Tuesday, April 28, 2020


Dr K K Aggarwal
President Confederation of Medical Associations of Asia and Oceania, HCFI and Past National President IMA

With regular inputs from Dr Monica Vasudev

772:  Asymptomatic transmission has made controlling the spread of the disease all the more difficult.
Controlling the disease requires testing of even asymptomatic cases in different population settings such as prisons, enclosed mental health facilities, homeless shelters, hospitalised inpatients and other congregate living situations, the researchers argued in an editorial published in the The New England Journal of Medicine (NEJM) on April 24.
These factors support the case for the general public to use face masks when in crowded outdoor or indoor spaces. The only strategy for a resource limited country is symptom-based case detection and subsequent testing to guide isolation and quarantine.
773: In an editorial at NEJM, the researchers from University of California, San Francisco pointed out that there are differences in transmission and spread of SARS-CoV-1 and SARSCoV-2.
SARS was controlled within 8 months after SARS-CoV-1 had infected about 8100 persons in limited geographic areas. In contrast, SARS-CoV-2 has infected much more people within five months and it is spreading around the world even now very rapidly.
A key factor in the transmissibility of Covid-19 is the high level of SARS-CoV-2 shedding in the upper respiratory tract, even among presymptomatic patients, which distinguishes it from SARS-CoV-1, where replication occurs mainly in the lower respiratory tract.
Viral loads with SARS-CoV-1, which are associated with symptom onset, peak a median of 5 days later than viral loads with SARS-CoV-2, which makes symptom-based detection of infection more effective in the case of SARS CoV-1.
774; NHS warns of rise in children with new illness that may be linked to coronavirus
Sent By Dr Reddy Telangana: NHS have written to doctors alerting them that children are falling ill with a new and potentially fatal combination of symptoms apparently linked to Covid-19, including a sore stomach and heart problems. The children affected appear to have been struck by a form of toxic shock syndrome.

In a letter to GPs in north London, reported by the Health Service Journal , NHS bosses said: “It has been reported that over the last three weeks there has been an apparent rise in the number of children of all ages presenting with a multi-system inflammatory state requiring intensive care across London and also in other regions of the UK.

“The cases have in common overlapping feature of toxic shock syndrome and atypical Kawasaki disease with blood parameters consistent with severe Covid-19 in children.

“There is a growing concern that a Sars-CoV-2-related inflammatory syndrome is emerging in children in the UK, or that there may be another, as yet unidentified, infectious pathogen associated with these cases.”
The NHS letter continues: “Abdominal pain and gastrointestinal symptoms have been a common feature, as has cardiac inflammation. This has been observed in children with confirmed PCR positive Sars-CoV-2 infection as well as children who are PCR negative. Serological evidence of possible preceding Sars-CoV-2 infection have also been observed.”

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