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Novel Corona Virus-2019: A Global Threat

- Dr Kiran Niraula and Dr Megha Ghimire

An endemic has been terrifying the world and keeping them on the toes. This was initially acknowledged by WHO on 31st December, 2019 in Wuhan City, Hubei Province of China. This new virus raised the concern of the whole world, as it did not coincide with other known viruses. This new virus was finally confirmed by the Chinese authorities on 7th January, 2020 as the coronavirus family, like SARS or MERS however new strain the one never seen before and the name given “2019-nCoV”.

Though the 2019-nCoV has been linked to seafood, bats, snakes and animal market, there has been no confirmed link to where this Corona virus emerged from. Some studies have shown that it has the animal reservoir similar to other viruses of the corona family, indicating the animal-to-human spread. A phylogenetic study based on published genomes suggests that the transmission was likely from a single infected animal. The virus subsequently spread to all other provinces of China and to more than twenty other countries in Asia, Europe, North America, and Oceania.WHO, in collaboration with the Chinese government has been making efforts to investigate the outbreak of the coronavirus and proceed for the rapid diagnosis and treatment measures.

The initial symptoms are similar to the common viral upper respiratory tract infections, and hence has created more chaos in the people. Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.According to the study article published in The Lancet detailing the clinical features of 41 infected patients, the characteristics were governed by analyzing data from the laboratory-confirmed cases of the virus via real-time polymerase chain reaction and next-generation sequencing. Standard recommendations to prevent infection spread include regular hand washing, covering mouth and nose when coughing and sneezing, thoroughly cooking meat and eggs. Avoiding close contact with anyone showing symptoms of respiratory illness such as coughing and sneezing is also recommended. No definitive drugs and/or vaccinationshave yet been confirmed, and the patients are being isolated and treated symptomatically. Many studies on different existing antivirals (eg. Indinavir, Saquinavir, etc.) are going on. Several organizations and institutions in different countries are already working on creating vaccines for 2019-nCoV.

The 2019-nCoV has been rapidly spreading to other countries over the world and have affected at least 22 countries. According to data published on 30th January, 2020, this notorious virus has killed at least 213 people and infected more than 9,812 people. WHO has declared a global public-health emergency as of Thursday, 30th January, 2020 as this virus have posed a grave threat and the real impact is yet unknown. The total number of cases internationally has surpassed that of the entire SARS outbreak.

The first case of this deadly virus was reported in Wuhan with the population of 11 million. On 23rd January, 2020, the local officials of the Wuhan quarantined the city by shutting down all the transportation, and on 25th January, the Chinese government barred its citizens from the domestic and international travels. Though the city of Wuhan has been quarantined, many people fled from the city as soon as the threat was introduced, resulting in the population decrease of the city to 6 million and ensuing rapid the transmission of the infamous virus worldwide. Many countries like USA and Japan evacuated their citizens from Wuhan as soon as the threat was imposed.Residents of few other countries including Nepal are advocating to bring back their loved ones, workers and students residing in Wuhan as they are not able to acknowledge the core scenarios of this grave threat. The transmission of the virus can occur through asymptomatic infected individuals as well as infected people who re under treatment and have shown signs of improvement.The governments of these countries are abiding by the policy of WHO and Chinese government of travel restrictions.

Few myths regarding the 2019-nCoV have also emerged among general population taking it as a normal flu or converging the effect only to old, children and comorbid people. But WHO has advised people of all ages to take steps to protect themselves from the virus following good hand hygiene and avoiding the close contact. Since it is a viral infection, the antibiotics have no role in its management. Though it has flu-like symptoms, it is more dangerous than the normal flu, as the nature and course of other viral flu along with their treatment are well known. But we are not well-versed with the exact nature, course, impact, morbidity and mortality following till date as it is the newest strain of mutated corona virus.It is the seventh known coronavirus to infect people, after 229E, NL63, OC43, HKU1, MERS-CoV, and SARS-CoV. Quarantine of the suspected cases is the effective measure till date. 

Though Nepal has been implementing the screening policy,itcannot yet be able to handle the emergency threat, and already 2 cases have been suspected herewith. They are kept in isolation at Teku hospital, Kathmandu. Ignoring the global public-health emergency policy of WHO and bringing back the locked-up citizens can only aid to the major threat. Had the policy been imposed early, major evacuation from the Wuhan could have been prevented and the grave results could have been put under control with less effort within the city itself.For now, the policy of the WHO implies an incubation period of 2-14days in suspected areas, entry and exit screening at international airports, which has been implemented in TIA as well, and medical observation of the suspected cases are implemented. Health desk has been setup on the border to China.The Chinese side has also stopped Nepali workers from going beyond Khasa as a precautionary measure.The best option for the present scenario is perseverance and mental and emotional support to those locked up in China, especially the city of Wuhan.If evacuation is planned it should be planed so that no one gets new transmission from less understood virus. 

Authors
1.    Dr Kiran Niraula
MBBS, MPhil (Epidemiology & Biostatistics), 
MS (Neurosurgery) 
Currently working as Consultant Neurosurgeon in ADK Hospital, Maldives [email protected] 
2.    Dr Megha Ghimire, 
MBBS, MD (Resident) 
Currently doing MD Pediatrics at King Edward Medical University, Lahore, Pakistan  [email protected]

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