Authors: Dr. Colin Michie, Paediatrician; Denise Harford, Nurse; Dr. Pat Kelly, Veterinarian
You will have heard of the coronavirus, Covid-19, first described in December last year in Wuhan, China, and officially named on February 11. This article is intended to provide some background information on the virus.
At the time of writing, Covid-19 has been identified in over 80 countries, has infected over 93,000 people and has caused over 3,000 deaths that we know about.
Human coronaviruses are routinely a common cause of colds. Typically in winter and spring, they give rise to sore throats, fevers and sometimes some swelling of the glands in one’s throat. There are several species of human coronavirus; there is no specific treatment for any of them.
The coronavirus family was first identified in the 1960s, in chickens; different types can be found in mammals (including whales), birds and reptiles.
Coronaviruses that infect humans include SARS (severe acute respiratory syndrome, causing outbreaks in 2002 and 2004) and MERS (Middle East Respiratory Syndrome, with an outbreak in 2012), both of which caused epidemics.
In order to compare these viruses, it is helpful to look at how infectious they are (how rapidly they can spread from human to human) and measure how severe the infections they cause might be.
This epidemic of a coronavirus is the first “disease X”. The World Health Organisation (WHO) warned in 2018 that there was a potential for a pandemic disease of a new agent. This strong prediction was based on three global changes.
First, humans move rapidly and in large numbers around our planet. Second, climate change is altering previous seasonal patterns. Third, progressive habitat destruction has increased human exposure to animals and vectors such as mosquitoes that might result in infection.
Pathogens such as viruses and bacteria change rapidly because of their continual multiplication and unpredictable gene exchanges, presenting new challenges to our health. At the time of writing this article, the WHO has classified Covid-19 to be a public health emergency of international concern.
Most recent epidemics of virus infection originated in animals, as though from some devil’s bestiary. For instance, influenza might spread from a duck or a pig then to humans (as with bird flu or swine flu – both influenza viruses) or from a bat and small mammals, or even camels to humans (as with corona viruses). As Louis Pasteur once observed, “Messieurs, microbes will always have the last word.”
If you are infected with Covid-19, the chances are you may have no symptoms at all. You might develop a fever and sore throat, just as with any other “cold”. If you are unlucky, you will develop signs of a chest infection, with a cough and difficulty breathing. This virus can cause severe pneumonia in a small number of individuals.
We do not know enough about Covid-19; information will build slowly. It is a new virus whose behaviour in our diverse communities and metissage has yet to be described. For instance, its incubation period may lie anywhere between five and 14 days.
Statements shared by WHO predict a mortality rate between five and 40 out of 1,000 infected individuals. The mortality from SARS was approximately 100 in every 1,000; MERS was greater still – in excess of 280 per 1,000.
The risk of dying from Covid-19 pneumonia depends on many factors that are not understood. It stands to reason too that well prepared, coordinated and resourced health services will reduce mortality rates among infected individuals, as this has been seen in other coronaviruses. Since January, research has been carried out into the possible value of several agents to treat Covid-19.
Curiously, Covid-19 has not been found to be a severe infection in children, unlike many other upper respiratory tract viruses. The most susceptible folk who do not recover as well appear to be elderly adults or those with underlying chest problems.
So how can you protect yourself against Covid-19?
The first approach is what governments refer to as “containment”. The next stage is “delay”.
Avoid contact with the organism. These concepts of quarantine are familiar to all on St. Martin, as this issue is often discussed with reference to infections such as norovirus or measles on a cruise ship.
“Quarantine” derives from “forty days” – a period historically considered sufficient to ensure a person, village or transported animal needed to be observed in isolation in order to ensure all were safe.
Small island populations, as history and statistical analysis show, are susceptible to new infections, particularly when they have large numbers of visitors. Historically, the use of small islands for quarantine, or lazarettos, is a long one too. If one can slow or stop the spread of Covid-19 now, in March, the hope is that warmer weather will reduce its spread. This pattern is seen in many other viruses that infect the upper respiratory tract.
Time will permit the development of an effective vaccine too. The long-term outcomes of containment are unclear. Viral transmission may slow down, but it might not. Covid-19 may become seasonal.
Clinical histories collected so far suggest Covid-19 is very infectious. Contact with secretions from an infected person’s upper respiratory tract is particularly risky as this contains most infectious particles. Coronaviruses can survive outside the body, so that hands, surfaces that might have been touched, and rooms where infected people have breathed will be contaminated.
The viral particles are small. They are round, each about 0.1 micron in size. That is, 60-80 of them could line up on one side of a red cell. And it takes a queue of about 150 red cells to reach a millimetre.
Health agencies advise avoiding close contact with those suffering with an upper respiratory tract infection and follow Leviticus – wash your hands thoroughly and regularly with soap and water. Those small Covid-19 critters can be effectively removed in this way. Dettol, bleach or other disinfectants are not needed!
Touch your own eyes, nose and mouth as little as possible and use disposable tissues to reduce the spread of secretions, should you cough or sneeze. Face masks will not prevent infection and are largely decorative because they leak and will let through small viral particles. High grade masks that seal around the nose and mouth are recommended only for health-care personnel working with identified infective patients.
Most of the world’s facemasks are manufactured in China, so the logistics of supplying these is becoming complicated. Facemasks are important in some occupations and hospitals to prevent the inhalation of particles larger than 0.3microns, so please do not stockpile them! In international airports, it is now commonplace to see many arriving on flights from South East Asia wearing a facemask – this is not a useful precaution for anyone.
The strategies of containment and delay have proved morally challenging. Fear, suspicion and attendant violence have produced what are likely to be the most dangerous long-term problems. Epic proportions of inaccurate and biased medical advice have been produced in many media. As examples, no supplementary foods, vitamins, minerals or diets have been found protective against Covid-19. Colloidal silver, bush teas or exercises will not help. None of these approaches has been found useful for populations faced with viral pneumonias; there is no reason for them to be effective against Covid-19.
The good news is that research on this virus is better coordinated internationally than for earlier epidemics, so high quality information should be generated faster (and available on websites such as London’s https://www.lshtm.ac.uk/research/research-action/covid-19 and America’s CDC website https://www.cdc.gov/coronavirus/2019-ncov/index.html).
Millions are now working from home. Thousands of hospitals are closed to visitors. Social norms are changing. By impacting the global economy’s supply and demand affecting the insurance industries, Covid-19 will result in challenges to St. Martin. Covid-19 is an epidemic in its early stages – it will change our world. We must all take care, keep up to date with what is really known of this virus and look after each other.
Image: Iranian women wear protective masks to prevent contracting coronavirus, as they walk in the street in Tehran, Iran, February 25. WANA/Nazanin Tabatabaee via REUTERS.
