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Covid-19 how serious is this virus?

The new corona virus has captured the attention of the world and has left many of us in Jamaica with a feeling of dread, but much of this worry is really justified? I will use my examination of the current scientific data to answer some basic questions about the virus and estimate its potential impact on our population.
  1. 1.What is the origin of this virus?

In an article published by the lancet (15/2/2020) 66% percent of initial infections were linked to the Huanan seafood market in Wuhan province. The link to this market lead to the initial assumptions that the virus originated in the market. The DNA profile of the virus may be as much as 96.6% similar to that of a corona virus of bats (Rhinolophus affinis), originally found in Yunnan or Zhejiang province, both of which were more than 900 kilometers away from the seafood market.

Many people believed that the practice of bushmeat consumption in many parts of china and the preparation and sale of the meat in wet markets gave the virus the opportunity to cross over from bats to humans. There is no evidence of the sale of the type of bat known to carry the bat virus in the Huanan seafood market, however 280 meters from the market the Wuhan Center for Disease Control & Prevention (WHCDC)is known to experiment on bats (Rhinolophus affinis) that may carry the bat corona virus.

Doctors working for the WHCDC were the first medical professionals infected with COVID-19. It is likely that someone from the WCDC was the “patient zero” for the current outbreak. There have been suggestions that COVID-19 has been manipulated by humans to make a bioweapon there is no evidence of this. Evolution will allow pathogens to mutate and even cross species barriers naturally.

  1. 2.What are the symptoms of the virus?

Generally speaking, the symptoms of COVID-19 are those of standards pneumonia with fever (87.95% of cases), dry cough (67.7% of cases) fatigue (38.1% of cases), phlegm/sputum (33.4% of cases), shortness of breath (18.6% of cases), joint and muscle pain(14.8% of cases), sore throat (13.9% of cases), chills (11.4% of cases), nausea and nasal congestion (less than 5% of cases).

People with COVID-19 usually develop signs and symptoms, including mild respiratory symptoms and fever, around of 5-6 days after infection however this may range between 1-14 days . There has been 1 case identified in of a 70-year-old in shanghai of a 70 year who apparently did not show symptoms for 27 days, but this has not been confirmed by the medical establishment. There are also cases of asymptomatic individuals that can still spread the disease.

Most people infected with COVID-19 virus have mild disease and recover. Approximately 80% of laboratory confirmed patients have had mild to moderate disease, which includes non-pneumonia and pneumonia cases, 13.8% have severe disease (dyspnea, respiratory in the severe form of the disease blood oxygen saturation drops below 93%, more than 50% of the lung fills with infiltrates. Approximately 6.1% of cases are critical respiratory failure, septic shock, and/or multiple organ dysfunction/failure.

  1. 3.How can it be spread?

Routes of transmission

COVID-19 is transmitted mainly via droplets and fomites (objects that can carry the disease e.g. clothes, utensils, pencils, books, furniture etc.).Simply put an infected person coughs or speaks causing infected saliva or phlegm to land on another person or object associated with people and then the infection is introduced to the mucous membranes of the eyes, nose, mouth and throat from those objects. The length of time the virus can remain intact on surfaces varies with temperature and humidity.

A compilation of 22 studies of CORONA viruses suggested that Human coronaviruses can remain infectious on inanimate surfaces at room temperature(250c) for up to 9 days. At a temperature of 30°C [86°F] or more, the duration of persistence is shorter. This suggests that in a well airconditioned room the virus could persist on the furniture for over a week, but it may persist for several hours in a non-air-conditioned room.

Airborne spread has not been reported for COVID-19 and it is not believed to be a major driver of transmission based on available evidence, however the virus has been found in the urine and feces of patients which may give rise to transmission due to aerosolization. If an infected person uses the toilet and flushes before closing the lid a mist of infected waste water could be sent up into the air to contaminate surfaces in the bathroom or this mist may be inhaled by an uninfected person.

The disease is transmissible during the incubation period (the time taken for the infected person to show symptoms) this makes isolating infectious people very difficult. The disease can spread from person to person via physical contact e.g. handshakes kissing, hugging etc. Sharing of personal objects like pencils note books cell phones, cutlery are all possible routes of transmission

In China, human-to-human transmission of the COVID-19 virus is largely occurring in families. in Guangdong Province and Sichuan Province78%-85% of infections have occurred in families. To date there is no reliable evidence that dogs or cats can act as hosts for the virus.

  1. 4. How dangerous is this virus?

People over the age of 60 and with pre-existing conditions like hypertension, diabetes cardiovascular diseases and chronic respiratory diseases are at the highest risk of developing the severe or critical form of the disease. Children are at the lowest risk with only 2.4% of cases being children/young adults under the age of 19. Only 2.4% of the under 19 developed the severe form and 0.2% the critical form of the disease.

the highest mortality was among people over 80 with a crude fatality rate of 21.9% (CFR). The CFR is higher Among males Compared to females (4.7%vs.2.8%). Patients with no other pre-existing conditions (comorbidities e.g. diabetes) had a fatality rate of 1.4%, but with Comorbid conditions the rate was: 13.2% For those with cardiovascular disease, 9.2% For diabetes, 8.4% For hypertension, 8.0% For chronic respiratory disease, and 7.6% For cancer.

As of March 9, 2020, worldwide there were approximately 110,000 confirmed cases of COVID-19 with 4,000 reported deaths. The global fatality rate is 3.6%. The case fatality rate outside mainland China was 1.7%

  1. 5.

Currently of the 195 recognized countries in the world 114 have confirmed cases of the virus. Since the assumed beginning of the outbreak in December the virus has therefore spread to 58.5% of countries in the world in a matter of 3-4 months. Below is a list of countries with confirmed cases of COVID-19 as of march 10, 2020

Afghanistan

Germany

Panama

Albania

Gibraltar

Paraguay

Algeria

Greece

Peru

Andorra

Holy See

Philippines

Argentina

Hong Kong

Poland

Armenia

Hungary

Portugal

Australia

Iceland

Qatar

Austria

India

Romania

Azerbaijan

Indonesia

Russia

Bahrain

Iran

Saint Barthelemy

Bangladesh

Iraq

Saint Martin

Belarus

Ireland

San Marino

Belgium

Israel

Saudi Arabia

Bhutan

Italy

Senegal

Bosnia and Herzegovina

Japan (+Diamond Princess)

Serbia

Brazil

Jordan

Singapore

Brunei

Kuwait

Slovakia

Bulgaria

Latvia

Slovenia

Burkina Faso

Lebanon

South Africa

Cambodia

Liechtenstein

South Korea

Cameroon

Lithuania

Spain

Canada

Luxembourg

Sri Lanka

Channel Islands

Macao

State of Palestine

Chile

Malaysia

Sweden

China

Maldives

Switzerland

Colombia

Malta

Taiwan

Costa Rica

Martinique

Thailand

Croatia

Mexico

Togo

Cyprus

Moldova

Tunisia

Czech Republic (Czechia)

Monaco

Ukraine

Denmark

Mongolia

United Arab Emirates

Dominican Republic

Morocco

United Kingdom

Ecuador

Nepal

United States

Egypt

Netherlands

Vietnam

Estonia

New Zealand

Faeroe Islands

Nigeria

Finland

North Macedonia

France

Norway

French Guiana

Oman

Georgia

Pakistan

  1. 6.Can it be caught more than once?

Currently there a 2 identified strains of the virus. The L strain is the more lethal strain and is responsible for 70% of infections. The S strain seems to be less virulent but it has also killed people. It may be possible to contract each strain separately but this has yet to be demonstrated

  1. 7.After recovery from the virus are you safe to be around?

A recent study from china has found that patients thought to be recovered from the virus still had detectable levels of virus in their blood up to two weeks later. There are no identified cases of recovered patients infecting others but it may be possible.

  1. 8. What are the possible treatment avenues for this virus?

There is no specific antiviral treatment recommended for COVID-19 though some drugs such as chloroquine, phosphate, lopinavir/ritonavir, alpha interferon, ribavirin, Arbidol are currently in use. Most people can manage their symptoms such as fever and cough at home by following these steps:

  • Control your fever with aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen), or acetaminophen. DO NOT give aspirin to children.
  • Drink plenty of fluids to help loosen secretions and bring up phlegm.
  • Do not take cough medicines without first talking to your doctor. Coughing is one way your body works to get rid of an infection. If your cough is preventing you from getting the rest you need, ask your doctor about steps you can take to get relief.
  • Drink warm beverages, take steamy baths and use a humidifier to help open your airways and ease your breathing. Contact your doctor right away if your breathing gets worse instead of better over time.
  • Stay away from smoke to let your lungs heal. This includes smoking, secondhand smoke and wood smoke. Talk to your doctor if you are a smoker and are having trouble staying smoke free while you recover. This would be a good time to think about quitting for good.
  • Get lots of rest. You may need to stay in bed for a while. Get as much help as you can with meal preparation and household chores until you are feeling stronger. It is important not to overdo daily activities until you are fully recovered.
  • If your pneumonia is so severe that you are treated in the hospital, you may be given intravenous fluids and antibiotics, as well as oxygen therapy, and possibly other breathing treatments.

In severe cases

  • Respiratory failure will require a breathing machine or ventilator.
  • Antibiotics to prevent or control sepsis due to secondary bacterial infections
  • Surgery to drain Lung abscesses, which are infrequent, but serious complications of pneumonia.
  1. 9.How many people are likely to die?

Some epidemiologists have estimated that between 40-70% of the world’s population will be exposed to the virus within a years’ time. The extent of the impact on the Jamaican population is difficult to determine however we can make some educated guesses based on knowledge of the virus and the Jamaican population.   According to Statistical Institute of Jamaica ‘s Website in 2014 Jamaica’s population was 2,714,734. taking the 40 and above age groups we can get an idea of the number of Jamaicans at significant risk from the virus. What is the risk of death in I each of the groups above? Table 1 gives us a rough estimate of the death rate per age group from china.

Table 1. death rate by age of infected groups

AGE

% DEATH RATE

80+ years old

14.8

70-79 years old

8

60-69 years old

3.6

50-59 years old

1.3

40-49 years old

0.4

30-39 years old

0.2

20-29 years old

0.2

10-19 years old

0.2

0-9 years old

no fatalities

If we assume that 40% percent of the most susceptible groups in Jamaica will get corona virus within the year then we are left with an estimate of 367,780 infected with 14,220 deaths within a year of the virus reaching the island (See table 2).

Table 2. estimated mortality due to COVID-19 in the 40+ age groups in Jamaica within a year

age range

No. in Jamaica

No. infected assuming 40% rate

estimated deaths

70-79 years old

158677

63471

5078

60-69 years old

161168

64467

2321

50-59 years old

256657

102663

1335

40-49 years old

342948

137179

5487

  1. 10.What can I do to reduce my risk of exposure?
  • Wash your hands thoroughly before you leave your home and when you leave public spaces if possible.
  • Use hand sanitizer to clean your hands if washing them is impractical
  • You can carry a small bottle of 90% alcohol and use it to wipe the surface of chairs and benches in public places before you use them
  • Do not touch your face if you have not cleansed your hands
  • Avoid public transportation as much as possible close proximity to infected people can seriously increase your risk. Route taxis may be faster than a half empty JUTC bus but the bus is the safer option.
  • If you are in the higher risk groups avoid hugging touching and or kissing others as much as possible
  • Avoid using other people’s property! don’t borrow their pens, their books or anything else that if you can avoid it and do not lend out your own.
  • Take Vitamin D supplements, vitamin d has been proven to decrease risks associated with respiratory illnesses. Older people that do not spend a lot of time out doors may increase their resistance by up to 80%
  • Sleep well, having regular sessions of 7-9 hours of sleep can boost your immune system

Currently there are no vaccines available for this disease and the time required for widescale production of vaccines is normally one year. Paper Face masks are mostly useless at preventing infection because they are too porous. Specialty masks like the m95 masks may prevent viral inhalation, but they cannot prevent contact with the membranes of your eyes or ears.

Paper masks may reduce the spread of the virus from infected persons and may also reduce how often you touch your face both of these factors may reduce the overall spread of the disease. It is likely that his virus may be with us from now on just like the influenza virus another seasonal malady making us ill and killing the most vulnerable amongst us.

Overall, it is just a matter of time before the first confirmed case of corona virus is reported in Jamaica, considering tourism and the frequent travels of so many of our citizens it is inevitable. The virus will cause deaths in this country it will slow tourism and cause economic harm. If we as Jamaicans stand together, we can weather this storm.

Author John Hall, Science lecturer at University of Technology and the Caribbean School of Medical Sciences Jamaica.

Last modified onWednesday, 11 March 2020 21:42
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