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COVID-19: What have we learned so far

In December 2019 we first heard about this novel coronavirus in Wuhan, China. Since that time it has spread globally. I first wrote about it on January 21 and again on February 13th. A lot has changed in that short period of time.


Infections have now been reported in 49 countries. A particularly large outbreak occurred among the passengers and crew of the Diamond Princess cruise ship, where more than 700 infections are reported.


As I write this blog there have been more 82,166 confirmed cases of the novel coronavirus, now officially known as COVID-19 and more than 2,803 confirmed deaths globally.


This includes at least four deaths in the US.


Also as I write this blog, there have been confirmed cases of COVID-19 on every

continent except Antarctica.


The full economic ramifications of the novel infection are yet to be determined.


So what do we know about the virus


The novel coronavirus is now officially known as COVID-19.


It is a new human-infecting Betacoronavirus virus that, based on its genetic similarity to two bat-derived SARS-like coronaviruses, likely originated from bats.


Incubation periods of this virus is thought to range from 1 to 14 days with a median of 5 to 6 days.


Currently the WHO and Centers for Disease Control and Prevention (CDC) have based their quarantine policy based on this.


The virus appears to be transmitted primarily through large droplets. However, it has also been found in other body fluids such as blood and stool. Hence, it may be possible to transmit the virus by other means.


Unfortunately, transmission of the virus from an asymptomatic carrier may be possible. This has not been definitively confirmed.


What happens to those who are infected?


Looking at the data, which mostly comes from patients in Wuhan, China, the median age of those infected is in the 50s.


About one in four get very sick and require hospital admission and about one out of every ten develops respiratory failure requiring a breathing machine (ventilator).


Some countries have reported worse outcomes. Iran seems to have a higher mortality rate, but as of yet it is unclear why this is so.


Broadly speaking, the clinical presentation of this virus includes fever, dry cough and fatigue. These are vague symptoms similar to the flu.


Chest imaging usually finds patchy infiltrates in both lungs.


The good news is that it appears most patients have a mild illness.


Testing


Both the WHO and CDC recommend screening those who are returning from travel to China (especially Hubei Province).


These recommendations will soon be modified given the increasing number of cases globally and a recent report of a case in California with no history of travel or known contact with someone who traveled to China.


So what is going on locally and globally?


First, lets go over some of the terms that are being thrown around in the news and social media.


How prevalent is this virus?


The cases of a particular disease, in this case COVID-19, that are present in a community is referred to as the endemic level of the disease.


This is the expected number of confirmed infections due to a disease in a community. In the absence of any intervention the disease may continue to occur at this level indefinitely. Thus, the baseline level is often regarded as the expected level of the disease.


With very rare diseases such as rabies, even a single infection warrants an investigation. While more common diseases are only monitored for deviations from the norm.


When the number of infections from a disease increases above what would be expected, that is referred to as an epidemic.


Epidemic refers to an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area.


To have an epidemic you need an infectious agent (i.e. COVID-2019) and susceptible hosts (people in Wuhan, China).


Pandemic refers to an epidemic that has spread over several countries or continents, usually affecting a large number of people.


Scientists have differed over the exact definition of a pandemic, but everyone agrees that the word describes the widespread occurrence of disease, in excess of what might normally be expected in a geographical region.


So technically a pandemic is the worldwide spread of a new disease such as COVID-19.


To date, the COVID-19 outbreak has not been called a pandemic.


The world is small


With the ease of international travel and increase in the global population, it is only a matter of time before a global scale pandemic like this will strike with potentially devastating effects.


Several new viruses have emerged in recent years, including SARS, MERS, Ebola, Zika and most recently, the novel coronavirus.


Unfortunately, although we know this, we are still grossly unprepared to deal with emerging infections.


But it isn’t all doom and gloom!


There are some practical things you can do to protect your health as the spread of COVID-19 is inevitable.


Restricting travel to and from China appears to have helped minimize the number of infections in the US.


So far there have been over 100 confirmed cases of COVID-19 in the US.


The CDC has stated: “Americans should prepare for the possibility of disruptions to their daily lives if the virus were to start spreading in the U.S.”


This may include closing schools, working from home and delaying elective medical procedures.


Preventive measures


While there’s no vaccine to prevent the coronavirus infection, there are still things you can do to protect yourself.


Coronaviruses tend to spread from person to person through coughing and sneezing.


Despite this, aggressive measures in China to prevent the spread of this disease seem to be working.


Other things you can do


Hand-washing


Regularly and thoroughly clean your hands with soap and water (any soap will work) or alcohol-based hand rub. This is just a good habit to develop and will help you avoid other common ailments as well.


Socializing


Put some distance between yourself and anyone with an active cough or sneeze.


This helps avoid the small liquid droplets which may contain viruses.


As your hand comes into contact with different surfaces throughout the day, it is easy to pick up a virus and your contaminated hand can transfer the virus to your nose, eyes or mouth.


Don’t touch your eyes, nose and mouth!


Hygiene


Covering your mouth and nose with your bent elbow or tissue when you cough or sneeze isn’t just the socially polite thing to do, it can help minimize spreading droplets that can spread disease to others.


Face masks?


The Centers for Disease Control and Prevention says it "does not recommend that people who are well wear a face mask to protect themselves from respiratory diseases, including COVID-19."


The CDC also states "Face Masks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to others."


Transmission and infection of health care workers is a major problem. The CDC recommends that health care workers use personal protective equipment (PPE) and implement standard, contact, and airborne precautions including the use of eye protection.


Health care workers should wear a gown, gloves, and either an N95 respirator plus a face shield or goggles or a powered, air-purifying respirator.


Keep in mind, most surgical face-masks are not going to prevent your exposure to droplets that could potentially cause disease.


Should you change travel plans?


It would probably be wise to hold off on travel to China at this point in time. It is still not clear how transmittable COVID-19 is and who is at the greatest risk of developing serious complications from it.


Thus far it seems like the elderly with underlying medical problems are the highest risk group for a bad outcome due to COVID-19 infection.


The U.S. State Department has basically said don’t travel to Hubei.


If you must travel to China, especially if traveling to high risk regions of the country, it is recommended to wear a mask (questionable how helpful this is), wash hands often, and avoid contact with sick people.


I can’t emphasize enough that the typical over-the-counter surgical masks don’t protect against airborne illnesses.


Treatment


As of today, there is no antiviral treatment recommended for COVID-19.


Supportive care is the mainstay of treatment.


Clearly this is an evolving issue and we will continue to learn more as time goes on. One thing to take away from this novel virus that started in China and is now a global health problem is that we need to stop looking at the world in a “us” and “them” way and realize we are all on this planet together and “we” share all the good and bad that comes with it.


Stay tuned, more to come.

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