Coronavirus Epidemic:

It is an epidemic that has the epicenter in an overcrowded nation like China, which has 1386 million inhabitants (2017), the initial area quarantined is 44 million people, as many inhabitants as the Argentine republic. Its health authorities act every day, with a virus spreading in geometric form, which is in the upward phase of dissemination, due to the epidemiological characteristics so particular to prevent its spread. Initial tests seem to say that two weeks before the onset of its symptomatic stage the virus may be being transmitted.

It is a virus that genetically has a sequence like SARS, but evidently has more propagation capacity. Because of its features it will now extend from Asia to the rest of the Northern Hemisphere, and in the coming winter in the southern hemisphere. He has no active treatment. Patients with symptoms should be in respiratory isolation. The virus is called 2019 – nCoV from Wuhan, China. The initial 41 cases originated in a Seafood market, all of which had viral pneumonia. The severity of the disease is worrisome, with 30% of patients developing respiratory distress syndrome requiring intensive therapy, of these initial cases 6 patients developed heart injury and 4 required respiratory mechanical assistance.

It appears that, for the third time, in so many decades, a zoonotic coronavirus crossed species to infect human populations. The other outbreaks of respiratory coronavirus in humans (severe acute respiratory syndrome SARS CoV and middle eastern respiratory syndrome coronavirus MERS CoV) has 3% mortality. As of January 24 we had 800 cases reported and 3% mortality. https://promedmail.org .

The viral genome has been sequenced, and these results together show that it is 75-80% identical to SARS CoV and is even more closely related to several bat coronaviruses.  Notably 2019 – Wuhan nCoV grows better in human airway epithelial cells than in standard tissue cells. Identification will enable the development of reagents to address key unknowns about this new coronavirus infection and guide the development of antiviral therapies. Also be able to detect prevalence of infection in humans and possible zoonotic sources. As well as being able to develop antiviral therapies and vaccines.

2019-nCoV is likely to behave more like SARS-CoV and adapt even more to the human host, with a better binding to hACE2. As a result, it will be important to obtain as many non-related clinical isolates temporarily and geographically as possible to assess the degree to which the virus is mutating and assess whether these mutations indicate adaptation to the human host. In addition, if 2019-nCoV is similar to SARS-CoV, the virus will spread systemically.  Obtaining patient samples in the autopsy will help to elucidate the pathogenesis of infection and modify therapeutic interventions rationally. It will also help validate the results obtained from experimental laboratory animal infections.

A second key question is the identification of the zoonotic origin of the virus. Given their close similarity to bat coronaviruses, bats are likely to be the primary reservoir of the virus. SARS-CoV was transmitted to humans from exotic animals in wet markets, while MERS-CoV was transmitted from camels to humans.  In both cases, the ancestral hosts were probably bats. It is important to know whether 2019-nCoV is transmitted directly from bats or through intermediate guest and will help define zoonotic transmission patterns.

In a communication in another Lancet article, Jasper Fuk Woo Chan and his colleagues from the Hubei Province Health Commission, first announced a group of unexplained cases of pneumonia on December 31, 2019, clinical and microbiological data were reported from a family of six people who had traveled to Wuhan contracting pneumonitis being admitted to Shenzhen Hospital, five were identified with 2019.nCoV infected. None had been to Wuhan Market. The authors claimed that this corroborates human-human transmission.

High initial mortality rates would be due to a bias in early exchange of initial data on the most severe cases that required attention, as they were severe cases. Stabilized communication would not exceed 3%.

WHO experts are to know the actual figures for introducing a real-time simulation, which can translate the risk of spreading the disease.

China has quickly isolated and sequenced the virus and shared this data. These lessons were learned in the SARS epidemic.

Some of the aspects known so far make me assume that the spread to other countries will be impossible to contain, despite all the measures implemented in confinement, because there is a prolonged asymptomatic stage of transmissibility.

That at the time of the cut and quarantine, movements of people occurred that can spread.

Therefore, it would be possible to expect that this spread would be impossible to contain. It would be unwise to determine the actual degree of severity of this pathology and its mortality.

There are many gaps in our knowledge, The first experiences with these patients were not yet documented.

The exposure and possible infection of health workers remain extremely worrying.

China’s public health authorities are under enormous pressure to make difficult decisions, with incomplete and rapidly changing information about the epidemic.

Quarantines, motorway closures,  may seem like a drastic measure: whether or not they represent effective control deserve careful investigation and much will depend on maintaining trust between the authorities and the population. Openness and data exchange are paramount.

It is necessary to determine the extent of interhuman transmission and the spectrum of clinical disease. The different issue to the other coronaviruses, according to the knowledge we have, so far, is that it would have receptors in the upper airway tract, this would confer a possible transmissibility in pre-disease stage.

We are facing the first epidemic that would entrust the capacity to compromise the global health of humanity in the Neovesalian era  of medicine,  in a short time, which will require firm measures, with a single command, with a strong determination to mitigate the damage generated by a virus that will spread following an exponential cycle, because there is no way to contain it.

Publicado por saludbydiaz

Especialista en Medicina Interna-nefrología-terapia intensiva-salud pública. Director de la Carrera Economía y gestión de la salud de ISALUD

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