By: Dr. Abhishek Pandey, Oral and Dental Surgeon & Asstt. Editor-ICN
LUCKNOW: Corona viruses or nCoV are the viruses belonging to a large family, causing illness ranging from common cold to more severe diseases. These diseases include –
- Middle east respiratory syndrome or [MERS-CoV]
- Severe acute respiratory syndrome or [SARS-CoV]
A Novel coronavirus or nCoV has been identified as a new strain that has not been previously identified in humans. However, an outbreak of unusual respiratory condition was first reported in Wuhan, China, due to the infection caused by novel corona virus, now known as COVID-19.
Severe Acute Respiratory Syndrome Coronavirus 2 or [SARS-CoV-2]
The International committee on Taxonomy of viruses or ICTV announced ‘’Severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2’’ as the name of the new virus. It is genetically associated with the coronavirus that is responsible for the SARS outbreak of 2003. However, when related, they found both the viruses to be different.
Further, on 11th February 2020, the World Health Organization or W.H.O., announced COVID-19 as the name of this disease and the “COVID-19 virus” as the virus responsible for this disease. Based upon the transmission rate, the W.H.O has declared the outbreak of the COVID-19 as a global health emergency.
Structure of Virus –
Coronaviruses are a family of positive single-stranded RNA virus, classified under Nidovirales order. These viruses are enveloped and are round and sometimes pleomorphic of approximately 80 to 120 nanometer in diameter. The virus contains an internal helical RNA-protein nucleocapsid surrounded by an envelope made up of lipids and viral glycoproteins. These glycoproteins are spike protein, membrane protein, and small membrane.
The spike protein or “S” is a type I glycoprotein that forms the peplomers on the virus surface, giving the virus its corona or crown-like morphology in the electron microscope. The coronaviruses attach to the cell surfaces through the spike.
The viral replicase is a huge protein complex comprising of 16 viral sub-units and plays an essential role in the coronavirus replication and transcription at the cytoplasmic membrane.
Modes of Transmission
The main modes of transmission of Coronavirus are,
1). Person to Person
2). Household transmission
3). From contact with infected surface or object
Person to person transmission– COVID -19 can be transmitted between people who are in close contact with one another or (within about 6 feet).
The transmission is through the respiratory droplets produced by the infected person when he or she sneezes or coughs.Possible inhalation or (into the lungs) of the droplets landing in the oral cavities or noses of people in close proximity.
Contact with Infected Surfaces or Objects
As per the World Health Organization or W.H.O, a person might be susceptible to COVID-19 if he or she touches a surface or object containing the virus and then touching their own mouth, nose, or face. However, this is not the main route of transmission.
Based on the available data, it can be stated that airborne and faecal contamination rarely transmits COVID-19.
CLINICAL PRESENTATION–
According to the Centre for Disease Control or CDC, patients above the age of 50, are more vulnerable for the attack and persons with underlying diseases like Diabetes, Parkinson disease and Cardiovascular diseases are at high risk.
As per the World Health Organization or W.H.O statistics, the median age of affected people is 51 years with the majority of cases that is 77.8 percent aged between 30–69 years. Statistical data also reveals that 51.1% of the affected population is males.
INCUBATION PERIOD– Symptoms may appear 2 to 14 days after exposure to virus.
Clinical Features-
- Coughing and sneezing
- Runny nose
- Shortness of breath
- Breathing difficulties
- Sore throat
- Fever
- Fatigue
- Pneumonia
- Severe acute respiratory syndrome
- Lungs inflammation and congestion
- Cardiovascular damage
- Diarrhea
- Decreased Kidney functions and
- Kidney failure
DIAGNOSTIC CRITERIA-
The prime suspects for COVID-19 include patients with fever and lower respiratory tract symptoms.
The geographical distribution and recent contact with the suspected patients should also be taken into consideration.
Finally, if suspected with coronavirus, infection control measures should be implemented, and public health officials should be notified.
According to CDC, diagnosis should be based on clinical and epidemiological factors.
The clinical criteria for confirming the diagnosis of the severity of Coronavirus is broadly categorized into the following types –
- Mild
- Moderate
- Severe, and
- Critical
In case of mild, the symptoms include fever less than 38 degrees centigrade. In case of moderate condition, the patient may be presented with Fever, respiratory symptoms and imaging findings of pneumonia.
If the Patient is affected severely with corona virus then any of the below mentioned findings can be observed
- Respiratory distress
- Oxygen saturation less than 93% at rest
- Partial pressure of oxygen and fraction of inspired oxygen less than or equal to 300 millimeters of mercury.
Patient should have a rapid progression that is greater than 50 % on CT imaging within 24 – 48 hours and should be managed as severe.
In case of critical condition such as Respiratory failure, Shock and Extra pulmonary organ failure, Intensive care unit (ICU) is necessary.
Early Investigations and Methods –
Respiratory material from upper and lower respiratory tract must be collected. The upper respiratory tract specimen includes nasopharyngeal or oropharyngeal swab or wash in ambulatory patients.
The lower respiratory specimens include sputum and or endotracheal aspirate.Other methods of collection include blood and stool.
The specimens are to be collected in sterile containers and must be stored at 2 to 8 degree centigrade. In case of delay, the specimens are frozen at minus 20 degree centigrade and then shipped.
Laboratory Investigations –
The various laboratory investigations include:
- Nucleic acid amplification tests or NAAT tests by Real Time Reverse Transcription Polymerase Chain Reaction or RT-PCR for COVID 19 to check for evidence of viral load indicating active infection.
- Serological testing for detecting antibodies.
- Viral Sequencing.
- Viral culture.
Rapid collection of the specimen and testing of specimens from patients meeting the suspect case definition for COVID-19 is a priority for clinical management and outbreak control and should be guided by a laboratory expert.
Case Management of COVID-19 –
As per the World Health Organization or W.H.O, the patients with suspected COVID-19 should be triaged at the first point of contact. The emergency treatment should be initiated based on the disease severity. Patients, household members and caregivers should be educated about personal hygiene, basic Infection Prevention and Control or IPC measures to prevent the widespread of the infection.
Home Management of Patients with Suspected COVID-19 Infection –
The management of patients suspected with Coronavirus includes the following steps:
- The patient should be placed in a well-ventilated room, and his or her movement should be limited in the house.
- All the household members should reside in a different room or should maintain a distance of at least one meter from the sick person.
- The number of caregivers should be limited. Visitors should not be allowed to meet the patient until he or she recovers completely.
- Hand hygiene should be performed only if hands are visibly dirty. However, soap and water are indicated for visibly dirty hands.
- A medical mask should be provided to the patient to avoid the spread of infection.
- Caregivers should also be provided with the mask. Furthermore, masks should not be touched or handled during use and should be disposed of on a regular basis.
- Direct contact with body fluids must be avoided.
- Masks or gloves should not be reused.
- Use disposable glasses and plates for the patient.
- Daily surfaces should be disinfected. These include bedside tables, bedframes and other furniture. Regular household soap or detergent containing 0.5 percent of bleach solution should be used for cleaning.
- Disinfect the bathroom and toilet surfaces at least once in a day.
- The patient’s clothes, bed linen, and bath and hand towels should be washed at 60–90 degree centigrade and changed on regular basis.
According to the Centre for Disease Control or CDC, there is no specific antiviral treatment available for COVID-19. However, people with COVID-19 should be provided with supportive care to help the patients.
General Hygiene Practices –
The key preventive measures are to follow good hygiene practices.
Practicing frequent hand-hygiene which involves:
- Washing hands with soap and water or alcohol-based hand-rub and
- Keeping a hand-sanitizer with self.
All offices should have liquid soaps, hand rubs, refilled or replaced.
- Follow the culture of ‘Namaste’ and maintain ‘two arms’ length or (6 feet) optimally but at least an arm’s length or (3 feet) from a person who is sneezing or coughing. Be aware, avoid close contact.
- Follow respiratory hygiene or cough etiquette (cough or sneeze into the inside of elbow or arms, not bare hands. If using disposable tissue paper, discard appropriately, and perform hand-hygiene).
- Offer a surgical mask to a person who is coughing or sneezing.
- Keep the workplace clean and hygienic.
- Avoid eating raw or undercooked meat.
- Visit the doctor if you are unwell.
Governmental Measures –
Globally, preventive and control measures are being implemented rapidly.
The governmental measures for prevention include three stages:
- First stage
- Second stage
- Third stage
First stage is the early stage of the outbreak.
It focuses on:
- Preventing the export of cases from the affected areas
- Control the source of infection, block the route of transmission and prevent the further spread of infection.
Second stage:
- It focuses on reducing the intensity of the epidemic
Third stage:
It focuses on:
- Reducing the clusters of cases
- Controlling the epidemic
- Balancing between prevention and control
Travel Advise –
- According to the C.D.C, travelers are advised to refrain from traveling to China, Singapore, the Republic of Korea, Islamic Republic of Iran and Italy.
- Citizens with a history of travel to these countries may be quarantined for 14 days on arrival.
- The W.H.O has developed a guidance document for the International Air Transport Association or IATA to provide advice to cabin crew and airport workers.
It is important to protect yourself and others. Follow the Do’s and Don’ts listed here, and stay safe!
“PREVENTION IS ALWAYS BETTER THAN CURE.”
