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COVID-19; How Do We Prepare for the Worst

Mar 10, 2020
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It’s been about 70 days since we learnt about a new deadly respiratory virus from Wuhan, China. COVID-19 thus far has caused more than 3600 reported deaths out of over 100,000 reported cases globally. In the US, over 19 deaths and 400 cases have been reported, that include 70 cases repatriated to the US. Warm countries with high level of humidity have reported much less cases compared to the rest of the world. COVID-19 Novel Coronavirus is a highly contagious virus with a low case fatality (low virulence). The fear seems to be even more contagious that the disease itself. The anxiety and paranoia primarily emanated by the media caused panic among the young and the old, sparing no barriers or borders. Some over-react by stockpiling day to day items causing further panic among people who witness such actions. Some sneak out the surgical masks from the hospitals dedicated for healthcare workers. Some have cancelled their travel plans specially cruises and foreign travel. The governments have recognized certain countries with high prevalence such as China, South Korea, Italy, Iran and Japan (Level 2 and 3) for official travel restrictions.

When we, as Infectious Disease Specialists were asked to closely monitor the situation in the hospitals, we started analyzing the situation in a deep sense. We have formed task forces, delivered lectures and CME talks as well as townhall style talks, participated in webinars and conference calls with a purpose of slowing down, if not containing the current crisis. We have sacrificed our time to alleviate the anxiety among our employees as well as patients on regular basis through such efforts. We have been following WHO, CDC and local public health guidelines and protocols constantly and have passed them to the nursing teams and others who are an integral part of our efforts to contain the virus. Yet, what we experienced during last 9-10 weeks is unparallel to anything that we have seen and dealt with in the past. During 2009 H1N1 influenza outbreak and 2015 Ebola outbreak we were actively involved in the containing efforts; but the fear and the uncertainty we are experiencing now with this crisis seem quite unprecedented compared to those pandemics. One notable feature among the cases reported so far, is that the prevalence of COVID-19 among kids is low and fatalities are even lower unlike 2009 H1N1 pandemic. Unfortunately, like in many respiratory infections causing pneumonia, the elderly and the patients with underlying medical issues are the most vulnerable to death caused by COVID-19.

What baffles me the most is the fact that we feel helpless when a potential patient comes into ER with respiratory symptoms and fever with or without travel or contact history, but how do we distinguish that patient from an Influenza patient. Due to strict guidelines by CDC and nonavailability of adequate test kits of RT-PCR for COVID-19, we have undertested such patients so far and I believe that this is the real reason behind relatively low numbers of cases reported in the US. The more we test, the higher the numbers will be, thus expanding the denominator. The case fatality numbers are somewhat erroneous because of under-reporting of actual cases around the world and under-testing in countries like US. The case fatality among previous coronavirus outbreaks were 10% with SARS (originally from China) and 35% with MERS (originally from Saudi Arabia). COVID-19 case fatality has been around 4%, but with constantly evolving numbers, this will be revisited every few weeks by WHO and CDC. When you compare these numbers with previous Flu pandemics that killed about 50 million people in 1918 with Spanish Flu, about 1-2 million with Asian and Hong Kong Flu in 1950’s and 1960’s, over 100000 with the recent H1N1 Flu, one wonders whether we have done enough to prevent another major deadly pandemic.

The prevention strategies primarily revolve around enhanced infection control practices with attention to the details. We cannot stress enough the importance of hand hygiene, facial hygiene and respiratory etiquettes at time like this. PPE (personal protective equipments) such as surgical masks, N95 sealed masks, gloves and gowns are extremely important to prevent community and healthcare related spread of such infections. We do need to stay at home when we have a respiratory infection and the employers have been asked to make provisions for such sick leave in times like this. The simple hygienic measures need be practiced thoroughly and meticulously, and we do have to pay attention to the details. For example, handwashing should be with soap and water over 20 seconds. Hand sanitizers should cover all the spots on your hands for an adequate period. Social distancing and mitigation are an integral part of prevention of this infection along with avoidance of shaking hands and other contacts with peoples.

My prediction as an Infectious Diseases specialist is that we have not peaked with COVID-19 yet; but it will soon die a slow death among us within next few weeks. The anxiety around this novel virus will die down in the meantime in most western countries. We do not know how the virus will behave in the Southern hemisphere with their winter arriving in June. The virus may undergo mutations during that period. Yet we can make an educated guess that all this will impact the behavior of the virus in the next few years. This will reiterate the significance of an effective vaccine against COVID-19. The effectiveness of currently available therapeutic options (Remdesivir, HIV antivirals like Kaletra, Chloroquine and others in clinical trials) against this virus will tell us how the fatality numbers evolve next few weeks. But the best and the most efficacious approach to any new virus will be prevention through vaccine development. Dozens of research groups around the world are racing to create a vaccine as COVID-19 cases continue to grow. Importantly, they’re pursuing different types of vaccines — shots developed from new technologies that not only are faster to make than traditional inoculations but might prove more potent. Some researchers even aim for temporary vaccines, such as shots that might guard people’s health a month or two at a time while longer-lasting protection is developed.

Written By: Dr Deepthi Jayasekera, Clinical Professor and Specialist in Infectious Diseases Foothill Infectious Disease Group, Claremont

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