What is the Novel Coronavirus, COVID-19?

• Coronavirus is a virus causing cold and flu symptoms and has been around and identifiable for many, many decades.
• In December 2019, a novel coronavirus strain was first detected in Wuhan, China, causing fatal respiratory disease in around 2% of those who contracted it. It is a completely new strain which is very contagious and can be serious in some cases.
• This coronavirus has its origin in bats and originally spread to humans from infected animals! Now, of course, human-to-human transmission is the reason for the rapid spread.
• The Novel Coronavirus was officially named COVID-19 by the World Health Organization. Through global travel and spread, the outbreak has reached significant proportions in many parts of the globe, and has been declared a public health emergency. It has swept from China to several Asian, European, Australasian and American countries, and has reached African shores in the past month.
• There are now over 98 000 recognised cases worldwide, and there have been 3356 fatalities (Statistics from 5^th March 2020). South Africa has identified its first case this week, a 38-year-old male who had travelled to Italy in a group. We shall see more cases in South Africa in the ensuing weeks.
• Symptoms and diagnosis in South Africa will be complicated by the overlap with the annual Influenza season, starting in April/May. Therefore, a FLU VACCINE is particularly important this year.

What are the symptoms of the novel Coronavirus:

• Fever (usually over 38 degrees Celcius) and chills.
• Cough and sneezing.
• Shortness of breath or difficulty breathing in the more serious cases.

Note:

• The majority of people have mild, cold and flu type symptoms.
• Symptoms can last up to 2 weeks.
• Children and young adults seem to handle the disease well.
• The elderly have the highest complication rate by far.
• Those with underlying respiratory and cardiac diseases, as well as those with immune issues, will be at greater risk of more severe symptoms.

Who is at risk of contracting coronavirus?

• Everyone who has been in close contact with a person with Coronavirus is at risk.
• However, the virus seems to favour infecting the over 30’s! 78% of recorded cases have occurred between 30 and 69 years of age, and only 1.2% in children.
• The case fatalities are highest in the elderly (14.8% of 80 year-olds), only 0.4% in 40-something year-olds and 0.2% in people 10-19 years.
• Healthcare workers caring for patients with COVID-19 are at elevated risk of exposure.
• Travelers returning from affected international locations where community spread is occurring are at elevated risk.
• People in communities where ongoing spread with COVID-19 has been reported are at elevated risk, though the exposure risk is still relatively low.

How does the virus spread?

1. By respiratory droplets coughed, sneezed or exhaled by a person who has the illness. Coronavirus can be caught by being within a 1-2 metre vicinity of the carrier.
2. Close personal contact (touching and shaking hands with a person who has the virus).
3. By touching objects or surfaces on to which the virus has landed- such as desks, tables- and then touching one’s mouth, nose or eyes.

Note:

• The incubation period (between contact and becoming ill) is up to 2 weeks but symptoms may occur within days of contact in some cases.
• The patient is actually at their most infectious in the day or two BEFORE symptoms appear!

How is coronavirus diagnosed?

• If a person has worrying, flu-like symptoms and has been in contact with a coronavirus carrier or has recently travelled in a coronavirus-affected area, then they need to be screened.
• Screening consists of respiratory swabs performed by a doctor, physiotherapist, nurse or pathology lab- of the throat/tonsils, back of the pharynx and sometimes deeper down in the respiratory tree.
• There are some centralised laboratories in South Africa to which all samples will be couriered. These tests are very specialised. If a swab comes back negative and the patient continues to have symptoms, a repeat swab may be needed.
• Blood tests testing for antibodies against the virus are currently being developed.

How is coronavirus treated?

• The treatment of milder cases is much the same as cold and flu treatment: maintaining nutrition and hydration, temperature control, symptomatic treatment of runny noses and lots of rest.
• Antibiotics and existing antivirals do not treat the disease so should not be used in mild to moderate cases.
• More serious cases of respiratory involvement (“pneumonitis”) may need hospitalisation, oxygen, nebulisers, antibiotics for secondary infection, and even ventilatory support

How can we prevent the spread of disease?

• Prevention of spread is key!
• There is no medication available to reduce the risk of disease after contact with a coronavirus sufferer.
• Currently, there is no vaccine yet but vaccines are being researched avidly. The reality is that stringent safety and efficacy tests of a vaccine take several months to years to complete, so the outbreak will probably be over by the time a vaccine is available.

So, what can we do to help prevent spread of the disease?

• The best way to prevent spread is early detection and quarantining of infected patients, or of those with a high suspicion of having the virus, so that they come into contact with as few people as possible. Isolation should be for around 14 days.
• If a person has cold symptoms with a fever, then they should rather not go to school/work until they have more clarity on their condition.
• China (and more recently Italy) have set the precedent of closing work spaces and schools in epidemic areas. It will hopefully not come to this in SA but the situation will need to be monitored.
• Practice COUGH HYGIENE:  cough into a tissue, not into your hand, and throw the tissue into a closed bin immediately. Wash hands afterwards.
• KEEP YOUR DISTANCE from people who seem to have a cold, and politely nod your head instead of shaking hands/hugging.

• HANDWASHING is key! Clean hands frequently during the day, after coughing, and after touching desktops/tabletops and toys that may be contaminated.
• Hands should be washed with soap and water (for at least 20-30 sec), especially after possible contact with coronavirus carriers or after touching respiratory secretions, noses, mouths, desks, and even toys in an area where the coronavirus status is unknown.
• Using hand sanitisers with at least 60% alcohol will also help.
• Having hand sanitisers with at least 60% alcohol dotted around the schools or offices would be an advantage.
• Routinely wearing face masks if you are well will NOT adequately protect you from contracting the virus, so is not worthwhile. If you HAVE the virus, then face masks may be used.

 Healthcare workers dealing with potential COVID-19 cases should:

• Wear a face mask AND eye protection.
• Wear a disposable protective gown and gloves, discarded after seeing the patient.
• Wash hands strictly and use hand sanitizer with at least 60% alcohol before and after seeing the patient.
• Contact the NICD Clinical Hotline when taking samples from suspected coronavirus patients: Tel 082 883 9920.

 Hospitals

• The South African government has designated 13 public hospitals for the handling of suspected coronavirus cases.
• Each private hospital will have a preferred plan: Hospitals will need designated “wards” or “areas” to treat patients with suspected coronavirus.
• For milder cases, home treatment is preferable.

Note:

• Family doctors, paediatricians and physicians need to know in advance if there is a patient with possible coronavirus symptoms, so that the patient does not sit in an open waiting room, and is handled and swabbed in a different room to where the “well” patients or patients with other conditions are seen.
• PLEASE INFORM YOUR DOCTOR IN ADVANCE IF YOU ARE WORRIED ABOUT CORONAVIRUS SYMPTOMS OR HAVE TRAVELLED IN AN AREA WHERE CORONAVIRUS IS RIFE.
• Remember if you have a chronic condition such as asthma, make sure it is very well controlled at baseline so that your chest is not at risk if you get the virus.

Let’s put it into perspective:

• Each year up to 65 000 patients die of respiratory disease caused by the influenza (flu) virus.
• Thus far, coronavirus has infected around 100 000 people (known cases- this may be much more) and caused fewer than 4000 deaths worldwide.
• More than 80% of people with COVID-19 have mild disease and recover. In about 5% of cases the patient has a critical disease, and in 2% (or less) of cases the disease causes a fatal respiratory disease. The mortality rate is similar to that of a bad “flu” virus.
• The coronavirus spreads more quickly under cold conditions. We hope that the fact that we are still in the warm summer/early autumn may be a protective factor in SA over the next month or two.
• However, we could be in for a double whammy of influenza season as well as coronavirus, so take your flu jab soon!

• Children under the age of 15 years seem to be at very low risk of contracting the virus and are certainly not at high risk of serious disease. In fact, children may have such mild disease that they are not really even aware of it and can spread the disease unknowingly!

NOTE: This virus is relatively new. New information is going to become available on a daily basis so keep up to date with the latest news.

Since this article was written, 12 further contacts have tested positive for COVID-19

Copyright, Prof Claudia Gray, 5 March 2020

About the Author https://kidsallergy.co.za/professor-claudia-gray/