COVID-19 and Lockdowns; Effects on Nations- Onibokun Samson O.

CORONAVIRUS (COVID 19)

Introduction:

December 31^st 2019:

WHO was alerted to several cases of pneumonia in Wuhan City, Hubei Province of China. The virus did not match any other known virus. 

January 7^th 2020:

Chinese authorities confirmed that they had identified a new virus. The new virus is a coronavirus, which is a family of viruses that include the common cold, and viruses such as SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome). This new virus was temporarily named “2019-nCoV.” ¹ 

February 28th 2020: 

WHO stated its risk assessment worldwide for the Coronavirus was now "very high".

March 11th 2020: 

The spread of the coronavirus was declared a Pandemic by the World Health Organization

Coronaviruses are zoonotic, meaning they are transmitted between animals and people.  Several known coronaviruses are circulating in animals that have not yet infected humans. This new strain of conoravirus has been officially referred to as the novel coronavirus (2019-nCoV). ²

WHO has been working with Chinese authorities and global experts from the day they were informed, to learn more about the virus, how it affects the people who are sick with it, how they can be treated, and what countries can do to respond. ³

Signs and Symptoms of Coronaviruses - General Overview:

Common human coronaviruses usually cause mild to moderate upper-respiratory tract illnesses, like the common cold. Most people get infected with these viruses at some point in their lives. These illnesses usually only last for a short amount of time. Symptoms may include:

o    Runny nose

o    Headache 

o    Cough

o    Sore throat 

o    Fever

o    General feeling of being unwell

Human coronaviruses can sometimes cause lower-respiratory tract illnesses, such as pneumonia or bronchitis. This is more common in people with cardiopulmonary disease, people with weakened immune systems, infants, and older adults. ⁷

Signs and Symptoms of the Novel Coronavirus (2019-nCoV)

Source: WHO

Based on what was seen with other coronaviruses, it is believed that symptoms of 2019-nCoV may appear in as few as 2 days or as long as 14 after exposure. 

TRANSMISSION AND TREATMENT:

Introduction

2019-nCoV is a betacoronavirus, like MERS and SARs, all of which have their origins in bats. 

Chinese authorities have successfully sequenced the genome of the virus allowing for effective detection. The US CDC confirmed the same genome in the first two cases in the US.  

Early on, many of the patients in the outbreak of respiratory illness caused by 2019-nCov in Wuhan, China had some link to a large seafood and live animal market (also known as "wet markets"), suggesting that initial spread of the virus was animal-to-person. 

Subsequently it has become clear that human-to-human contact is able to spread the virus. 

The complete clinical picture with regard to 2019-nCoV is still not fully clear. Reported illnesses have ranged from infected people with little to no symptoms to people being severely ill and dying.

How does the Novel Coronavirus spread from Person-to-Person?

·         Human coronavirus most commonly spread from an infected person to others through:

o    The air by coughing and sneezing

o    Close personal contact, such as touching or shaking hands

o    Touching an object or surface with the virus on it, then touching your mouth, nose, or eyes before washing your hands

o    Rarely, fecal contamination

·         When person-to-person spread has occurred with MERS and SARS, it is thought to have happened mainly via respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza and other respiratory pathogens spread. Spread of SARS and MERS between people has generally occurred between close contacts.

It’s important to note that how easily a virus spreads person-to-person can vary. Some viruses are highly contagious (like measles), while other viruses are less so.

·         Should you be tested for the Novel Coronavirus (2019-nC0V)?

US CDC guidelines state: "If you develop a fever* and symptoms of respiratory illness, such as cough or shortness of breath, within 14 days after travel from China, you should call ahead to a healthcare professional and mention your recent travel or close contact. If you have had close contact** with someone showing these symptoms who has recently traveled from this area, you should call ahead to a healthcare professional and mention your close contact and their recent travel." As the virus has now spread globally, the connection with China is significant but becoming less important.

Fever may not be present in some patients, such as those who are very young, elderly, immunosuppressed, or taking certain fever-lowering medications. Clinical judgment should be used to guide testing of patients in such situations.

Close contact is defined as:

o    being within approximately 6 feet (2 meters), or within the room or care area, of a novel coronavirus case for a prolonged period of time while not wearing recommended personal protective equipment ; close contact can include caring for, living with, visiting, or sharing a health care waiting area or room with a novel coronavirus case.– or –

o    Having direct contact with infectious secretions of a novel coronavirus case (e.g., being coughed on) while not wearing recommended personal protective equipment.

Treatment

·         According to the US CDC, there is no specific antiviral treatment recommended for the novel coronavirus infection. People infected with 2019-nCoV should receive supportive care to help relieve symptoms. For severe cases, treatment should include care to support vital organ functions. People who think they may have been exposed to 2019-nCoV should contact your healthcare provider immediately.

What happens in hospital?

Those who get admitted to hospital are given treatment for their symptoms while their immune systems try to fight the virus off. Hospitalization also serves to isolate patients and stop the virus spreading.

In severe cases, the virus can cause pneumonia - an inflammation of the lungs. In those cases breathing may need to be supported. Patients are given oxygen and in the worst cases may be put on a ventilator. 

In milder cases, patients struggling to maintain blood pressure can be given an intravenous drip. Fluids can also be given in cases of diarrhea, and ibuprofen is also available for pain relief.

How Deadly is the Coronavirus?

Based on data from 44,000 patients with this coronavirus, the WHO says:

o    81% develop mild symptoms.

o    14% develop severe symptoms.

o    5% become critically ill.

The proportion dying from the disease appears low (between 1% and 2%) but the figures are unreliable.

Thousands are still being treated but may go on to die - so the death rate could be higher. But it is also unclear how many mild cases remain unreported - so the death rate could also be lower.

To put this into context, about one billion people catch influenza every year, with between 290,000 and 650,000 deaths.

How to Self-Isolate

If you suspect you have coronavirus, have been in contact with someone who has it, or have been to a place where there are a lot of cases of the virus, then the official advice is to self-isolate.

The top five methods to successfully self-isolate include:

1. Stay at home - Do not go to work or school, or other public spaces. Do not have any visitors.

2. Call ahead - If you develop symptoms such as a cough or fever, then seek advice first by phoning your local medical center or hospital. Don't just turn up as this could potentially spread the virus if you have it.

3. Separate yourself - If you live with others then you should stay in a well-ventilated bedroom with the door shut. If you share a bathroom then use it after everyone else. Don't share towels and toiletries.

4. Dispose of waste carefully - Your waste should be double-bagged.

5. Order in food - Order food online or ask your family or friends to help. Ask the person to leave food deliveries on the doorstep.

RECENT DEVELOPMENT:

Overview

Patients with 2019-nCoV infection are presenting with a wide range of symptoms. Most seem to have mild disease, and about 20% appear to progress to severe disease, including pneumonia, respiratory failure and in some cases death.

According to real-time data from Johns Hopkins University as of 8:00 am (GMT) March 20th 2020, the latest figures on the novel coronavirus are as follows:

o    244,523 cases confirmed globally with 81,199 of these cases confirmed in mainland China.

o    10,031 confirmed deaths, with the first death outside of China reported in the Philippines.

o    86,031 patients of the virus have been reported as having recovered fully.

o    The virus has now been confirmed in 159 countries and territories outside of China

Of these confirmed cases, World Health Organization (WHO) has confirmed that over 8,204+ of these cases have been classified as 'severe'. Due to the increased transmission of this virus, the WHO has undertaken risk assessments which concluded that the global risk was now "very high".

How the Coronavirus has Spread in China:

Thousands of patients have been infected with the virus across China, with central Hubei province being the worst-affected. Restrictions on travel are affecting at least 20 million people across 10 cities - including the capital Wuhan, where the virus emerged. 

In a bid to tackle the increased demand for medical services, the authorities are building makeshift hospitals. People have been asked to wear face masks in public places. 

The Chinese government has also closed a number of temples, the Forbidden City and part of the Great Wall.⁴ 

Source: China National Health Commission, BBC Research, January 28th 2020

Locations with Confirmed Cases of Novel Coronavirus:

According to data from Johns Hopkins University⁵, as of March 20th 2020, over 159 countries/territories outside of China have confirmed cases of the novel coronavirus.

Distribution of Novel Coronavirus cases:

Other Recent Developments

Scientists in Australia have become the first to recreate the new coronavirus outside of China in what they have called a "significant breakthrough". The discovery will be shared with the World Health Organization (WHO) in the hope it may help efforts to diagnose and treat the virus. 

Scientists in China have also recreated the virus and shared its genome sequence.

Chinese authorities have said the virus - like a normal flu - is able to spread during its incubation period. According to the WHO, the incubation period can range from two to 14 days, however, WHO said it remains unclear whether it is contagious before symptoms appear. ⁷

A number of airlines have cancelled all flights to China.

In the United States, it was stated by State Government officials that the virus may have been in Washington State for weeks before detection in late Feb, and that up to 1,500 people may have been infected.

On March 8th, the government of Italy placed 16 million people under quarantine in the Northern Italian Lombardy region as it battled to contain the spread of coronavirus. 

Anyone resident in the Lombardy region and 14 other central and Northern provinces will need permission to travel. The cities of Milan and Venice are both affected. Closure of schools, gyms, museums, nightclubs and other venues was also announced. 

For the first time, Pope Francis live-streamed his Sunday Prayers in St. Peter’s Square rather than appearing in person.

As of March 16th, More than 100 million people in Europe face country lockdowns as governments requests no travel outside the home except for exceptional circumstances and the purchasing of food, going to work, or seeking medical treatment. 

Italy, Spain and France were the first countries to order national lockdowns with other European countries to follow. 

As of March 17th, Global deaths and infections from Covid19 surpassed those inside China the first time since the beginning of the outbreak. 

In the United States, as of March 9th, 19 people have been killed by the virus which has affected more than 30 states and the District of Columbia, turning the virus spread into a serious health crisis. 

In comparison with other countries impacted by the virus, a relatively small number of the population has been tested for the virus.

In the United States, the CDC issued a recommendation that gatherings of over 50 people should not take place. 30 states have closed all schools. Over 2,000 additional labs able to test for the virus came on stream.

INTERNATIONAL RESPONSE:

Overview:

Outbreaks of novel virus infections among people are always of public health concern. The risk from these outbreaks depends on characteristics of the virus, including whether and how well it spreads between people, the severity of resulting illness, and the medical or other measures available to control the impact of the virus (for example, vaccine or treatment medications). ¹

The World Health Organization coordinates global responses in these case. Established in 1948, it is the directing and coordinating authority on international health within the United Nations system.

WHO Statement 30 January 2020

o    As of Jan 30th 2020, the WHO Committee believed that it was still possible to interrupt virus spread, provided that countries put in place strong measures to detect disease early, isolate and treat cases, trace contacts, and promote social distancing measures commensurate with the risk. Efforts have however proved insufficient. Following the Statement, it set in place the following Strategic Objectives in dealing with the crisis.

WHO Coronavirus Crisis Strategic Objectives:

o    Interrupt human-to-human transmission including reducing secondary infections among close contacts and health care workers, preventing transmission amplification events, and preventing further international spread*

o    Identify, isolate and care for patients early, including providing optimized care for infected patients.

o    Identify and reduce transmission from the animal source

o    Address crucial unknowns regarding clinical severity, extent of transmission and infection, treatment options, and accelerate the development of diagnostics, therapeutics and vaccines

o    Communicate critical risk and event information to all communities and counter misinformation

o    Minimize social and economic impact through multisectoral partnerships.

·         * _{This can be achieved through a combination of public health measures, such as rapid identification, diagnosis and management of the cases, identification and follow up of the contacts, infection prevention and control in health care settings, implementation of health measures for travellers, awareness-raising in the population and risk communication.}

CDC’s Interim Recommendations for the Commercial Airline Industry:

 The CDC has instructed airlines to report travelers with specific symptoms arriving from China.

The criteria for reporting a suspected case of novel coronavirus includes travelers arriving from China with:

1.      Fever (person feels warm to the touch, gives a history of feeling feverish, or has an actual measured temperature of 100.4°F [38° C] or higher) that has persisted for more than 48 hours; OR

2.      Fever AND one of the following:

o   Persistent cough

o   Difficulty breathing

o   Appears obviously unwell

After arrival, a health assessment of the sick traveler’s symptoms and possible exposures will be carried out; CDC will update the airline about the results of the testing and any need for follow-up of exposed crew members or passengers.³

USA is prepared for Covid-19 outbreak says President Donald Trump

In the United States, President Trump has appointed his Vice-President Mike Pence to coordinate the government response to the Covid-19 outbreak. Sixty cases have so far been reported in the US, but President Trump expressed confidence that the US would be able to handle the Covid-19 outbreak.

Alex Azar, the US health secretary, said the White House had developed a plan to focus on five priorities, including better disease surveillance, local government response coordination, developing therapeutics, and increasing manufacturing of personal health protection equipment, like masks.

Quarantine in Northern Italy:

Italy has become Europe's first significantly impacted country. The outbreak in Italy centered around a group of towns in the Lombardy and Veneto regions. By late Feb, 11 towns were closed-off, in which more than 50,000 people are quarantined.

There are signs the virus is spreading within Italy, as new cases have been reported in Tuscany, Sicily and Liguria

Italian authorities have confirmed more than 41,035 cases and 3,405 deaths there. Since March 17th 2020, Italy has been in full lockdown

SUMMARY:

·         On January 7^th 2020, Chinese authorities confirmed that they had identified a new virus, which is believed to have originated from Wuhan, China. The new virus is a coronavirus, which is a family of viruses that include the common cold, and viruses such as SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome). This new virus was temporarily named “2019-nCoV.” 

·         As the virus has now spread globally, the connection with China is significant but becoming less important.

·         Coronaviruses are zoonotic, meaning they are transmitted between animals and people.

·         Symptoms can include fever, followed by a dry cough and then, after a week, leads to shortness of breath and some patients needing hospital treatment. Other symptoms can include sneezing, headaches, and possible kidney failure. 

·         Human coronaviruses most commonly spread from an infected person to others through: the air by coughing and sneezing; close personal contact, such as touching or shaking hands; touching an object or surface with the virus on it, then touching your mouth, nose, or eyes before washing your hands and rarely, fecal contamination.

·         If you develop a fever and symptoms of respiratory illness, such as cough or shortness of breath, within 14 days after travel or coming into contact with someone who has traveled, you should call ahead to a healthcare professional and mention your recent travel or close contact. 

·         On January 27th, 2020 CDC issued updated travel guidance for China, recommending that travelers avoid all nonessential travel to all of the country (Level 3 Travel Health Notice).

·         On March 11th 2020, the spread of the coronavirus was declared a Pandemic by the World Health Organization.

·         As of March 20th 2020, 244,523 cases confirmed globally with 81,138 of these cases confirmed in mainland China.

·         A total of 10,031 people (March 20th 2020) so far have died following infection with the novel coronavirus. 

·         It has also been reported that 86,031 (March 20th 2020) people have so far recovered from this coronavirus

 

Bibliography:

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