The following describes what we know as of early February 2020 regarding the clinical presentation of patients with confirmed infection due to the Coronavirus (Covid19) and is according to latest updates available from World Health Organisation (WHO) and Centers for Disease Control (CDC).
Signs: The incubation period is 5 days (4 to 9 days). Frequently reported signs are those of a mild ‘common cold’ or flu-like signs such as high fever, cough, muscle pain and tiredness. Sore throat has been reported early. Less common symptoms include sputum production, headache, coughing and diarrhoea. There seem to be a number of people who are totally asymptomatic.
If there is a clinical deterioration, this seems to happen within 2 weeks of being infected and include lung infections or heart complications. The fatality rate is similar to that of Influenzae at 2-4% and is probably lower as we increasingly discover healthy or mildly ill carriers.
Risk factors for severe illness are not yet clear but again seem to be similar to those of the Influenzae flu virus: the elderly and people with chronic medical conditions. At this stage It is unclear if pregnancy also increases the risks.
Coronaviruses make up a large family of viruses that infect birds, mammals (including bats, civets, camels etc) and humans. There are seven known Coronaviruses that infect humans. These viruses have been responsible for outbreaks including the Severe Acute Respiratory Syndrome (SARS) in 2002-2003 and the Middle East Respiratory Syndrome (MERS) in 2015. The four most common human Coronaviruses, utilise only humans as their natural hosts.
Covid19 seems to cause similar diseases to the other Coronaviruses though perhaps not as severe, as those responsible for the SARS and MERS outbreaks. But what is surprising is that it seems, to be much more contagious and spreads very fast. So since the clinical risks are not yet fully understood, all countries are on high alert.
Transmission: Coronaviruses can be transmitted through respiratory droplets that infected people expel when they breathe, cough or sneeze. Contrary to common belief, a typical surgical mask cannot stop the viral particles, but simple measures such as washing hands, disinfecting frequently touched surfaces and objects and avoiding touching face, eyes and mouth, can greatly lower your risk of infection. The viruses generally cannot survive for more than a few hours on surfaces outside a human host.
Diagnostic Testing: Confirmation of infection is performed on respiratory specimens which can include nasopharyngeal or throat swabs, or aspirates. It takes up to 24 hours to have the results and this depends on the workload at the labs.
Prevention: All hospitals are aware of the measures to take to reduce risks of transmission. Some hospitals are not geared to keep patients who are suspected of being infected and therefore will refuse admission to anyone considered at risk. For the time being, the list has increased to people recently coming from China and some areas of South East Asia. Hospitals that are geared to take care of these patients, do so following very strict protocols to protect staff and all other patients.
Clinical Management and Treatment: No specific treatment for this Coronavirus infection is currently available. Clinical management includes prompt implementation of infection control measures and supportive management of complications if indicated. Patients with a mild clinical presentation may not initially require hospitalisation. All patients should be monitored closely. The decision to monitor a patient in the inpatient or outpatient is to be made on a case-by-case basis.
Travel: At this time of year with half term holidays many of our families are travelling abroad by plane, train, boat and car. Currently there are no travel restrictions to or from mainland Europe, but keep up to date with the latest travel advice from UK and European Governments, as well as any advice from the World Health Organisation, as this is currently a rapidly changing situation. When travelling encourage your family to blow noses and sneeze into disposable tissues, and dispose of them in bins. Hand washing with simple soap and water is very effective in reducing the spread of all viruses. There is currently no need to wear any form of personal protection - such as masks or gloves and these have little if any benefit. Finally in public places e.g. restaurants etc, use a hand cleanser if available, or simply wash hands before eating. Above all enjoy your holiday!
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