cases surpassed even the 8,096 cases worldwide
representing the final SARS count in 2003.
- MERS
(2012) killed 858 people out of the 2,494 infected (with a fatality rate
of 34.4%).
PMO Suggestions
10th January: I wrote an editorial:
Corona virus strain causing pneumonia in Wuhan, China
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)
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 from China affected
areas, Time to collaborate on Nosode therapy (Exports of masks banned on 31st
January by Indian Government)
27: History of anti-fever drugs at airports should be taken
28: Do research on Nosodes
29: Closure of live markets all iover
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, suspend AI
flights to China and Hong Kong [New Delhi, Feb 4 (IANS) National passenger carrier Air India on
Tuesday said that it will suspend flight services to Hong Kong owing to the
outbreak of deadly coronavirus. The suspension will come into force from Friday
until March 28, the airline said in a statement. Earlier, Air India had
cancelled its flight to Shanghai from January 31 to February 14.]
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]
Confirmed Cases and Deaths
by Country and Territory
(Affecting 28 countries
and territories)
Search:
|
Country
|
Cases
|
Deaths
|
Region
|
|
China
|
24,324
|
490
|
Asia
|
|
Japan
|
33
|
0
|
Asia
|
|
Thailand
|
25
|
0
|
Asia
|
|
Singapore
|
24
|
0
|
Asia
|
|
South Korea
|
18
|
0
|
Asia
|
|
Hong Kong
|
17
|
1
|
Asia
|
|
Australia
|
13
|
0
|
Australia/Oceania
|
|
Germany
|
12
|
0
|
Europe
|
|
United States
|
11
|
0
|
North America
|
|
Taiwan
|
11
|
0
|
Asia
|
|
Malaysia
|
10
|
0
|
Asia
|
|
Vietnam
|
10
|
0
|
Asia
|
|
Macao
|
10
|
0
|
Asia
|
|
France
|
6
|
0
|
Europe
|
|
United Arab Emirates
|
5
|
0
|
Asia
|
|
Canada
|
5
|
0
|
North America
|
|
India
|
3
|
0
|
Asia
|
|
Philippines
|
2
|
1
|
Asia
|
|
Italy
|
2
|
0
|
Europe
|
|
United Kingdom
|
2
|
0
|
Europe
|
|
Russia
|
2
|
0
|
Europe
|
|
Nepal
|
1
|
0
|
Asia
|
|
Finland
|
1
|
0
|
Europe
|
|
Sweden
|
1
|
0
|
Europe
|
|
Sri Lanka
|
1
|
0
|
Asia
|
|
Cambodia
|
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. 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. 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%
|
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