Corona Virus

 

Corona Virus

Dr Nimal Gamage

Internal Medicine, Cosmetic Surgery, Cardiology

 

    First described in detail in the 1960s, the coronavirus gets its name from a distinctive corona or 'crown' of sugary-proteins that projects from the envelope surrounding the particle. Encoding the virus's make-up is the longest genome of any RNA-based virus a single strand of nucleic acid roughly 26,000 to 32,000 bases long. 
 

 

 

    SARS was first recognised as a distinct strain of coronavirus in 2003. The source of the virus has never been clear, though the first human infections can be traced back to the Chinese province of Guangdong in 2002.

    The virus then became a pandemic, causing more than 8,000 infections of an influenza-like disease in 26 countries with close to 800 deaths.

     MERS was first identified in Saudi Arabia in 2012 in people displaying symptoms of fever, cough, shortness of breath and occasionally gastrointestinal problems such as diarrhoea. An animal source for the virus has never been officially confirmed, though evidence points to dromedary camels as a potential reservoir of infection.

    The World Health Organisation has identified around 2,500 cases of infection in 27 countries since initial outbreaks, resulting in nearly 860 deaths.

 

   The genome of the novel coronavirus consists of a single strand of RNA. Microbes with that kind of genome mutate notoriously quickly, said biologist Michael Farzan of Scripps Research, who in 2005 was part of the team that identified the structure of the spike protein by which SARS enters human cells.

 

 

    The bad reflects the fact that the number of 2019-nCoV cases and deaths so far suggests that the new coronavirus has a fatality rate around 2%. Thats almost certainly an overestimate, since mild cases arent all being counted. But even 2% is less than SARS 10% and nowhere near the 37%  of MERS (Middle East respiratory syndrome coronavirus). On the other hand, seasonal flu kills fewer than 0.1% of those it infects, though thats still tens of thousands of deaths a year just in the U.S. The global disaster that was the 1917 Spanish flu pandemic killed 2.5%.

 

     But SARS has a molecular proofreading system that reduces its mutation rate, and the new coronaviruss similarity to SARS at the genomic level suggests it does, too. That makes the mutation rate much, much lower than for flu or HIV, Farzan said. That lowers the chance that the virus will evolve in some catastrophic way to, say, become significantly more lethal.

     Exposure to the four endemic coronaviruses produces immunity that lasts longer than that to influenza, Webby said, but not permanent immunity

     The common-cold-causing coronaviruses are different enough that an infection from one wont produce immunity to another.

 

   Other recent studies have produced similar results. A study of 99 coronavirus patients at Wuhan Jinyintan Hospital showed that the average patient was 55 1/2 years old, and men represented around 68% of the total cases. A third study of nearly 1,100 coronavirus patients (which is still awaiting peer review) identified a median age of 47, with men representing around 58% of all cases.

 

 

    For people who have recovered there is some evidence of permanent damage to lungs.  We found some fibrosis [scarring] in the lungs, but we dont know if that is reversible, he says. Is it something that will resolve, or will it stay in the lungs? And what might the consequences be?

The total number of currently infected people is likely to be higher than official reports suggest, and one epidemiologist is predicting that 60 per cent of the worlds population could eventually be affected.


 

   Genomic analyses of the new coronavirus have revealed that its spike protein differs from those of close relatives, and suggest that the protein has a site on it which is activated by a host-cell enzyme called furin.

   This is significant because furin is found in lots of human tissues, including the lungs, liver and small intestines, which means that the virus has the potential to attack multiple organs,

 

    Chinese scientists reported in the medical journal JAMA an apparent case of asymptomatic spread of the virus, from a patient with a normal chest CT scan. The researchers concluded with stolid understatement that if this finding is not a bizarre abnormality, the prevention of COVID-19 infection would prove challenging.

   For all the advances in basic science, the process cannot proceed to an actual vaccine without extensive clinical testing, which requires manufacturing many vaccines and meticulously monitoring outcomes in people. The process could ultimately cost hundreds of millions of dollarsmoney that the NIH, start-ups, and universities dont have. Nor do they have the production facilities and technology to mass-manufacture and distribute a vaccine.

 

   And coronaviruses could present a particular challenge in that at their core they, like influenza viruses, contain single strands of RNA. This viral class is likely to mutate, and vaccines may need to be in constant development, as with the flu.

   Coronavirus bug can cover longer distances than previously thought can stay on surfaces upto 10 days such as glass, plastic and paper.

 

    Most cases of COVID-19 are reportedly mild, but that term can be misleading. As the World Health Organization adviser Bruce Aylward clarified last week, a mild case of COVID-19 is not equivalent to a mild cold. Expect it to be much worse: fever and coughing, sometimes pneumoniaanything short of requiring oxygen. Severe cases require supplemental oxygen, sometimes via a breathing tube and a ventilator. Critical cases involve respiratory failure or multi-organ failure.

 

    The experience can slowly progress from the familiarcough, congestion, feverto a life-threatening inflammatory response as the virus spreads down into the lungs, filling the airways with fluid. Survivors can have permanent scarring in the lungs. The virus can also spread into other organs, causing liver damage or gastrointestinal disease. These effects can play out over longer periods than in the flu, sometimes waxing and waning. Some patients have begun to feel better, then fallen critically ill. The disease can be fatal despite receiving optimal medical care.

 

    In China, the sensitivity of tests has been reported to be as low as 30 to 60 percentmeaning roughly half of the people who actually had the virus had negative test results. Using repeated testing was found to increase the sensitivity to 71 percent. But that means a negative test still couldnt fully reassure someone like the teacher that he definitely doesnt have the virus.  They found that viable virus could be detected up to three hours later in the air, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel.

 

     The time from symptom onset to death ranges from 2 to 8 weeks for COVID-19.10 This means there are individuals who are the early or mid-stages of infection who will die at a later date.

    1918 Spanish flu was one of the worst epidemics in the world ever. This influenza outbreak wasnt restricted to Spain and it didnt even originate there (recent research by Olson et al. (2005) suggests that the epidemic originated in New York due to evidence of a pre-pandemic wave of the virus in that city).1

    But it was named as such because Spain was neutral in the First World War (1914-18), which meant it was free to report on the severity of the pandemic, while countries that were fighting tried to suppress reports on how the influenza impacted their population to maintain morale and not appear weakened in the eyes of the enemies.

 

    The influenza outbreak started in the Northern Hemisphere in the spring of 1918. The virus spread rapidly and eventually reached all parts of the world: the epidemic became a pandemic.2

    Even in a much less-connected world the virus eventually reached extremely remote places such as the Alaskan wilderness and Samoa in the middle of the Pacific islands.3

    While peak mortality was reached in 1918 the pandemic did not end until two years later in late 1920.

 

    To have a context for the severity of influenza pandemics it might be helpful to know the death count of a typical flu season. Current estimates for the annual number of deaths from influenza are around 400,000 deaths per year. Paget et al (2019) suggest an average of 389,000 with an uncertainty range 294,000 from 518,000.4

    The widely cited study by Johnson and Mueller (2002) arrives at a much higher estimate of 50 million global deaths. But the authors suggest that this could be an underestimation and that the true death toll was as high as 100 million.7

 

    Estimates suggest that the world population in 1918 was 1.8 billion.  The global death rate would have been 5.4% if 100 million people in fact died.

 

   Two decades before the Spanish flu the Russian flu pandemic (1889-1894) is believed to have killed 1 million people.12

   The age-specific mortality seems to be very different. As weve seen above, the Spanish flu in 1918 was especially dangerous to infants and younger people. The new coronavirus that causes COVID-19 appears to be most lethal to the elderly, based on early evidence in China.20

 

   The Spanish flu hit the world in the days before antibiotics were invented; and many deaths, perhaps most, were not caused by the influenza virus itself, but by secondary bacterial infections. 

   Patients with the new coronavirus keep the pathogen in their respiratory tract for as long as 37 days, a new study found, suggesting they could remain infectious for many weeks.

   No one has a good answer to that question yet, says Iwasaki. But she and other experts suspect it may be down to the unique way childrens immune systems respond to these viruses.

   A common complication of covid-19, SARS and MERS in adults is acute respiratory distress syndrome, where the immune response against the coronavirus becomes overzealous and causes life-threatening damage to the lungs.

  

Because childrens immune systems are still developing, one suggestion is that they are shielded from this type of dangerous immune response called a cytokine storm  when they get covid-19 or similar diseases. During the SARS outbreak, two studies found children produced relatively low levels of inflammation-driving cytokines, which may have been what protected their lungs from serious damage.

 

 

   A recent case study described a young child with covid-19 who had high levels of virus but no symptoms. Whether or not children in this condition are infectious isnt yet known, but finding out will be critical to tackling this pandemic.


 

 

 

    Sars-CoV-2 shares between 80% and 90% of its genetic material with the virus that caused Sars hence its name. Both consist of a strip of ribonucleic acid (RNA) inside a spherical protein capsule that is covered in spikes. The spikes lock on to receptors on the surface of cells lining the human lung the same type of receptor in both cases allowing the virus to break into the cell.

    No vaccine made from genetic material RNA or DNA has been approved to date, for example. So the Covid-19 vaccine candidates have to be treated as brand new vaccines

 

 

    An illustration of that is a vaccine that was produced in the 1960s against respiratory syncytial virus, a common virus that causes cold-like symptoms in children. In clinical trials, this vaccine was found to aggravate those symptoms in infants who went on to catch the virus. A similar effect was observed in animals given an early experimental Sars vaccine. It was later modified to eliminate that problem but, now that it has been repurposed for Sars-CoV-2, it will need to be put through especially stringent safety testing to rule out the risk of enhanced disease.

    Most vaccinologists, belive that a vaccine for corona virus will be ready before 18 months,

 

    Plenty has already been written about how the population of Italy differs from much of the world. According to a UN report in 2015, 28.6% of the Italian population was 60 years old or older (second in the world after Japan at 33%). This compares to South Korea, where 18.5% of the population is at least 60 years of age, ranking 53rd globally.

    By contrast, the outbreak in South Korea has occurred among much younger people. There, only 20% of cases have been diagnosed in those 60 years old and up. The largest affected group is those in their 20s, who account for almost 30% of all cases. According to data from the original outbreak in China, the overall death rate is 4.7% in men versus 2.8% in women -- a whopping difference. Which is good news for South Korea, where 62% of cases occur among women. In Italy, 28% of men versus 20% of women smoke, while in Korea, it is about 50% of men and less than 5% (!) of women.

 

     Some viral diseases, such as dengue, can cause more serious symptoms if a person has been previously exposed to a related strain of the virus and already has partial immunity. Existing antibodies can react to the related invader and trigger a dangerous overreaction, a phenomenon known as an antibody-dependent enhancement (ADE). Some researchers have suggested ADE might explain why the virus is more deadly in the elderly and less so in children, who have had less exposure to other coronaviruses.

   Less optimistic was a study published last week in The Lancet medical journal that showed the virus survived in one Chinese patients respiratory tract for 37 days  well above the average of 24 days for those with critical disease status.

   research from Guangdong province, China reporting that 14% of recovering patients had also retested positive.

 

    In terms of other after-effects, scientists are also currently speculating that coronavirus patients may suffer from reduced lung capacity following a bout of the disease. The Hong Kong Hospital Authority observed that two out of three recovering patients had lost 20-30% of lung function.

    The new study, which was published online in the journal Pediatrics, looked at 2,143 cases of children with confirmed or suspected COVID-19 that were reported to the Chinese Centers for Disease Control and Prevention between Jan. 16 and Feb. 8. More than 90% of the cases were asymptomatic, mild or moderate cases. However, nearly 6% of the childrens cases were severe or critical, compared with 18.5% for adults.

 

    A report issued Wednesday by the US Centers for Disease Control and Prevention shows younger people are making up a big portion of hospitalizations. Up to 20% of people hospitalized with coronavirus in the United States are young adults between ages 20 to 44, the study showed.

    The coronavirus is made up of around 29,000 building blocks of genetic material called nucleotides. 

    Other preliminary research examined virus samples from northern California, and found that the coronavirus was introduced to the area at multiple points.

 

 

    The largest study so far to look at mortality among coronavirus patients on ventilators was done by the Intensive Care National Audit & Research Centre in London. It found that among 98 ventilated patients in the U.K., just 33 were discharged alive.

    The numbers from a study of Wuhan, China, are even grimmer. Only 3 of 22 ventilated patients survived.

    And a study of 18 ventilated patients in Washington state found that nine were still alive when the study ended, but only six had recovered enough to breathe on their own.

 

    Unfortunately, Osborn says, "the ventilator itself can do damage to the lung tissue based on how much pressure is required to help oxygen get processed by the lungs.

    Fasting blood glucose should be under 90 mg/dL, or even better, in the 7580 range. If your level is 100125, you are considered in the pre-diabetes range and may be insulin resistant. If its over 125, you may have diabetes. Optimal fasting insulin is lower than 5 microunits/ml. Anything higher indicates insulin resistance.

 

   A Monash University-led study has shown a single dose of the drug Ivermectin could stop the SARS-CoV-2 virus growing in cell culture.

   'We found that even a single dose could essentially remove all viral RNA (effectively removed all genetic material of the virus) by 48 hours and that even at 24 hours there was a really significant reduction in it,' Monash Biomedicine Discovery Institute's Dr Kylie Wagstaff said on Friday.

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    One marriage registry official in China said he saw a quarantine-related spike in divorces, showing that more time in closed quarters may be doing some couples more harm than good.

    Wellenstein said she would "absolutely not" advise anyone to get pregnant now, due to the uncertainty swirling around Covid-19. "You can push off conceiving and getting pregnant," she said.

    There are a number of risk factors, starting with the fact that there's simply less care available in many areas as hospitals prioritize more resources toward helping the surge of Covid-19 patients being admitted.

    And for women who are already pregnant, each trip to the hospital during the pandemic carries additional risk

 

    Three patients with Covid had multiple thrombosis. Findings included leukocytosis, thrombocytopenia, an elevated prothrombin time and partial thromboplastin time, and elevated levels of fibrinogen and d-dimer. Subsequent serologic testing showed the presence of anticardiolipin IgA antibodies as well as antiβ2-glycoprotein I IgA and IgG antibodies.

    Antiphospholipid antibodies abnormally target phospholipid proteins, and the presence of these antibodies is central to the diagnosis of the antiphospholipid syndrome. However, these antibodies can also arise transiently in patients with critical illness and various infections.1 The presence of these antibodies may rarely lead to thrombotic events that are difficult to differentiate from other causes of multifocal thrombosis in critically patients, such as disseminated intravascular coagulation, heparin-induced thrombocytopenia, and thrombotic microangiopathy.

 

    After a person sneezes The largest droplets rapidly settle within 1 to 2 m away from the person. The smaller and evaporating droplets are trapped in the turbulent puff cloud, remain suspended, and, over the course of seconds to a few minutes, can travel the dimensions of a room and land up to 6 to 8 m away.

    Domesticated animals, including livestock, shared eight times more zoonotic viruses with people than wild mammals, such as H1N1 flu, hantaviruses and rabies.

 

 

 

   Scientists and public health organisations have long been calling for more attention to be paid to the role of increased encroachment on animal habitats in the emergence of infectious disease outbreaks.

   Deforestation, urbanisation and the expansion of agriculture have all brought more contact with these species as the human population has more than doubled since 1960, they have warned.

 

    South Korean officials on Friday reported 91 patients thought cleared of the new coronavirus had tested positive again.

    Nearly 7,000 South Koreans have been reported as recovered from COVID-19, the disease caused by the new coronavirus.

    Scientists believe that the virus may have been reactivated rather than the patients being re-infected.

    Chief among the worrisome test results were readings that suggested these apparently recovered patients continued to have impaired liver function. That was the case even after two tests for the live virus had come back negative and the patients were cleared to be discharged

 

   In an early study of COVID-19 patients in China, heart failure was seen in nearly 12% of those who survived, including in some who had shown no signs of respiratory distress.

   loss of sense of smell or taste is a stronger predictor of coronavirus infection than fever. Out of 400,000 people in the UK reporting one or more symptoms between March 24-29, 18% had lost their sense of smell or taste and 10.5% were suffering from fever.

 

   Black and Hispanic New Yorkers represent 51% of the city's population, yet account for 62% of Covid-19 deaths. They have twice the rate of death compared with whites, when adjusted for age. This likely is due to both a higher proportion of black and Hispanic New Yorkers being diagnosed with severe disease and a higher rate of death among those who are known to be infected
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