COVID-19 is the infectious disease caused by the most recently discovered SARS-CoV-2 coronavirus, an RNA virus which itself indicates the ability to mutate.
This new virus and disease were unknown before the outbreak which began in Wuhan, China, in December 2019. The virus is of zoonotic origin – current data points to bats as its primary hosts. It is fully susceptible to standard disinfection measures and sanitary procedures.
The infection enters through the respiratory system. It also replicates there infecting the pneumocytes; the virus is present mostly in saliva and upper respiratory tract secretion. The skin (hands) is not the entry of infection.
SARS-CoV-2 is transmitted via droplets, in saliva and sputum spread during cough or while managing intubation tube. There is no evidence that the virus is airborne or transmitted by contaminated items as it is in measles or smallpox.
We as physicians do not have any medication or vaccine at our disposal yet. It is worth mentioning that there is no drug or supplement that would be beneficial as far as viral infections are concerned (COVID-19 included); vit. C deficit is known to lower our immunity but when overused will not boost the immunity beyond certain plateau – AIDS patients were brutally made aware of that. Please take the TV commercials and ads with a grain of salt.
Epidemiologists assess that one infected person transmits the virus to 2-5 persons on average. Unfortunately,a person who does not show any symptoms can also be its host and thereby, the source of infection.
Atlanta CDC epidemiologists’ study conducted on a group of 445 people who were exposed to patients with confirmed COVID-19 disease indicates a 0,5% infection risk in cases of close contact with the patient (being in the same room, bus, shop, etc. ), whereas, in the cases of people who had intimate contact with those infected (household members, so-called body fluid transmission) the risk was approximately 10%. (https://www.cdc.gov/mmwr/volumes/69/wr/mm6909e1.htm?s_cid=mm6909e1_w)
The basic safety item of medical personnel is the medical disposable mask that sits tight and shields the respiratory tract during the patients’ examination (first of all the mask should be worn by the patient) and standard disinfection measures. The mask does not protect you 100% but it reduces the risk of the infection. Nonetheless, it is less useful as a protection against infection in public places; for places like this it is best to implement the so called cough and sneeze etiquette, frequently wash your hands and avoid touching your lip mucosa and conjunctiva with potentially contaminated hands.
It is worth considering replacing a typical handshake with a courteous bow as well as changing the religious habits – taking the Holy Communion on your hand and avoiding the use of Holy Water.
The symptoms and the basic tests results are non-specific (fever, cough, lymphopenia); they do not allow us to explicitly differentiate COVID-19 from type A influenza; the crucial diagnostic tool seems to be the computed tomography – in about 100% of patients typical radiological changes have been observed, even in lack of subjective dyspnea. Detecting the virus is necessary for epidemiological reasons, not only medical; medical procedures are the same regardless of the virus type – if the patient has fever and cough they shall be isolated (for example stay at home), and if they develop respiratory failure they need to be mechanically ventilated until the inflammation subsides. It is quite different regarding the flu – if the disease is confirmed we do have the medication and vaccine ready to use.
The course of disease analysis in over 72 000 patients in China has shown that 81% of them presented mild symptoms, 14% severe and the remaining and 5% critical.
Children and adolescents were only 2% of those infected. 87% cases of infection pertained to people aged 30-79, the death risk was 2.3%. However, in the cases of 80 years old the risk was significantly higher (14,8%). The elderly and those immunodeficency disorders (transplant patients, patients during chemotherapy, HIV patients) require most immediate medical attention.
The only medical intervention that will change the natural history of COVID-19 is the mechanical ventilation of patients with respiratory failure.
It should be emphasized that the that the infection rate in the case medical personnel is only 3.8%; in Wuhan, China it was 63% of all patients – however at the beginning of the epidemic. Moreover, the local government was actively blocking the information on new infections which contributed to the fact that the medical personnel in China did not use pertinent (but basic) means of personal protection.
Available data suggests that the current epidemiological threat is much less hazadrous than the first SARS epidemic in 2002/2003. The mortality rate was then 10% on average, and over 50% of fatalities were among the medical personel (hospital in Toronto!).
Unfortunately, we can deem it as certain that multiple airborne-droplet epidemics originating from Asia or direct contact infections from Sub Saharan Africa still await us in the future.