Coronavirus: population fears world pandemic

Publicação: 7 de February de 2020

Experts from around the world are searching for a vaccine against 2019-nCoV. However, it must undergo animal trials, what could take months until completed

On January 21 PAHO issued an alert to the countries of the Americas, recommending that health professionals have access to updated information on the disease and be ready to manage the infection

The World Health Organization (WHO) declared on January 30, in Genève, Switzerland, that the outbreak of the novel coronavirus (2019-nCoV) is a Public Health Emergency of International Concern (PHEIC). Currently, there are cases in several countries. The organ has listed in this category situations such as the H1N1 flu, in 2009, the Zika virus, in 2016 and the Ebola fever, that devastated part of West Africa from 2014 to 2016. The WHO has sent guidelines to hospitals around the world about infection prevention and control. The new virus spread more concerns after the information that it is transmissible between humans was released and it reached several countries, raising the risk of a pandemic. Several airports worldwide initiated systematic control protocols for flights arriving from risk areas. The mysterious virus has also become a risk factor for world markets.

The Pan American Health Organization (PAHO/WHO) issued, on January 21, an alert to its member countries recommending that health professionals have access to updated information about the disease, be familiar with the principles and procedures for manage infections and be able to obtain information about a patient’s travel history in order to connect that information to clinical data. The statement recommends that national authorities review the actions considered in response to the spread of SARS-CoV in 2003. “National authorities must adapt the manuals and take measures proportionate to the current risk, says the document. He also points out that there is no evidence to suggest that person-to-person transmission occurs easily. Finally, the PAHO states that member countries should strengthen active surveillance activities to detect unusual events, cases that can be considered suspect (especially among travelers) and to prevent the proliferation of the new coronavirus in the Americas.

The virus that surged in the Wuhan province, in central China, in the end of 2019, spread to Chinese metropolises like Beijing, Shanghai, Hong Kong and has struck around 30 countries and territories. Up to February 9th, 812 people had died in China by the Coronavirus, surpassing the deaths by SARS almost two decades ago. To this date, confirmed cases worldwide have reached 37,558, of which 37,251 are from China, where almost all deaths were recorded. It is speculated that a seafood market in Wuhan province, which has a population of 11 million people, is related to the first recorded cases. The country isolated about 20 million people in the region. On January 23, the connection between nCOV and bats was disclosed. The new virus that started to spread around the world is mobilizing international health authorities. As a protective measure in face of the high number of cases, the government of the Chinese capital decided to cancel the popular festivals that were planned for the celebration of the Chinese New Year. Every year, thousands of Beijing residents flock to parks and public spaces to watch traditional lion and dragon dances.

According to the WHO, the new coronavirus attack has not reached its peak. In a press conference, the executive director of health emergencies at WHO, Dr. Mike Ryan, warned that more cases and deaths are likely to arise. According to him, the outbreak is still evolving. Em 22 on January, British experts at London Imperial College have estimated that about 4 people in Wuhan are likely to be infected and, at worst, that number could be close to 9.700. WHO Director-General Dr. Tedros Adhanom Ghebreyesus, said the situation is an emergency in China, but it has not yet become a global health emergency – it can still become one. “We are completely committed to ending this outbreak as soon as possible. And I will not hesitate to reconvene the committee at a moment’s notice – anytime”, he added. On January 23 the emergency committee decided it was too early to consider the outbreak a global health crisis due to the limited number of cases.

Asked about the risks of a global pandemic, the President of China Society and Health Policy and Professor of Health Policy and Economics at Yale School of Public Health, Dr. Xi Chen, explains that several countries have already registered cases of the new coronavirus and in view of a higher level of globalization compared to 2003, during SARS, more countries may come to identify cases. But the professor is optimistic in saying that China and the world are better prepared to deal with nCoV than before. “The Chinese authorities have been efficient in identifying cases, sequencing the pathogen’s genome and releasing it to the scientific community”, he highlights.

Regarding new cases, Dr. Chen admits that Chinese tourists could take nCoV to many other countries in Asia given the spring festival, which has been an important holiday for many Asian countries, including Vietnam, Thailand and Korea, an event canceled by the Chinese government. Mobility in these countries can also increase the chance of infection. Still according to Dr. Chen, infections may have probably been underestimated due to incorrect diagnosis and underdiagnosis, for example. “Other cities can underreport, as they have less experience with the virus. However, with information sharing, I would expect less chance of underreporting”, he adds. For him, the high cost of diagnostic tests may have contributed to underreporting. “That was the reason why, in the beginning, only people associated with Wuhan were found infected. When the test becomes more accessible, for example, through government subsidies, more representative groups of people can be tested”, he concludes.

Scientists research a vaccine against new coronavirus

Scientists around the world have worked to find a vaccine against the 2019-nCoV. However, the solution must first undergo initial tests in animals, what could take months before completed, meaning it could take over a year before people could be vaccinated.

Inovio laboratory in San Diego, California, is one of the places where the vaccine is under development and scientists expect to have the final product for human tests in the summer and already gave it a name: “INO-4800”. The team in charge of the vaccine development uses a new DNA technology and works with a Beijing-based biotech company.

American and Russian scientists have also been conducting. The United States National Institute of Health (NIH) is researching the development of a vaccine and, according to the director of the allergy and infectious diseases sector, Dr. Anthony Fauci, we are close to taking the first steps towards its development. He also said that it will take a few months before the first phase of clinical trials begins and more than a year before it is available to patients.

Meanwhile, scientists from China and the American states of Texas and New York are working together to develop a vaccine. According to researcher and immunization expert Peter Hotez, the lesson learned is that coronavirus infections are serious and one of the biggest and newest threats to global health. He further stated that it is easier to develop a vaccine against coronavirus than against other viruses, such as HIV and Influenza. “All viruses have their challenges, but coronaviruses can be a relatively simple target when it comes to creating vaccines”, he emphasized.

The Russian government has also ensured that the country’s Ministry of Health is studying a coronavirus vaccine and has contacted Chinese researchers to obtain biological material to begin the investigation for this purpose. “We started to work with the vaccine, but we need to resolve fundamental issues. First, we need an appropriate animal model. Second, we need the live virus”, said Deputy Minister of Health Sergey Karyology.

According to microbiologist and physician, Dr. Yuen Kwok-yung, Hong Kong researchers have developed a vaccine that could cure people infected by the coronavirus. However, even in advanced development stages, it still must be tested in animals, what could delay distribution for people. Still according to him, the vaccine has chances of being based in an inactive version of the virus, what could lead to more severe symptoms if people are vaccinated, and then, become infected.

About the Novel Coronavirus

NCoV is a new strain that has not yet been identified in humans. The main symptom of Chinese coronavirus is high fever, which can be accompanied by cough, chest tightness and difficulty in breathing. Some patients examined had fluid in their lungs, featuring viral pneumonia and pleural effusion. Recommendations for avoiding contagion are similar to preventing SARS flu and coronavirus: maintaining good hand hygiene, wearing medical masks in case of cough, avoiding crowded and closed environments. According to some experts, the virus may not be as deadly as other coronaviruses, such as the Severe Acute Respiratory Syndrome (SARS), which killed almost 800 people during an outbreak from 2002 to 2003, also originated from China.

About the coronavirus virus – ICD10

Coronaviruses (CoV) are a large viral family, known since the mid-1960s, that cause respiratory infections in humans and animals. Generally, coronavirus infections cause mild to moderate respiratory illnesses, similar to a common cold. Most people become infected with common coronaviruses throughout their lives, with young children being more likely to become infected. Common coronaviruses that infect humans are alpha coronavirus 229E and NL63 and beta coronavirus OC43, HKU1.

Some coronaviruses can cause severe respiratory syndromes, such as the severe acute respiratory syndrome that was known by the acronym SARS. SARS is caused by the SARS-associated coronavirus (SARS-CoV), with the first reports coming from China in 2002. SARS-CoV spread rapidly to more than twelve countries in North America, South America, Europe and Asia, infecting more than 8.000 people and causing around 800 deaths, before the global SARS epidemic was brought under control in 2003. Since 2004, no case of SARS has been reported worldwide.

In 2012, another new coronavirus was isolated, distinct from the one that caused SARS at the beginning of the past decade. This new coronavirus was unknown as an agent of human disease until its identification, initially in Saudi Arabia and, later, in other countries in the Middle East, Europe and Africa. All cases identified outside the Arabian Peninsula had a history of travel or recent contact with travelers from countries in the Middle East – Saudi Arabia, Qatar, the United Arab Emirates and Jordan. Due to the location of the cases, the disease came to be designated as Middle East respiratory syndrome, or by the acronym MERS and the new virus was named MERS-associated coronavirus (MERS-CoV).

Clinical Manifestations

Common human coronaviruses cause short duration, mild to moderate respiratory infections. Symptoms can involve runny nose, cough, sore throat and fever. These viruses can sometimes cause infection of the lower respiratory tract, resulting in pneumonia. This condition is more common in people with cardiopulmonary diseases, with compromised immune systems or in the elderly.

MERS-CoV, like SARS-CoV, causes serious infections. For more information on the clinical manifestations of MERS-CoV, visit the page on MERS-CoV.

Incubation period

From 2 to 14 days

Communicable Period

In general, viral transmission occurs only as long as symptoms persist. Viral transmission is possible after resolution of symptoms, but the duration of the transmissibility period is unknown for SARS-CoV and MERS-CoV. During the incubation period and asymptomatic cases are not contagious.

Interhuman transmission

All coronaviruses are transmitted from person to person, including SARS-CoV, but without sustained transmission. Regarding the MERS-CoV, the WHO considers that there is currently well-documented evidence of person-to-person transmission, but without evidence that sustained transmission occurs.

Way of Transmission

In general, the main form of transmission of coronaviruses is through close contact from person to person.

Definition of close contact: Anyone who cared for the patient, including health professionals or family members; who has had physical contact with the patient; stayed in the same place as the sick patient (i.e. lived together or visited).

Source of infection

Most coronaviruses generally infect only one animal species, or at least a small number of closely related species. However, some coronaviruses, such as SARS-CoV, can infect people and animals. The animal reservoir for SARS-CoV is uncertain, but appears to be related to bats. There is also the likelihood of an animal reservoir for MERS-CoV that has been isolated from camels and bats.…