Dr. Basab Ghosh

[Dr Basab Ghosh, Diabetologist, Dr Basab`s Diabetes Care, Opposite Ramnagar 3, Krishnanagar, Agartala, Tripura. email: ]

The infectious disease COrona VIrus Disease-2019 (COVID-19) is a horror now in human life worldwide! COVID-19 is the seventh confirmed corona virus infection in humans and third global coronavirus infected outbreak. On 11 February 2020 World Health Organization (WHO) announced "COVID-19" as the name of this new disease caused by corona virus Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2). This new intruder in the struggling daily life of humans around the globe creates havoc and WHO declares the situation as "Pandemic"; an outbreak of a disease that occurs over a wide geographic area and affects an exceptionally high proportion of the population is called Pandemic. That tiny life threatened virus even notoriously put down the global market to build a global economical crisis!
The CoronaVirus (CoV) family is not new; those are a certain type of zoonotic virus family that causes respiratory illnesses in animals and zoonotic diseases from animals to humans.  Zoonotic diseases are an infectious disease caused by bacteria, viruses, or parasites that spread from non-human animals to humans. Sometimes coronaviruses that infect animals can change instructure and character to become a new human virus and make people sick. Once it is human virus it will spread from human to human in specific terms and conditions as acknowledged by scientist time to time. 
Coronaviruses cause illness to humans ranging from the mild common cold to pneumonia to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV) and the new introduction now is COVID-19. In fact, most people get some sort of coronavirus infection at some point in their lives. Corona means "crown," and the viruses are named for the proteins on the outside of the viruses that look like beautiful crowns. The good or bad news is that several known corona viruses are circulating among animals that have not yet infected humans!
Human coronaviruses were first identified in the mid 1960s. There are seven wild coronaviruses that become human coronavirus. Four common human coronaviruses causing mild cold and cough worldwide are 1) 229E (alpha coronavirus), 2) NL63 (alpha corona virus), 3) OC43 (beta coronavirus) and 4) HKU1 (beta coronavirus). Another three human corona viruses not only responsible severe health issues, they are also responsible for global outbreak of diseases: 1) MERS-CoV (the beta coronavirus that causes Middle East Respiratory Syndrome, or MERS), 2) SARS-CoV (the beta coronavirus that causes severe acute respiratory syndrome, or SARS), 3) SARS-CoV-2 (COVID-19).
First corona virus infected outbreak 2002-2004: SARS
The severe coronavirus disease SARS-CoV was transmitted from civet cats, a nocturnal carnivorous mammal native of Asia and Africa, to human. The incubation period for SARS is usually 2 to 7 days, but it can be up to 10 days in some people. Incubation period is the period between exposure to an infection and the appearance of the first symptoms. The period of isolation is determined from this incubation period, so it has important role in the prevention of the infectous disease. Thus transmission of SARS-CoV was primarily from person to person, occurred mainly during the second week of illness during the peak of virus emission in respiratory secretions and stool, and when cases with severe disease start to deteriorate clinically. 

The first corona virus strain causing SARC-CoV was identified during 2002 - 2004 outbreaks. That outbreak was originated from Foshan of China in November 2002 and was declared epidemic as cases confirmed around the globe including USA, Canada, Australia and even in India. Total more than 8000 people were infected and at least 774 died worldwide; deaths were mostly in China, Canada and Singapore. In India total cases confirmed were 3 and no deaths reported. Most cases of human-to-human transmission occurred in the health care setting, in the absence of adequate infection control precautions. Implementation of appropriate infection control practices brought the global outbreak to an end. 
Second corona virus infected outbreak 2012-2015: MERS
Scientific investigations confirmed that the coronavirus responsible for severe form of coronavirus disease MERS-CoV was transmitted from dromedary, an Arabian camel especially one of a light and swift breed trained for riding or racing, to humans. MERS-CoV did not pass easily between people unless there was close contact, such as the provision of clinical care to an infected patient without strict hygiene measures. The incubation period for MERS-CoV is between 2 and 14 days, with 5 to 6 days being average. 

The coronavirus strain responsible for MERS-CoV was first identified in 2012 during a new flu outbreak and till July 2015 those cases reported in over 21 countries mostly middle east and even South Korea, UK, USA, Bangladesh, China, Thailand; but not in India. As recorded South Korea was lastly infected in mid 2015; total 186 cases were infected and death took place in 38 among them.

Latest corona virus infected pendemic 2019-2020: COVID-19
On 11 February 2020, International Committee on Taxonomy of Viruses (ICTV) announced "Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2)" as the name of this new corona virus responsible for COVID-19 disease.  Presently corona viral strain of COVID-19 was first detected in Wuhan City, Hubei province, China in December 2019, however more recently, on 14 March 2020, South China Morning Post reported that this 55 year old from Hubei province could have been the first person to have contracted the disease on 17 November. 

This name SARS-CoV-2 was chosen because the virus is genetically related to the coronavirus responsible for the SARS outbreak of 2002; while related, the two viruses are different. COVID-19 cases mostly had links to the Huanan Seafood Wholesale Market, which also sold live animals. Might be the zoonotic virus was contaminated from live animals to eatable products in the market which was consumed uncooked; cooked animal product will not carry infection to the humans from animal. The WHO considers bats the most likely natural reservoir of SARS-CoV-2, but some differences between the bat coronavirus and SARS-CoV-2 suggest that an intermediate reservoir such as a pangolin corona virus might be involved in its introduction to humans. However it is believed that the virus possibly originated in horseshoe bats (genus Rhinolophus). 

The World Health Organization on 11th March 2020 declared the rapidly spreading SARC- CoV-2 a pandemic, acknowledging what has seemed clear for some time - the virus will likely spread to all countries on the globe. Pandemic is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear, or unjustified acceptance that the fight is over, leading to unnecessary suffering and death. We have never before seen a pandemic sparked by corona virus outbreaks in 2002-2004 or 2012-2015. This is the first pandemic caused by a corona virus in 2019-2020.

How it spreads?
• How easily virus spreads from person-to-person can vary. Some viruses are highly contagious i.e spread easily, while other viruses do not spread as easily.
• Another factor is whether the spread is sustained, spreading continually without stopping. SARS-CoV-2 virus of COVID-19 seems to be spreading easily and sustainably as “community spread” in some affected geographic areas.
• Community spread means people are infected with the virus in an area, where some are not sure how or where they got the infection. Best way to see community spread is the instance of Hubei province of China where first time SARS-CoV-2 is isolated in December 2019; till 14 March 2020, just 67,790 cases and 3,075 deaths have been reported only in Hubei province! Whereas since 11th March 2020, out of 114 countries 1,18,000 have been reported infected by the virus and 4,300 people have died so far. Community spread is so dangerous!
• For instance, in USA COVID-19 cases include:

• Imported cases in travellers

• Cases among close contacts of a known case

• Community spread cases where the source of the infection is unknown.

Whom to Suspect?
  • • Suspect a person suffering from corona if the person has fever, weakness, breathlessness or signs / symptoms of lower respiratory illness (cough or shortness of breath). 

  • • Any person including health care workers who have had close contact with a lab confirmed patients within 14 days of symptom onset.

  • • Any person including health care workers who have had close contact with a person who has travel history of corona affected country or area should also come under lens.

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 distance 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.

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, but this is not thought to be the main way the virus spreads. However main spread is by respiratory droplets of sick patients produced by their coughs or sneezes.
Can someone spread the virus without being sick?

• People are thought to be most contagious when they are very much symptomatic. 

• However some spread might be possible before people show symptoms but carrying the virus which is an extra feature of this new corona virus; but this is not thought to be the main way the virus spreads.

How to tackle the situation?
Preventive measures to reduce the chances of infection in locations with an outbreak of the disease are: 
  1. Stay home for people with high-risk exposures, like children, old age person, immunity suppressed people due to some medical conditions,

  2. Avoid non essential travel,

  3. Avoid public activities to cut short person to person contacts, 

  4. Use soap and water and wash for at least 20 seconds. If you don't have soap and water, you can also use hand sanitizer with at least 60 percent alcohol. Wash as frequently as virus contamination is possible.

  5. Practice good respiratory hygiene by covering mouth and nose with handkerchief, tissue paper or at least a piece of cloth while coughing.

  6. Avoid touching the eyes, nose, or mouth with unwashed hands,

  7. Social distancing strategies aim to reduce contact of infected persons with large groups by closing schools and workplaces, restricting travel and cancelling mass gatherings.

  8. According to the WHO, the use of masks is only recommended if a person is coughing or sneezing or when one is taking care of someone with a suspected infection.

  9. Stay home and call your doctor if you start having respiratory issues and think your symptoms are consistent with those of COVID-19.

  10. Presently, isolation or quarantine recommended for suspected cases for 14 days, as incubation period for this the incubation period for the coronavirus is somewhere between 2 to 14 days after exposure. On average, it takes about 5 days to develop symptoms, but this may change as we learn more about the virus. According to some recent reports, more than 97 percent of people who contract SARS-CoV-2 show symptoms within 11.5 days of exposure. 

The main way to tackle an outbreak is self awareness; if everyone consciously with good attitude maintain personal care and help others not to be infected that`s what is just required!
Social media like Face book, Twitter, Instagram or Whatsup to play a responsible role to fight the crisis; not to mislead the population! If social media is spreading consuming alcohol will be helpful to combat COVID-19, it`s ridiculous, rather alcohol will reduce immunity and that individual may be a high risk susceptible candidate for SARS-CoV-2 virus infection like old age persons, diabetics, chronic asthmatics, chronic kidney disease, chronic heart failure, etc. If at all term alcohol is applicable in COVID-19 pandemic that is for 60 percent alcohol based sensitizer as a reasonable alternative to soap water hand wash! I must remind again face musk covering nose and mouth and hand washing frequently when ever exposed to risk are the two main tools to protect ourselves and the society! 
If social media or print media is looking for fault in situation where administration forcefully dismantling public gathering, it`s surprising; those public gathering will very quickly allow the virus to spread in the community and WHO will have to rush to declare the condition in the next level from Pandemic to Global Disaster, what they are observing consciously in the coming days!
Let us fight together this medical emergency as our lifetime experience!

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