Novel coronavirus in China:
PASHUDHAN PRAHAREE NETWORK, 26TH JAN 2020
The numbers in China’s mystery new coronavirus are escalating fast, with more than 1,975 people infected and some 54 deaths recorded so far.
While the vast bulk of cases have been confined to China, cases in this fast-moving outbreak have now been found in the United States, Hong Kong, Malaysia, France, Australia, Thailand, South Korea, Taiwan, Macau, Japan and the Philippines. At least 30 people have been tested in the United Kingdom.
And experts the world over are on high alert after authorities confirmed that the virus could jump from human to human.
Although it remains unlikely that the outbreak will grow into a global epidemic, experts have been warning for years that the world is long overdue a major disease outbreak.
And so it is sensible to be prepared.
The new coronavirus is SARS-like, having originated in animals in the Hubei province of China. Arnaud Fontanet, head of the department of epidemiology at the Institut Pasteur in Paris, told that the new virus strain, which has been officially named “2019-nCoV,” is 80 percent genetically identical to SARS.
Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans.
Coronaviruses are zoonotic, meaning they are transmitted between animals and people. Detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans.
Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.
Standard recommendations to prevent infection spread include regular hand washing, covering mouth and nose when coughing and sneezing, thoroughly cooking meat and eggs. Avoid close contact with anyone showing symptoms of respiratory illness such as coughing and sneezing.
The first known outbreak was first detected in Wuhan, China, around mid December of 2019. The virus subsequently spread to Thailand (Bangkok); Japan (Tokyo); Taiwan (Taoyuan); South Korea (Seoul); other provinces of Mainland China; Hong Kong;[9] and then internationally.
Scientists at the Medical Research Council’s Centre for Global Infectious Disease Analysis at Imperial College London estimate that 4,000 people are infected with the coronavirus and are displaying symptoms within the city of Wuhan by 18 January 2020.
Signs and symptoms——-
Reported symptoms have included fever, fatigue, dry cough, shortness of breath, respiratory distress,pneumonia, kidney failure and death in severe cases. Among the majority of those hospitalized, vital signs were stable on admission, and they had leukopenia and lymphopenia.However, a quarter among those infected have experienced severe symptoms. Most of these patients also presented underlying conditions such as hypertension, diabetes or cardiovascular disease.
Transmission——-
Human-to-human transmission was confirmed in Guangdong, China on 20 January 2020, according to Zhong Nanshan, head of the health commission team investigating the outbreak
Treatment
No specific treatment for the virus is currently available, but existing anti-virals could be repurposed.
Molecular docking experiments by Innophore GmbH and Chinese scientists have found many potential protease inhibitors. Innophore found many hits, including both new chemicals and old drugs like lopinavir. The Chinese Academy of Sciences focused on existing drugs and botanicals. Several existing antivirals as well as cinanserin and cyclosporine A are predicted to be effective by the CAS with follow-up tests in progress.
Vaccine research——
In January 2020, based on the 2019-nCoV published genome, several projects, three supported by the Coalition for Epidemic Preparedness Innovations (CEPI), began work on creating a vaccine for the Wuhan coronavirus.The United States National Institutes of Health (NIH) started cooperating with the biotechnology company Moderna to create a vaccine, hoping to start production by May 2020. Their strategy is to make an RNA vaccine matching a spike of the coronavirus surface.The University of Queensland (UQ) aims for a molecular clamp vaccine that genetically modifies viral proteins to make them mimic the coronavirus and stimulate an immune reaction.[CEPI supports the Moderna and UQ projects and another by Inovio.An independent project is that of the University of Saskatchewan‘s Vaccine and Infectious Disease Organization – International Vaccine Centre (VIDO-InterVac), which received permission from the Public Health Agency of Canada to begin work on a vaccine. VIDO-InterVac aims to start production and non-human animal testing in March 2020, and human testing in 2021
Reservoir—-
During 17 years of research on the origin of the SARS 2003 epidemic, many SARS-like bat coronaviruses were isolated and sequenced, most of them originating from the Rhinolophus genus. With enough genomes it is possible to reconstruct a phylogenetic tree of the mutation history of a family of virus.
The Wuhan novel coronavirus has been found to fall into this category of SARS-like coronavirus. Two genome sequences from Rhinolophus sinicus with a resemblance of 80% had been published in 2015 and 2017.A third unpublished virus genome from Rhinolophus affinis with a resemblance of 96% to Wuhan novel coronavirus is mentioned in an article from the Wuhan institute of virology. For comparison, this amount of mutation is similar to amount of mutation observed over 10 years in the H3N2 human flu.
Animals sold for food are suspected to be the reservoir or the intermediary because many of first identified infected individuals were workers at the Huanan Seafood Market. Consequently, they were exposed to greater contact with animals
What is the virus causing illness in Wuhan?
It is a novel coronavirus – that is to say, a member of the coronavirus family that has never been encountered before. Like other coronaviruses, it has come from animals. Many of those infected either worked or frequently shopped in the Huanan seafood wholesale market in the centre of the Chinese city, which also sold live and newly slaughtered animals. New and troubling viruses usually originate in animal hosts. Ebola and flu are examples.
What other coronaviruses have there been?
Severe acute respiratory syndrome (Sars) and Middle Eastern respiratory syndrome (Mers) are both caused by coronaviruses that came from animals. Although Mers is believed to be transmitted to humans from dromedaries, the original hosts for both coronaviruses were probably bats. There are suspicions now that the new coronavirus may have originated in bats or snakes, and possibly then was transmitted to humans via an intermediary species. In 2002 Sars spread virtually unchecked to 37 countries, causing global panic, infecting more than 8,000 people and killing more than 750. Mers appears to be less easily passed from human to human, but has greater lethality, killing 35% of about 2,500 people who have been infected.
What are the symptoms caused by the Wuhan coronavirus?
The virus causes pneumonia. Those who have fallen ill are reported to suffer coughs, fever and breathing difficulties. In severe cases there can be organ failure. As this is viral pneumonia, antibiotics are of no use. The antiviral drugs we have against flu will not work. If people are admitted to hospital, they may get support for their lungs and other organs as well as fluids. Recovery will depend on the strength of their immune system. Many of those who have died are known to have been already in poor health.
Is the virus being transmitted from one person to another?
Human to human transmission has been confirmed by China’s national health commission. As of 24 January the Chinese authorities had acknowledged more than 1,000 cases and 41 deaths. In the past week, the number of confirmed infections has more than tripled and cases have been found in 13 provinces, as well as the municipalities Beijing, Shanghai, Chongqing and Tianjin. The virus has also been confirmed outside China, in Hong Kong, Macau, Japan, Nepal, Singapore, South Korea, Taiwan, Thailand, the US, and Vietnam. There have not been any confirmed cases in the UK at present, with the 14 people tested for the virus all proving negative. The actual number to have contracted the virus could be far higher as people with mild symptoms may not have been detected. Modelling by WHO experts at Imperial College London suggests there could be 4,000 cases, with uncertainty putting the margins between 1,000 and 9,700.
How worried are the experts?
There were fears that the coronavirus might spread more widely during the week-long lunar new year holidays, which start on 24 January, when millions of Chinese travel home to celebrate, but the festivities have largely been cancelled and Wuhan and other Chinese cities are in lockdown. At the moment, it appears that people in poor health are at greatest risk, as is always the case with flu. A key concern is the range of severity of symptoms – some people appear to suffer only mild illness while others are becoming severely ill. This makes it more difficult to establish the true numbers infected and the extent of transmission between people. But the authorities will be keen to stop the spread and will be anxious
At what point should you go to the doctor if you have a cough, say?
Unless you have recently travelled to China or been in contact with someone infected with the virus, then you should treat any cough or cold symptoms as normal. The NHS advises that there is generally no need to visit a doctor for a cough unless it is persistent or you are having other symptoms such as chest pain, difficulty breathing or you feel very unwell.
Why is this any worse than normal influenza?
We don’t yet know how dangerous the new coronavirus is – and we won’t know until more data comes in. Twenty-six deaths out of 800 reported cases would mean a 3% mortality rate. However, this is likely to be a overestimate since there may be a far larger pool of people who have been infected by the virus but who have not suffered severe enough symptoms to attend hospital and so have not been counted in the data. For comparison, seasonal flu typically has a mortality rate below 1% and is thought to cause about 400,000 deaths each year globally. Another key unknown, of which scientists should get a clearer idea in the coming weeks, is how contagious the coronavirus is. A crucial difference is that unlike flu, there is no vaccine for the new coronavirus, which means it is more difficult for vulnerable members of the population – elderly people or those with existing respiratory or immune problems – to protect themselves. One sensible step to get the flu vaccine, which will reduce the burden on health services if the outbreak turns into a wider epidemic.
Should we panic?
No. The spread of the virus outside China is worrying but not an unexpected development. It increases the likelihood that the World Health Organization will declare the outbreak to be a public health emergency of international concern on Thursday evening. The key concerns are how transmissible this new coronavirus is between people and what proportion become severely ill and end up in hospital. Often viruses that spread easily tend to have a milder impact.
Healthcare workers could be at risk if they unexpectedly came across someone with respiratory symptoms who had travelled to an affected region. Generally, the coronavirus appears to be hitting older people hardest, with few cases in children.
What are the symptoms of the new coronavirus?
According to the WHO, the new coronavirus causes a fever, fatigue, sore throat and dry cough in the early stages of the disease. As the illness progresses, patients may experience difficulty breathing.
But these symptoms – similar to many other respiratory diseases – are what make it so difficult to control.
And symptoms of coronavirus may not manifest until up to a week after contracting the virus, Dr Adam Kucharski, a professor at London School of Hygiene and Tropical Medicine told Sky News. Most symptoms begin to appear between three and six days after infection.
It is not yet known whether the virus can be spread by asymtomatic people.
Dr Kucharski also confirmed that elderly people with pre-existing health conditions are at greater risk of the virus, but said that the exact risk to younger people in good health is not known.
Coronaviruses are a family of viruses that originate in animals before making the jump to humans. Seven, including the new virus, have been found in humans, with four causing only mild, common cold-like symptoms.
But two – Middle East respiratory syndrome (Mers) and severe acute respiratory syndrome (Sars) – are much more severe, having killed more than 1,500 people between them.
Around 15 to 20 per cent of hospital cases are severe and the current death rate stands at about two per cent. This is quite high but it may be because authorities are not aware of milder cases of the disease.
How are coronaviruses transmitted?
Like other coronaviruses – such as the common cold – the virus is spread via droplets when a person coughs or sneezes. It can also be spread when someone touches a contaminated surface such as a door handle.
Hospitals are also key locations for “super spreading” events – when a single patient infects many people. When patients arrive in hospital with vague respiratory symptoms health workers may not know they need to take special precautions such as wearing masks or keeping them away from other patients.
The outbreak originates from animals and the source is thought to be a seafood market in Wuhan which also traded in other live animals such as marmots and bats.
Can the new coronavirus be treated?
There are no specific treatments for coronaviruses – just as there is no treatment for the common cold.
Peter Horby, professor of emerging infectious diseases and global health, at the Centre of Tropical Medicine and Global Health at the University of Oxford, said the disease bore all the signs of a “classic viral pneumonia”.
“There are currently no antivirals for this, so care is just supportive, supporting the lungs and other organs until patients recover,” he said.
“There are other potential therapeutics out there but no effective antiviral,” he added.
Is there a vaccine?
There is currently no vaccine to protect against the novel coronavirus, although researchers in the US and China have already begun working on one, thanks to China’s prompt sharing of the virus’s genetic code.
However, any vaccine will not be available for up to a year and would most likely be given to health workers most at risk of contracting the virus.
For now, it is a case of containment. China has started building a 1,000-bed hospital to treat patients with the virus which it hopes to finish within days.
The graphic below shows how the virus is spread.
What can you do to limit the risk of catching the new coronavirus?
The risk to the UK is remains low. But anyone travelling to China and worried about catching the virus needs to take the basic hygiene precautions.
Maria Van Kerkhove, acting head of emerging infectious diseases at the WHO, said: “Coronaviruses typically cause respiratory symptoms so we recommend basic hand hygiene such as washing hands in soap and water and respiratory hygiene so when you sneeze, sneeze into your elbow.”
She cautioned against any unnecessary contact with live animals in China.
Nick Phin, deputy director of the National Infection Service at Public Health England, added: “Individuals should seek medical attention if they develop respiratory symptoms within 14 days of visiting Wuhan, either in China or on their return to the UK, informing their health service prior to their attendance about their recent travel to the city.”
What advice has the UK government issued?
The government has not issued any travel or trade restrictions with China and says the risk to the UK is currently low and even the risk to travellers to Wuhan – a city of 11 million people – is also low.
However, it says its advice is constantly under review.
Travellers arriving on flights at Heathrow from Wuhan will be separated from other passengers and Public Health England has announced “enhanced monitoring of direct flights” and health workers on site to greet incoming flights from Wuhan. Although the unprecedented quarantine in place in China means flights have temporarily been halted.
Have international travel warnings been issued?
The European Centre for Disease Control (ECDC) is updating advice every day and said on Saturday that although cases are “likely” in Europe, the risk of transmission remains “low”.
“Assuming that timely and rigorous infection prevention control measures are applied around imported cases detected in the EU/EEA, the likelihood of further sustained spread in community settings is considered low.”
Three airports in the EU have direct flight connections to Wuhan – including London Heathrow. But with much of China in quarantine and transport hubs shut down, these flights have now been stopped.
The risk of international transmission remains highest in Asia, where cases have already crossed borders. Tighter screening measures have been introduced at airports across the continent, as well as in Australia, New Zealand and at three major transit hubs in the United States.
But screening cannot pick up everyone as the incubation period for contracting the virus and the onset of symptoms is between six to 10 days.
Professor David Heymann, infectious diseases expert at the London School of Hygiene and Tropical Medicine, said: “Temperature screening picks up people with fevers – but people can take aspirin if they want to travel and don’t want to get picked up. The best thing to do is educate people – if you’re sick you should tell a doctor,” he said.
Are certain groups more at risk?
At least two of the deaths have been in people with underlying conditions and older people seem to be more vulnerable to the most severe form of the disease.
But information filtering out of China and other countries suggests that people of all ages are at risk of contracting the disease. Wuhan’s health commission said in a statement that the 60 most recent cases range in age from 15 to 88.
What is the difference between a coronavirus and a flu virus?
Coronaviruses and flu viruses might cause similar symptoms but genetically they are very different.
“Flu viruses incubate very rapidly – you tend to get symptoms two to three days after being infected, but coronaviruses take much longer, ” said Professor Neil Ferguson, a disease outbreak scientist at Imperial College London.
“[With the] flu virus you become immune but there are lots of different viruses circulating. Coronaviruses don’t evolve in the same way as flu with lots of different strains, but equally our body doesn’t generate very good immunity,” he added.
What risks are presented if the coronavirus mutates?
Chinese officials have warned that the virus is already starting to mutate, which means there’s a chance that the disease could start to infect many more people.
“The worry is that if you have a new virus that is exploring a human host it’s possible that they might mutate and spread more easily in humans,” Jonathan Ball, professor of molecular virology at the University of Nottingham, told The Telegraph.
The genetic sequence of the virus shows a slow mutation rate, said Prof Ferguson.
“Could it mutate to become more lethal and transmissible? That’s speculation,” he said.
How does this coronavirus compare to past respiratory pandemics?
The 1918 Spanish Influenza – or H1N1 virus – remains the most devastating flu pandemic in modern history. The disease swept around the globe and is estimated to have caused between 50 and 100 million deaths.
The same virus was also behind the 2009 swine flu outbreak, which is thought to have killed as many as 575,400 people.
Other major influenza outbreaks include the Asian flu in 1957, which led to roughly two million deaths, and the Hong Kong flu 11 years later which killed one million people.
But coronavirus outbreaks have been far smaller. Sars eventually spread to 27 countries in total, infecting around 8,000 people and killing 700.
Mers on the other hand has proved less explosive but more tenacious – it first emerged in 2012 in Jordan, when it jumped from camels to humans, and then spread throughout the Arabian peninsula.
Around 2,500 cases of the disease have been identified so far and, while the disease hit a peak of more than 600 cases in 2014, there were still more than 190 cases last year. It is more deadly than Sars, and has claimed around 850 lives in total.
UPDATES—
Chinese authorities have identified a cluster of novel coronavirus 2019-nCoV infections in Wuhan City, China. Cases have also been reported from Japan, Republic of Korea, Singapore, Vietnam, Nepal, Malaysia, France, Australia and the United States. All the cases outside China had a recent travel history to China prior onset, except in Vietnam. The first cases in the EU/EEA were confirmed in France. Further global spread is likely.
The 2019-nCoV is a new strain of coronavirus that has not been previously identified in humans. Outbreaks of novel virus infections among people are always of public health concern, especially when there’s little knowledge about the characteristics of the virus, how it spreads between people, how severe are the resulting infections and how to treat them.
Human-to-human transmission has been confirmed but more information is needed to evaluate the full extent of this mode of transmission. The source of infection is unknown and could still be active. EU/EEA countries should ensure that timely and rigorous infection prevention and control measures (IPC) are applied around cases detected in the EU/EEA, in order to prevent further sustained spread in the community and healthcare settings.
Assuming that timely and rigorous IPC measures are applied around imported cases detected in the EU/EEA, the likelihood of further sustained spread in community settings is considered low.
All flights from Wuhan have been cancelled. The Chinese New Year celebrations at the end of January will increase travel volume to/from China and within China, hence increasing the likelihood of arrival of cases in the EU.
The outbreak investigations are ongoing and as this is an emerging, rapidly evolving situation,
The death toll had risen to 56 as of 25 January 2020.
Source- https://www.theguardian.com
https://www.telegraph.co.uk/global-health
