13.Is The Record Of The Most Mortal Outbreak About To Be Broken

Is the record of the most mortal outbreak about to be broken?

VetPubHealth Journal ISSUE 17 IVSA Standing Committe on One Health April 2020 Ibrahim atia IVSA Egypt In 1918, a strain of influenza known as Spanish flu caused a global pandemic, spreading rapidly and killing indiscriminately. Young, old, sick and otherwise-healthy people all became infected, and at least 10% of patients died. Estimates vary on the exact number of deaths caused by the disease, but it is thought to have infected a third of the world’s population and killed at least 50 million people making it the deadliest pandemic in modern history. Although at the time it gained the nickname “Spanish flu,” it’s unlikely that the virus originated in Spain. THE CAUSE OF THE SPANISH FLU: The outbreak began in 1918, during the final months of World War I, and historians now believe that the conflict may have been partly responsible for spreading the virus. On the Western Front, soldiers living in cramped, dirty and damp conditions became ill. This was a direct result of weakened immune systems from malnourishment. Their illnesses, which were known as “la grippe,” were infectious, and spread among the ranks. Within around three days of becoming ill, many soldiers started to feel better, but not all were able to make it. During the summer of 1918, as troops began to return home on leave, they brought with them the undetected virus that had made them ill. The virus did spread across cities, towns and villages in the soldiers’ home countries. Many of those infected, both soldiers and civilians, did not recover rapidly. The virus was hardest on young adults between the ages of 20 and 30 who had previously been healthy. MODE OF TRANSMISSION: Through inhalation of the respiratory droplets whish are transmitted from the infected person through the air SYMPTOMS: The first wave of the 1918 pandemic occurred in the spring and was generally mild. The sick, who experienced such typical flu symptoms as chills, fever and fatigue, usually recovered after several days, and the number of reported deaths was low. However, a second, highly contagious wave of influenza appeared with a vengeance in the fall of that same year. Victims died within hours or days of developing symptoms, their skin turning blue and their lungs filling with fluid that caused them to suffocate. REACTION OF THE WORLD TOWARD THE OUTBREAK: The city closed saloons, theatres and schools, and public gatherings were banned. Hospitals in some areas were so overloaded with flu patients. Thus, schools, private homes and other buildings had to be converted into makeshift hospitals, some of which were staffed by medical students. People were advised to avoid shaking hands and to stay indoors. Libraries put a halt on lending books, and regulations were passed banning spitting the transmission of the flu by ordering businesses to open and close on staggered shifts to avoid overcrowding on the subways Treat TREATMENTment Unlike today, there were no effective vaccines or antiviral drugs that treat the flu, the first licensed flu vaccine appeared in America in the 1940s. The treatment was largely symptomatic, aiming to reduce fever or pain. Aspirin, or acetylsalicylic acid was a common remedy. For secondary pneumonia, doses of epinephrin were given. To combat the cyanosis, physicians gave oxygen by mask or some injected it subcutaneously. Salicin was used to 38

VetPubHealth Journal ISSUE 17 IVSA Standing Committe on One Health April 2020 reduce pain, discomfort and fever and claimed to reduce the infectivity of the patient. Another popular remedy was cinnamon in powder or oil form with milk to reduce the higher temperature. Finally, salt of quinine was suggested as a treatment. Most physicians agreed that the patient should be kept in bed. With that was the advice of plenty of fluids and nourishment. The application of cold to the head, with warm packs or warm drinks was also advised. Warm baths were used as a hydrotherapeutic method in hospitals but were discarded for /lack of success. CONTROL With no vaccine to protect against influenza infection and no antibiotics to treat secondary bacterial infections that can be associated with influenza infections, control efforts worldwide were limited to non-pharmaceutical interventions such as isolation, quarantine, good personal hygiene, use of disinfectants, and limitations of public gatherings, which were applied unevenly. SPANISH FLU PANDEMIC ENDS By the summer of 1919, the Spanish flu pandemic came to an end, as those that were infected either died or developed immunity. About the new outbreak that may break Spanish flu record as the most mortal outbreak Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases, such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARSCoV). A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans. Corona viruses are zoonotic, meaning they are transmitted between animals and people. Detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans. Recently, novel coronavirus was detected in China in December 2019, it is named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), while the disease associated with it is referred to as COVID-19. Coronaviruses are viruses that transmitted among animals but some of them are also known to affect humans. After they have infected animals, they can eventually be transmitted to humans. The current COVID-19 outbreak caused around 10, 000 reported cases in China during the first month of the outbreak, with additional cases subsequently being detected in Europe and other countries. On February 13, official statistics reported that China had 15, 141 new cases of COVID-19, which represented the single largest number of cases reported on one day since the start of the epidemic .Till now, number of cases reached 524,010, while the number of deaths is 23, 670. 123,322 cases were reported as recovered. MODE OF TRANSMISSION The virus is thought to spread mainly from person-to-person, between people who are in close contact with one another (within about 6 feet) through the respiratory droplets that are produced when an infected person coughs or sneezes. SYMPTOMS 1-The most common symptom is fever, abnormal elevation in body temperature is noticed. 2-we could say that dry cough is the most important second symptom as corona virus attacks lower respiratory system, begins with lungs that cause destruction in alveoli then blockage of respiratory tracts. 3- Runny nose is also observed. 4- General fatigue in all of body organs 5- Sometimes, it accompanies with severe diarrhea. 6- Vomiting can be a signal that the person is attacked by COVID-19. 39

THE REACTION OF THE WORLD TOWARD THE OUTBREAK Stopping all international trips between countries, postponing all exams for all stages of education and applying the e- learning via using different online applications, increasing the awareness of the public through the media, in addition to adding restrictions and regulations that people should follow; by wearing protective clothes as face mask and gloves and by staying at home. TREATMENT There is no approved drug to prevent or treat coronavirus disease (COVID-19). Thus, people may need supportive care to help them breathe. The World Health Organization (WHO) announced a large global trial, called SOLIDARITY, to find out whether any can treat infections with the new coronavirus for the dangerous respiratory disease. The study, which could include many thousands of patients in dozens of countries, has been designed to be as simple as possible so that even hospitals overwhelmed by an onslaught of COVID-19 patients can participate. WHO is focusing on what it says are the four most promising therapies: an experimental antiviral compound called remdesivir; the malaria medications chloroquine and hydroxychloroquine; a combination of two HIV drugs, lopinavir and ritonavir; same combination plus interferon-beta,(an immune system messenger that can help cripple viruses). HOW LONG THIS OUTBREAK WILL LAST? (1)Chodosh, Sara (18 March 2020). “What the 1918 flu pandemic can teach us about COVID-19, in four charts”. PopSci. Retrieved 20 March 2020. (2)Crossley, B. M., Mock, R. E., Callison, S. A., & Hietala, S. K. (2012). Identification and characterization of a novel alpaca respiratory coronavirus most closely related to the human coronavirus 229E. Viruses, 4(12), 3689-3700. (3)Cui, J., Han, N., Streicker, D., Li, G., Tang, X., Shi, Z., ... & Wang, L. (2007). Evolutionary relationships between bat coronaviruses and their hosts. Emerging infectious diseases, 13(10), 1526. (4)Geller, C., Varbanov, M., & Duval, R. E. (2012). Human coronaviruses: insights into environmental resistance and its influence on the development of new antiseptic strategies. Viruses, 4(11), 3044-3068. (5)Gouilh, M. A., Puechmaille, S. J., Gonzalez, J. P., Teeling, E., Kittayapong, P., & Manuguerra, J. C. (2011). SARS-Coronavirus ancestor’s foot-prints in South-East Asian bat colonies and the refuge theory. Infection, Genetics and Evolution, 11(7), 1690-1702.. (6)Langford, C. (2005). Did the 1918–19 influenza pandemic originate in China?. Population and Development Review, 31(3), 473-505. (7)Phillips, H., & Killingray, D. (Eds.). (2011). The Spanish influenza pandemic of 1918-1919: New perspectives. Routledge. (8)Shanks, G. D. (2016). No evidence of 1918 influenza pandemic origin in Chinese laborers/soldiers in France. Journal of the Chinese Medical Association, 79(1), 46- 48. (9)Spreeuwenberg, P., Kroneman, M., & Paget, J. (2018). Reassessing the global mortality burden of the 1918 influenza pandemic. American journal of epidemiology, 187(12), 2561-2567. (10)Worobey, M., Cox, J., & Gill, D. (2019). The origins of the great pandemic. Evolution, medicine, and public health, 2019(1), 18-25. References: 40

-Unfortunately, it is not possible to predict how long the outbreak will last and how the epidemic will evolve overall. We are dealing with a new virus and therefore a lot of uncertainty remains. For instance, it is unknown whether transmission will decrease during the summer, as what is observed for seasonal influenza.