Coronavirus, simple facts

The more we hear about the Coronavirus ( SARS-COV-2) and the more we read from different sources , the mor it seems that no one has the full picture about this virus yet nor has the level of danger it posses on communities and countries or what is the best way to face it. What we know so far from scientific entities, governmental and non governmental agencies is that Coronaviruses are a large family of viruses that are common in people and many different species of animals, including camels, cattle, cats, and bats. Rarely, animal coronaviruses can infect people and then spread between people.

The origin of this outbreak of Coronavirus believed to be from bats, and in China traditionally people use bats for food and medicinal purposes. Also the Coronavirus is used in the Biological Warfare and different countries has developed different subtypes of this virus including Russia, China and the United States of America.

So far we are not very clear to how it started in China but at the beginning it was tied to a large seafood and live animal market (wet market, as they call it), suggesting animal-to-person spread in Wuhan where the outbreak started. But later on the reports came out to say that a lot of the people who got sick did not visit that market nor they ate wild life animals!! So it remains an open question to how did the virus get to those patients and being transmitted human to human!!

The virus has 2-7 days , up to 14 days in some reports, incubation period so you can be totally  asymptomatic and test positive in early stages of this phase, but still be transmitting the disease to others. In general the symptoms are similar to those of the flu including fever, cough, myalgia, and shortness of breath.Other less commonly reported respiratory symptoms include sore throat, headache, cough with sputum production and/or hemoptysis (bloody cough). Some patients have experienced gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms.

Transmission from person-to-person happens through droplets that are spread via coughing and spitting. The virus can survive on solid surfaces for 12 hours. Ingesting the virus should not cause the disese because the stomach acid will neutralize it. 

According to CDC, risk factors for severe illness are not yet clear, although older patients and those with chronic medical conditions may be at higher risk for severe illness. Among more than 44,000 confirmed cases of COVID-19 in China as of Feb 11, 2020, most occurred among patients aged 30–69 years (77.8%), and approximately 19% were severely or critically ill . Case-fatality proportion among cases aged ≥60 years was: 60-69 years: 3.6%; 70-79 years: 8%; ≥80 years: 14.8%. Patients who reported no underlying medical conditions had an overall case fatality of 0.9%, (which is less than the general risk of death from Bacterial Pneumonia or influenza which is 5.9 %) but case fatality was higher for patients with comorbidities: 10.5% for those with cardiovascular disease, 7% for diabetes, and 6% each for chronic respiratory disease, hypertension, and cancer. Case fatality for patients who developed respiratory failure, septic shock, or multiple organ dysfunction was 49%. 

The main concern and the reason behind this international panic and the declaration of global pandemic is that we have not met this virus before and we have no immunity against it, so it can spread very easily from person-to-person and will make a lot of people sick at the same time! SO most likely the majority of us will survive the virus and will have immunity after that but because we are worried that too many people might get sick at the same time, the health system could be overwhelmed and it might fail, that is why the government is canceling events and closing schools. This preventive method is called discontinuation of transmission through isolation.

Current treatment for the severe cases are all investigational, FDA has not approved any specific medication for the treatment of Coronavirus,  but we have few antiviral medications that are used to treat other infections have been used successfully to treat Coronavirus, such as Lopinavir/Ritonavir and Remdesivir. Also Chloroquine, an antimalarial medication seems to have good activity against the virus in small reports. The majority of cases will only need supportive care and close monitoring.

What to do? Do NOT panic please. Panicking will create a huge uncertainty in everyones mind, and people with go into survival mode and we will not be able to help each other and function as a community to defeat this pandemic and protect our children. Imagine your self in a movie theater and someone screamed that there is a fire somewhere and instead of taking a moment to assess the situation and see if we can put the fire down or create a safe exit for everyone , you started panicking and trying to get to the emergency doors without any regards to the guy next to you..in this case you might get pushed, elbowed, stabbed or even killed in the process. We need to be smart and cautious more than panicky. Look around, do you personally know any one with true, positive test proven infection. Have you been to China ,Europe or Washington state recently. If the answer is no then your chance to contract the virus is still low. Remember even if you meet someone with flu symptoms, we are in the allergy season and we still have flu viruses out there so please use face mask and hand hygiene as recommended and stay away from big gatherings and avoid traveling until the pandemic is contained. 

Author
Dr.Ousama Moammar Board Certified in Internal Medicine/Critical Care

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