Corona Virus - In A Brief!

Coronavirus: Brief Summary

• It is a rapidly evolving disease across all strata of society with increase death rate potential 
• Person to person spread is confirmed
• Clinical trials and investigations to learn more are ongoing. There is no treatment or vaccination at present. 
• Prevention is better than cure.
• Avoid unnecessary panic in society, awareness about the disease profile is key to prevention and cure.

Definition
Coronavirus disease COVID-19 as it is now known as by WHO (World Health Organization) has been defined as a potential severe acute respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2)

Clinical presentation is of respiratory infection with a symptom severity ranging from the mild common cold like illness to severe viral pneumonia leading to acute respiratory distress syndrome which is potentially fatal.

Nearly 80000 cases with 2800 death and mounting, have been reported in china (as of 1 March 2020). The outbreak has escalated rapidly across the globe with more and more number of a person becoming infected. Due to migration of population and overcrowded atmosphere, the spread has become easy and helped in the spread.

SARS-COV-2 belong to serbecovirus subgenus of the coronavirus family and its the seventh coronavirus known to infect humans.

A majority of patients in the initial stage of outbreak reported a link to the human south china seafood market, a live animal or wet market, suggesting the zoonotic origin of the virus, however, it's yet to be confirmed. Person to person spread has been confirmed in the community among close contact, in both family and hospital settings.

Transmission is through droplets produced when a person sneeze or cough. The contribution to transmission by the presence of the virus in other body fluids is unknown, but studies are going on to find out any relation. There is growing evidence that transmission from an infected but asymptotic person can occur in an endemic area. It's still unknown whether perinatal or through breastfeeding is possible.

As per current studies, incubation period is from 1-14 days. Median incubation period has been 5 days and transmission is possible during the incubation period. The high viral load has been detected in nasal and throat swab soon after the onset of symptoms. Even asymptotic patient has a similar viral load. 

Primary Prevention

The only way to prevent infection is to avoid exposure to the virus and maintain a high level of personal hygiene.

• Wash hands with soap and water properly and avoid touching face nose and mouth with unwashed hands.
• Avoid close contact with people. Minimum distance advocated is 1meter (3feet).
• Practice respiratory hygiene, covering nose and mouth while sneezing or coughing. Discard the handkerchief and wash hands.
• Avoid unprotected contact with live animals and avoid the consumption of raw or uncooked meat.
• Seek medical advice if you have fever, cough and difficulty in breathing, travel history is mandatory. Not all cases of URTI (upper respiratory tract infection) can be termed as coronavirus infected cases.

WHO does not recommend that people to wear a medical mask in a community setting if they do not have any symptoms as there is no evidence available on its usefulness to protect people who are not ill. Instead, it creates more panic and confusion in an otherwise healthy person.

Screening and Quarantine 
People travelling from high endemic or epidemic areas will be subjected to screening procedures. Upon receiving any positive information or symptoms by any such person will be quarantined to a period of 14 days, 

Such cases to be reported to local health authorities. All new cases need to be isolated to prevent transmission and confirmed cases to be subjected to treatment guidelines as issued by who and local health authorities. 

Infection prevention and control 
Triage all patients on admission and isolate suspected cases from confirmed cases.
Following basic principles of infection prevention and control as per who guideline to be implemented:-

•     Isolate all suspected cases from confirmed cases in an isolated area
•     Practice hand and respiratory hygiene 
•     Offer a medical mask
•     Wear protective clothing and equipment 
•     Prevent needle stick and sharp injury
•     Practice safe waste disposal management principles, environment cleaning and patient clothing sanitisation 
•     Use of single-use and disposable equipment.

Clinical Presentation
Clinical presentation resembles viral pneumonia and severity of illness range from mild to severe. Approximately 80% are mild, 14% severe and 5% critical.

The most common symptoms are:- fever, cough, dyspnoea, myalgia, fatigue
Less common are:- anorexia, sore throats, headache, confusion, dizziness, rhinorrhoea, chest pain, haemoptysis, abdominal pain, nausea vomiting and diarrhoea.

Laboratory Findings
The most common laboratory abnormalities inpatient hospitalised with pneumonia include leukopenia, lymphopenia, leucocytosis, and elevated liver transaminases. Neutropenia, thrombocytopenia, anaemia decreased albumin and renal impairment.
Oxygen saturation of less than 90% will be shown by pulse oximetry.

Blood and Sputum Culture
Chest x-ray and CT. Unilateral lung infiltrates found in 75% cases and bilateral in 25% cases.
Multiple mottling and ground glass appearance found in 14% cases.

Risk factors
Strong: - residence in or travel to the affected area prior to the onset of symptoms. And the history of close contact with an infected person.