By the 2020 FIP YPG Publications Team
Date and Time Written: 31 January 2020 (3:30 PM, GMT +0)
This article has been edited on 22 February 2020 to update the name of the disease and virus to the WHO and ICTV official names.
On 31 December last year, an outbreak of respiratory illness caused by a novel coronavirus was reported to have originated from Wuhan, Hubei Province, China (CDC, 2020a). From the central Chinese city with a population of over 11 million, the virus is spreading rapidly and crossing borders, sparking worldwide rush to contain the outbreak.
It is not the first time China is linked to a coronavirus. In the early 2000s, SARS coronavirus (SARS-CoV) was reported to have infected its first human victims in the Guangdong province of southern China. Detailed investigations revealed that SARS-CoV was passed from civet cats to humans, affecting 26 countries and causing more than 8000 cases in 2003 (WHO, n.d.-a).
On January 22, the World Health Organization (WHO) declined to designate the novel coronavirus outbreak a Public Health Emergency of International Concern (PHEIC), noting that although the disease has spread outside of China, the number of cases in the other countries is still relatively few, and the disease does not seem to be spreading in those countries (WHO, n.d.-b & APhA, 2020). However, on January 30, the organization has declared otherwise, with a concern that it could spread to countries with weaker health systems, and expressed the need for global solidarity (WHO, 2020a).
What is a coronavirus? What is a novel coronavirus?
Long before the 21st century, human coronaviruses (CoVs) were considered a frivolous pathogen causing the “common cold” in healthy people (Paules, Marston, & Fauci, 2020).
COVs are ecologically diverse with four main subgroups; alpha, beta, gamma, and delta. Named after the crown-like spikes on their surface, seven coronaviruses (229E, NL63, OC43, HKU1) can directly affect humans (CDC, 2020b). Coronaviruses (CoVs) are zoonotic, meaning they are spread between animals and people (WHO, n.d.-c). Sometimes, coronaviruses that affect animals evolve and infect humans causing severe symptoms e.g., the severe acute respiratory syndrome coronavirus (SARS-CoV) of 2002 and the Middle East respiratory syndrome coronavirus (MERS-CoV) of 2012.
The novel coronavirus (nCoV) is a new strain that has not been previously identified in humans (WHO, n.d.-c). This particular virus from Wuhan is temporarily termed the 2019 novel coronavirus or 2019-nCoV (WHO, n.d.-d).
What are the symptoms?
Common symptoms of coronaviruses include runny nose, headache, cough, sore throat, body aches, shortness of breath, and fever (CDC, 2019). Some of these symptoms are mild, such as the common cold, while others as in the case of SARS-CoV, MERS-CoV, and 2019-nCoV are more likely to progress to a more severe disease such as pneumonia (Paules, Marston, & Fauci, 2020 & CDC, 2019).
Currently, the incubation period of 2019-nCoV has been estimated as 2–10 days. These estimates will be refined as more data becomes available. Since it is crucial to determine if asymptomatic individuals can spread the virus, understanding the time when infected patients transmit the virus to others is paramount for control efforts (WHO, n.d.-d).
How is it transmitted?
Human to human transmission of SARS-CoV and MERS-CoV occurred through droplets, contact and fomites, suggesting that the mode of transmission of 2019-nCoV will be similar (WHO, n.d.-d). Currently, it is uncertain if another route of transmission, fecal-oral contact, might spread this particular virus (Ellerin, 2020).
Where did it come from?
The natural reservoir of CoVs have been presumed to be bats. Other animal species that serve as host include camels, cattle, and cats (CDC, 2020-d). While the actual host of 2019-nCoV has not been detected, reported cases were related to exposure to a large seafood market selling many species of life animals (Paules, Marston, & Fauci, 2020).
What are the countries affected?
As of January 30, 2020, a total of 9,776 confirmed cases of the 2019-nCoV have been reported; China (9,670 cases), Thailand (14 cases), Japan (11 cases), Singapore (10 cases), Australia (9 cases), Taiwan (9 cases), Malaysia (8 cases), Macau (7 cases), South Korea (6 cases), United States of America (6 cases), France (5 cases), Germany (4 cases), United Arab Emirates (4 cases), Canada (3 cases), Vietnam (2 cases), Nepal (1 case), Finland (1 case), Philippines (1 case), Cambodia (1 case), Sri Lanka (1 case). These confirmed cases have led 1,239 cases of severe illness and 213 deaths (WHO, n.d.-d & John Hopkins CSSE, 2020).
All reported cases outside China had a travel history to Wuhan city except for 2 cases whose travel histories are still being investigated and one case of human-to-human transmission in Vietnam (WHO, n.d.-d). In addition, 15 healthcare practitioners have been infected in Wuhan (Paules, Marston, & Fauci, 2020).
What is being done to control the outbreak?
WHO’s strategic objectives in response to this crisis is to prevent exportation of cases from China to other countries/territories and interrupt the transmission of the virus from person to person. Specifically, WHO’s strategic objectives include (WHO, n.d.-d):
- Limiting human-to-human transmission including reduction of secondary infections among close contacts and health care workers, the prevention of transmission amplification events, and further international spread from China;
- Identifying, isolating, and caring for patients early, including providing optimized care for infected patients;
- Identifying and reducing transmission from the animal source; addressing crucial unknowns regarding clinical severity, extent of transmission and infection, treatment options; and accelerating the development of diagnostics, therapeutics, and vaccines;
- Communicating critical risk and event information to all communities and countering misinformation; and
- Minimizing social and economic impact through multi-sectoral partnerships.
In addition, many countries are limiting flights from the region and screening travelers at point of entries. As public health officials work to limit the spread and provide care to infected individuals, government, scientists, and drug makers are sprinting to develop new drugs and vaccines.
What is the treatment? Is there a vaccine available?
While there is currently no specific antiviral treatment for 2019-nCoV, supportive care can help relieve symptoms (CDC, 2020d). Specialized and aggressive care in an intensive care unit (ICU) can be lifesaving, especially for those patients with severe conditions (Ellerin, 2020).
In search for vaccines, biomedical researchers are using SARS-CoV and MERS-CoV as prototypes in the development of antivirals (Paules, Marston, & Fauci, 2020). Also, approaches adapted to the development of vaccines for SARS-CoV and MERS-CoV are being pursued. For example, the Coalition for Epidemic Preparedness Innovations (CEPI) has requested the University of Queensland (UQ) to use its recently developed rapid response technology to develop a vaccine for 2019-nCoV at an unprecedented speed (UQ, 2020). Also, the National Institute of Health (NIH) has partnered with the company Moderna Therapeutics on developing a vaccine targeting 2019-nCoV while the company Inovio Pharmaceuticals secured a $9 million grant from CEPI to develop a vaccine (Alltucker, 2020).
Australian scientists are the first outside of China to copy the 2019-nCoV. This discovery will enable scientists to develop a test to identify infected individuals and help speed up the search for a vaccine (Scott, 2020).
Timeline of the Disease Outbreak
As of the time this article is being written, the following are the latest details in the timeline of how the novel Coronavirus outbreak has developed and spread beyond China:
31 January: Death toll reaches 213; UK reports first cases (John Hopkins CSSE, 2020 & Pharmaceutical Technology, 2020)
30 January: WHO declares the outbreak a Public Health Emergency of International Concern (PHEIC), reminding that countries are legally required to share information with WHO under the International Health Regulations (IHR) (WHO, 2020a); Death toll touches 170 as of late 29 January; India and Philippines confirm first cases; Russia closes 2,700 mile border with China (Pharmaceutical Technology, 2020)
29 January 2020: Death toll reaches 132; UAE and Germany report four cases (Pharmaceutical Technology, 2020); British Airways suspends flights to and from mainland China (BBC, 2020); China’s first coronavirus hospital opens after spending two days to transform an empty building into a 1,000-bed medical center (You and Blanchard, 2020); Australian scientists first outside of China to create a lab-grown version of the coronavirus, helping vaccine efforts (Scott, 2020)
28 January 2020: Death toll touches 107; Hong Kong restricts transport from mainland China; Japan reports first domestic transmission and sends plane to evacuate nationals (Pharmaceutical Technology, 2020)
27 January 2020: First coronavirus case in Sri Lanka; More countries look to evacuate citizens (Pharmaceutical Technology, 2020)
26 January 2020: First case in Mexico; US and France to evacuate nationals from Wuhan; WHO changes risk to “high” and not “moderate” (Pharmaceutical Technology, 2020)
25 January 2020: First cases in Canada and Nepal; Hong Kong announces health emergency (Pharmaceutical Technology, 2020)
24 January 2020: China implements further travel restrictions; Starts building temporary hospital (Pharmaceutical Technology, 2020)
23 January 2020: First confirmed case in Singapore; China implements travel bans (Pharmaceutical Technology, 2020)
22 January 2020: WHO holds on declaring the outbreak a Public Health Emergency of International Concern (PHEIC) (Pharmaceutical Technology, 2020 & WHO, n.d.-b)
21 January 2020: First confirmed case in the US (Pharmaceutical Technology, 2020)
20 January 2020: First case detected in South Korea (Pharmaceutical Technology, 2020)
17 January 2020: China reports second coronavirus death (Pharmaceutical Technology, 2020)
15 January 2020: First confirmed case in Japan (Pharmaceutical Technology, 2020)
13 January 2020: First confirmed case in Thailand (Pharmaceutical Technology, 2020)
11 January 2020: Chinese health authorities reported the first coronavirus fatality (Pharmaceutical Technology, 2020)
09 January 2020: Coronavirus genome sequence released (Pharmaceutical Technology, 2020)
08 January 2020: First suspected coronavirus cases in Thailand (Pharmaceutical Technology, 2020)
07 January 2020: Virus identified as coronavirus 2019n-CoV (Pharmaceutical Technology, 2020)
06 January 2020: SARS, MERS and bird flu ruled out (Pharmaceutical Technology, 2020)
05 January 2020: WHO advises against travel restrictions (Pharmaceutical Technology, 2020)
03 January 2020: Passengers screened at Wuhan Airport (Pharmaceutical Technology, 2020)
01 January 2020: US Centers for Disease Control and Prevention (CDC) identified Wuhan market as outbreak hub (Pharmaceutical Technology, 2020)
31 December 2019: Chinese authorities reported the cluster of cases to the WHO China Country Office (WHO, 2020b).
08 December 2019: Earliest case of symptom onset from a confirmed nCoV case detected in Wuhan (WHO, 2020b).
Role of the General Public
While all sectors of society have roles in outbreak preparedness and response, the general public plays crucial roles in mitigating the spread of the novel coronavirus such as the following:
- Avoiding close contact with people experiencing acute respiratory infections (WHO, n.d.-d). Close contact is being within approximately 6 feet (2 meters), or within the room or care area, of a novel coronavirus case for a prolonged period of time while not wearing recommended personal protective equipment or PPE (CDC, 2020d);
- Frequent hand-washing, especially after direct contact with sick people or their environment (WHO, n.d.-d);
- Wearing a facemask accurately and changing it regularly (Landon, 2020);
- Not touching eyes, nose, and mouth (WHO, n.d.-e);
- Throwing used tissue away immediately and properly (WHO, n.d.-e);
- Avoiding unprotected contact with farm or wild animals (WHO, n.d.-d);
- Practicing cough etiquette (maintain distance, cover coughs and sneezes with disposable tissues or clothing, and wash hands), especially for people with symptoms of acute respiratory infection (WHO, n.d.-d);
- Since some countries are currently experiencing flu and respiratory disease season, the CDC recommends getting vaccinated, taking everyday preventive actions to stop the spread of germs, and taking flu antivirals if prescribed (CDC, 2020d);
- For people who think they may have been exposed, they should contact their healthcare provider immediately (CDC, 2020d). Also, they are advised to remain at home “while appropriate transport to hospital can be arranged” (Burns, 2020);
- Observing good food safety practices. Thoroughly cook meat and eggs. Raw meat, milk, or animal organs should be properly handled. Use different kitchen utensils for raw meat and cooked foods. Do not eat sick animals or animals that died of diseases (WHO, n.d.-e);
- When in wet markets, avoid contact with wastes and fluids. Those working in wet markets must disinfect equipments and working site at least once a day. After work, remove protective clothing, wash everyday, and leave at the work area. Also, avoid exposing family members to soiled work clothing and shoes (WHO, n.d.-e); and
- Avoid spitting in public (WHO, n.d.-e).
The WHO does not recommend any specific health measures for travellers, however, it should be noted that if symptoms resemble a respiratory illness, either during or after travel, travellers must seek medical attention and share their travel history with their healthcare provider (WHO, n.d.-d). Furthermore, it is recommended that travelers avoid all non-essential trips to China and stay up to date with notices such as the CDC’s travel health notices related to this outbreak (CDC, 2020d).
For health professionals, they should be on the look-out for people with travel history to China and fever and respiratory symptoms (CDC, 2020d). Within healthcare facilities, enhance standard infection prevention and control practices should be observed, especially in emergency departments (WHO, n.d.-d).
In addition, the public must be vigilant and up-to-date with the latest developments of the outbreak and avoid spreading fake and exaggerated news so as not to create unnecessary panic.
Where to track the latest information
- The Center for Disease Control and Prevention (CDC) maintains information on:
- Recent developments about the 2019 novel coronavirus (2019-nCoV)
- Interim guidance for healthcare professionals
- Precautions for intending travellers
- Approaches implemented to curb the spread of the virus
2. The Epidemic Tracker of the China Center for Disease Control and Prevention provides current numerical data on the confirmed cases of infected individuals, suspected cases, as well as total death and recovery rates.
3. The WHO provides:
- Current news on the disease outbreak
- Technical guidance for both health professionals and the general public
- Advice for international travel and trade
4. Live updates from media organisations such as BBC, CNBC, NPR, CNN, Washington Post, and The New York Times, also serve as a useful source for prompt updates.
*The second part of this article will focus on the role of pharmacists in the COVID-19 outbreak.
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