Dr KK Aggarwal
29th Jan: 5,974 confirmed cases, with 132 deaths and 103 cured
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.
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.
3.2019-nCoV: The virus is 75 to 80% identical to the SARS-CoV
The case fatality is lower than SARS, MERS and EBOLA- 2019 nCoV mortality rate is 3% compared to MERS 35%, 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 %.
Its not a global emergency yet- WHO now has clarified that the risk was “very high in China, high at the regional level and high at the global level.” WHO explained that it had stated “incorrectly” in its previous reports that the global risk was “moderate”. The correction of the global risk assessment does not mean that an international health emergency has been declared. This is an emergency in China but it has not yet become a global health emergency.
Its Zoonotic- 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.
It is unlikely to spread through seafood in India- 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 is weak- 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. 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.
It’s 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.
The incubation period- Up to 2 weeks, according to WHO.
Symptoms- Lancet: 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.
Drugs- There is no proven antiviral treatment for the coronavirus. 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 researches around the world as they race to develop a vaccine and detection tests.
Universal droplets precautions the answer-
1.Quarantining for two weeks of the LRTI patient.
2. Timely diagnosis
3. Strict adherence to universal precautions
Its all over ( but all primary cases, Secondary cases only in China)- Australia, Macau, Hong Kong, France, Japan, Malaysia, Nepal, Singapore, Taiwan, South Korea, Thailand, United states, Vietnam
Evacuation- 29th Jan: 9:15 am: Charter jet evacuating Japanese nationals from Wuhan lands in Tokyo
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)
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
27: Anti fever drugs at airports should be taken
28: Do research on Nosodes