Coronavirus - Epidemic or a Pandemic

A new virus that has gained traction in China has begun a global spread, and the world is now alarmed.

Background

Coronaviruses (CoV) belong to a group of viruses normally associated with the common cold to more severe infections like the Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV).  A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans.  

Coronaviruses are zoonotic. They are transmitted between animals and people.   SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans. Symptoms include cough, fever, breathlessness, and in serious cases, pneumonia, severe acute respiratory syndrome and kidney failure

In the 21st century, novel coronavirus has caused deadly pandemics- SARS (severe acute respiratory syndrome) in 2003, MERS (Middle East respiratory syndrome-spread from camels) in 2012 and now the Wuhan virus which as per latest figures has infected over 6000 persons and caused over 140 fatalities, and counting.

As per Gao Fu, director of the Chinese Centre of Disease Control and Prevention initial investigations indicate that the virus came from wild animals sold at a meat market in Wuhan which enabled wild animals and domestic ones to be in close proximity thus facilitating trans species mutation of pathogens. Most new viruses have been seen to originate from animal hosts, like Ebola and flu.

Foreign countries are working closely with Chinese authorities to evacuate their citizens back home.  About 4 million people had left Wuhan before the lockdown was imposed, and the infection is now being reported in 13 other Chinese provinces as also in Hong Kong, Macau, Japan, Nepal, Singapore, South Korea, Taiwan, Thailand, US, Australia, and Vietnam. 

Director-General Tedros Adhanom Ghebreyesus of the World Health Organisation (WHO) has created a special emergency committee to monitor the developing situation. China is giving full access and maintaining transparency. The DG WHO had visited China to make an on-spot assessment. WHO will take a call whether the outbreak merits to be labelled as a Public Health Emergency of International Concern (PHEIC).  In the interim, it has categorized the risk as " very high in China, high at the regional level and high at the global level".

Wuhan city of 11 million is under lockdown, and the entire province of Hubei has been imposed with travel curbs. 16 more cities are under partial lockdowns being imposed by the PLA.

Analysis

Having learned a costly lesson from the SARS pandemic, the Chinese have lost no time in sharing the details with WHO and other countries. False pride and the inherent desire to keep information leakage to the minimum has not come in the way in the early realization that this has global implications and the world has to come together to deal with it. This is a major plus that will enable mankind to ultimately kill this infection, which may still be some time in coming. In the interim, the death count will steadily continue to rise. 

The mortality rate of SARS was estimated to be 10% while MERS was much higher at 37%.  The current SARS mortality rate of 10%, MERS 37%-coronavirus is reasonably lethal. It is directly attacking the lungs resulting in multiple pneumonia and lung failure.  No specific treatment is available except for supportive management.

While both SARS and MERS virus originated from bats, with the intermediary being civet and camel respectively, it is suspected that in the case of 2019 nCov too, the original host is a bat. However, there are conspiracy theories circulating about  

People are being advised by WHO to adopt precautionary measures like avoiding crowded places, maintaining high standards of personal hygiene like frequent hand washing and using of duly approved face masks in public places.

Oil prices slumped a further 2% to multi-month lows on Monday as the rising number of cases of the new China virus and city lockdowns deepened concerns about demand for crude, even as Saudi Arabia's energy minister sought to calm the market. Brent crude fell by $1.12 a barrel, or 1.9%, to $59.57 by 0113 GMT, having earlier dropped to $58.68, the lowest since late October. Indian Sensex lost 450 points, and there are fears of a further slow down of the economy with Chinese manufacturing being severely affected by the disruption.

India Watch 

Approximately 23000 Indian students study in China with a large number in Wuhan medical university.  The Indian Embassy has set up hotlines and is in consultation with the Chinese authorities to plan their evacuation if permitted.  Right not the infected cities are in lockdown mode and move in and out may not be permitted by the Chinese government. However, India is keeping aircraft on the stand by. 

As of now two persons returning from China were under observation in Mumbai and one in Kochi.   

Assessment

  • Imperative that scientists crystallize a blueprint to diagnose treat and contain the virus. The fact is that the infection is spreading, faster than it was earlier thought, and the death count is rising. Therefore, all countries have to put their scientific resources together and bring closure to this spread as early as possible and save lives.
  • A surveillance system to detect fresh cases if carried out with full participation of the community can be effective in detecting and nipping in the bud such highly infectious diseases. In fact, in Wuhan, it is reported that public groups are giving awards for reporting individuals who have still not registered even though showing symptoms of infection. 
  • Coronavirus infections do not have a specific treatment.  Supportive measures to keep the fever down and prevent dehydration can be taken. Isolation is the key to contain the spread. 
  • Efforts are being made worldwide to find a cure or vaccine, which is a complex and time-consuming process.  

 

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