Coronavirus – déjà vu?

A new coronavirus (2019-nCoV) has been grabbing the spotlight away from Megxit and our President’s impeachment trial. The virus will play itself out, but in the meantime, we need to educate ourselves about it – awareness is half the battle. What we know so far is that this new CoV causes respiratory symptoms (fever, cough, difficulty breathing) and it has killed 41 people. Calling a virus a CoV is the same as calling someone a human – details emerge only upon closer examination. CoVs belong to a large family of viruses, some of which cause the common cold, while others have caused the more serious and potentially fatal Severe Acute Respiratory Syndrome (SARS) and Middle Eastern Respiratory Syndrome (MERS).

In 2002/2003, the SARS coronavirus (SARS-CoV) caused an outbreak in 37 countries in 9 months, with most cases and deaths occurring in mainland China and Hong Kong. 8,273 individuals were reported sick; 775 died – overall fatality rate of 9%. However, in the elderly, the fatality rate was worse – over 50%! Since 2012, MERS coronavirus (MERS-CoV) has shown 2,494 cases spread out over 27 countries, making it one of our most lethal viruses with a fatality rate of about 34%.

To trace the origin of a virus, we have to figure out where they naturally hang out. For SARS-CoV, that natural hang out is the wild horseshoe bat. Scientific research revealed the presence of SARS-CoV in civets from live animal markets, but not in civets that lived in the wild or the ones from farms that didn’t have exposure to live animal markets. We think that live animal markets provided the right environment for SARS-CoV to pass from wild horseshoe bats to masked palm civets – humans became infected when they purchased and slaughtered civets from these markets. Once the SARS-CoV adapted to the human body, infected people spread the virus to others.

September 2012: The first MERS-CoV case was identified in Saudia Arabia. Camels of middle east origin and humans have gotten infected with MERS-CoV, showing us one potential source of infection – contact with camels of middle east origin. However, many MERS-CoV infections were in people who did not have contact with camels. This could mean either infected people can spread the virus to others and/or we have failed to identify a host that passes on the virus to us, like the masked palm civet in the case of SARS-CoV.

History has an unfortunate tendency to repeat itself, which is a good thing when we can learn from it. The 2002/2003 SARS-CoV outbreak could have been far worse, if we hadn’t engaged in strict infection control measures. Scientists and health care providers raced against time to

1. isolate sick patients so they wouldn’t infect others,
2. engage in appropriate infection control so that patients couldn’t infect others, including healthcare providers taking care of them,
3. play detective and trace every person who may have been in close contact with the SARS patient, so that we could
4. monitor, diagnose, and isolate new cases as soon as, and if they started showing symptoms.

December 2019: It is with a sense of déjà vu that we battle a new CoV causing severe respiratory illness in people – this time, in Wuhan, China. So far, 41 people have died. Although official reports of infected people stand at 1200, thousands more are projected to have been exposed and/or infected. Although initial cases were of people who got infected after exposure to a live seafood and animal market, we are now seeing infections due to people-to-people spread of the virus. Travelers from Thailand, Japan, South Korea, Taiwan, United States, Singapore, Nepal, Vietnam, Hong Kong, Scotland, and Northern Ireland are being treated for symptoms. 

It should not surprise us that the virus shows people-to-people spread – both SARS-CoV and MERS-CoV had shown this behavior as well. We didn’t find out the natural hang out of MERS-CoV and we don’t have that information yet for the new CoV. It seems very likely that one of the animals from the live animal market is responsible for spreading this virus to humans. The hunt is on to identify the natural reservoir of this virus as well as the animal that has exposed humans to 2019-nCoV.

CDC staff will screen travelers from Wuhan on arrival at United States airports. The goal is for the screenings (which include getting the temperature taken and having a questionnaire filled out) to identify anyone who shows signs of fever, cough, or breathing difficulties. These individuals will subsequently undergo a more stringent assessment. In fact, CDC was able to identify the first case of this virus in the U.S. – the passenger who lives just north of Seattle, arrived at the Seattle Tacoma airport on Jan. 15 and sought medical attention on Jan. 19. Hopefully, we will soon be able to determine the incubation period of the virus (how long after exposure to the virus does it takes for symptoms to develop?). This will be a crucial figure for us as we attempt to trace all the people who came in contact with a newly diagnosed patient.

What is a bit alarming is the fact that 136 new cases were confirmed just over this past weekend (Jan 18 – 19) in Wuhan as well as in the bustling cities of Beijing, Shanghai, and Shenzhen, all in China! With the Chinese New Year celebrations coming up this week, there will be millions of travelers in close proximity to one another as they travel nationally and internationally to celebrate with their loved ones.

In the absence of answers to so many of our questions, the smart thing to do is to engage in basic infection prevention. 

If YOU are the one who is sick, do the following:

• Get appropriate help for your illness from your physician, if necessary.
  • The new CoV infected individuals have been showing symptoms of fever, cough, and shortness of breath. 
• The CDC recommends staying home if you have fever (temperature of 100 Fahrenheit or greater) and respiratory symptoms, until 24 hours after your fever ends without the help of medication.
• Take medications to suppress your symptoms.
• Wear a mask, but only if it doesn’t interfere with your breathing.
• Skip meetings where you have to be in a room and in close contact with others.
• Use technology and FaceTime yourself into the meeting.

All of us should always do the following:

• Do not engage in an open-mouthed cough or sneeze – trap those potentially infectious cough and sneeze particles by using a tissue or handkerchief or your sleeve.
• Do not touch your face (especially your eyes, nose, and mouth) without first washing your hands.
  • And then of course, there is a right way to wash hands.
    • Lather your hands with soap and water, scrub for 20 seconds (include areas under your nails, back of your hands, and between your fingers), rinse with running water, dry with clean towel.
    • IF using an alcohol-based hand sanitizer, look at the label to know the right amount to use, rub sanitizer over all surfaces of hands and fingers, until dry, which takes about 20 seconds.
• Hydrate well.
• Eat well – avoid processed foods, when possible.
• Have an exercise regimen (depending on your health, you may need to consult your doctor before initiating this).

If you are surrounded by people who are sick, do this:

• Feel free to wear a mask.
• Pay attention to your hand hygiene.
• Wipe down common use areas that may be contaminated with cough and/or sneeze droplets from people who are ill.

Prevention of infections is easy – but it doesn’t happen without awareness and without you Saying NO To Infections. Be smart. Inform yourselves about relevant topics of the day. Click HERE to subscribe to this website. Click HERE to access a previous post on Flu prevention and HERE to access the post on Infection Prevention at large events.