Coronavirus: 2019 Outbreak

HEALTH FEATURE

GLOBAL CONCERNS WHAT YOU SHOULD KNOW

It is important to understand that this is a dynamic situation that is changing day to day.

CORONAVIRUS

2019 OUTBREAK

by William T. Budd; Ph.D

It is hard to turn on the television or open social media without witnessing misinformation about the coronavirus currently spreading across the planet. It is important to understand that this is a dynamic situation that is changing day to day. At the time of this writing, there have been over 120,000 world-wide cases with just over 1000 in the United States. As we learn more about the virus and its infectious potential, responses may evolve. As a scientist, it is my job to help others understand what we currently know.

What is CoVID-19?

On December 31, 2019, Chinese health officials reported a cluster of cases of acute respiratory infection that was isolated to a market in the city of Wuhan China. Within a few days, scientists had been able to confirm that this was a coronavirus that had never been seen (novel). Initially, reported as the Wuhan virus, it is now more widely known as CoVID-19. Coronaviruses were discovered in the 1960’s and are a common cause of the common cold. There have been other outbreaks of coronaviruses including the 2003 SARS-CoV and 2012 MERS-CoV.

“As a scientist, it is my job to help others understand what we currently know..”

HEALTH FEATURE

“Novel viruses arise out of genetic mutations that occur upon infecting their host cell.�

Novel viruses arise out of genetic mutations that occur upon infecting their host cell.

Novel viruses are of concern to health officials and scientists for several reasons.

First, we know nothing about their infectious capabilities, mortality rates and pathogenicity. More importantly, these viruses have potential to escape our acquired immune system response, meaning that we have not developed antibodies that allow our white blood cells to target the virus. Initially this virus appears to have a mortality rate of over 3.4%. However, as with most viruses, the deaths tend to be more common in persons that are elderly and infirmed.Â

Since the initial outbreak in China, there have been reports of sustained person-toperson spread with over 120,000 persons infected with a near 10% increase daily. For these reasons, every public health agency considers the public health threat to be high.

This does not mean that we need to open our bunkers and isolate ourselves from all others. This does mean that our government and public health officials need to be monitoring the situation, allocate funding to ensure necessary measures to protect human needs and most importantly aggressively combat false information. As citizens, we need to be proactive in limiting the spread of the virus especially towards our more vulnerable citizens.

HOW IS COVID-19 SPREAD?

Much remains unknown about this particular strain of Coronavirus.

Current understanding is largely based upon knowledge of similar strains including SARS and MERS. Infectious organisms/ agents are passed through direct and indirect contact methods. Direct contact occurs from an infected person to an uninfected person within close contact. The virus is transmitted through infected respiratory droplets that are produced when a person sneezes or coughs and inhaled by the uninfected person. It is thought that the virus is most contagious when a person is symptomatic. However, there is a chance that the virus can be spread during the incubation period in which the infected person does not realize they are sick. Indirect contact occurs when an infected person sneezes/coughs and touches a secondary object such as a phone.

Intact viral particles may remain infectious for up to two days on surfaces.

“This particular virus has not shown a large propensity to spread widespread across a community.”

This particular virus has not shown a large propensity to spread widespread across a community. On average, an infected person will pass the virus to two other people. Contrast this to measles in which a single infected person will infect up to 9 others. The majority of the cases detected thus far have been in direct contact with an infected individual. In fact, most of the cases occur within the same household or other facility where strict isolation is not always available.

WHAT ARE THE SYMPTOMS? Our media has not done a good job to help our citizens understand the symptoms of the CoVID19. The best clinical indicators for potential infection are fever and dry cough exhibited in over 90% of infected persons.

There are other symptoms that have been associated with the virus but do not exhibit the frequency. Healthcare facilities are becoming overwhelmed with persons coming into emergency departments with other symptoms thinking they are infected with CoVID19.

WHO IS AT THE HIGHEST RISK FOR DYING? WHAT HAPPENS TO MAKE SOMEONE SO SICK? As discussed previously, the deaths tend to occur more frequently in persons over the age of 70. The majority have another underlying health condition as well such as heart disease, diabetes and emphysema (COPD). Many of the persons that have died are active smokers which seemingly increases the risk of significant/severe illness. Thankfully, most of the persons (81%) with known infection will exhibit only a few days of mild symptoms including fever and cough. Some progress to pneumonia and exhibit more significant symptoms including difficulty breathing and low oxygen levels.

The sickest patients may require aggressive support in an intensive care unit with some being placed on a ventilator. However, it is important to remember that most of these patients have pre-existing health conditions that are easily exacerbated by any respiratory infection.

cough

difficulty breathing

sore throat

WHAT SHOULD I DO IF I AM AT A HIGHER RISK? Currently, the Centers for Disease Control recommends that persons at higher risk prepare for a wide-scale outbreak. Ensure that you have necessary medications on-hand including any over the counter medications that are needed. Stock up on household items and groceries so you can limit the amount of exposure to crowds.

INSIDE MEDICINE I 2020

fever

“Frequent hand washing is the best method for preventing this illness.”

Close contact with persons that are ill should be avoided. Frequent hand washing is the best method for preventing this illness. Wash your hands after touching your face, sneezing, coughing or blowing your nose. If possible, do not touch surfaces that are frequently touched by others. If you cannot avoid touching these surfaces, wash your hands or use hand sanitizer soon after. Avoid crowds when possible. Allow family members to pick up groceries, medications and other supplies. Consider cancelling any unnecessary travel.

WHAT DO I DO IF I SUSPECT I HAVE AN INFECTION? Unless you are experiencing severe symptoms such as difficulty breathing, chest pain, shortness of breath, confusion or lethargy, do not go to your physician’s office or the emergency department. The most important first step is to call your physician.

Most persons with this infection can and will safely recover at home without any need for medical intervention. If you suspect you have an infection, isolate yourself from others. Stay home and limit contact with family members. Keep in mind that the majority of infections are spread because of close contact. Help keep the infection numbers low and break the infection cycle. If you do need to leave your home and go to a physician’s office or emergency department, wear a mask. If you are caring for someone that is sick, wear a mask. Wash your hands frequently! Wash your hands with soap and water for at least 20 seconds. Clean all high touch surfaces with a disinfectant. Monitor your temperature and be vigilant for symptoms of progressing infection such as difficulty breathing.

Coronavirus (Co-VID19) is a concern for public health workers due to its pandemic potential. However, misinformation has led to unnecessary fear and panic. Viruses such as Co-VID19 are easily spread from person to person through respiratory droplets when in close proximity to someone with the illness. Armed with appropriate information, we can prepare and protect ourselves from this infection. It is important to remain vigilant, especially if you are in the high-risk group. If you think you are infected, protect those around you and isolate yourself. If the transmission rate can be reduced through isolation, infection rates will begin to decrease.

INSIDE MEDICINE I 2020