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Friday, March 29, 2024

No country can cope with COVID-19

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"Except, perhaps, China–with its wealth, its authoritarian government, its healthcare resources, and the single-mindedness to impose draconian measures."

A team of doctors from the World Health Organization and China studied 55,924 cases of COVID-19 in China mainland last February 2020—the largest study ever of the coronavirus infection.

After 114 countries were hit, almost 125,000 infected and 4,585 deaths, WHO on Wednesday officially declared coronavirus a pandemic. It changes little, except alert countries invaded to be more aggressive in taking actions first to contain it, and then, mitigate its impact. No country under attack can take it easy.

The Italian government is the first country in the world to lock down nationwide. And yet, infection keeps spreading. In just one day, after four days of lockdown, infection rose 23 percent to 12,462 and deaths rose 32 percent to 827.

No country, however, rich or resource-endowed, can contain it. Except China—with its wealth, its authoritarian government, its health care resources, and the single-mindedness to impose draconian measures.

Among the major findings of the WHO-China joint mission: COVID-19 is mild, doesn’t attack children; those above 60 are the highest risk; patients recover within two weeks. Incubation period is five days, not 14. It takes two weeks to recover if one is infected.

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Other findings:

• COVID-19 is a zoonotic virus. It is believed to have come from an animal in Wuhan City’s Huanan Wholesale Seafood Market. From Wuhan, the virus radiated to other parts of Hubei province and China, which explains a relatively high R0 (pronounced r-zero or R naught) or reproduction number of 2-2.5. R0 is the number of persons, on average, an infected person will infect. Measles has an RO of 12 to 18.

• Symptoms, including mild respiratory symptoms and fever, appear 5-6 days after infection (mean incubation period 5-6 days; range 1-14 days).

• Most people infected with COVID-19 virus have mild disease and recover.

Approximately 80 percent of patients had mild to moderate disease, which includes non-pneumonia and pneumonia cases, 13.8 percent have severe disease (dyspnea, respiratory frequency ≥30/minute, blood oxygen saturation ≤93 percent, PaO2/FiO2 ratio <300, and/or lung infiltrates >50 percent of the lung field within 24-48 hours) and 6.1 percent are critical (respiratory failure, septic shock, and/or multiple organ dysfunction/failure).

• Individuals at highest risk for severe disease and death include people aged over 60 years and those with underlying conditions such as hypertension, diabetes, cardiovascular disease, chronic respiratory disease and cancer.

Disease in children appears relatively rare and mild. About 2.4 percent of cases were under 19 years. A very small proportion of those aged under 19 years have developed severe (2.5 percent) or critical disease (0.2 percent).

• Of 44,672 infections, only 965 (2.2 percent) were under 20 years of age and there was just one recorded death (0.1 percent) in this age group. About 78 percent of cases were in the 39-63 year-old age bracket.

• The median time from onset to clinical recovery for mild cases is approximately 2 weeks; 3-6 weeks for patients with severe or critical disease.

• As of Feb. 20, 2020, 2114 of the 55,924 laboratory confirmed cases died for a crude fatality ratio of 3.8 percent. CFR varies by location and intensity of transmission (5.8 percent in Wuhan vs. 0.7 percent in other areas in China).

• COVID-19 is transmitted via droplets and fomites during close unprotected contact between an infector and infectee. Fomites are objects that carry infection like clothes, utensils, and furniture.

• In China, human-to-human transmission of the COVID-19 virus is largely occurring in families.

• Contact follow up is painstaking, with a high percentage of identified close contacts completing medical observation. Between 1 and 5 percent of contacts were subsequently laboratory confirmed cases of COVID-19, depending on location.

• COVID-19 is a newly identified pathogen. There is no known pre-existing immunity in humans. Everyone is assumed to be susceptible.

• COVID-19 has low attack rate on people 18 and below (only 2.4 percent of reported cases). No transmission from a child to an adult noted.

• The main signs and symptoms of CO-VID-19 include fever, dry cough, fatigue, sputum production, shortness of breath, myalgia or arthralgia, sore throat, and headache. Nausea or vomiting has been reported in a small percentage of patients (5 percent).

• Patients with COVID-19 are not permitted visitors. Staff use coveralls, masks, eye cover, and gloves, removing PPE only when they leave the ward.

• In Wuhan, there are 45 designated hospitals, six of which are designated for critical patients, and 39 for severe patients and/or any patients >65 years old. There are an additional 10 temporary hospitals reconstructed from gymnasium and exhibition centers, which are for mild patients.

• There are no specific anti-viral or immune modulating agents proven (or recommended) to improve outcomes. All patients are monitored by regular pulse oximetry.

• Patients were treated according to China’s National Clinical guidelines. The guidelines include supportive care by clinical category (mild, moderate, severe and critical), as well as the role of investigational treatments such as chloroquine, phosphate, lopinavir/ritonavir, alpha interferon, ribavirin, arbidol.

• Coronavirus’ closest relationship was with the bat SARS-like coronavirus strain BatCov RaTG13, identity 96 percent.

• China capitalized on the use of technology, big data and AI for COVID-19 preparedness, readiness and response. Authoritative and reliable information, medical guidance, access to online services, provision of educational tools and remote work tools have been developed in and used across China. These services have increased accessibility to health services, reduced misinformation and minimized the impact of fake news.

• China practiced meticulous case and contact identification for COVID-19. From one percent to 5 percent of contacts were found infected.

In Wuhan, it deployed more than 1,800 teams of epidemiologists with a minimum of five per team, to trace tens of thousands of contacts a day.

Contact follow up is painstaking, with a high percentage of identified close contacts completing medical observation. Between one percent and 5 percent of contacts were subsequently confirmed cases of COVID-19.

In Shenzhen City, near Hong Kong, 100 percent of the contacts of 2,842 infected persons were traced. Of the 2,842 contacts, 2,240 (72 percent) completed medical observation. Among the close contacts, 88 or 2.8 percent were found infected. In Guangdong province, 99 percent of 25,493 COVID-19 cases were contacted. About 479 (4.8 percent) were found infected.

• The infected were tested for influenza-like illness and severe acute respiratory infection. All their visitors were tested for fever.

biznewsasia@gmail.com

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