Dr Noureen Ahmad, General Practitioner, Belgium
In December 2019, there was an outbreak of a new respiratory virus in Wuhan, the capital of Hubei, China. Upon investigation, a new virus of the coronaviruses was discovered, later named as COVID-19. Coronaviruses are positive RNA viruses that can be found in humans and animals.
Usually, these viruses give mild symptoms, however, in the past, some of these coronaviruses have led to a pandemic.
A few decades ago, there was a huge outbreak of coronaviruses known as severe acute respiratory syndrome coronavirus (SARS) and the Middle East respiratory syndrome corona virus (MERS), causing more than 10,000 deaths around the world.
Right now, COVID-19 is the recent discovered coronavirus causing widespread havoc.
Etiology
After the outbreaks with SARS and MERS, further investigation had been done to find the cause of these coronaviruses.
Current studies show that just like SARS and MERS, COVID-19 is initially to be found in bats and wild animals. This virus might be transmitted to humans on markets where they purchase these animals.
Epidemiology
In a recent report of World Health Organization (WHO) there are more than 90,000 confirmed cases (and counting) of COVID-19. Around 80,000 of such cases are in China and still increasing in number. Countries outside of China have confirmed approximately 15,000 cases of COVID-19. The most affected countries in Asia, besides China, are South Korea and Japan, while in the Eastern Mediterranean Region it is mostly Iran.
In the past weeks, the COVID-19 virus also reached Europe, with Italy, France and Germany as the most affected countries currently. Recently, there are also confirmed cases in America and in Africa.
Travelling might be one of the greatest causes of this fast spreading of COVID-19 to the rest of the world. As COVID-19 is spreading very quickly around the globe, it is thought that there must be a humanto-human transmission. This can happen through respiratory droplets in the air when an infected person coughs or sneezes. When these droplets get in direct contact with the eyes, nose or mouth or are inhaled, they can enter the body and cause the COVID-19 infection.
COVID-19 can also be found on surfaces or objects, however this is not considered as main transmission route due to a limited life expectancy of the virus outside the human body. There are also other potential routes of transmission, such as urine, stool, food and pregnancy, however the exact mechanism of is unknown.
Clinical presentation – Symptoms
Before clinical symptoms are visible, there is an incubation period. The incubation period is the time between exposure to an infection and the appearance of the first symptoms. Normally, the first symptoms occur between 3-5 days, however the start of the symptoms can delay to 25 days. The risk of getting seriously ill rises with the age and people over 40-50 seem especially more vulnerable. Also, people with pre-existing diseases (weakened immune systems, diabetes mellitus, heart and lung diseases) have more chance of complications.
Children can get infected with COVID-19, however the exact pathology is yet unknown. It is also important to mention that the clinical symptoms of COVID-19 are nonspecific, meaning these symptoms show resemblance with common diseases like a cold and seasonal flu. Recent studies show that the most common symptoms in COVID-19 patients are fever, cough, fatigue or muscle pains, breathing difficulties (dyspnea or shortness of breath).
Rarely, symptoms of the upper respiratory tract were reported, such as runny nose and throat pain. Less frequent symptoms are also mucus production, headaches and coughing up blood. There are no or less gastrointestinal symptoms reported such as abdominal pain and diarrhea. These latter symptoms were more presented in SARS and in MERS patients. Some studies also showed that few infected patients with COVID-19 can remain asymptomatic.
Once infected with COVID-19, it can rapidly spread in the body and can create a high inflammation in the lungs thus lead to pneumonia (lung infection) and thereafter respiratory failure (acute respiratory distress syndrome). In the blood, it can lead to depletion of the red and white blood cells (anemia and leucopenia) and cause organ dysfunction (heart and kidney injuries) leading to death.
Diagnosis
As mentioned before, the symptoms of COVID-19 are unspecific, which means the diagnosis of COVID-19 also depends on the epidemiological factors, such as exposure to the affected COVID-19 areas or to COVID-19 positive patients. This means that only patients who present themselves with symptoms that have been mentioned above and had exposure once, or more, during the 14 days prior to the onset of symptoms to an affected area of COVID-19, close contact with COVID-19 affected patients or close contact with people from the affected area should be further examined.
When a doctor thinks the clinical case is susceptible for COVID-19 infection, further testing will be required in specialised labs, aft er discussing with the local health department. The first test is the swab test, where a special swab will be used to take a sample of the nose or throat. If the result for this test is positive for COVID-19, further testing is required preferably in hospital and in quarantine. This can be a full blood test and chest CT-scans, depending of the severity and the clinical presentation of the patient.
Treatment
As COVID-19 is a new disease that was just discovered three months ago, there is no cure and no vaccine at the moment, however there are currently trials and research going on. Antibiotics are not effective against a virus. The care of COVID-19 patients exists in providing appropriate and supportive help to relieve and treat their symptoms. In order to control COVID-19, focus should remain on prevention and quarantine to block human-to-human transmission. Th us, it is important to focus on further prevention of COVID-19 spread by keeping proper hygiene and listening to advice from your government.
Patients who meet the upper criteria mentioned above are advised not go to the waiting room of their GP or go to emergency in the hospital, but instead, if possible, contact their GP through telephone to avoid further transmission of this virus. Also, people who do not match the criteria and have a common cold or flu are advised to stay at home. To maintain good hygiene in order to protect oneself against COVID-19 includes washing hands frequently (+/-1 minute) and disinfecting your hands with alcohol gel sanitisers (+/- 30 secs). This should happen after visiting the toilet, aft er sneezing, coughing and aft er blowing the nose and before and after eating. When sneezing or coughing, it is recommended to use a disposable tissue and throw it in the bin immediately. If a tissue is not available, it is advised to use the bend of one’s elbow, covering the nose and mouth. Also, one should avoid close contact with anyone showing symptoms of respiratory infection and maintain a distance of more than one metre.
The question arises as to whether medical facial masks are needed. The WHO recommend using facial masks if respiratory symptoms are present or coming into contact with suspected COVID-19 patients. Surfaces in public places can also carry COVID-19, however there are some chemical disinfectants such as chlorine-, bleach- and alcohol-based substances that kill the COVID-19 virus on the surfaces. These chemicals have less impact on the virus on more the skin and it is even considered to be dangerous.
Phones, tablets and computers also carry many viruses and it is important to avoid touching the eyes, nose and mouth if hands are not disinfected. It is also advisable to wash hands aft er coming into contact with pets and aft er preparing raw meat. Besides good hygiene, it is important to maintain a healthy lifestyle, which includes a proper diet, using a variety of vegetables and fruits as they contain many vitamins and minerals which can support the immune system (such as vitamin C and D).
Furthermore, regular exercise and a good night’s rest can keep your body fit. It is normal to feel sad, stressed, anxious and confused during a crisis, so it is important to limit worry. Preventing a disease is better than cure. If one does get ill, one must remember “And when I am ill, it is He Who restores me to health.” (Surah al-Shu‘ara, Ch.26: V.81)