Dr. Rupendra Shrestha
A novel coronavirus (SARS-CoV-2) that cause COVID-19 was discovered a
couple of months ago from China. While the virus has been declared
pandemic, many questions related to it are still unanswered.
So, the writer revisited important facts about COVID-19, which are of use to the general public.
1. What is COVID-19?
COVID-19 is a coronavirus disease caused by severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2). The virus was first detected in the
city of Wuhan, China, on December 2019.
2. What is SARS-CoV-2?
SARS-CoV-2 is a novel virus that is responsible for outbreak of
COVID-19 (respiratory illness), which has now spread all over the world.
3. What is known about the virus?
SARS-CoV-2 is a β-coronavirus, an enveloped, non-segmented
positive-sense RNA virus. There are four species of coronaviruses (CoV),
namely α, β, γ, and δ. α and β species infect mammals, while birds are
affected by γ and δ species.
Of the six human-susceptible CoVs, α-CoV (HCoV-229E and HCoV-NL63)
and β-CoV (HCoV-HKU1 and HCoV-OC43) are less pathogenic and cause mild
respiratory symptoms.
While two other known β-CoV (SARS-CoV and MERS-CoV) result in severe
and potentially lethal infections of the respiratory tract. In rows, the
SARS-CoV-2 genome sequence is 79.5 per cent, similar to that of a
SARS-CoV.
4. What is the incubation period of the virus?
According to the World Health Organization (WHO), the incubation
period of SARS-CoV-2 is anywhere between 1–14 days. However, the median
incubation time is about 5 days before developing symptoms.
5. How long does coronavirus survive outside of the body?
According to the Center for Disease Control and Prevention (CDC),
coronavirus remains viable and infectious in the air for up to 3 hours.
It survives on surfaces (plastic and stainless steel) for around 2-3
days.
6. What is the typicalhost for SARS-CoV-2?
SARS-CoV-2 genome sequence is 96.2 per cent identical to that of a
bat CoV RaTG13.Based on this result, the bat is suspected of being a
natural host of virus origin.
7. How is SARS-CoV-2 transmitted to a human?
SARS-CoV-2 outbreak is likely to be a bat-origin that crosses the species barrier to humans.
Direct contact with unknown intermediate hosts, consumption of wild
animals, or spillover from bats could be the main routes of virus
transmission to a human.
However, the possible intermediate host is yet to be identified.
Although the route of transmission to humans remain elusive, the spread
between humans is rapid.
8. What is the mechanism of infection?
SARS-CoV-2 interacts with angiotensin-converting enzyme 2 (ACE2) to
infect humans. ACE2 is a cell receptor that is present in the lower
respiratory tract of a human.
9. What arethe COVID-19 case-fatality ratio (CFR) and infection-fatality ratio (IFR)?
An overall CFR of 2.3 per cent and IFR of 0.66 per cent was reported
in mainland China. The higher case fatality rate is among >80 years
and lowest in 0-9 years of age group.
10. What are the signs and symptoms of COVID-19?
Fever, tiredness, dry cough, and shortness of breath are the most
common symptoms. About 80 per cent of patients recover without specific
treatment, but older people and patients with comorbidities are more
prone to becoming severely ill.
11. When to visit doctors during the COVID-19 pandemic?
Seek a doctor for medical attention if emergency warning signs for
COVID-19 are noticed. Such sign includes trouble breathing, persistent
chest pain, inability to arouse, and bluish face/lips.
12. Why some patients with COVID-19 die?
Older people and patients with comorbidities are more susceptible to
complications like acute respiratory distress syndrome (ARDS), sepsis
and septic shock, multiorgan failure, thus leading to death.
13. Can virus re-infect after COVID-19 patient has recovered?
As the body's immune response, it is unlikely to get re-infected with
COVID-19. Antibodies produced during infection provide immunity to the
specific virus for months or even years.
Antibodies are usually formed 7-10 days after the initial onset of
illness to neutralize the virus in the patients. Moreover, how COVID-19
immunity protects against infection in future is yet to be determined.
14. How to boost immunity for a healthy life?
Several body organs, including the immune system, functions better when protected from environmental assaults.
Maintaining a consistent healthy lifestyle can be accomplished by
avoiding smoking, moderately consuming alcohol, eating fruits,
sufficient sleep, minimizing stress, daily exercise, maintaining a good
weight and personal hygiene, etc.
Some powerful immune boosters include yogurt, citrus fruits, spinach, broccoli, ginger, garlic, and almond.
15. Is SARS-CoV-2 a laboratory construct?
SARS-CoV-2 is neither a purposely created, bioengineered virus nor an escape from the laboratory.
16. Is there any possibility of vertical transmission from mother to newborn?
Although there is no conclusive evidence, some research indicates the possibility of vertical transmission.
There are no reports of intrauterine transmission, but cases have been reported of in utero infection.
SARS-CoV-2 was not detected in maternal milk, and pregnancy doesn't
worsen the clinical symptoms. However, due to close contact during
feeding, droplet transmission to the newborns may occur.
17. Does the virus infect pets?
Recently, human to cat transmission of COVID-19 was reported in Belgium.
However, chicken, pigs, ducks, and dogs are not susceptible to infection. There is no clear information yet.
18. How useful are soap-water or alcohol-based sanitizers?
Soap-water is more effective in removing germs than hand sanitizers.
But, alcohol-based hand sanitizers effectively reduce the number of
germs, but sanitizers do not remove all kinds of organisms. Hand
sanitizers with 60-95 per cent alcohol quickly minimize and kill
microbes compared to non-alcoholic sanitizers.
19. Is the surgical face mask effective against transmission of SARS-CoV-2?
Yes, the surgical face mask prevents SARS-CoV-2 from spreading and also reduces the transmission of seasonal coronaviruses.
20. Who should wear a mask in an outbreak?
People with symptoms of illness, older people, patients with comorbidities, and frontline healthcare workers should wear a mask.
The use of a mask is intended to prevent the spread of the virus
during the outbreak. Depending on availability, use of the mask can be
optional to healthy people.
21. Why is it necessary to protect healthcare workers?
Healthcare workers (doctor, nurse, and laboratory scientists) are at
the frontline to flight COVID-19 and provide medical care to the
patients. Also, during an outbreak, the hospital environment could
potentially be a source of virus spread, including healthcare works,
patients, and visitors.
22. Who should involve in the testing of COVID-19?
Only certified medical laboratory scientists, pathologists, and
physician-scientists should be involved in the testing of clinical
samples for COVID-19.
They contribute to diagnostic reasoning and manage the care of
patients with suspected or confirmed cases. Proper handling of
infectious clinical samples and accurate diagnosis is vital in
healthcare for prevention and treatment.
23. Who should be tested for COVID-19?
Not everyone needs to be tested for COVID-19. Only hospitalized
patients, symptomatic medical staff, people in close contact with
infected patients, and visitors from the epidemic area should be tested
for COVID-19. Most people suffer from mild illnesses and may recover at
home.
24. Is COVID-19 curable?
So far, no approved antiviral therapies have been approved for
COVID-19. Many of the symptoms can be cured, and hence, treatment
depends on the patient's health condition.
25. Is there any vaccine available for COVID-19?
Few vaccines for novel coronavirus are under trial and may take years to be available for use to common people.
26. What are investigational agents for COVID-19?
Clinical studies are being conducted on a number of antiviral and
supporting drugs, including remdesivir, chloroquine, hydroxychloroquine,
and tocilizumab. A list of international clinical trials is available
on the
https://clinicaltrials.gov/.
27. What is an alternative therapy for COVID-19?
Passive antibody therapy (convalescent sera of individual recovered
from COVID-19) could be an alternative one. At this point, WHO does not
recommend any medicines to treat COVID-19 or to cure it.
28. What is shielding, self-isolation, social distancing, and quarantine?
Shielding is for those considered to be extremely vulnerable as a consequence of a specific health condition.
Self-isolation means remaining indoors and completely avoiding interaction with other people.
Social distancing is about restricting person-to-person contact.
Quarantine is a state, period, or place of isolation in which people
who have traveled or who have been exposed to infection are kept.
29. Is lockdown a solution to control COVID-19?
Yes, lockdown helps to prevent the spread and transmission of virus
between humans. It is an emergency protocol that usually stops people
from leaving an epidemic area.
30. Why have the South Asian countries reported less cases?
There is no clear explanation behind the low cases in south Asian countries.
But, it may be due to lack of mass testing, immunization with BCG,
and the small number of visitors migrating to these countries.
31. Is hygiene hypothesis preventive for COVID-19?
There is no clear explanation behind link between them yet.
32. Why are the people working remotely during an outbreak?
It is to break the chain of virus transmission between humans and
help to control the spread of the virus. "Stay home to protect yourself
and then protect others."
33. Why is mass and indiscriminate testing necessary?
Mass and indiscriminate testing is the only way to stop the spread of the virus.
Identification and treatment of the disease limits the disease's expansion.
So, initiate to find, isolate, test, and treat every case, to break the chains of virus transmission.
34. How active surveillance systems and rapid response teams be helpful in an outbreak?
Active surveillance helps to provide the most reliable and timely information about the circumstances of the outbreak.They maintain regular communication with healthcare providers or the general public to obtain information.
Rapid case detection and response team is essential to stopping an
outbreak through efficient monitoring and laboratory testing, effective
management, and a strong workforce.
35. What is PPE, and why is it necessary for healthcare workers?
PPE (Personal Protective Equipment) includes gowns, masks, gloves,
protective glasses and shoes or face shields, respirators and full-body
suits, which are critical for reducing exposure to workplace hazards.
36. What are patients kept in negative pressure isolation room in the hospital?
Negative pressure rooms isolate patients with contagious diseases to shield everybody else from exposure.
This helps in trapping and holding potentially harmful particles
within the room. It allows air to flow into the room but does not allow
it to escape.
37. Why is health and science correspondence necessary in Nepal?
Health and science correspondence is necessary to convey
evidence-based news and to deliver higher content, reliable, and
accurate health stories. They have a much higher capacity for knowing
the problems, accessing credible sources, keeping broad field expertise,
connecting with their organizations, and advocate for quality
reporting.
38. Why is Nepal struggling to test COVID-19?
While the world lacks sufficient SARS-CoV-2 testing capacity, Nepal
has a specific lack of knowledge about DNA testing and molecular genetic
facilities in the health care system.
In addition, Nepal does not have enough medical geneticist and
genetic counselor whileignoring the value of genetic testing by the
doctor in medicine.
39. How to control COVID-19 in Nepal?
WHO recommended standard precautions should be emphasized, and in particular, careful hand hygiene should be maintained.
Some critical factors need to be introduced, including awareness of
the epidemiological situation in the country and worldwide, activating
24/7 emergency response services such as public health authorities,
making on-site availability of sufficient PPE for healthcare workers,
isolating suspected COVID-19 cases, arranging diagnostic testing, safety
screening of frontline personnel in the event of an outbreak,
environmental cleaning and waste management, and long-term surveillance,
etc.
40. How can lack of support from people disturb prevention?
Effective attempt to search and diagnosis help in breaking the chain of disease transmission in society.
But, a one unsupportive people or a group can interfere the efforts to prevent disease and cause a major outbreak.
This loophole might be tough to control without citizen discipline, and support for social distancing by all citizens
41. How to confront a viral pandemic when vaccines and drugs are months or year away?
An old method known as passive antibody therapy helps doctors fight
COVID-19. It requires the use of virus-neutralizing antibodies that are
obtained from COVID-19 recovered patients.
42. How should Nepal prepare for possible future epidemic?
Nepal needs careful strategic planning before an outbreak happens.
Such planning takes considerable time and should therefore be addressed urgently.
Active planning should be implemented for operational planning,
including occupational safety measures, stockpiling of equipment and
drugs, professional training,and triage policy development.
In addition, Nepal should invest in health and research to achieve stronger pandemic preparedness.
43. What Nepal should learn from COVID-19 for future?
While the extent of the COVID-19 outbreak remains uncertain, there is considerable concern about the global spread of the virus.
A few useful insights about how future possible threats can be
mitigated, includes early warning and accurate diagnosis, transparency
to the public, activate 24/7 emergency response system, initiate active
surveillance, precise documentation of possible carriers and infected
people, and prepare with basic needs like facemasks and sanitizers.
In addition, the government should robust research and biotech industry.
44. How to find positivity in this grim pandemic situation?
While being bound to the home during a pandemic, people may find
positivity in recreating their hobbies such as painting, crafting,
singing, and dancing, engaging in meditation and yoga, reducing stress
in yourself,and maintaining healthy and happy family time.
Dr. Shrestha (MS, PhD) is a Clinical Molecular
Geneticist, working at Department of Genetics, Department of
Opthalmology and Visual Sciences at Albert Einstein College of Medicine,
New York, USA. source: risingnepal daily, 9 april 2020