Overview

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The outbreak of Coronavirus COVID-19 infection was first reported in the city of Wuhan in the Chinese province of Hubei and declared a public health emergency there on 30 December 2019. As of this writing on 1 March 2020, the virus has infected more than 88,000 people and killed at least 3,000. The vast majority of infections and deaths have occurred in China and particularly in its original epicenter of Wuhan. However, the virus has spread across the globe with infections and fatalities reported in more than 50 countries. In a sudden spike, COVID deaths and significant infections were reported in South Korea, Iran and Italy over the weekend of Dec 21-23, 2020, spawning new epicenters. Many epidemiologists (scientists who track diseases) believe that we are on the verge of a Coronavirus pandemic. A pandemic defines sustained person-to-person-to- person transmission in many regions as opposed to an epidemic, which refers to a sustained infection confined to one region. The most recent disease pandemic was the 2009-2010 H1N1 influenza virus (swine flu) which is estimated to have infected more than 11-21% of the global population and to have killed hundreds of thousands of individuals.

The Virus

Coronaviruses, such as the causative agent of COVID-19, belong to a large family of viruses that infect both humans and animals. There are now seven known human coronaviruses such as the common human viruses HCoV 229E, HCoV OC43, HKU1 and NL63, which are among the viruses that cause mild upper respiratory illness like the common cold in people or occasional bronchitis. COVID-19 virus is a zoonotic virus, meaning it has jumped from an animal host to humans and is similar to other coronaviruses that have been responsible for recent acute respiratory diseases such as the Middle Eastern Coronavirus (MERS-CoV) and the Severe Acute Respiratory Syndrome virus (SARS-CoV).

MERS originated in Camels and SARS is thought to have come from civet cats, an animal similar to the mongoose. The animal source of the COVID-19 virus has not been clearly established, but the International Committee on Taxonomy of Viruses (ICTV), which is the organization that officially classifies viruses, has given the COVID-19 virus the official name SARS-COV-2, because it has genetic similarity to the SARS virus. But the WHO and others are using COVID-19 designation for public communications to avoid confusion between this new virus disease from the SARS disease. Virologists are studying a number of coronaviruses that are circulating in animals but have not yet jumped to humans. When a new coronavirus is seen in humans it’s identified as a novel coronavirus (nCoV) until it’s properly classified.

Available data indicate that the COVID-19 virus is more contagious, but less deadly than the closely related SARS and MERS. The case fatality rate for SARS is approximately 9.6%. MERS is more deadly with a fatality rate of 34%. The current fatality rate for COVID-19 is approximately 2% with most scientists believing that it may eventually be 1% or less due to the fact that large numbers of asymptomatic or mildly symptomatic infected people are not being counted. In comparison, the fatality rate of the more widely spread influenza virus is 0.1%, but influenza kills tens of thousands of people every year. Much caution is warranted in determining the true fatality rate of COVID-19 as it’s too early yet to get accurate infection estimates. For example, Iran is reporting high fatality rates for the number of confirmed infections. While South Korea testing approximately 10,000 people per day has a lower mortality rate.

The Disease

COVID-19 is an upper respiratory disease. The majority of people infected with the virus may not feel sick at all or may show mild symptoms or signs of the infection such as fever, dry cough, runny nose and tiredness; symptoms that are typical of the flu. These signs may be sub-clinical or mild enough that the infected person may not seek medical help at all.

However, in some people, the disease may progress to a more serious respiratory distress illness and pneumonia. With the current available data, WHO estimates that 80% of infected people recover from the infection without treatment, but 1 out 6 infected persons becomes seriously ill. In particular, and as is typical of other viral upper respiratory infections, older people and people with conditions such cardiovascular disease, diabetes or high blood pressure are at increased risk of serious illness and death.

The most recent study from Chinese scientists with access to the largest number of infected people, suggests that diabetes in particular is a strong predisposing factor for serious illness and death from COVID-19.

Prevention and Protection

COVID-19 is thought to have spread from a wet market, the Hunan Sea Food Market in Wuhan- a city of more than 20 million people. A wet market is a series of stalls where live fish and animals as well as fresh meat are sold. The first infected patients have all been in that market.

It’s now being spread from person to person like other respiratory viruses. Our information is not complete yet and is mainly derived from what is known about previous coronavirus outbreaks. Transmission occurs between people who are in close proximity to each other via aerosols (virus droplets) from an infected person coughing or sneezing. It’s possible for these droplets to travel through air and inhaled directly by people nearby. These viral droplets may also fall on objects and picked up by people touching these objects who may transfer the virus to their mouths or noses.

Given these modes of transmission, protection at the personal level is based on good hygiene habits and commonsense approach to daily activities. The WHO and other disease control and prevention agencies are offering the following advice:

  • Regular hand washing with soap or other disinfectants frequently
  • Avoiding touching your nose and mouth
  • Covering your mouth and nose when sneezing and coughing to prevent the spread if you are sick.
  • Cooking eggs and meat thoroughly
  • Avoiding close contact with someone with flu systems
  • When sick stay at home to avoid infecting others in your community.

Controlling the spread of this new disease is a global undertaking. The World Health Organization, national centers for the control and prevention of diseases, and government authorities around the world are vigorously working to clamp down on this new fast-spreading virus.

Measures to control the spread of a fast-moving viral infection are resource intensive and the worry now is that many resource-poor countries with inadequate health facilities may be ill-prepared if the virus continues to spread and for that reason solidarity between all nations is extremely important.

The authorities in Somaliland have started to put in place certain measures specially at airports and customs entry point, but much remains to be done.

There is a need for a robust information campaign explaining, without panicking the population, the correct information about the disease and how individuals may protect themselves, their families and their community. WHO and other organizations have created easily understood messaging packages and must widely disseminated.

First and foremost, people must be educated to be truthful about their travels and any symptoms they may have, to ensure that they are not putting their loved ones and their community at risk. Few days under quarantine or surveillance is a small price to pay for avoiding this infection from spreading to your family and community.

Treatment

COVID is a viral infection and, therefore, antibiotics are ineffective. There are no drugs or other treatments available to treat infected patients at the present time. Some drugs that have some efficacy in other viral diseases and some novel medications are being tested. At the present time, treatment is limited to initially relieving the systems and providing supportive care for the seriously ill.

The best way to prevent a viral infection is to develop an effective vaccine for it. Many laboratories around the world are rushing to construct and effective vaccine and several vaccine formulations are at the very early stage of development, but at best an effective vaccine in many months away as each candidate vaccine must undergo months-long careful step-wise clinical trials. Finally, it is important to note that SARS-CoV, the virus most closely related to the COVID-19 virus (or SARS-CoV2), has not remerged since 2003 except for three laboratory accidents and one more new case- all in China. At the end SARS-CoV2 may behave like its cousin and pass into dormancy or given its already wide global reach, become seasonal like the influenza.

Dr. Ahmed Esa

Dr. Ahmed Hussein Esa is the Founder and President of Abaarso Tech University, in Hargeisa, Somaliland. Dr. Esa is a former Assistant Professor at Johns Hopkins School of Medicine, where he received his PhD and was honored with Frederik Bang Award for Excellence in Research. He was also the head of Flow Cytometry at the Immunology Department, Institute Pasteur in Paris. Currently, he is the Executive Director of IPRT.