Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA
More than 50% countries ( 103), > 1 lac cases,
> 4505 expected deaths, > 318n expected deaths in Italy
India:
17 Indians abroad
infected with coronavirus: 16 cases reported from Japan on the
cruise ship and one from the UAE.
Total 51 cases
Update: 103 ( more than
50%) Countries,
106,195 cases, 3600 deaths, 60190 recovered,
60190 Currently
Infected Patients, 42405 (86%) in Mild Condition, 6035 (14%) Serious or
Critical, likely deaths ( 3600 + 6035
x 15 = 905 ) = 4505 with
the present trend and available treatment, 10,000 cases outside China. Likely
deaths in Italy 318 (they have the highest elderly population)
Near Pandemic: all continents except Antarctica, cases- clusters- community spread; deaths in
19 countries outside China; > 26,000 cases outside China, epidemics in
China, S Korea, Iran, Italy, France and Germany with > 20000 cases,
WHO: dog in Hong Kong infected with the coronavirus
isn’t showing any symptoms. Tested “weakly positive” for COVID-19 in late
February. There’s no evidence that animals can transmit the coronavirus but
they will study the case to address further questions.
All of the 3,533 people aboard a cruise ship idling off San Francisco will
be tested for the coronavirus, after 19 crew members and two passengers tested
positive.
Hubei, the Chinese province at the center of
the coronavirus outbreak, reported that there were no new infections outside
its capital, Wuhan.
Colour
Coding: Red
infected persons, Yellow close contacts of infected persons, Green non
infected.
Red and Yellow:
Isolation and Surgical Masks
Green: Universal
standard precautions, Hand hygiene, Cough etiquette and respiratory hygiene
COVID-19 Mortality Rate: March 5
1. 3.4% Mortality Rate estimate by the WHO as of March 3
2. Mortality Rate in China as of Feb. 20 (3.8% nationwide, 5.8% in Wuhan,
0.7% other areas)
3. Mortality Rate in China as of Feb. 4 (2.1% nationwide, 4.9% Wuhan, 3.1%
Hubei, and 0.16% other provinces) reported by the NHC of China
4. Death rate among patients admitted to hospital (HFR): 15%
5. Comparison, seasonal flu generally
kills far fewer than 1% of those infected.”
Confirmed Cases and Deaths by Country, Territory,
or Conveyance
The coronavirus COVID-19
is affecting 103 countries and territories around the world
and 1 international conveyance (the Diamond
Princess cruise ship harbored in Yokohama, Japan). The day is
reset after midnight GMT+0. The "New" columns for China display
the previous day changes (as China reports after the day is over). For all
other countries, the "New" columns display the changes for the current
day while still in progress.
Search:
|
Country,
Other |
Total
Cases |
New
Cases |
Total
Deaths |
New
Deaths |
Total
Recovered |
Active
Cases |
Serious,
Critical |
Tot Cases/
1M pop |
||
|
China
|
80,696
|
+45
|
3,097
|
+27
|
57,083
|
20,516
|
5,264
|
56.1
|
||
|
S. Korea
|
7,134
|
+93
|
50
|
+2
|
118
|
6,966
|
36
|
139.1
|
||
|
Italy
|
5,883
|
233
|
589
|
5,061
|
567
|
97.3
|
||||
|
Iran
|
5,823
|
145
|
1,669
|
4,009
|
69.3
|
|||||
|
France
|
949
|
16
|
12
|
921
|
45
|
14.5
|
||||
|
Germany
|
800
|
18
|
782
|
9
|
9.5
|
|||||
|
Diamond Princess
|
696
|
6
|
245
|
445
|
32
|
|||||
|
Spain
|
525
|
10
|
30
|
485
|
9
|
11.2
|
||||
|
Japan
|
461
|
6
|
76
|
379
|
28
|
3.6
|
||||
|
USA
|
438
|
+3
|
19
|
15
|
404
|
8
|
1.3
|
|||
|
Switzerland
|
268
|
1
|
3
|
264
|
31.0
|
|||||
|
UK
|
209
|
2
|
18
|
189
|
3.1
|
|||||
|
Netherlands
|
188
|
1
|
187
|
1
|
11.0
|
|||||
|
Belgium
|
169
|
1
|
168
|
1
|
14.6
|
|||||
|
Sweden
|
161
|
1
|
160
|
15.9
|
||||||
|
Norway
|
156
|
156
|
28.8
|
|||||||
|
Singapore
|
138
|
90
|
48
|
8
|
23.6
|
|||||
|
Hong Kong
|
108
|
2
|
51
|
55
|
6
|
14.4
|
||||
|
Malaysia
|
93
|
23
|
70
|
2.9
|
||||||
|
Bahrain
|
85
|
6
|
79
|
50.0
|
||||||
|
Austria
|
81
|
2
|
79
|
1
|
9.0
|
|||||
|
Australia
|
77
|
+3
|
3
|
22
|
52
|
1
|
3.0
|
|||
|
Greece
|
66
|
66
|
1
|
6.3
|
||||||
|
Kuwait
|
61
|
1
|
60
|
14.3
|
||||||
|
Canada
|
60
|
8
|
52
|
1
|
1.6
|
|||||
|
Iraq
|
54
|
4
|
1
|
49
|
1.3
|
|||||
|
Thailand
|
50
|
1
|
31
|
18
|
1
|
0.7
|
||||
|
Iceland
|
50
|
1
|
49
|
|||||||
|
Egypt
|
48
|
1
|
47
|
|||||||
|
Taiwan
|
45
|
1
|
15
|
29
|
1.9
|
|||||
|
UAE
|
45
|
7
|
38
|
2
|
4.5
|
|||||
|
India
|
34
|
3
|
31
|
|||||||
|
Lebanon
|
28
|
1
|
27
|
3
|
4.1
|
|||||
|
Denmark
|
27
|
1
|
26
|
4.7
|
||||||
|
San Marino
|
26
|
1
|
25
|
5
|
||||||
|
Czechia
|
26
|
26
|
2.4
|
|||||||
|
Israel
|
25
|
3
|
22
|
1
|
2.9
|
|||||
|
Portugal
|
21
|
21
|
2.1
|
|||||||
|
Vietnam
|
21
|
+1
|
16
|
5
|
||||||
|
Algeria
|
19
|
19
|
||||||||
|
Brazil
|
19
|
19
|
||||||||
|
Finland
|
19
|
1
|
18
|
3.4
|
||||||
|
Ireland
|
19
|
19
|
3.8
|
|||||||
|
Palestine
|
19
|
19
|
3.7
|
|||||||
|
Oman
|
16
|
2
|
14
|
3.1
|
||||||
|
Russia
|
15
|
3
|
12
|
|||||||
|
Ecuador
|
14
|
14
|
1
|
0.8
|
||||||
|
Georgia
|
13
|
13
|
1
|
3.3
|
||||||
|
Romania
|
13
|
3
|
10
|
0.7
|
||||||
|
Croatia
|
12
|
12
|
2.9
|
|||||||
|
Qatar
|
12
|
12
|
4.2
|
|||||||
|
Slovenia
|
12
|
12
|
5.8
|
|||||||
|
Macao
|
10
|
10
|
0
|
|||||||
|
Estonia
|
10
|
10
|
7.5
|
|||||||
|
Argentina
|
9
|
1
|
8
|
|||||||
|
Azerbaijan
|
9
|
9
|
0.9
|
|||||||
|
Mexico
|
7
|
+1
|
1
|
6
|
||||||
|
Saudi Arabia
|
7
|
1
|
6
|
|||||||
|
Chile
|
7
|
7
|
||||||||
|
Philippines
|
6
|
1
|
2
|
3
|
1
|
|||||
|
Belarus
|
6
|
6
|
0.6
|
|||||||
|
Pakistan
|
6
|
1
|
5
|
|||||||
|
Peru
|
6
|
6
|
||||||||
|
Poland
|
6
|
6
|
||||||||
|
New Zealand
|
5
|
5
|
1.0
|
|||||||
|
French Guiana
|
5
|
5
|
||||||||
|
Hungary
|
5
|
5
|
0.5
|
|||||||
|
Afghanistan
|
4
|
4
|
||||||||
|
Indonesia
|
4
|
4
|
||||||||
|
Senegal
|
4
|
1
|
3
|
|||||||
|
Luxembourg
|
3
|
3
|
||||||||
|
North Macedonia
|
3
|
3
|
1.4
|
|||||||
|
Bosnia and Herzegovina
|
3
|
3
|
0.9
|
|||||||
|
Malta
|
3
|
3
|
||||||||
|
Slovakia
|
3
|
3
|
0.5
|
|||||||
|
Cambodia
|
2
|
1
|
1
|
|||||||
|
Dominican Republic
|
2
|
2
|
||||||||
|
Morocco
|
2
|
2
|
1
|
|||||||
|
Bulgaria
|
2
|
2
|
||||||||
|
Cameroon
|
2
|
2
|
||||||||
|
Faeroe Islands
|
2
|
2
|
||||||||
|
Maldives
|
2
|
2
|
||||||||
|
South Africa
|
2
|
2
|
||||||||
|
Andorra
|
1
|
1
|
||||||||
|
Armenia
|
1
|
1
|
||||||||
|
Jordan
|
1
|
1
|
||||||||
|
Latvia
|
1
|
1
|
0
|
0.5
|
||||||
|
Lithuania
|
1
|
1
|
||||||||
|
Monaco
|
1
|
1
|
||||||||
|
Nepal
|
1
|
1
|
0
|
|||||||
|
Nigeria
|
1
|
1
|
||||||||
|
Sri Lanka
|
1
|
1
|
0
|
|||||||
|
Tunisia
|
1
|
1
|
||||||||
|
Ukraine
|
1
|
1
|
||||||||
|
Bhutan
|
1
|
1
|
||||||||
|
Colombia
|
1
|
1
|
||||||||
|
Costa Rica
|
1
|
1
|
||||||||
|
Gibraltar
|
1
|
1
|
1
|
|||||||
|
Vatican City
|
1
|
1
|
||||||||
|
Liechtenstein
|
1
|
1
|
||||||||
|
Moldova
|
1
|
1
|
||||||||
|
Paraguay
|
1
|
1
|
||||||||
|
Serbia
|
1
|
1
|
||||||||
|
Togo
|
1
|
1
|
||||||||
|
Total:
|
106,195
|
146
|
3,600
|
29
|
60,190
|
42,405
|
6,035
|
13.6
|
||
Highlighted in
green
= all cases have
recovered from the infection
Highlighted in grey
= all cases have
had an outcome (there are no active cases)
Formula
of C
Corona, COVID starts with C
China Pneumonia was the earliest
name
Containment is feasible
Chain of transmission needs to be
broken
3 C’s: 1st Case, 1st Cluster and 1st
Community spread whenever a new Case comes
Avoid COHORT of Contacts
Close contacts
Cap prise of essential items
Contact tracing is the most
important step
Care of the elderly, they are the
highest risk
Convince the patients to wear
surgical masks
Cough not to be ignored, can be
corona or TB
Follow CDC guidelines
Chaos in Iran, do not let it happen
in your country
Chloroquine can be tried
Colour Coding: Red, yellow and Green
is important
Stay Connected with updates
Know COUNTRIES not affected
Critical cases: requiring mechanical
ventilation has high mortality
No CONTACT policy with social
distancing
Check list of hospitals
Check points ( all port entries)
Collective action ( government, associations,
media} and CONTROLLED measures
Condom: No evidence that it protects
Congenital: No evidence of
congenital Covid 19
Clearing of antigen
Complain: Section 270 of IPC
Do not criticise if the disease
happens
Remain CALM during illness
Communication is the key
Commitment of government
CAD patients are highest risk
Children are less likely to get
infected and die
COLD BLOODED ANIMALS ARE NOT THE
SOURCE
Claim: of insurance should not be
cancelled
Main Points
· Isolate patients, avoid
cohort (clusters) of contacts. Diamond Princess : 706 cases (23%), 6 deaths, 36
serious
· Ban export of masks,
PPE, anti-viral, anti HIC drugs. India has banned export
of 26 drugs and drug ingredients, most of them antibiotics, without explicit
government permission.
· Like Tamiflu, three
prescriptions required to get masks, PPE
· Increase access to
respirators for health care personnel
· Involve IMA, HCFI, FOMA
· “Today we will issue new guidance from the
C.D.C. that will make it clear that any American can be tested, no
restrictions, subject to doctor’s orders,” Mr. Pence
· Flu vs COVID 19: It’s a
lung disease, not a stuffy nose disease. 90% get a fever, 80 percent get a dry
cough, and then it drops down to 30% getting shortness of breath and malaise —
you know, being tired. A runny nose only
shows up in 4 percent, and that may be people who also happen to have a cold or
flu, too. Mild
means a positive test, fever, shortness of breath, and possibly even pneumonia,
but not so bad that you need to be hospitalized. Once you need oxygen, then you
go over into the severe category.
· DO’s: hand washing, avoiding sick people, and not touching our
face with unwashed hands –
· Insurance to pay
COVID 19 SUTRAS
· Possibly behaves like SARS; near
pandemic in 30 days. causes mild illness in 82%, severe illness in 15%,
critical illness in 3% and death in 3.4 % cases
( 15% of admitted serious cases, 71% with comorbidity, 10% in Iran);
affects all ages but predominately males ( 56%, 87% aged 30-79, 10% aged <
20, 3% aged > 80); with variable incubation period days ( 2-29, mean 3 based on 1,324 cases, 5.2 days based on
425 cases, 6.4 days in travellers from
Wuhan); mean time to symptoms 5
days, mean time to pneumonia 9 days,
mean time to death 14 days, mean time to
CT changes 4 days, 3-4 reproductive
number R0 ( flu 1.2, SARS 2), epidemic doubling time 7.5 days ( Korea 1 day probably due
to super spreader), Tripling time in Korea 3 days, Positivity rate ( UK 0.2%, Italy 5.0%,
France 2.2%, Austria 0.6% and USA 3.1% ;
has origin possibly from bats (mammal), spreads like large droplets and predominately
from people having lower respiratory infections and hence standard droplet precautions
the answer for the public and close contacts and air born precautions for the
healthcare workers dealing with the secretions.
· Clinically all patients have fever,
75% have cough; 50% weakness; 50% breathlessness with low total white count and
deranged liver enzymes. 20% need ICU care and 15% of them are fatal. Treatment
is symptomatic though chloroquine, anti-viral and anti-HIV drugs have shown
some efficacy.
· Only 20% will have
symptoms and will go for testing, rest may self-quarantine, 15% of serious will
die. In Iran 16 died of 95 tested means
they are only testing serious patients.
What is COVID 19?
· Disease: coronavirus disease or (COVID-19) [11th February]
· Virus: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [11th February] Earlier name
2019 novel coronavirus. It is more close to SARS with many aspects.
·
Name: as per WHO guidelines
previously developed with the World Organisation for Animal Health (OIE) and
the Food and Agriculture Organization of the United Nations (FAO).WHO policy is not linking the name to
a person, animal, place or country.
·
WHO also
refer the virus as “the virus responsible for COVID-19” or “the COVID-19 virus”
when communicating with the public.
Is it in a pandemic state?
·
As
per WHO and CDC pandemic declaration is likely. WHO says outbreak is “getting bigger”, can spread worldwide
and is “literally knocking at the doors?”
· On 21st Feb CDC said it
is a Pandemic Alert and a tremendous Public Health Threat.
· Who said, "… we are concerned
about the number of cases with no clear epidemiological link, such as travel
history to China or contact with a confirmed case".
· Community spread: Cases are detected in Singapore, South Korea, Taiwan,
Vietnam, Hong Kong and Japan in community where it's not known what the source
of the infection was.
· 24th Feb: We're in a phase of preparedness for a potential
pandemic.
· 25th Feb: Preparing for community transmission of the COVID-19
coronavirus
· Feb 29: WHO
raises Global Risk from Coronavirus to the highest level of alert “We have now increased our assessment of
the risk of spread and the risk of impact of COVID-19 to very high
at global level,”
· WHO: “If we don’t act... that may be a future
that we have to experience,” “a lot of
the future of this epidemic is in the hands of ourselves?” [
· 29th Feb first US death
in a patient with a community spread case.
What is a pandemic?
· WHO: "the
worldwide spread of a new disease" and ability to spread from person to
person.
· CDC: Spreads
across "several countries or continents, usually affecting a large number
of people.
· UK's Health and
Safety Executive: Virus markedly different from recently circulating strains
and humans have little or no immunity to it.
What is coranxiety?
Anxiety
about falling ill and dying; avoiding or not approaching Healthcare facilities
due to fear of becoming infected during care; fear of losing livelihood; fear of
not being able to work during isolation; fear of being dismissed from work if found positive;
fear of being socially excluded; fear of getting put into Quarantine; fear of
being separated from loved ones and caregivers due to quarantine; refusal to
take care of unaccompanied or separated minors; refusal to take care of people
with disabilities or elderly because of their high- risk nature; feeling of helplessness;
feeling of boredom; feeling of depression due to being isolated;
stigmatization of being positive infection; possible anger and aggression
against government; unnecessary approaching the courts, possible mistrust on information provided by government. relapses of
mental illness in already mental patients; overstress on people to cover work
of infected colleagues, quarantined for 14 days and insufficient or incomplete
information leading to myths and fake news.
If
the anxiety is not tackled what will happen?
Normal people will buy masks, get the tests done,
get admitted and finish resources meant for high risk persons.
Why so much rear when the mortality is <
1%
The population is totally susceptible and in
a country like India with huge population the deaths in numbers will be very
high.
When deaths are less seen in people with age
less than 50 years then why anxiety in younger them?
The younger population has more fear of
getting quarantines for 14 days or fear of losing their beloved elderly ones
with comorbid conditions.
Does it affect the doctors also?
As on 14th Feb, 1,716 medical workers have contracted the virus and
six died in China. 1,502 were in Hubei Province, with 1,102 of them in Wuhan. The number represent 3.8% of China’s overall
confirmed infections as of Feb. 11 with 0.3% deaths. (18th Feb:
Director of Wuhan Hospital died). Over
3000 workers involved so far. 2 workers who were
sent to Wuhan in January end to help build new hospital got infected.
What is
the seriousness profile?
It
causes mild illness in 82%, severe illness in 15%, critical illness in 3% and
death in 2.3 % cases. About 6% patients admitted in ICU require mechanical
ventilation, or died [NEJM]
How
many deaths occur in patients without comorbidity?
No deaths have occurred among those with mild or even severe symptoms.
How much time it
takes to recover?
People with mild
cases recover in about two weeks, while those who are sicker can take anywhere
from three to six weeks.
In
which cases it is riskier?
It caused
death in 15% of admitted serious cases. 71%
deaths are in patients with comorbidity. [ 72,314 Chinese cases, largest
patient-based study, JAMA)
COVID-19 Fatality Rate by COMORBIDITY:
Percentage does NOT
represent in any way the share of deaths by pre-existing condition.
Rather, it represents, for a patient with a given pre-existing condition,
the risk of dying if infected by COVID-19.
Pre-existing condition Death Rate/confirmed cases Death Rate/ all cases
Cardiovascular
disease 13.2%
10.5%
Diabetes 9.2% 7.3%
Chronic
respiratory disease 8.0%
6.3%
Hypertension 8.4%
6.0%
Cancer 7.6% 5.6%
no pre-existing
conditions 0.9%
What is the case fatality of COVID 19?
· 3.4 % overall
·
Wuhan 4.9%
·
Hubei Province 3.1%
·
Nationwide in China 2.1%
·
Other provinces 0.16%.
·
NEJM: 1,099 cases from China,
finds a lower rate: 1.4%. The death rate may be even lower, if there are many
mild or symptom-free cases that have not been detected. The true death rate
could turn out to be like that of a severe
seasonal flu, below 1 percent.
·
Case fatality 10% in Iran, probably they are underreporting mild
cases.
Why did
the first Chines doctor die?
Li Wenliang, 34, perhaps, while treating
patients was exposed to a large blast of the virus.
What is the case fatality as per the age?
The % shown do
not have to add up to 100%, as they do
NOT represent share of deaths by age group but represents, for a
person in a given age group, the risk of dying if
infected.
AGE Death
Rate/ Confirmed cases Death rate/ all
cases
80+ 21.9% 14.8%
70-79 8.0%
60-69 years old 3.6%
50-59 years old 1.3%
40-49 years old 0.4%
30-39 years old 0.2%
20-29 years old 0.2%
10-19 years old 0.2%
0-9 years old No
fatalities
What is the case fatality of other viruses?
·
MERS
34% (2012, killed 858 people out of the 2,494 infected)
·
SARS
10% (Nov. 2002 – Jul. 2003, originated from Beijing, spread to 41 countries, with
8,096 people infected and 774 deaths).
· Ebola 50%
· Smallpox 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
· Swine flu < 0.1-4
%.
· Seasonal flu 0.01%
·
Number of flu deaths every year: 290,000 to 650,000
(795 to 1,781 deaths per day)
Why
elderly people are at risk?
The elderly and the
sick – may have an immune response that is dangerous. It’s called a “cytokine
storm,” when immune cells are overproduced and flood into the lungs, causing
pneumonia, inflammation and shortness of breath.
Which occupation person are at risk of
death?
Patients who
reported being retirees had the highest case fatality rate at 5.1 per cent.
Does it
affect all sexes?
56% are
males. Although men and women have been infected in
roughly equal numbers, the death rate among men was 2.8 percent, compared with
1.7 percent among women.
Does it
affect all ages?
87% aged 30-79
10% aged < 20
3% aged > 80
What is
the incubation period?
· Variable, 2-14 days (mean 3 based on
1,324 cases, 5.2 days based on 425 cases, 6.4 days in travellers from Wuhan)
· 24
days has been observed.
WHO said it could reflect a second exposure rather than a long incubation
period. Hubei Province local government on Feb. 22 has reported a case with an
incubation period of 27 days.
What are
different numbers?
· Mean time to symptoms: 5 days
· Mean time to pneumonia: 9 days.
· Mean time to death: 14 days
· Mean time to CT changes: 4 days
· Reproductive number (R0 or R not): Number
of persons infected by one infected person. In COVID 19 it is 3-4
· R0 of flu: 1.2
· R0 SARS 2
· Epidemic doubling time: 7.5 days
· Epidemic doubling time in S Korea: 1
day, Probably due to super spreader?
· Epidemic tripling time: S Korea 3
days again due to a super spreader.
What is
the positivity rate in contacts who are tested?
UK
0.2%, Italy 5.0%, France 2.2%, Austria 0.6% and USA 3.1%
Which countries one should not travel?
· Level 1 in all countries (Exercise normal standard hygiene precautions)
· Level 2 in all affected countries (Exercise a high degree of caution)
· Level 3 in all countries with secondary cases (Reconsider your need to
travel)
· Level 4 in affected parts of China and S Korea, Iran, Italy (Do not
travel)
Is it a
Zoonotic disease?
Zoonotic and linked to
Huanan Seafood Wholesale Market as 55% with onset before January 1, 2020 were
originated there but only 8.6% of the subsequent cases. The Chinese government
has banned the wildlife trade until the epidemic passes.
Is it linked to bats?
It is closely related to several bat
coronaviruses. Bats are the primary reservoir for the virus. SARS-CoV was
transmitted to humans from exotic civet animals in wet markets, whereas
MERS-CoV is transmitted from camels to humans. In both cases, the ancestral
hosts were probably bats. Snakes and pangolins have been thought to be the
intermediate host. One thing is clear the origin is from a mammal.
What
are different types of transmissions?
· Droplets, large > 5-micron
organisms, flu, corona.
· Air borne, < 5-micron organisms,
TB, chicken pox, measles.
· Contact on the surface: COVID 19,
SARS, Flu [It may be possible
that a person can get COVID-19 by touching a surface or object that has the
virus on it and then touching their own mouth, nose, or possibly their eyes]
Which
are more important droplet precautions or contact precautions?
Both.
In community spread contact precautions becomes more important. In SARS in Hong
Kong the contact precautions worked more than the droplet precautions.
Can it
transmit from pregnant mother to the baby?
No or little evidence to
support the possibility of vertical transmission from the mother to the baby.
[Lancet Feb 20]
Which
part of the respiratory tract it effects?
·
Both upper and lower respiratory tract.
·
URTI causes fever with sore throat and
mild cough.
·
LRTI causes fever with cough, and
breathlessness.
·
Which is
more contagious LRTI or URTI?
·
COVID 19
uses the same cellular receptor as SARS-CoV (human angiotensin-converting enzyme
2 [hACE2]), so transmission is expected more after signs of lower
respiratory tract disease develop.
·
COVID 19 grows better in primary human airway
epithelial cells than in standard tissue-culture cells, unlike SARS-CoV or
MERS-CoV. It is likely that COVID 19 will behave more like SARS-CoV.
Why LRTI is more infectious?
· SARS is high [unintelligible] kind
of inducer. This means that when it infects the lower part of the lung, the
body develops a very severe reaction against it and leads to lots of inflammation
and scarring.
· In SARS after the first 10 to 15
days it wasn’t the virus killing the patients it was the body’s reaction. Is
this virus in the MERS or SARS kind picture or is this the other type of virus
which is a milder coronavirus like the NL63 or the 229? It may be the mild
(unintelligible) kind inducer. [Dr John Nicholls University of Hong Kong]
What is
the clinical presentation?
· Clinically all patients have fever (subjective
or evident). No fever no corona.
· 75% have cough
· 50% weakness
· 50% breathlessness
· Low total white count
· Deranged liver enzymes.
·
It starts with fever, followed by a dry cough. After a week, it can
lead to shortness of breath, with about 20% of patients requiring hospital
treatment.
Notably, the COVID-19 infection rarely seems to cause a runny nose, sneezing, or sore throat (these symptoms have been observed in only about 5% of patients). Sore throat, sneezing, and stuffy nose are most often signs of a cold.
Notably, the COVID-19 infection rarely seems to cause a runny nose, sneezing, or sore throat (these symptoms have been observed in only about 5% of patients). Sore throat, sneezing, and stuffy nose are most often signs of a cold.
How
many need admission and ICU care?
20% need ICU care and 15% of them are fatal. Those cases categorised as critical has the highest fatality rate—at 49.0
per cent.
What is
the treatment?
Symptomatic
though chloroquine, anti-viral & anti-HIV drugs have shown some efficacy.
What do you mean by Public
Health Emergency of International Concern?
COVID 19 was declared as
PHEIC on 30th Jan 2020 which means it is mandatory to report to WHO
each human and animal case.
Is it the first time that a
PHEIC has been declared?
· No, Prior 5 PHEIC’s ARE
·
26th April 2009 - 10th August 2010
Swine flu
· May 2014 Polio: resurgence of wild polio
· August 2014 Ebola: It was the first PHEIC in a resource-poor setting
·
Feb 1, 2016 to 18 Nov 2016 Zika
·
2018–20 Kivu Ebola
What is Public Health
Emergency of a state?
· Kerala declared it when it had three
cases and later lifted it on 12th Feb.
· San Francisco declared it even
without a case on 26th February.
· Washington declared a state
emergency on 1st March
Did China delay in reporting
of cases?
· While there were
300 cases and 5 deaths with SARS before the Chinese government reported it to
the World Health Organization, there were only 27 cases and no deaths with
COVID-19 before it was reported to that agency.
·
Chinese
authorities-imposed lockdown measures on ten cities in an unprecedented effort
to contain the outbreak of corona virus and built a specialized hospital
[Huoshenshan Hospital] in just 10 days as part of China’s intensive efforts to
fight corona virus. A second facility with 1,500 beds is also being opened.
During SARS in 2003, a facility in Beijing for patients with that viral disease
was constructed in a week.
What are lab confirmed
Cases?
Positive throat swab test.
What are CT positive cases?
CT showing pneumonia like changes
What is total number?
· Lab confirmed + CT
Diagnosed Cases
· This was the
criteria used from 12-19 February in China.
· Before and after
only lab confirmed cases are counted.
· Sudden jump in deaths and new cases
on 12th is due to inclusion of CT diagnosed cases.
What will be the estimated
deaths if CT diagnosed cases were also included?
Around 5% deaths will get
added to total deaths.
What are the possible modes of spread? Myths
and facts
·
Person-to-person: Yes, the virus can spread from one person to
another, most likely through droplets of saliva or mucus carried in the air for
up to six feet or so when an infected person coughs or sneezes, or through
viral particles transferred when shaking hands or sharing a drink with someone
who has the virus.
· Casual exposure:
No, Human to human
contact requires prolonged contact (possibly ten minutes or more) within three
to six feet. But with contact transmission this may not be applicable.
· Currency notes: The central banking authorities of China are
disinfecting, stashing and reportedly even destroying cash to stop the spread of
the coronavirus. People’s Bank of China says that the cash collected by
commercial banks must be disinfected before being released back to customers.
·
Fabric, carpet, and other
soft surfaces: Currently, there’s no evidence.
·
Hard surfaces: Virus could be on
frequently-touched surfaces, such as a doorknob, although early information
suggests viral particles would be likely to survive for just a few hours (WHO).
· Biometric attendance:
Maharishi Valmiki
hospital in Delhi stops biometric attendance
· Kissing: Kissing scenes have been banned
in movies in China. France have advised to cut back on “la bise,” the custom in
France and elsewhere in Europe of giving greetings with kisses, or air kisses,
on the cheeks.
· Breath analyser for alcohol: Kerala exempted air crew from breath analyser
tests
· Public gatherings: Affected
countries have banned death ceremonies, people gathering.
· Uncovered eyes: The
transmission is through mucus membra contamination. One case got infected while
using gown, but eyes not covered.
· Eating meat, fish or Chicken: Its
not a food borne illness but a respiratory illness. It cannot occur by eating
any food or meat. However, it is always advised not to touch raw meat, eat raw
meat or eat partially cooked meat to prevent meat related food borne illnesses.
Eating fish and chicken is safe.
· Eating snakes or drinking bat soups: No eating wild animals cannot cause it. Handling their
secretions can cause it.
· Handling wild animals or their meat:
Yes, if their secretions are handled
by the animal handlers.
·
Semen: We do not know, in
patients infected with Ebola, the virus may persist for months in the testes or
eyes even after recovery — and can infect others and
keep the epidemic going.
·
Sex
like EBOLA and ZIKA: We have no evidence yet.
·
Goods for affected areas: People
receiving packages from China or other affected areas are not at risk of
contracting the COVID 19 as
the virus does not survive long on objects, such as letters or packages.
·
Pipes: Ventilation system connects
one room to the next. There has been previous concern that the coronavirus can
spread through pipes
·
Stress: Stress and anxiety are known to suppress the immune system,
making people more susceptible to contracting the virus.
·
Patients without symptoms: 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
COVID 19 infection acquired outside of Asia in which transmission of mild cases
appears to have occurred during the incubation period in the index patient but
the same has been challenged now.
·
Corona beer: It has nothing to do with coronavirus. It’s a
brand of beer.
What is no contact
policy?
Greeting people by
namaste, bowing or elbow touch. Corona Namaste is a no contact policy in public. Let’s not shake hands, IMA and
CMAAO promotes the concept of Corona Namaste.
Why the cases did not occur
in other countries in the initial phase?
Initial serious illness in
other countries were less as patients with breathlessness were unlikely to
board and patients will mild illness or asymptomatic illness are less likely to
transmit infections. Foer transmission you require cough secretions or nasal
discharge.
Should we fear?
It’s time for facts, not
fear; for rationality, not rumours and for solidarity, not stigma.
What is the Help line
number?
23978046
What is a biphasic
infection?
Coronavirus
follows what is known as a biphasic infection: the virus persists and causes a different
set of symptoms than observed in the initial bout. The recovered person, too,
can develop other symptoms, including insomnia and neurological problems, said
Angela Rasmussen, a virologist at Columbia University.
What is a spreader and a super spreader?
Spreader: An infected person with normal
infectivity.
Super spreader
· An infected person
with high infectivity, can infect hundreds of cases in no time. What cause a
person to become super spreader is not known, HIV person becomes a super
spreader if he or she is coinfected with STI.
· The examples are
the first case in Wuhan, a female in the S Korea Daegu fringe Christian group Shincheonji Church where she
(61 years) infected more than 51 were infected.
· In the church people shout out 'amen' after every sentence
the pastor utters, pretty much every few seconds. And they do that at the top
of their lungs, sending respiratory droplets flying everywhere.
What can be the cause of a cluster of cases
or a hot spot without a super spreader?
People catching the virus from infected
surfaces. We don’t know how long the germs stay on surfaces, but similar
viruses can live for a week.
What are the various clusters of corona viruses?
·
The largest cluster was the Wuhan itself where over five crore people
were locked down ending up with over 2000 deaths.
·
The second largest lockdown was in Japanese diamond princess ship where
over 3000 patients were locked up and 23% of them developed COVID 19 virus
infection.
·
The third example the cult church in South Korea where one lady infected
with the virus spread it to over 30 people attending the church and she also
infected multiple people in a hospital where she was treated and one person
later died.
·
Shandong province in China reported
that 207 cases of the new coronavirus were reported in Rencheng prison as of
Feb. 20, citing information from the provincial government. A jail in the
Zhejiang province has also reported a total of 34 infections. All of them are
inmates, according to Chinese media. A
jail will behave like a ship and end up with 21% getting infected.
Can the
court take cognigence in corona epidemic?
· Despite CDC protest, 14 Americans infected with coronavirus on the Diamond.
Princess cruise ship shared a plane back to the U.S. with healthy passengers,
separated by plastic sheeting. (New York Post)
· A court temporarily
blocked the U.S. government from sending up to 50 people infected with a new
virus from China to a Southern California city for quarantine after local
officials argued that the plan lacked details about how the community would be
protected from the outbreak.
·
Hong Kong
police this week nabbed a part-time security guard at a shopping mall for
allegedly writing on social media that multiple staff members had caught a
fever and gone on sick leave. The messages "caused panic" and helped
"breed paranoia".
·
The
government separately blamed "evil" rumour-mongers for fuelling a run
on goods at supermarkets such as toilet paper and rice.
· Singapore has
announced severe penalties for non-compliance of the quarantine order,
including fines or jail time.
· Prosecutors may
investigate the founder and top leaders of Shincheonji Church of Jesus, whose
members account for > 60% of confirmed cases on murder and other charges for
failing to provide an accurate list of church members and by interfering with
the government’s efforts to fight the outbreak.
·
IPC: 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.
What do you mean by the word
corona?
‘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.
What is the composition of
this virus?
It is a single-strand, positive-sense RNA genome ranging from 26 to 32 kilobases in length, Beta corona virus from Corona family.
What are other dreaded corona viruses?
· COVID 19 is one of
the three deadly human respiratory coronaviruses. Others are Severe acute
respiratory syndrome coronavirus [SARS-CoV] and Middle East respiratory
syndrome coronavirus [MERS-CoV]).
· COVID 19 virus is
75 to 80% identical to the SARS-CoV
Where did it originate?
Wuhan, China December 2019.
1st case informed to the world by Dr. Li Wenliang who died on 6th
Feb.
Will this virus survive
heat?
Virus is likely to be killed
by sunlight, temperature, humidity. SARS stopped around May and June in 2003
due to more sunlight and more humidity.
Did
it originate from the WUHAN bio terror lab?
Unlikely,
nobody will procedure bioweapon to be used on themselves or without
simultaneously making an anti-weapon or antidote. It’s a myth that the
virus was part of China's "covert biological weapons programme" and
may have leaked from the Wuhan Institute of Virology and was linked to the
suspension of a researcher at Canada's National Microbiology Lab.
Is it true that China killed 20,000 COVID 19 patients?
It’s a fake news linked to a diversion to a
sex site.
In
initial days does it has high viral load.
Detection of COVID 19 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]
Was Diamond Princess ship
quarantine a successful model?
·
Does not look like as 23% of cases got infected. 705 cases got the virus and 6 deaths and 36
still serious as on 1st march. Would mean 6 + 36x15 = 1-12 cases
will die.
· The people on quarantine are kept under
a 14-day quarantine. If they are placed together and if anyone is diagnosed
during that period, the quarantine will add another 14 days.
· The longer you have several thousand
people cohoused you will continue to propagate waves of infection.
· A better way to quarantine is to
break up these people into smaller groups and quarantine them separately. Why quarantine
children < 15 years when the virus is not risky for them and why not
separate elderly people with comorbid conditions at high risk of deaths and
quarantine them separately in one to one or small groups.
How long was the quarantine
in the ship?
14 days for the passengers
and another 14 days for the crew who took care of the people in the first 14 days.
What are different
ways to control the infection in the
community?
·
Lockdown in China: Unprecedented quarantines across Hubei, locking in about
56 million people, in a bid to stop it spreading. Results 2% deaths,
· Locking of a village in
Vietnam: More than 10,000 people in villages near
Vietnam's capital were placed under quarantine on 13th February after
six cases of the deadly new coronavirus were discovered there. These cases did
not become a hotspot probably there was no super spreader kin those cases. Only
16 cases are so far.
· Kerala model of containment
in India: Hospital one to one quarantine of infected
patients and individual home quarantine of contacts. They could contain the
virus in the state.
Was it correct for India to
have cultural evenings by quarantine people brough from China?
It was risky to allow people
to celebrate and have cultural programs during quarantine. As was seen in India
people dances together with surgical masks during quarantine period,
Is there a role of
quarantine in the sunlight?
Quarantine them like TB
sanitoriums with both sun-balconies and a rooftop terrace where the patients
would lie all day either in beds or on specially designed chairs.
What should one wear
at the triage section of emergency room?
Surgical 3 layered
mask to the patient; Isolation of two beds with at least three feet distance,
Cough etiquette and Hand hygiene for all.
What are different
precautions?
·
Droplet precautions: Three-layer surgical mask
by patients, their contacts and health care workers, in an adequately ventilated
isolation room, health care workers while caring with the secretions should use
eye protection, face shields/goggles. One should limit patient movement,
restrict attendants and observe hand hygiene.
·
Contact
precautions: When entering room - gown, mask, goggles, gloves – remove before
leaving the room; Dedicated equipment/ disinfection after every use; Care for
environment- door knobs, handles, articles, laundry; Avoid patient transport
and Hand hygiene
·
Airborne
precautions when handling virus in the lab and while performing
aerosol-generating procedures: Room should be with negative pressure with
minimum of 12 air changes per hour or at least 160 litres/second/patient in
facilities with natural ventilation. There should be restricted movement of
other people and all should use gloves, long-sleeved gowns, eye protection, and
fit-tested particulate respirators (N95 or equivalent, or higher level of
protection)
What are the precautions for general public?
· Strict
self-quarantine if sick with flu like illness: 2 weeks
·
Wash your hands often and for at least 20 seconds
with soap and water or use an alcohol-based hand sanitizer.
·
Avoid touching:
Eyes, nose, and mouth with unwashed hands.
·
Avoid close contact: (3-6 feet) with people who are
sick with cough or breathlessness
·
Cover your cough or sneeze with a tissue, then
throw the tissue in the trash.
·
Clean and disinfect frequently touched objects and
surfaces.
Which masks for which patients?
· Surgical 3 layered Masks: For
patients and close contacts
· N 95 Masks: For health care providers
when handling respiratory secretions.
What are the lab tests?
There are two ways to detect
a virus: through the genetic material DNA or RNA or to detect the protein of
the virus. The rapid tests look at the protein. It takes 8-12 weeks to make commercial
antibodies. So right now, for the diagnostics tests they are using PCR which
give you a turnaround in 1-2 hours.
What are false
positive and false negative results?
·
PCR tests may detect remnants of the measles
virus months after people who had the disease stop shedding
infectious virus.
·
Negative test can be if the test is done poorly, or
the samples are stored at a temperature at which the virus deteriorates. The
throat swab may also simply miss the virus that is hiding elsewhere in the
body.
·
A virus test is positive if the virus is there on
the swab in sufficient quantities at the time you swabbed the person. A
negative test is not a definitive that there is no more virus in that person.
Can you give an
analogy of a negative test?
A jam jar with
mold on top. Scraping off the surface might give the impression that the jam is
now mold-free, but in fact the jar may still contain mold that continues to
grow.
What samples to collect?
BOTH the upper respiratory
tract (URT; nasopharyngeal and oropharyngeal) AND lower respiratory tract (LRT;
expectorated sputum, endotracheal aspirate, or bronchoalveolar lavage). Use
viral swabs (sterile Dacron or rayon, not cotton) and viral transport media
Can it be done by private
labs?
Not yet in India. In US in January, all testing had to be done
in CDC laboratories. However, on February 4, the US FDA issued an emergency-use
authorization for the CDC's COVID 19 Real-Time RT-PCR Diagnostic Panel, which
allows it to be used at any CDC-qualified laboratory in the United States.
What precautions to take in the lab?
BSL 2 (3 for viral culture labs)
Why pharma companies did not
make SARS vaccine?
· With SARS, in 6 months the virus was
gone, and it never came back. Companies may not spend millions to develop a
vaccine for something which may never come back.
· The UN agencies should have
initiated the development of vaccine against corona virus, SARS or MERS strain,
if that was available, it might have reduced the case fatality of COVID 19.
Can it cause secondary infection?
Secondary infection, E Coli,
are most likely the cause of deaths of the patients in the Philippines and HK.
Is there any proven treatment?
No
Which anti-viral have been
tried?
·
A combination of lopinavir and ritonavir showed
promise in lab in SARS. Combination of lopinavir, ritonavir and recombinant
interferon beta-1b was tried in MERS.
·
Scientists
in Australia have reportedly recreated a lab-grown version of COVID 19.
· Is chloroquine effective?
· 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.
· Is there any role of anti-HIV drugs?
· In Thailand Oseltamivir along with lopinavir and ritonavir, both HIV
drugs have been used successfully.
· The Drug Controller General of India
has approved the "restricted use" of a combination of drugs
(Lopinavir and ritonavir) used widely for controlling HIV infection in public
health emergency for treating those affected by novel coronavirus.
· What is the role
of experimental drug Rrom Gilead Sciences Inc., called remdesevir?
· On 6th
Feb in China and late February in USA trial has started.
·
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 COVID 19
shares some similarity to HIV virus also)
What are other treatments
tried?
· 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
· In SARS, people were put-on
long-term steroids ending with immunosuppression and late complications and death.
The current protocol is short term treatment.
·
Pneumococcal vaccine and Hib vaccine do not
provide protection against COVID
19.
·
Regularly rinsing
the nose with saline does not protect people from infection with COVID 19 or respiratory infections
although it can help people recover more quickly from the common cold.
·
There is no
evidence that using mouthwash will protect you from infection with COVID 19 although some brands or
mouthwash can eliminate certain microbes for a few minutes in the saliva in your
mouth. Keep your throat moist, avoid spicy food and load up on
vitamin C can not kill the virus.
·
There is no evidence that eating garlic
protects people from COVID
19.
·
Sesame oil does not kill the new coronavirus.
Chemical disinfectants that can kill the COVID 19 on surfaces are bleach/chlorine-based
disinfectants, either solvents, 75% ethanol, peracetic acid and chloroform.
·
Antibiotics do not work against viruses.
Can dog/pets get the COVID 19 virus?
There is no evidence.
Who is more
vulnerable?
People with
pre-existing medical conditions (such as asthma, diabetes, heart disease)
appear to be more vulnerable to becoming severely ill with the virus.
What
are various fake news?
·
COVID 19
linked to Donald Trump, US intelligence agencies or pharmaceutical
companies.
·
Avoiding
cold or preserved food and drinks, such as ice cream and milkshakes, for "at
least 90 days can help.
·
Experts have been aware of the virus for
years: The virus is not new, its two deadly forma have already caused SERS
and MERS in the world. These types of viruses will keep on coming.
What is the role
of CMAAO and other Medical Associations?
Get 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
should emphasise on reducing human infection, prevention of secondary
transmission and international spread. Intensify IEC activities.
CMAAO IMA FOMA MAMC Recommendations
Prise control of PPE; accreditation of private
labs for testing; private insurance should cover the infection; IEC and CME activities
to be intensified; allow paid leaves for air born and droplet infections; allow
teleconsultations in flu like diseases; CSR funds for vaccine research; Surgical
three-layered masks at public places; Start National program on respiratory
secretions born illnesses; in India incorporate respiratory infection control
under swatch bharat
How to suspect a corona case?
·
CDC has already revised it Criteria to Guide
Evaluation of PUI (person under investigation) for COVID-19
·
Fever or signs/symptoms of lower respiratory
illness (cough or shortness of breath) AND
Any person, including health care workers who has had close contact with a laboratory-confirmed4
COVID-19 patient within 14 days of symptom onset
·
Fever and signs/symptoms of a lower respiratory
illness (cough or shortness of breath) requiring hospitalization AND A history of travel from affected
geographic areas (China, Iran, Italy, Japan, South Korea) within 14 days of symptom
onset
·
Fever with severe acute lower respiratory illness
(pneumonia, ARDS) requiring hospitalization and without alternative explanatory
diagnosis (e.g., influenza) AND No source of exposure has been identified.
What
is a Probable case?
A
suspect case for whom testing for COVID 19 is inconclusive or for whom testing
was positive on a pan-coronavirus assay.
What is a confirmed case?
A
person with laboratory confirmation of COVID 19 infection, irrespective of
clinical signs and symptoms.
What is uncomplicated
illness?
Patients with uncomplicated
upper respiratory tract viral infection, may have non- specific symptoms such
as fever, cough, sore throat, nasal congestion, malaise, headache, muscle pain
or malaise. The elderly and immunosuppressed may present with atypical symptoms.
These patients do not have any signs of dehydration, sepsis or shortness of
breath
What do you mean by close
contact?
Close contacts are people
providing direct care to patients, working with infected health care workers,
visiting infected patients or staying in the same close environment, working
together in close proximity or sharing the same classroom environment with an
infected patient, traveling together with infected patient in any kind of
conveyance, living in the same household as an infected patient. The
epidemiological link may have occurred within a 14-day period before or after
the onset of illness in the case under consideration. But once the community spread occurs the
definition will no longer be correct.
What is the definition of
different cases?
· Primary
case: Who got infected first in Wuhan in China?
· Secondary
case: When the primary cases infected the second
person and tertiary when the secondary cases transmitted to another person.
· Primary
case: The first case in the China Wuhan in
late December.
· Index
case: The first case in any country or the
province.
What is community spread?
Means when the infection
spreads without any contactable contact. Once that happens closing borders will
not contain the virus. All cases with flu like illness will be presumed to be VOVID
19 AND ONLY patients with breathlessness will be tested.
What are mitigation guidelines?
·
Universal
non-pharmaceutical interventions include personal practices, covering coughs
and washing hands, as well as community and environmental measures such as
surface cleaning.
·
Universal
community measures include social distancing, or limiting contact in
face-to-face settings, closing schools, telework or tele school for children,
and recommending “modify, postpone, or cancel mass gatherings.
·
In
healthcare system triaging patients, conducting patient visits via
telemedicine, and delaying elective surgeries.
·
Commercial
labs need to pitch in for testing.
·
Better to
be overprepared than underprepared.
·
The
testing criteria may change to testing only symptomatic cases and admitting
cases only with breathlessness. (probably Iran is doing this)
What are high risk countries?
China, Macau, Hong Kong,
Taiwan, South Korea, Singapore, Italy, Iran, and Japan.
Will
Iran be the next China?
· With 54 deaths in
Iran, looks like that Iran government is hiding the true extent of the
outbreak. If the virus kills about 2 percent of known victims, then the number
of cases should be 2100. Infact the death rates outside china are 1% and in
that case the number will be much higher in Iran.
· Cases in Iraq,
Afghanistan, Bahrain, Kuwait, Oman, Lebanon, United Arab Emirates and Canada
have been traced to Iran. Iran borders are crossed each year by millions of religious
pilgrims, migrant workers and others, is one of the biggest causes for
worry in what threatens to become a global epidemic.
Will afghan be the next source of carrying infection in
India?
· Religious
pilgrims, migrant workers, businessmen, soldiers and clerics all flow
constantly across Iran’s frontiers, often crossing into countries with few
border controls, weak and ineffective governments and fragile health systems.
·
Many Afghanis are coming to India daily on health
visa and many of them come via Iran. It is likely many of them would carry the
virus to India.
What is the role
of 14 days quarantine?
Quarantines and
travel restrictions now in place in many counties, including the US, are also
intended to help break the chain of transmission. Public health authorities
like the CDC may recommend other approaches for people who may have been
exposed to the virus, including isolation at home and symptom monitoring for a
period of time (usually 14 days), depending on level of risk for exposure.
Should I wear a
face mask to protect against coronavirus?
Currently, face
masks are not recommended for the general public. Some health facilities
require people to wear a mask under certain circumstances, such as if they have
travelled from the city of Wuhan, China or surrounding Hubei Province, or other
affected countries or have been in contact with people who did or with people
who have confirmed coronavirus.
If you have
respiratory symptoms like coughing or sneezing, experts recommend wearing a
mask to protect others. This may help contain droplets containing any type of
virus, including the flu, and protect close contacts (anyone within three to
six feet of the infected person).
Should someone who
is immunocompromised wear a mask?
Only if you are
attending a public function. However, if your healthcare provider advises you
to wear a mask when in public areas because you have a particularly vulnerable
immune system, follow that advice. But if masking has not been recommended to
you to protect against the flu and numerous other respiratory viruses, then it
doesn’t make sense to wear a mask to protect against COVID-19.
Should I accept
packages from China?
There is no reason
to suspect that packages from China harbour COVID-19. Remember, this is a
respiratory virus like the flu. We don’t stop receiving packages from China
during their flu season. We should follow that same logic for this novel
pathogen.
Can I catch the
coronavirus by eating food prepared by others?
COVID-19 and other
coronaviruses have been detected in the stool of certain patients, so we
currently cannot rule out the possibility of occasional transmission from
infected food handlers. The virus would likely be killed by cooking the food.
Should I travel on
a plane if I have fever?
Of course, if anyone
has a fever and respiratory symptoms, that person should not fly
if possible, but anyone who has a fever and respiratory symptoms and flies
anyway should wear a mask on an airplane.
What should people
do if they think they have coronavirus, or their child does? Go to an urgent
care clinic? Go to the ER?
Call your doctors
instead of rushing to emergency room.
Can people who recover
from the coronavirus still be carriers and therefore spread it?
There is no
current evidence?
Are we missing infections in India?
We do not know. In
Iran the country missed hundreds of cases till two persons died. Infect the
first case was the one who died.
Can people who
recover from a bout with the new coronavirus become infected again?
·
The Japanese government reported that a woman in
Osaka had tested positive for the coronavirus for a second time,
weeks after recovering from the infection and being discharged from a hospital.
Combined with reports from China of similar
cases, the case in Japan has raised some questions. Reinfections are common among people who have
recovered from coronaviruses that cause the
common cold.
·
Reinfection in a short time is unlikely. Even the mildest of infections should leave at least
short-term immunity against the virus in the recovering patient. More likely, the
“reinfected” patients still harboured low levels of the virus
when they were discharged from the hospital, and testing failed to pick it up.
·
Even if there were occasional cases of reinfection,
they do not seem to be occurring in numbers large enough to be a priority at
this point in the outbreak.
How long the
antibodies last?
Research with MERS has shown
that the strength of the immune response depends on the severity of the
infection, but that even in those with severe disease — which should produce
the strongest immune responses — the immunity seemed to wane within a year.
Why SARS never entered India except a few
cases and neighbouring countries?
Either cases were not detected or by the time
it reached India there was already a summer.
Are antibodies protective?
On Feb. 13, a Chinese senior
health official called on people who had recovered from the new coronavirus to donate blood plasma, because it might
contain valuable proteins that could be used to treat sick patients, according to The New York Times.
When should I suspect corona cases in India?
H1N1 negative flu like illness.
What is Environmental
disinfection?
· CDC states routine cleaning and
disinfection procedures are appropriate for COVID-19 virus. Products approved
by the Environmental Protection Agency for emerging viral pathogens should be
used.
· SARS and MERS,
have been found to persist on inanimate surfaces, including metal, glass or
plastic surfaces, for as long as nine days if that surface had not been
disinfected, according to a research published in The Journal of Hospital
Infection.
· Human
coronaviruses can be efficiently inactivated by surface disinfection procedures
with 62-71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite"
or bleach within one minute.
· For SARS
coronavirus, the range of persistence on surfaces was less than five minutes to
nine days.
· According to the CDC,
the flu virus can live on some surfaces for as long as 48 hours and potentially
infect someone if the surface has not been cleaned and disinfected.
In
which conditions seasonal flu is more dangerous?
The flu is more dangerous to young children. Children
infected with the new coronavirus tend to have mild or no symptoms. It is also dangerous for pregnant women. Whether
the COVID 19 poses as serious a threat to pregnant women is not known.
How many people die of seasonal flu?
As of Feb. 22, in the current season there were at least 32 million cases of
flu in the United States, 310,000 hospitalizations and 18,000 flu deaths,
according to the C.D.C.
Can the warm
atmosphere kill the virus?
Coronavirus may retreat as weather
warms, just as influenza does. Because this is a new virus, there is no
information about how the weather might affect it.
Even if the virus were to diminish in the spring,
it might rebound later in the fall, as the weather cools. This is a pattern
often seen in severe flu seasons.
Can dengue coexist with COVID 19?
In Thailand a 35-year-old man who was diagnosed with dengue and
COVID-19 died. When combined with the
emerging infectious disease, it created complications leading to multi-organ
failure.
What is the preparedness in India?
The two designated hospitals in Delhi are RML
and Safdar Jang, both have an OPD of thousands of people. Ideally such OPDs should be held at places
where there no mix up with other types of patients.
Do we have a China like make-shift hospital
like facility in India?
Not so far.
How is the India government coordinating with
the IMA?
I am not aware of any such meeting.
How many Indian got Corona in the Diamond
Princes ship?
16
What is the role of army in containment of
any epidemic?
In March 2016 there
was a biggest military mobilisation in
Brazil’s history: 220,000 army, navy and air force personnel were called into
action, as well as 315,000 public officials. The enemy was tiny Aedes
aegypti mosquito which is believed to be responsible for the spread of
the Zika virus.
What
can happen if the disease spread in a city?
· Like Diamond
princess ship, quarantine will lead to 23% getting infected
· Like 1200 who
attended church 14% them have exhibited cough and
other symptoms
· China locked down
5 crore people with self-quarantine policy, 80,000 got infected (0.0016% of the
community) and 2760 deaths (0.0000552% of the population)
· 647,406
people close contact with infected patients (1:8 patients).
What
is the expected number of cases in Delhi in a Wuhan like situation?
· Total expected
positive in 1.67 crore population = 26720
· Likely contacts:
213760
· Expected serious
cases = 20% = 4008
· Likely deaths: 926
· At risk 60+
population In Delhi = 1164147
What
will be the preparedness needed then in Delhi?
4000
corona beds (15% of patients); self-quarantine of 17-20000 patients; no
admission for patients without breathlessness; paid teleconsultation of mild
cases; ICU beds with ventilatory care 3% (801 beds); Listing of hospitals with
ECHMO machines; PPE 5 per patient (20,000 per day); Surgical masks usage: 213760 per day; Hand sanitisers: at least 2
lac per day; Health care providers dedicated with corona handling training:
20,000; 250 persons trained in handling dead bodies of infected cases; 500-1000
dedicated mental health councillors to tackled corona anxiety; 20 corona
spokesmen to speak the same language; Prize cap of masks, other related
diagnostics and PEPs; censoring of myths and fake news on social media and earmarked and segregated areas for Corona
triage: suspect but not serious; suspect and serious; confirmed but not serious
and confirmed and serious?
What is the role of CMAAO in COVID 19?
CMAAO alerted
·
26 December 2019: viruses
like SARS detected and Chinese scientists alerted the world about it.
·
3 January 2020: Transition
from human to human raised concern
·
Despite this, on January
5, the Wuhan administration mentioned that the illness doesn’t seem to unfold
from people to people. China lastly formally confirmed on 20 January that the
corona was spreading from human to human.
·
7th January: WHO to
monitor China's mysterious pneumonia of unknown virus outbreak?
·
8th: CMAAO warns Asian
citizens travelling China over mystery pneumonia outbreak
·
10th: It’s a new strain of
corona virus in the china pneumonia
·
13th Jan: China Virus Outbreak Linked to Seafood Market
·
15th Jan: 1st Case China
Pneumonia Virus Found in Thailand outside China.
·
21st Jan: New China
coronavirus can spread between humans
·
22nd Jan: New China virus
now in US, Thailand, Japan, South Korea and Taiwan: Will India or other Asian countries
be spared
·
23rd Jan: Corona Virus:
will it be declared as International Public Health Emergency by WH
·
11th 24th Jan: Corona
virus 1st Death Outside Wuhan Epicentre Is Reported. W.H.O. DECISION: Corona
virus is spreading, but the organization says it is not a global emergency
·
25th Jan: 25 Jan Indian
Govt should pay for the treatment of India trapped in China with Corona Virus
Since than it has been covering daily.
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