Friday, February 28, 2020

Super-spreader a must for becoming a hot spot of Corona Without a super spreader the cases in the Country may die out of its ownSuper-spreader a must for becoming a hot spot of Corona Without a super spreader the cases in the Country may die out of its own

Super-spreader a must for becoming a hot spot of Corona
Without a super spreader the cases in the Country may die out of its own

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

Super-spreader are individual patients who pass on an infection to large numbers of people and is a feature of nearly every outbreak. Infact the primary case of every epidemic is a super spreader. China cases in Wuhan also might have started with a super spreader.

On average, each person infected with the new coronavirus is passing it on to between two and three other people. But this is only an average; some people will pass it on to nobody while others pass their infection on to far more.

In 2015, a super-spreading event led to 82 people being infected from a single hospital patient with Middle East respiratory syndrome (Mers).

And in the Ebola epidemic in West Africa, most cases (61%) came from just a tiny handful of patients (3%).

Some just encounter far more people - either because of their job or where they live - and that means they can spread more of the disease, whether they themselves have symptoms. Others are "super-shedders", who release unusually large amounts of virus (or other bug) from their bodies, so anybody encountering them is more likely to become infected.

Hospitals treating severe acute respiratory syndrome (Sars) became a major centre of super-spreading because the sickest patients were also the most infectious and they encountered lots of healthcare workers.

It plays a big role at the beginning of any outbreak, when the virus is trying to get established. When it makes the jump into the first patient, the disease might fizzle out before it can cause a large outbreak. But if it can quickly find its way into a super-spreader, then it gives the outbreak a boost. The same rules apply when cases are imported into other countries.

"Typhoid Mary", Irish cook Mary Mallon (1869-1938), unknowingly passed on typhoid fever when she had no symptoms and ended up spending decades in exile and forced quarantine.

HIV person coinfected with STI becomes a super spreader.

A heterosexual man co-infected with HIV, hepatitis C virus, and herpes simplex 2 virus has unusually high semen HIV RNA levels.

20/80 rule, a small percentage of individuals within any population was observed to control most transmission events.

1. China first case looks like was a super spreader
2. The cases in Diamond Princess ship was a case of super spreader focal outbreak
3. The lady in South Korea cult church was a super spreader. There were 28 cases of the coronavirus in South Korea on Feb. 13. Four days had passed without a new confirmed infection. President Moon Jae-in predicted that the outbreak would “disappear before long,” while the prime minister assured people that it was OK not to wear surgical masks outdoors. They probably missed the super spreader possibility. The virus had been rapidly spreading at the time through a large, secretive church in Daegu, with the presence of a super spreader, where it has since mushroomed into the largest epidemic of the coronavirus outside China, with 1,766 cases, including 13 deaths. Now the president is facing a political backlash over his response as the number of cases continues to climb — 505 new infections on Thursday alone.
 4. Iran outbreak is possibly from a super spreader

Possibilities of finding super spreaders

1.     Person with lower respiratory corona illness

2.     Person with coronas pneumonia

3.     Critically ill or terminal corona infected patients

4.     Immunocompromised persons with corona infection

5.     Person who have not suffered from any other corona illness in past with non-virulent strains

6.     Rapidly developing corona illness with very short incubation period

7.     Direct exposure to a super spreader compared to secondary or tertiary cases

8.     Co-infection with another pathogen

9.     Delayed identification and hospital admission of a super spreader

In India we got three cases and none of them was a super spreader. Lots of Afghanis are coming from IRAN, a possible source of super spreader. And if one super spreader come to India it will create a havoc.

1.     Low grade transmission: Through a spreader
2.     High grade transmission: through a super spreader, usually will end up with community spread.

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