- The unique thing about this coronavirus is that it is a novel strain
- Over 20,000 passengers have been screened at Indian airports
- Coronavirus has not yet become a public health emergency
Chinese authorities have confirmed more 9,000 cases and a total of 213 deaths due to the new coronavirus. The number of confirmed cases of the new coronavirus has overtaken the 2003 SARS outbreak in China. Coronaviruses are zoonotic, meaning they are transmitted between animals and people. 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.
Coronavirus: What's in the name?
The name of coronavirus comes from its shape, which resembles a crown or solar corona when imaged using an electron microscope. The three deadly human respiratory coronaviruses so far:
1. Severe acute respiratory syndrome coronavirus [SARS-CoV]
2. Middle East respiratory syndrome coronavirus [MERS-CoV])
3. 2019-nCoV: The virus is 75 to 80% identical to the SARS-CoV
Coronavirus: How the disease develops
People infected with these coronaviruses suffer a severe inflammatory response.
1. It has high mortality
In the current situation, the mortality rate is 3%, but steadily increasing. The severity of illness is concerning: almost a third of patients developed acute respiratory distress syndrome requiring intensive care; So far as per data available, six patients died; five had acute cardiac injury; and four required ventilation.
2. 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.
3. Human-to-human infection is weak
Both SARS-CoV and MERS-CoV infect intrapulmonary epithelial cells more than cells of the upper airways. Epithelial cells are cells that come from surfaces of your body, such as your skin, blood vessels, urinary tract, or organs. 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 median time from onset of symptoms to first hospital admission was 7.0 days (4.0-8.0), to shortness of breath was 8.0 days (5.0-13.0), to ARDS was 9.0 days (8.0-14.0), to mechanical ventilation was 10.5 days (7.0-14.0), and to ICU admission was 10.5 days.
4. It is unlikely to spread by eating sea food in India
It has been traced to snakes in China, so, it is unlikely to spread in India by eating 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 this coronavirus outbreak. However, how the virus could adapt to both the cold-blooded and warm-blooded hosts remains a mystery.
5. Flight transmission
Transmission of food borne diseases on aircraft, including cholera, shigellosis, salmonellosis, and staphylococcal food poisoning, have been well documented. Transmission of smallpox on aircraft was reported in 1965. An outbreak of influenza occurred in 1979 among passengers on a flight that had a three hours' ground delay before take-off. The influenza attack rate among the passengers was very high (72%), and was attributed to the ventilation system not operating during the ground delay. Epidemiological investigations have also indicated that measles may have been transmitted aboard international flights. To date, no case of active TB has been identified as a result of exposure while on a commercial aircraft. However, there is some evidence that transmission of M. tuberculosis may occur during long (i.e. more than eight hours) flights, from an infectious source (a passenger or crew member) to other passengers or crew members.
6. 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.
- Universal droplet and contacts precautions is the answer
- Quarantining for two weeks of the LRTI patient
- Timely diagnosis
- Strict adherence to universal precautions
Coronavirus has spread all over the world. Cases have been confirmed in Australia, Macau, Hong Kong, France, Japan, Malaysia, Nepal, Singapore, Taiwan, South Korea, Thailand, United States and Vietnam.
Coronavirus: Is it a public health emergency?
There is an emergency in China, but it has not yet become a global health emergency.
Coronavirus: Indian scenario
At present, In India, over 20,000 passengers have been screened at Indian airports for the novel coronavirus infection. Although suspected cases of the virus have been reported in many states, including Kerala and Maharashtra, none of them have been tested positive "till date". In Maharashtra two of the three persons admitted to a hospital in Mumbai for possible exposure to the coronavirus have tested negative for infection but are still under observation as a
Coronavirus: Detection and symptoms
Any patient suffering from respiratory symptoms could have a potential coronavirus, especially in case he or she has travelled to China recently. In case we signal coronavirus, then we have to make sure that the patient is kept in isolation. The secretion (sample from the patient) is examined with the Polymerase Chain Reaction (PCR)-based technique. This sample could be throat or lower-respiratory tract based secretion.
The unique thing about this coronavirus is that it is a novel strain. It is a new strain of corona which has occurred because of a mutation occurring in the already-existing strain of coronavirus. So, after detecting coronavirus from the respiratory secretion, the strain has to be further checked if it is a lower strain or not.
Coronavirus: Precautions to be taken by people in India
In case there is a confirmed case of coronavirus in India, it is important that people protect themselves by taking the following precautionary measures:
- Use a mask as much as possible and cover the nose while sneezing
- Clean hands with soap water or alcohol based hand rubs
- Avoid going in crowded places ad close contact with anyone with a cold or fever
- Hospitals must also be vigilant about patients coming with respiratory symptoms.
- Avoid unprotected contact with farm animals
Currently, there is no treatment available for coronavirus, nor any vaccine to prevent it. Although scientists from all over the world are working on the vaccine for this virus which will help contain the virus from a bigger outbreak, the current treatment is only supportive, including the following important steps:
- Make the patient comfortable and help in relieving the symptoms
- Viral infections have their own course and subside on their own.
- Make sure that the patient takes proper care and eats the right kind of food that can boost immunity and prevent the infection from getting worse.
(Dr. Laxman Jessani, Consultant, Infectious Diseases, Apollo Hospitals, Navi Mumbai)
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