Bisher AKIL, MD

Archive for the ‘Infections worthy of news’ Category

Coronavirus: An Update

In General Health, Infections worthy of news on March 1, 2020 at 3:53 pm

Introduction: Human coronaviruses (HCoVs) have long been considered inconsequential pathogens, causing the “common cold” in otherwise healthy people. However, in the 21st century, 2 highly pathogenic HCoVs—severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV)—emerged from animal reservoirs to cause global epidemics with alarming morbidity and mortality. In December 2019, yet another pathogenic HCoV, 2019 novel coronavirus (2019-nCoV), was recognized in Wuhan, China, and has caused serious illness and death. The ultimate scope and effect of this outbreak is unclear at present as the situation is rapidly evolving.

How deadly is it? Epidemiologists are still trying to determine exactly how deadly covid-19. About 2 percent of reported cases have been fatal, but many experts say the death rate could be lower. That’s because early in an outbreak, mild illnesses may not be reported. If only people with severe illness — who are more likely to die — seek care, the virus will appear much more deadly than it really is because of all the uncounted people with milder symptoms.

How is it spread?: The reproduction number, or “R” number, appears to be around 2.5. That means every person who is infected will pass the disease on to 2.5 other people. The influenza virus is a little lower. Measles has a much higher R number of about 18. These are averages .Covid-19 spreads similar to other coronaviruses that cause cold-like symptoms, experts have said. There have been reports of people transmitting the virus before they show symptoms, but most experts think this is probably not a major driver of new infections. What is concerning, however, is that symptoms can be mild, and the disease can clearly spread before people realize they’re sick. A report in the New England Journal of Medicine suggested covid-19 reaches peak infectiousness shortly after people start to feel sick, spreading in the manner of the flu. A study published in JAMA chronicled the case of a 20-year-old Wuhan woman who appeared to infect five relatives, even though she never showed signs of illness.

What are the symptoms? : Symptoms are primarily respiratory. Coughing and shortness of breath are common, according to the CDC. Fever is also possible. The severity of the symptoms depends highly on the patient’s age and immune system.  For the elderly and those with underlying heart disease, diabetes or other conditions, coronavirus can cause pneumonia and lead to organ failure and death. But for most people, cases have been mild, requiring little to no medical intervention.

Do we have a test?: Yes,. A kit is available from the CDC, and today the FDA licensed other tests from private laboratories.

Is there a treatment?: There is no licensed medication for the treatment of this virus. . Gilead pharmaceutical has the antiviral drug remdesivir as a possible coronavirus treatment. It is now in clinical trials in several countries, including China. It has been used at least once in the US on compassionate basis.

How do I prepare? There are some basic precautions you can take, which are the same as what you should be doing every day to stave off other respiratory diseases: Wash your hands regularly. Cover your nose and mouth when you sneeze. And when you’re sick, stay home from work or school and drink lots of fluids.. The CDC recommends washing with soap and water for at least 20 seconds after using the bathroom, before eating and after blowing your nose or sneezing. It also advises not to touch your eyes, nose and mouth and to clean objects and surfaces you touch often.   Here is a video from WHO to show to proper hand wash:

Should I wear a mask?: If you’re not already sick and you’re not a health-care worker, the short answer is no. The main point of the mask is to keep someone who is infected with the virus from spreading it to others . CDC does not recommend that people who are well wear a face mask to protect themselves from respiratory diseases. Common surgical masks block the droplets coming out of a sick person from getting into the air, but they are not tight enough to prevent what’s already in the air from getting in. There are specialized masks — known as N95 masks because they filter out 95 percent of airborne particles. The masks are difficult to use without training. They must be fitted and tested to work properly.

When will it end? Unknown; it could follow a seasonal pattern (appears in cold weather and disappears with warm weather), and to return next season. However, there is evidence that it persists in Southern hemisphere countries that already have warm weather.

What about a vaccine?: several agencies and pharmaceutical companies are working on developing a vaccine; it is not likely that vaccine will be available this year and it not likely to be used in treatment.


<<Disclaimer: This summary is  compiled from information available through medical journals (New England Journal of Medicine, The Lancet, JAMA and others),government and public health sites (CDC, DHHS and FDA) and media outlets (New York Times, Washington Post and others) . Many of the information we know now, will likely to change as we know more- BA>>

Coronoviruses in the news

In Immune System, Infections worthy of news on January 23, 2020 at 5:51 pm

An outbreak of respiratory illness caused by a novel (new) coronavirus (termed “2019-nCoV”) that was first detected in Wuhan City, Hubei Province, China and which continues to expand. Chinese health officials have reported hundreds of infections with 2019-nCoV in China, including outside of Hubei Province. A number of countries, including the United States, have been actively screening incoming travelers from Wuhan and human infections with 2019-nCoV have been confirmed in Taiwan, Thailand,  Japan and South Korea. The United States announced their first infection with 2019-nCoV detected in a traveler returning from Wuhan on January 21, 2020.

Coronaviruses are a large family of viruses, some causing illness in people and others that circulate among animals, including camels, cats and bats. Rarely, animal coronaviruses can evolve and infect people and then spread between people such as has been seen with MERS [ Middle East Respiratory Syndrome is viral respiratory illness that is new to humans. It was first reported in Saudi Arabia in 2012 and has since spread to several other countries, including the United States. Most people infected with MERS-CoV developed severe respiratory illness, including fever, cough, and shortness of breath. Many of them have died] and SARS [Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a coronavirus called SARS-associated coronavirus (SARS-CoV). SARS was first reported in Asia in February 2003. The illness spread to more than two dozen countries in North America, South America, Europe, and Asia before the SARS global outbreak of 2003 was contained. Since 2004, there have not been any known cases of SARS reported anywhere in the world]. When person-to-person spread has occurred with SARS and MERS, it is thought to have happened via respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza and other respiratory pathogens spread. Spread of SARS and MERS between people has generally occurred between close contacts. Past MERS and SARS outbreaks have been complex, requiring comprehensive public health responses.

Early on, many of the patients in the outbreak in Wuhan, China reportedly had some link to a large seafood and animal market, suggesting animal-to-person spread. However, a growing number of patients reportedly have not had exposure to animal markets, suggesting person-to-person spread is occurring. At this time, it’s unclear how easily or sustainably this virus is spreading between people.

Both MERS and SARS have been known to cause severe illness in people. The situation with regard to 2019-nCoV is still unclear. While severe illness, including illness resulting in a number of deaths has been reported in China, other patients have had milder illness and been discharged.

It’s not clear yet how easily 2019-nCoV spreads from person-to-person. It’s important to know this in order to better assess the risk posed by this virus. While CDC considers this is a serious public health concern, based on current information, the immediate health risk from 2019-nCoV to the general American public is considered low at this time.

More cases are likely to be identified in the coming days, including possibly more cases in the United States. Given what has occurred previously with MERS and SARS, it’s likely that some person-to-person spread will continue to occur.

Notes: the above information was compiled on 23 of January 2020, from various sources, and primarily from the CDC; although I usually report scientific data from peer-reviewed papers, I felt this need be reported given a lot of my patients travel to China for business. Bisher Akil, MD