It’s not new

Every decade, a zoonotic coronavirus crosses species that infect humans and in this decade, we have a virus, called 2019-nCoV, first identified in Wuhan, China, in persons exposed to a seafood market.

Name

The name ‘coronavirus’ is derived from its shape, resembling a crown or solar corona when seen under an electron microscope.

The three deadly human respiratory coronaviruses so far:

1. Severe acute respiratory syndrome coronavirus [SARS-CoV]
2. Middle East respiratory syndrome coronavirus [MERS-CoV])
3. 2019-nCoV: The virus is 75 to 80% identical to SARS-CoV

Pathogenesis

Infection with these coronaviruses is associated with a severe inflammatory response.

It has high mortality

In the current situation, the mortality rate is 3%. The severity of illness is a cause for concern. Almost one-third of patients developed acute respiratory distress syndrome; six patients died; five had acute cardiac injury; and four required ventilation.

Its zoonotic

It is closely related to several bat coronaviruses. It seems that bats are the primary reservoir for the virus. SARS-CoV was transmitted to humans from exotic animals in wet markets, and MERS-CoV transmitted to humans from camels. The ancestral hosts were probably bats in both the situations.

It is more infectious to humans

The 2019-nCoV seems to thrive better in primary human airway epithelial cells than in standard tissue-culture cells, unlike SARS-CoV or MERS-CoV. The 2019-nCoV seems likely to behave more like SARS-CoV.

Human-to-human infection is weak

SARS-CoV and MERS-CoV affect intrapulmonary epithelial cells more than upper airway cells. Transmission thus occurs from patients with recognized illness and not from patients with mild, nonspecific signs. 

2019-nCoV seems to use the same cellular receptor as SARS-CoV (human angiotensin-converting enzyme 2 [hACE2]). Transmission thus seems to occur only after signs of lower respiratory tract disease develop.

The median time from onset of symptoms to first hospital admission was 7.0 days (4.0–8.0), to shortness of breath was 8.0 days (5.0–13.0), to ARDS was 9.0 days (8.0–14.0), to mechanical ventilation was 10.5 days (7.0–14.0), and to ICU admission was 10.5 days.

Its unlikely to spread by eating sea food in India

The infection has been traced to snakes in China, so, it is unlikely to spread in India by eating sea food.  Snakes hunt for bats.  Reports suggest that snakes were sold in the local seafood market in Wuhan. It is quite possible that the 2019-nCoV jumped from the host species, i.e., bats, to snakes and then to humans at the beginning of the outbreak. It is not yet known how the virus could adapt to both the cold-blooded and warm-blooded hosts.

Flight transmission

There have been reports of transmission of foodborne diseases on aircraft, including cholera, shigellosis, salmonellosis, and staphylococcal food poisoning. Transmission of smallpox on aircraft was reported in 1965. An influenza outbreak was reported in 1979 among passengers on a flight that had a three hours’ ground delay before takeoff. The influenza attack rate very high (72%) among passengers. It was attributed to the failure of operation of ventilation system during the ground delay. Measles may also have been transmitted aboard international flights. No case of active TB has been identified due to exposure on a commercial aircraft. However, transmission of M. tuberculosis may occur during long (>8 hours) flights, from an infectious  passenger or crew member to other passengers or crew members.

 It’s a large droplet infection

Transmission of 2019-nCoV probably occurs through large droplets and contact and less frequently through aerosols and fomites.

Universal droplets precautions is the answer

1. Quarantining for two weeks of the LRTI patient
2. Timely diagnosis
3. Strict adherence to universal precautions

Its all over

Australia (4), Macau (1), Hong Kong (5), France (3), Japan (3), Malaysia (4), Nepal (1), Singapore (3), Taiwan (3), South Korea (3), Thailand (5), United states (3), Vietnam (2).

Is it a public health emergency?

There is an emergency in China, but it has not yet become a global health emergency.

PMO Suggestions Sent

17^th Jan: India at threat of Coronavirus. Advisory should be issued (18^th - Indian government issues travel advisory as Chinas mysterious Coronavirus spreads in other countries)

22^nd Jan: Still not being declared to be a notifiable disease; N 95 to be included in the list of essential drugs and price capped; Oseltamivir should also be price capped; air flights should have available air masks for all passengers; not declaring flu like symptoms while boarding or landing should be a punishable offence ( 23^rd - India advisory to airports).

24^th Jan: Inter-ministerial Committee needs to be formed on Coronavirus (PMO took a meeting on 24^th evening)

25^th Jan: Indian government should pay for Indians affected with the virus in China

26th Jan: Need of National Droplet Infection Control program; Policy to ban export of face masks; policy to evacuate Indians from Chinas affected areas; Time to collaborate on Nosode therapy.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA