coronavirus

The Novel Coronavirus or 2019-nCoV

The outbreak of the nCoV struck various parts of the world in 2019, starting from Wuhan, China. Wuhan City, a major transportation hub, is a city in Hubei Province in China. This abbreviation nCoV stands for novel coronavirus. As of 30 January 2020, there are 7,818 confirmed cases globally, according to the World Health Organization or WHO. Of these, 7,736 cases are in China, and 82 cases are outside China. However, there are 12,167 suspected cases. 

The WHO Risk Assessment has tagged China as very high. The rest of the world is labeled as high.

The WHO risk assessment is the “scientific evaluation of known or potential adverse health effects resulting from human exposure to foodborne hazards.”

Coronavirus 

The coronavirus, named as such because of the spiky proteins on the outer shell of the virus, can be transmitted zoonotically or between people and animals. Other coronaviruses are investigated by international organizations. Findings point to SARS-CoV, also known as Severe Acute Respiratory Syndrome-Coronavirus, was transmitted from civet cats to humans. The Chinese braise the meat of civet cat in soy sauce and hoisin sauce. Civet cats’ perineal glands are also harvested for high-end fragrances. Cages in a restaurant in Southern China, which carried raccoons, badgers, and civet cats, were found to be positive with the SARS-CoV. The civet cat is also used by some countries such as Indonesia or Vietnam, to produce a specific type of coffee bean. 

Another coronavirus that was first identified in Saudi Arabia in 2012, the Middle East Respiratory Syndrome (MERS-CoV) is also transmitted between people and animals. Unlike SARS-CoV, which points to the civet cat as the carrier, the MERS-CoV can attribute the outbreak from infected dromedary camels. The dromedary camel originated in many countries in Asia and Africa, particularly the Arabian peninsula and the Horn of Africa. There are two species of camel, the Dromedary or Bactrian. The main difference is in the number of their humps. Dromedaries have one hump while the Bactrian has two humps. Some studies have reported that dromedaries may have been infected by the MERS-CoV in the distant past by bats.

The 2019-nCoV is zoonotic as well. Recent studies have shown that the nCoV has trace findings in bats. These bats are consumed in certain parts of China, Vietnam, Indonesia, Palau, and Guam. Bats, considered a delicacy, are prepared through grilling, frying, or stewing in a particular sauce. Moreover, most of the earliest cases were related to the Huanan Seafood Wholesale Market in Wuhan, China. The seafood and the live-animal market is closed since 1 Jan 2020.

Amongst the three coronaviruses, MERS-CoV has the highest case fatality rate at 37.1 percent. This is followed by the SARS-CoV, which has a fatality rate of 14 percent to 15 percent. The 2019-nCoV, despite being more infectious than the SARS-CoV, has a case fatality rate of 2 percent. This rate is not the basis of how deadly or contagious disease is. Remember that the case fatality rate is computed by the number of deaths divided by the number of diagnosed persons over a specific period of time. If there are more persons diagnosed, the case fatality rate would be lower. Similarly, if there are fewer persons diagnosed, the rate in deaths by specific cases climbs up.

Symptoms of 2019-nCoV

According to the Centers for Disease Control and Prevention or CDC, symptoms include fever, cough, and shortness of breath. Fever may not be present in the elderly, the young, the immunosuppressed, or those taking fever-lowering medicines. The average incubation period of the novel coronavirus is 5.2 days. The incubation period is counted from the time of exposure to the time before the first symptoms appear.

Fever, on the one hand, is defined as higher than normal body temperature. This condition may be accompanied by headache, malaise, and shivering. On the other hand, cough is a reflex action of the body to clear airways of irritants like mucus, food, dust, and smoke. A person with shortness of breath is said to have difficulty in breathing

Clinical syndromes associated with novel coronavirus

In one of the studies of the novel coronavirus, a few patients of the novel coronavirus have developed pulmonary edema, ARDS, multiple organ failure, and severe pneumonia. These patients have all died.

The World Health Organization has listed clinical syndromes associated with 2019-nCoV. Uncomplicated illness is defined as those with non-specific symptoms such as fever and cough. Mild pneumonia is next on the list. Severe pneumonia is the third illness on the list. Other clinical syndromes are acute respiratory distress syndrome, sepsis, and septic shock.

Non-specific illnesses are symptoms that do not narrow down to a specific disease. These are fever, cough, malaise, nausea, vomiting, or difficulty in breathing. 

Pneumonia is classified as mild, moderate, or severe. Mild pneumonia may be treated at home through oral antibiotics. Moderate pneumonia symptoms include low blood pressure, worsening of difficulty in breathing, and drowsiness. Persons with moderate pneumonia should be treated at the hospital. Usually, two different antibiotics are provided to the patient after assessment. When the patient has organs such as the heart, the kidneys, or lungs as failing, pneumonia is classified as severe. These patients are rushed into intensive care with intravenous antibiotic treatment and are hooked on mechanical ventilation. 

The Mayo Clinic defines ARDS or Acute Respiratory Distress Syndrome when fluid is accumulated in the tiny air sacs of the lungs. This fluid prevents air from entering the sacs, depriving your organs of the much-needed oxygen. Human organs need oxygen to function. Because the air sacs are filled with fluid, there is severe shortness of breath as well as difficulty and rapid breathing. Patients with ARDS also have low blood pressure. Because little oxygen is being distributed throughout the body, confusion and extreme tiredness may sink in. Mayo Clinic reports that if ARDS develops, many people do not survive. Some people survive ARDS. However, some who survive have chronic lung damage.

When the body becomes out of balance because of the poor response to body chemicals, the body is threatened by sepsis. This condition may damage multiple organ systems. As an infection, sepsis is common but more dangerous in the elderly, pregnant women, infants, immunocompromised people, and people who have diabetes or cancer. Septic shock is a severe form of sepsis. The condition is considered as a septic shock when two elements are present. The first element is when there is a need for medication to maintain blood pressure greater than or equal to 65 mm Hg, Mayo Clinic reports. The second element is when there are high levels of lactic acid in the blood after receiving the fluid replacement. When there are high levels of lactic acid in the blood, oxygen is not being used properly.

2019-nCoV vs 1918-influenza virus

In research published by The New England Journal of Medicine, the 2019-nCoV is more infectious than the 1918 influenza virus. The publication has come up with the R-nought value, also known as the measure of infectiousness. The novel coronavirus has an R-nought value of 2.2. This means that one patient can infect more than two persons. However, influenza that was a pandemic in 1918 has a value of 1.80. A higher R-nought value, such as that with the novel coronavirus, means that it is more infectious compared to illnesses that have a lower value.

However, a higher R-nought value does not mean that the novel coronavirus will “ultimately cause more severe illness or deaths,” according to Marc Lipstich, PhD, a professor of epidemiology at Harvard University. Also, the director of the Center for Communicable Disease Dynamics (CCDD), Dr. Lipstich, further explains that if the transmission, before symptoms occur, is not too common, then it may be more effective to control the 2019-nCoV than the previous flu pandemic.  

Risk factors

The precipitating factors of the nCoV include exposure to the Huanan Seafood Wholesale Market. Before 1 Jan 2020, the majority of the cases of the novel coronavirus were people who are exposed to the said market. For the predisposing factors, older adults are most likely prone to infections, especially with the novel coronavirus. Because elderly adults have other chronic health conditions like chronic obstructive pulmonary disease or COPD, which makes them more susceptible to infections, other illnesses like diabetes also make it harder for seniors to fight off infections. 

Some studies report that the coronavirus multiplies in the lungs exclusively. NEJM further reports that there are zero cases of 2019-nCoV on children 15 years of age and under. Also, in the same paper published last 29 January 2020, said journal explains that the children are not necessarily immune to the virus. Younger people may be better at fighting off the novel coronavirus.

Aside from older adults, other people susceptible to the novel coronavirus are diabetics, people with HIV infection, people with long-term use of immunosuppressive agents, and pregnant women.

Method of transmission

The transmittal of the novel coronavirus is through droplet transmission. Droplet transmission is different from the airborne transmission. Their difference lies in which agents carry the virus. Airborne agents may carry viruses or bacteria through smaller particles like dust. However, droplet agents may carry viruses or bacteria through larger particles such as those generated via coughing, sneezing, or talking to mucosal surfaces such as the eyes, mouth, or nose.

Treatment

Like most viruses, the approach to treating novel coronavirus is with supportive care treatments. Immediately go to a hospital specializing in skin infections. This includes supportive therapy and monitoring at the earliest time possible. First, supplemental oxygen therapy is provided. Conservative fluid management is also provided for patients with severe acute respiratory infection or SARI. Another treatment listed by the World Health Organization is to give antimicrobials to treat all likely pathogens causing SARI. An understanding of the co-morbid conditions, especially on the elderly or immunocompromised, is important as well. Plus, it is a must too to monitor patients with SARI closely.  

Prevention

Wash hands

It is never emphasized enough to wash hands frequently with soap and water. Hands can be rubbed with alcohol-based products as well. Remove any jewellery. Wet your hands. Use sufficient soap and lather well. Scrub all parts of your hands. These are your fingers, your nails, under your nails, back of your hands, your wrists, and forearms for at least 10 to 15 seconds. Rinse your hands under clean running water. 

Avoid touching eyes, mouth, and nose.

Your hands may be infected with the novel coronavirus. These mucosal surfaces, such as the eyes, mouth, and nose can be entered by viruses or bacteria.  

Cover mouth and nose

If you suddenly cough or sneeze, cover mouth and nose with a flexed elbow or a disposable tissue. Wash your hands and elbow thoroughly with soap and water. Discard used tissue in a closed bin.

 If others are coughing or sneezing, maintain at least 3 feet or 1 meter in the distance.

Cook animal products well. 

Raw or undercooked animal products may be contaminated with the novel coronavirus. Do not consume animals that have shown links to the coronaviruses such as bats, civet cats, raccoons, badgers, or dromedary camels. 

Seek professional help as soon as possible

If you have been in close contact with someone from China and have respiratory symptoms akin to the novel coronavirus, seek professional help as soon as possible.

Believe it or not, garlic would not save you from the novel coronavirus. What may save you from the novel coronavirus are the preventive techniques mentioned above. Research and development have made progress. Humans continue to not only survive but thrive. According to Anthony Fauci, an immunologist, microbes “just genetically evolve in a way that selects for their self-preservation.”

Similarly, humans must do everything in their power to preserve their kind, first, and foremost. This quest for self-preservation is where similarities between humans and viruses start and end. Contrary to viruses which don’t think, humans, think. Like what they say, the world cannot be changed without changing our thinking. And up to how much has the world changed? More than you know.

Citations