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Medisina at Politika by Dr. Rey Pagtakhan  

COVID-19 epidemic in China: A global concern

by Dr. Rey Pagtakhan

A. Human and societal toll

China is in the midst of an epidemic due to a new coronavirus that was not previously identified to cause illness in people. The World Health Organization (WHO) now officially names it COVID-19.

Over 42,670 have taken ill and 1,018 lives – and counting – have been lost. Over 60 million residents are quarantined in their homes and apartments. The entire province and adjacent cities are in lockdown. Air flight and land travel is restricted or cancelled. Classes are suspended, factories and offices closed, and tourism is depressed.

These are the toll on human life and health, and the monumental disruptions in China.

B. How the epidemic began

It was around December 8, 2019 when a cluster of patients in Wuhan, Hubei, China presented with fever, cough, malaise and chest images that resembled a viral pneumonia. Since most of the patients shared a history of exposure to the Huanan South China Seafood Market, an alert was issued and an expert team of physicians, epidemiologists, virologists, and government officials was soon formed. On December 31, 2019, 59 patients “with pneumonia of unknown cause” were transferred to a designated hospital and the WHO was notified. The following day, January 1, 2020, a virus was isolated and the Huanan wet market was closed. Further characterized, the new virus pathogen was posted as “2019-nCoV,” henceforth to be officially called COVID-19. A diagnostic test was developed by January 10. The first case outside Wuhan was confirmed in Thailand on January 13th. By January 23rd, 800 cases had been confirmed in patients from 20 regions of China and nine other countries.

C. Worldwide tracking of cases

In response to the outbreak, the Johns Hopkins University’s Center for Systems Science and Engineering (JHUCSSE) launched its online dashboard on January 22nd to track in real-time, the cases, both the confirmed and recovered, as well as the deaths. This dashboard gets its data from the Centers for Disease Control and Prevention in the USA and Europe, and the WHO, thereby providing the global public a better appreciation of the rapidly unfolding outbreak.

D. A comparative view of COVID-19 vs. SARS

Differences: The two virus strains belong to the same family group called coronavirus due to their crown-like appearance, but their genome sequence is different. COVID-19 differs from SARS as follows: a) the source of outbreak and city of origin (a wet market in Wuhan vs. contaminated sewage in Hong Kong); b) an animal host (unknown vs. bats and civets); c) effectiveness of human-to-human transmissibility (RO number of about 2 vs. 2.7); d) duration of epidemic (2.5 months vs. four months; e) number of cases (42,670 and counting vs. 8,422;) f) number of deaths (1,018 vs. 916); g) case fatality rate (2.39 per cent vs. 10.88 per cent); h) risk to health care workers (low vs. high constituting 25 per cent of total; i) non-prominence of diarrhea (2 per cent versus 25 per cent); j) rarity of cold-like symptoms like runny nose, sneezing, sore throat (4 per cent vs very common); k) response to anti-viral drugs (none vs. available); l) vaccine availability (promising development vs. none), and m) rapid diagnostic test (available vs. none).

To date, case fatality rate from one published report is equal to and from another report is higher than for SARS, but the ongoing tracking with the JHUCSSE dashboard shows a lower fatality rate. It is too early to make a definitive comparison since some 36,900 cases, and counting, remain after taking into account the number of deaths and recovered from the total confirmed,

Similarities: The two diseases share the same 1) modes of transmission (droplets from symptomatic patients and non-symptomatic carriers); 2) incubation period (up to 14 days); 3) scope of geographic spread (25 to 28 countries); 4) capability to do serious harm (occurrence of fatal cases); 5) risk factors for death (presence of underlying medical conditions); 6) high occurrence of pneumonia; 7) common symptoms of fever, cough, fatigue and difficulty of breathing; 8) average duration of about a week from onset of illness to shortness of breath and hospitalization; 9) quarantine of contacts and elimination of animal reservoirs help in the effective control of spreading the two diseases, just as 10) early detection, strict isolation of patients, practice of droplet and contact precautions, and compliance with the use of personal protective equipment help prevent hospital-acquired spreading.

E. Global concern and Canada’s response

The WHO declared on January 30th a public health emergency of international concern “to fight further spread in China and globally, and to “protect states with weaker health systems.” Its team headed by Canadian expert Dr. Bruce Hayward visited China to do a follow-up on the ground. USA followed with its own declaration the following day.

Canada’s public health response reflects preparedness and planning. It includes the airlift evacuation from Wuhan of Canadian citizens and permanent residents and their two-week quarantine at the Canadian Forces Base Trenton. The Public Health Agency of Canada activated the Health Portfolio Operations Centre and the Public Health Response Plan to support effective coordination of federal, provincial and territorial preparedness and response across Canada. Meanwhile, the National Microbiology Laboratory has developed a real-time diagnostic test and is working collaboratively with Canadian provincial public health laboratories to ensure testing capacity in multiple jurisdictions.

Hon. Dr. Rey D. Pagtakhan, P.C, O.M., LL.D., Sc.D., M.D., M.Sc., is a retired lung specialist and professor of pediatrics and child health from the Children’s Hospital of Winnipeg and the University of Manitoba Faculty of Medicine. As Canada’s former Secretary of State for Science, Research and Development he made a presentation on “The Global Threat of Infectious Diseases” at the G-8 Countries’ Science Ministers and Advisors Carnegie Group Meeting held on June 13-15, 2003 in Berlin, Germany.

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