What you need to know about Coronavirus - 2019 (COVID-19) - by Dr Hasnain Hyder Karan, M.B.B.S.

What is Coronavirus?

Coronaviruses are a type of enveloped RNA virus that cause disease in mammals and birds, and in humans are known to cause a number of respiratory infections such as the common cold or more severely, pneumonia and severe respiratory distress syndrome. They get their name from the Latin word corona which means crown, referring to their morphological structure of proteins studded on the surface of the virus. ​

Where did COVID-19 come from?

In particular the COVID-19 (short for coronavirus disease 2019) formerly known as nCoV 2019 (novel coronavirus 2019)​ is the cause of an respiratory illness outbreak which has been classified as a global health emergency by the World Health Organization​. It is a subspecies of coronaviridae that is distinct from the severe acute respiratory syndrome - coronavirus (SARS coronavirus 2013), and at present has no available cure or vaccine. COVID-19, was first discovered in December 2019 amongst a group of patients with pneumonia who were all linked to a seafood and live animal wholesale market in Wuhan, Hubei Province, China.

The mode of transmission or the method by which the virus spread to humans first, is currently not known, what is known is that human to human transmission via respiratory droplets is confirmed at an alarming rate​. According to the WHO situational report 22 - published on February 11, 2020, COVID-19 and other similar coronaviruses are found circulating in bats, specifically those of the Rhinopholus bat subspecies. This subspecies of bat is prevalent in Southern China, parts of Asia, the Middle East, Europe and Africa. The current working theory as to the mode of transmission of COVID-19 is that these bats are hunted and sold directly to restaurants in China posing a risk for transmission of the virus. However they are not sold specifically at seafood or live animal markets in China (the initial group of patients who tested positive), hence an intermediate host is suspected as most probably playing a role in transmission​. An intermediate host is an organism which supports the development and maturation of a parasite or virus for it to eventually pass on to humans​, such as rodents and small mammals which carry fleas in the case of the bubonic plague.

What are the signs and symptoms of COVID-19?

The symptoms of COVID-19 encompass two broad categories: respiratory and gastrointestinal and may include symptoms such as:

•    shortness of breath
•    cough
•    sneezing
•    nasal congestion
•    sore throat
•    diarrhea
•    generalized weakness
•    fever

These symptoms may appear within 2 to 14 days after initial exposure​ this period is known as the incubation period, or the period between the initial exposure to an infection andthe appearance of clinical symptoms. Severe cases of COVID-19 develop into severe acute respiratory syndrome (SARS), pneumonia, and septic shock which are attributed to the majority of deaths. General population groups which are at higher risk for COVID-19 include young children, the elderly, and those with underlying conditions such as (hypertension, heart disorders, diabetes, liver disorders and respiratory disease).

Data reports suggest that since December 31 and as of February 11 the current number of laboratory confirmed cases worldwide is 41,118, and total deaths are 1,018, with numbers rapidly rising. The total number of cases reported in India are 3, and all are present in the state of Kerala, 2 of the 3 cases reported have tested negative for coronavirus. As of February 13, 2020 two more passengers have been isolated at Kolkata airport on suspicion of being seropositive for COVID-19.

How does COVID-19 spread?

COVID-19 is a respiratory disease and as such is spread from person to person in close contact with an infected individual (within a distance of 6 feet). Spread of the virus occurs via respiratory droplets produced when an infected person coughs or sneezes. These respiratory droplets can land in peoples oral cavities or nostrils, and may even be inhaled into their lungs. ​It is not clear as to whether the virus can spread via touching a contaminated surface however prevention guidelines listed below should be adopted.

Prevention Guidelines according to the CDC and WHO:

As was stated earlier, there is no vaccine to prevent COVID-19 currently, and at present the best strategy to prevent infection is to avoid being infected. Such prevention strategies are outlined below:

  • The ​use of a facemask is not currently recommended by the Center for Disease Control ​however ​it is recommended for healthcare professionals and caretakers of the elderly to wear a medical mask to avoid spreading the infection to those at higher risk.
  • However the use of a medical mask (facemask) may be worn in certain countries due to local cultural habits. This measure alone however is NOT sufficient to provide adequate levels of protection. The other strategies listed below should be adopted as well.
  • Wash your hands with soap and water for at least 20 seconds especially after going to the bathroom, after blowing your nose, coughing, sneezing, and before eating
  • Avoid closed spaces with large groups of people.
  • Avoid close contact with sick individuals presenting with symptoms mentioned above
  • Avoid touching your eyes, mouth, or nose with unwashed hands
  • Cover your cough or sneeze with either a flexed elbow or a tissue, and dispose of the tissue immediately after use and wash your hands.
  • Avoid unprotected contact with wild or farm animals
  • Stay at home when you are sick, and if you’ve recently traveled from China and notice symptoms above, seek medical care.

Current treatment and a possible vaccine in the future?

So with all the hysteria and misinformation spreading about COVID-19, what does the future hold in terms of treating this respiratory disease and developing a vaccination one might ask? Treatment of COVID-19 thus far has been purely supportive, and it includes: giving supplemental oxygenation to patients with SARS, using conservative fluid management for patients with no symptoms of shock, giving empiric antimicrobials for treatment for other microbials causing SARI, and closely monitoring patients for any deterioration in their condition and applying other supportive care protocols.

No vaccine has currently been developed for prevention of COVID-19, and reports suggest that it may take at least a year before a vaccine is developed let alone ready to be administered. Despite the lack of a vaccine, according to a current WHO research convention held in Geneva, Switzerland (February 11-12): moving forward the WHO is planning to accelerate global research and organise international action on COVID-19. It plans to do this by building on existing SARS and MERS coronavirus research in order to accelerate scientific information needed to minimize the impact of the COVID-19 outbreak. This research has culminated in the formation of a global research publication database accessible on the WHO’s website, as well as set the priorities on all aspects of the outbreak.

The topics discussed at length at the conference, will hopefully give researchers and doctors alike the edge in combating existing cases of COVID-19 as well as stem it’s spread through the development of a vaccine. If you wish to learn more about COVID-19, check the World Health Organization’s novel Coronavirus 2019 updates online as well as read reputed medical sources.

Dr Hasnain Hyder Karan (M.B.B.S) is an intern physician at Shadan Hospital and a graduate of Shadan Institute of Medical Sciences. He lives in San Francisco, California, USA, and pursued his medical education in Hyderabad. He is currently studying for the United States Medical Licensing Exam and aspires to obtain residency in Internal Medicine. His fields of interest include Cardiology, Global health, and Neurology. Besides medicine, he enjoys playing basketball as well as watching NBA games, hanging out with close friends, and is an avid reader.                  - (Pic: Dr. Aakash Goyal M.B.B.S)