(Updated on 2021 August 30 @ 7 AM)
The dawn of the new year was spoiled by a dangerous guest who popped an ugly head in Wuhan, Mainland China. By the time WHO was alerted, dozens of patients were down with pneumonia and the corona virus that caused it was termed a novel one. A novel corona virus is one that has not been identified earlier. So, this was a variant of Corona virus, quite different from the earlier versions we knew. The Corona virus family already had its infamous track record to deal with. SARS (2003) and MERS (2012) are both corona viruses in earlier avatars. Both spread quickly and created panic in all countries that reported it. Many health workers lost their lives during both epidemics too. This new corona virus was later named COVID-19.
Even though these three variants are severe pathogens, four other corona viruses that infect humans (229E, NL63, OC43 & HKU1) result in milder forms of infection. Current mortality (confirmed cases, CFR) rates look somewhere in the range of 2% which could come down significantly with better awareness, early identification and adequate supportive management. There is wide variability in the case fatality rates ( deaths per 100 cases confirmed) with higher rates reported from Mexico (10.2%), Italy (8.8%), UK (6.0%) Belgium (4.9%),France (3.7%) and Spain (3.4%). US is currently at 2.7%, Brazil at 2.9% and India is at 1.5%. The mortality is less than 1% for those below 50 years with no other illnesses. It is close to 2% among those 50 to <60 years, 4% among those 60-<70 years, 8% among those 70-<80 years and 15% for those above 80 years. High mortality is seen among those with heart diseases (10%), diabetes (7%) respiratory diseases (6%) and hypertension (6%). The mortality among the critically ill patients who require ventilatory support is very high and ranges between 50% to 80%. The older SARS epidemic had close to 8500 cases with low (11%) mortality. On the contrary, the MERS epidemic of 2012 had close to 2500 cases with very high mortality (35%). This puts the mortality of the current epidemic much lower than the SARS and MERS epidemics, both variant types of corona viruses. SARS epidemic in 2002 resulted in 774 fatalities across all countries that reported it. Similarly, MERS resulted in 858 fatalities. One blip of hope comes from the fact that the current one appears to be the least fatal of the trio with very low mortality despite the very high infectivity.
There is no clarity now as to the source of the current epidemic but suspicion leads to wet markets (where live and dead animals are sold for food) in Wuhan where wild as well as farm animals were sold for food. All but one of the first nine patients visited the food market in Wuhan. Genetic analysis reveals that the virus is very closely related to two variants discovered from bats in China during 2018. There is still suspicion about an intermediate host connecting primary host to humans and pangolins are the lead suspects. The illness is very similar to common viral infections. A recent study reports that fever and cough was present in more than 80% with shortness of breath in another 30%. Less common symptoms reported were muscle ache(11%), headache (8%), sore throat (5%) and running nose (4%). The disease can be confirmed by a realtime RT PCR (rRT PCR) done in respiratory specimens and sera. Most infected patients show high fever and x-rays showed invasive lesions in lungs suggestive of severe pneumonia. In the very severe forms, it can result in acute respiratory syndrome which was reported in one in six infected patients in this early series from Wuhan. Approximately half of the patients who developed acute respiratory distress syndrome died in Wuhan.
Currently there is no specific drug proven effective for this variant of corona virus infection. All patients with corona virus infection are treated symptomatically. Symptomatic treatment is very important and will save the majority of lives. As of now, there are eight vaccines available launched by Oxford, Pfizer, Moderna, Gamaleya, Bharath Biotech, J&J, Sinopharm and Novavax. Many countries including all in Europe, US, have started massive vaccination campaigns against this illness. India started vaccinating in February and is yet to cross 5% of its population. The investigations that followed the 2002 SARS epidemic in China proved that the virus was transmitted from civet cats to humans. Similarly, the 2012 MERS epidemic is suspected to be transmitted to humans from dromedary camels. There is every likelihood that such an animal to human transmission happened in this current epidemic as well but we need to wait for the evidence to claim so. Human to human transmission of corona virus happen primarily through respiratory droplets. Spread by close contact, aerosols and fomites are also documented.
So here is what we can do to reduce/prevent person to person transmission of the same.
1. Avoid close contact with anyone suffering from acute respiratory illness.
2. Practice strict hand hygiene (hand washing with soap for minimum 20 seconds) especially after direct contact with ill people and their settings. If you cannot wash your hands, use a sanitiser with 70% or more of alcohol.
3. People with symptoms of acute respiratory infections should be requested to practice cough etiquette – maintain distance, cover cough and sneezes with disposable tissues and wash hands well.
4. Strict infection control practices in hospitals especially in emergency departments.
5. Avoid unnecessary travel and stay away from crowded places likes malls, cinema halls and fairs. If you want to visit public/crowded places, wear a mask and the regular surgical mask is ok for public use. If you can’t get one, a cloth mask or even one made at home is better than none. The N95 mask is needed only if you are a medical person, or a Covid patient or a bystander to a Covid patient.
6. All elderly as well as those with chronic diseases should take extra care to stay away from anyone with respiratory symptoms. They should wear a mask throughout if there are cases in the nearby locality. If possible, they should adopt reverse quarantine.
The risk of infection for healthcare providers is very high in corona virus variants. The 2002 SARS variant had approximately 8 to 12 % infections reported from healthcare workers and the 2012 MERS variant had 20% infections reported from the same group. The current corona virus variant will probably have a low percentage of infection among healthcare providers due to lessons learned from SARS & MERS epidemics as well as advanced technologies. At least 3300 healthcare workers were reported to be infected till date from China alone. Informal reports from Italy says that 10 to 20% of healthcare providers who are treating Covid patients got infection in due course there.
Among countries, Czechia (156K/Million), Bahrain (152K/M), Slovenia (124K/M), Uruguay (108K/M), Sweden (108K/M) and US (104K/M) have the highest values for case densities currently. The maximum deaths per million population were reported from Peru (5813), Hungary (3114), Czechia (2837), Bosnia Herzegovina (2962) and Bulgaria (2631). As of today (2021 August 30) over 217,174,735 cases and 4,514,198 deaths are confirmed from countries/territories across the globe. Among infected countries, US stands first as of now (39,664,831 cases, 654,589 deaths). The next five countries with maximum reported cases are India (32,737,569 cases, 438,387 deaths), Brazil (20,741,815 cases, 579,330 deaths), Russia (6,882,827 cases, 181,637 deaths), France (6,742,488 cases, 114,210 deaths) and UK (6,731,423 cases, 132,437 deaths).
India currently is in a rapid second wave of the epidemic. The country could cross 35 to 40 million cases in this wave and may report 550,000 – 600,000 deaths by year end. The current situation in India looks grim and the healthcare delivery is stretched beyond imagination. Among those who tested positive globally, approximately 113,566 (0.6% of currently infected 18,598,188) are critical. Among those (198,576,547) with an outcome, a total of 4,514,198 people are reported to be dead (2%) and remaining 194,062,349 (98%) were reported recovered/discharged. So far, close to half of the total deaths are from just six countries – US, Brazil, India, Mexico, Russia and UK (more than 2175,000 deaths).
There is no need to panic as all countries are doing everything possible to contain the ongoing epidemic. We may see multiple waves in all countries till we have a successful vaccine drive that leads to more than 60% people vaccinated. The question as to whether another virus will change and come in the form of another pandemic from the animal world next door is very relevant here. There is every reason to believe this will happen again due to the close contact humans have currently with massive farm animal populations like poultry and livestock. All we need to do is step up surveillance in the animal world and closely follow patterns of every virus-related epidemic with utmost seriousness. The only two ways to lessen the damage from these novel viruses that may emerge in future is absolute surveillance and prompt responses to early cases. Spread the message of social distancing, wearing of masks and hand washing to save lives now. These three are our only options till specific drugs or vaccines come to the scene. And please do not spread fear or false information. Please do remember that if you take this illness lightly, the disease will bring serious consequences to you, your family and the society at large. We are talking about an epidemic that has doubled its size in the last five months by moving from 108 million to 216 million cases. So be serious in all your actions.
Spread the message to save lives. Dr. Manu Raj @ DocM Health
Twitter doc_manu
