THE CORONAVIRUS DISEASE 2019: FACTS, FINDINGS, AND FIGURES
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS coronavirus 2, or SARS-CoV-2), a virus closely related to the SARS virus. The disease was discovered and named during the 2019–20 coronavirus outbreak. Those affected may develop a fever, dry cough, fatigue, and shortness of breath. A sore throat, runny nose or sneezing is less common. While the majority of cases result in mild symptoms, some can progress to pneumonia and multi-organ failure.
The infection is spread from one person to others via respiratory droplets produced from the airways, often during coughing or sneezing. Time from exposure to onset of symptoms is generally between 2 and 14 days, with an average of 5 days. The standard method of diagnosis is by reverse transcription-polymerase chain reaction (rRT-PCR) from a nasopharyngeal swab or sputum sample, with results within a few hours to 2 days. Antibody assays can also be used, using a blood serum sample, with results within a few days. The infection can also be diagnosed from a combination of symptoms, risk factors and a chest CT scan showing features of pneumonia.
Hand washing, maintaining distance from people who are coughing and not touching one’s face with unwashed hands are measures recommended to prevent the disease. It is also recommended to cover one’s nose and mouth with a tissue or a bent elbow when coughing. Those who suspect they carry the virus are recommended to wear a surgical face mask and seek medical advice by calling a doctor rather than visiting a clinic in person. Masks are also recommended for those who are taking care of someone with a suspected infection but not for the general public. There is no vaccine or specific antiviral treatment, with management involving the treatment of symptoms, supportive care, and experimental measures. The case fatality rate is estimated at between 1% and 3%.
The WHO has declared the 2019–20 coronavirus outbreak a Public Health Emergency of International Concern (PHEIC). As of 29 February 2020, China, Hong Kong, Iran, Italy, Japan, Singapore, South Korea, and the United States are areas having evidence of community transmission of the disease.
SIGNS AND SYMPTOMS
|Shortness of Breath||18.6%|
|Muscle Pain or Joint Pain||14.8%|
|Nausea or Vomiting||5%|
Those infected may either be asymptomatic or develop symptoms including fever, cough, and shortness of breath. Diarrhea or upper respiratory symptoms (e.g. sneezing, runny nose, and sore throat) are less frequent. Cases can progress to pneumonia, multi-organ failure, and death in the most vulnerable.
The incubation period ranges from 1 to 14 days with an estimated median incubation period of 5 to 6 days according to the World Health Organization (WHO).
Based on 55,924 laboratory-confirmed COVID-19 cases in China, the WHO found the following prevalence of symptoms:
Another study of 1,099 Chinese patients found that CT scans showed ground-glass opacities in 56% of patients, but 18% had no radiological findings. 5% of patients were admitted to intensive care units, 2.3% needed mechanical support of ventilation, and 1.4% died. Bilateral and peripheral ground-glass opacities are the most typical CT findings, according to researcher Bernheim et al. Consolidation, linear opacities, reverse halo sign are other radiological findings. Initially, the lesions are located to one lung, but as the disease progress, indications manifest to both lungs at 88% of patients. Children seem to handle the disease better than adults as the symptoms are usually milder, but sufficient evidence is still lacking.
The disease is caused by the virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), previously referred to as the 2019 novel coronavirus (2019-nCoV). It is primarily spread between people via respiratory droplets from coughs and sneezes.
The virus is thought to have an animal origin. There has been a “continuous common source” of the outbreak in December 2019, which would imply that several animal-to-human zoonotic events occurred at the Huanan Seafood Wholesale Market. The primary source of infection became human-to-human transmission in early January 2020.
Global health organizations have published preventive measures to reduce the chances of infection in locations with an outbreak of the disease. Recommendations are similar to those published for other coronaviruses: stay home, avoid travel and public activities, wash hands with soap and hot water often, practice good respiratory hygiene, and avoid touching the eyes, nose, or mouth with unwashed hands.
The use of masks by healthy members of the public is not recommended outside of China.
To prevent transmission of the virus, the Centers for Disease Control and Prevention (CDC) recommends that infected individuals stay at home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask (especially in public), cover coughs and sneezes with a tissue, regularly wash hands with soap and water, and avoid sharing personal household items.
The CDC recommended that individuals wash hands often with soap and water for at least 20 seconds, especially after going to the toilet or when hands are visibly dirty, before eating, and after blowing one’s nose, coughing, or sneezing. It further recommended using an alcohol-based hand sanitiser with at least 60% alcohol, but only when soap and water are not readily available. The WHO advises individuals to avoid touching the eyes, nose, or mouth with unwashed hands.
In early 2020, the WHO said it did not expect a vaccine against SARS-CoV-2 to become available in less than 18 months.
There are no specific antiviral medications approved for this disease. Symptoms are managed with supportive care. Both the WHO and the Chinese National Health Commission have published detailed treatment recommendations for hospitalized patients with a severe acute respiratory infection (SARI) when a SARS-CoV-2 infection is suspected. WHO advises against the use of steroids and methylprednisolone unless the disease is complicated by acute respiratory distress syndrome. The WHO also recommended volunteers take part in randomized controlled trials for testing the effectiveness and safety of potential treatments.
Bruce Aylward, assistant director-general of the World Health Organization (WHO), has stated: “there is only one drug right now that we think may have real efficacy and that’s remdesivir.” It was reported on 25 February 2020 that clinical trials for this drug were in progress, with results possibly available within weeks.
The Beijing branch of China’s National Health Commission suggested the use of lopinavir/ritonavir as part of treatment plans in the absence of an approved drug for this indication. The lopinavir/ritonavir combination and interferon can now be claimed for via health insurance in some countries.
Chloroquine was being trialed in China in February 2020, with preliminary results that seemed quite positive. The drug was enrolled in treatment guidelines.