Corona viruses 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)Severe Acute Respiratory Syndrome (SARS-CoV) as well as Wuhan Corona virus disease of 2019 (Wuhan COVID-19).                                                             

Severe acute respiratory syndrome (SARS) is a new type of atypical pneumonia that infects the lungs, caused by a new strain of coronavirus. SARS or Severe acute respiratory syndrome is a viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus (SARS-CoV). SARS was first reported in Asia in February 2003. Over the next few months, the illness spread to more than two dozen countries in North America, South America, Europe, and Asia before the SARS global outbreak of 2003 was contained.

The SARS outbreak of 2003: According to the World Health Organization (WHO), a total of 8,098 people worldwide became sick with SARS during the 2003 outbreak. Of these, 774 died.                                                                        

How does SARS spread? The main way that SARS seems to spread is by close person-to-person contact. The virus that causes SARS is thought to be transmitted most readily by respiratory droplets (droplet spread) produced when an infected person coughs or sneezes. Droplet spread can happen when droplets from the cough or sneeze of an infected person are propelled a short distance (generally up to 3 feet) through the air and deposited on the mucous membranes of the mouth, nose, or eyes of persons who are nearby.

The virus also can spread when a person touches a surface or object contaminated with infectious droplets and then touches his or her mouth, nose, or eye(s). In addition, it is possible that the SARS virus might spread more broadly through the air (airborne spread).

Examples of close contact include kissing or hugging, sharing eating or drinking utensils, talking to someone within 3 feet, and touching someone directly. Close contact does not include activities like walking by a person or briefly sitting across a waiting room or office.

SARS Clinical picture: In general, SARS begins with a high fever (temperature greater than 100.4°F [>38.0°C]. Other symptoms may include headache, an overall feeling of discomfort, and body aches. Some people also have mild respiratory symptoms. About 10 percent to 20 percent of patients have diarrhea. After 2 to 7 days, SARS patients may develop a dry cough. Most patients develop pneumonia.

WHO has revised the SARS case definitions as follows:                 

Suspected Case: A person presenting after 1 February 2003 with history of high fever (>38C) and one or more respiratory symptoms including cough, shortness of breath, difficulty breathing AND one or more of the following: close contact with a person who has been diagnosed with SARS, recent history of travel to areas reporting cases of SARS.

Probable Case: A suspected case with chest x-ray findings of pneumonia or Respiratory Distress Syndrome or a person with an unexplained respiratory illness resulting in death, with an autopsy examination demonstrating the pathology of Respiratory Distress Syndrome without an identifiable cause.

Treatment: Largely supportive. At present, patients are being treated empirically with antibiotics and in some cases, anti-viral agents.

Wuhan novel corona virus infection:

Caused by a novel coronavirus (COVID-19), Coronavirus disease – 2019  Which is a new strain that has not been previously identified in humans. The new coronavirus, known as COVID-19 appears to be similar to SARS in two important ways: They share 80% of their genetic codes, and both originated in bats. SARS jumped from bats to weasel-like mammals called masked palm civets, then to humans. The spill over happened in the wet markets of Guangdong, China.

SARS  is considered the first pandemic of the 21st century, since it spread across many countries. The virus emerged in Guangdong and infected 8,098 people over the course of eight months, killing 774. Just one month after the first confirmed case of the novel coronavirus, the total global case count has surpassed that of SARS. The death toll in mainland China has also exceeded that of the SARS outbreak there.

In essence, the novel coronavirus is a version of SARS that spreads more easily but causes less damage. The first report of the novel coronavirus came on December 31, 2019.

Wuhan is a city of 11 million people in the central province of Hubei, China. SARS originated in the Guangdong province in southeastern China, near Hong Kong.

One reason SARS spread to so many places around the world is that Chinese authorities initially attempted to hide the outbreak from the WHO. The Chinese government didn’t inform the WHO about SARS until February 14, 2003 — 88 days after the first reported case. According to The Sydney Morning Herald, doctors in Beijing were ordered by authorities to hide SARS patients from WHO officials  during inspections. During the initial stages of that outbreak, the Chinese government also concealed information from the public, which exacerbated the spread of disease. China announced the  Wuhan coronavirus outbreak to the public much more immediately.

One person with the new coronavirus can pass it to three to five others, a statistic called the virus’ R0 value.

The new corona virus has spread far faster than SARS did. It took eight months for SARS to spread to more than 8,000 people. The Wuhan corona virus infected over 20,000 people in about five weeks.

The new corona virus’ fatality rate has not yet been determined with accuracy, but it seems to be around 2% so far. The SARS fatality rate was 9.6%.

On January 30, 2020 the World Health Organization declared the corona virus outbreak a public-health emergency of international concern. Authorities quarantined Wuhan on January 23, halting all public transportation, including city buses, trains, and ferries. The order prevents any buses or trains from coming into or leaving the city and grounds all planes at the Wuhan airport. On March11,2020 WHO declared the corona virus as a pandemic.

According to the World Health Organization (WHO), 50% of people impacted by SARS were age 65 or older, while the other half of infected patients varied widely in age.

So far, studies of patients who died from Wuhan coronavirus complications reported that the median age of those who have died is around 75. Many of those individuals had other health issues like high blood pressure, diabetes, and Parkinson’s disease.

Incubation period of COVID – 19: The virus’ average incubation period is about five days, but can range anywhere from two to 14 days.

Infectivity: The infected person spreads the virus to about 3 – 5 others.

Mode of transmission of COVID – 19:

Person-to-person spread: The virus is thought to spread mainly from person-to-person, between people who are in close contact with one another (within about 6 feet), through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

Can someone spread the virus without being sick? People are thought to be most contagious when they are most symptomatic (the sickest). Some spread might be possible before people show symptoms; there have been reports of this occurring with this new corona virus, but this is not thought to be the main way the virus spreads.

Spread from contact with contaminated surfaces or objects: It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes.

Corona virus have the potential to remain on metal, glass and plastic surfaces for two hours to nine days.              

Theoretical possibility’ that COVID-19 can spread from animals to humans, but pets not a serious vector of transmission.

How easily the virus spreads:  The virus that causes COVID-19 seems to be spreading easily and sustainably in the community (“community spread”) in some affected geographic areas. Community spread means people have been infected with the virus in an area, including some who are not sure how or where they became infected. The coronavirus has spread to nearly all of the world’s countries and territories.

April 27, 2020 statistics:

China — where the virus first began to spread in late 2019 — has  seen a sharp drop-off in its rate of new cases.

Corona virus test: Testing may be needed if someone have symptoms of infection and have recently traveled to parts of the world where infection rates are high or have had close contact with someone who has traveled to one of those areas.

The following are examples of COVID-19 tests: Blood test (Leucopenia and lymphopenia are characteristic for COVID-19. Most infections show lymphocytosis but COVID-19 show lymphopenia), Chest CT scanning (Characteristic patches appear. CT scanning is mainly indicated for those patients in whom fever regained after improvement), COVID – 19 rapid test  (Can detect infection in patients in under two and a half hours — measured from the time the sample is taken to the time the result arrives. Is a reliable, rapid diagnosis directly on site), RT-PCR Test (Its sensitivity is about 70%), Swab test (Using a special swab to take a sample from nose or throat), Nasal aspirate (Injecting a saline solution into nose, then removing the sample with gentle suction), Tracheal aspirate (Putting  a thin, lighted tube called a bronchoscope down mouth and into lungs, where  a sample will be collected), Sputum test.                                                       

COVID – 19 Clinical picture: Typical corona virus patients develop a fever, dry cough, or shortness of breath, but these symptoms may appear at different times — or not at all. Severe cases tend to worsen about five to 10 days after symptoms start. Pneumonia is the cause of death in most cases. Pneumonia occurs usually in the 8th day after starting of symptoms. Pneumonia occurs in one of every five patients.

COVID – 19 X ray

COVID – 19 High risk groups: Death rates for older patients are much higher. Coronavirus patients with underlying health problems are more likely to die than otherwise healthy people. Healthcare workers are particularly at risk.                                                                                                 

No specific treatment or vaccine has been developed for COVID – 19. On May 1, 2020 WHO announced that corona virus pandemic will continue and that all world nations are required to live with it.

Due to COVID – 19 pandemic Health care systems are straining under the surge of patients and a paucity of medical equipment like ventilators as well as protective masks and gloves, giving rise to growing concerns about the exposure of hospital personnel.

COVID – 19 Prevention strategies:                                                                                 

To prevent the spread of the coronavirus, people should wash their hands frequently with soap and water, making sure to scrub for at least 20 seconds.

The CDC and other authorities recommend social distancing to slow the virus’s spread and prevent the influx of cases from overwhelming hospitals.

Social distancing, according to Johns Hopkins, consists of “deliberately increasing the physical space between people to avoid spreading illness,” which includes staying at least 6 feet away from other people, canceling events, and working from home if possible

It is recommended to avoid handshakes, hugging, kissing and to avoid contact with confirmed or suspected cases, to use masks and gloves and special precautions are required for medical personnel dealing with COVID – 19 patients, It is required to call immediately the health local authorities if having any sign or symptom as fever, dry cough, shortness of breath, etc.  Number 105 was the hot line number for the Egyptian Ministry of Health at the time of COVID – 19 pandemic.

Special measures for medical personnel:The optimal solution is to fully protect the entire body surface, isolate it from the environment, and breathe in air from a portable source Emergency physicians, anesthesiologists and intensive care specialists, as well as the relevant scientific societies issue recommendations concerning endotracheal intubation or other procedures dangerous for the medical personnel It should be remembered that endotracheal intubation by using direct laryngoscopy without adequate protection presents a high risk of Covid – 19 infection.

Take foods that may help to boost the immune system: Citrus fruits, Vegetables, Dark chocolate, Berries, Pineapple, Turmeric, Oily fish, Broccoli, Sweet potatoes, Spinach as well as Ginger.

COVID – 19 Control  strategies:                                                                                 

Case finding: Corona virus infection is suspected in any patient with fever and or cough or dyspnea and is confirmed by: Blood test (Leucopenia and lymphopenia are characteristic for COVID-19), Chest CT scanning (Characteristic patches appear), Swab test (Using a special swab to take a sample from nose or throat).

Notification: Call immediately the health local authorities if having any sign or symptom as fever, dry cough, shortness of breath, etc.  Number 105 was the hot line number for the Egyptian Ministry of Health at the time of COVID – 19 pandemic.

Isolation: At home with strict safety precautions for mild uncomplicated cases and in hospital for cases requiring the use of ventilator. According to oxygen level, one of two techniques can be used: Continuous Positive Airway Pressure, CPAP or Intubation and mechanical ventilation.

Disinfection: Once the disease runs its course, the room or rooms that the sick person used, along with the objects he or she came in contact with, need to be cleaned and disinfected.If possible, dedicate one bedroom and bathroom for the sick person to use and make sure everyone else uses others. While the person is sick, have them clean the rooms they use if they are well enough to do so. If they are not able, caregivers should clean and disinfect the rooms. Disinfect specifically the objects that the ill person touches or interacts with, “So, for example, if someone is sick and staying in bed and only getting up to go to the bathroom, pay close attention to the nightstand, the bed linens, the bathroom door handle, the taps, the flush on the toilet,” etc. Start every cleaning session with clean gloves and a face mask.When cleaning and disinfecting hard surfaces – such as counters, tabletops, door knobs and bed frames – use any household detergent or soap and water before disinfecting. “Soap and warm water works very well at destabilizing corona virus by destroying the fatty membrane that holds the virus. Once clean, hard surfaces can be disinfected using EPA-approved products such as Lysol or Clorox. Always follow the manufacturer’s instructions, especially on how long your should leave the product on the surface before wiping it off

Treatment: Early management leads to good improvement. The most important medical treatments are: Hydroxychloroquine, Anticoagulants, Azithromycin and Corticosteroids. Plasma of recovered patients containing COVID – 19 antibodies is useful in some cases especially those on mechanical ventilation.

Release: Public Health required two negative COVID-19 tests at least 24 hours apart to release people from isolation. Starting from May 22, 2020 new criteria has been adopted for the release of COVID-19 patients: For people with testing positive who have symptoms, at least 10 days must have passed since recovery (defined as resolution of fever without the use of medications and improvement in respiratory symptoms) and at least 10 days have passed since symptoms first appeared. With recurrent symptoms, at least 10 days must have passed since recurrent symptoms appeared and at least 14 days have passed since the date of the most recent positive test result.

Measures to help people live with corona virus including availability and obligatory use of masks, social distancing, ensuring availability of disinfection chambers at all work places, availability of cameras at airports to assess temperature, availability of simple treatment lines for uncomplicated cases as vitamin c, zinc and Zithromax, health education campaigns, etc.

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