Rep. Mark Green Update On Coronavirus (COVID-19)
Updated February 29, 2020
As an emergency medicine physician, I want to ensure everyone has the latest details on COVID-19.
America lost its first victim to COVID-19 last night. He was a man with comorbidities in his 50’s from Washington State. Please join us in prayers for his family.
New diagnosis of the virus continues to fall in China which is encouraging. The RNA of the virus remains stable, with no signs of mutation.
It is important to remember this virus is following the influenza play book. Recall too that influenza was the 8th most common cause of death in the US in 2017.
The latest case numbers and mortality rates:
China mortality remains around 3.4% while outside China the mortality rate hovers around 0.7%. We do not have complete data.
South Korea had its fourth death bringing its mortality rate there to 0.12%. The sole American soldier to test positive in S. Korea is in isolation along with his wife and child.
The Journal of the American Medical Association published a study highlighting the mortality by demographic. Here are some important points:
*No child less than 9 has died from the disease while persons greater than 80 years of age have a 14.8% mortality, 70-79 years of age had a mortality of 8%. This is clearly a disease of the elderly and infirmed as is influenza.
*Men appear to be both presenting and dying at a higher rate in China but this data should be approached very cautiously as almost 50% of men smoke in China, a rate over twice the rate of women. Smokers are clearly at higher risk for complications.
*Individuals with comorbidities also have a higher mortality rate: Cardiovascular disease (10.5%) Diabetes (7.4%)
Currently the following travel advisories are in effect (NOTE CHANGES FROM MY LAST UPDATE):
China – Level 4 No American should travel to China
South Korea, Iran and parts of Italy – Level 3 Avoid non-essential travel
Japan, non-affected parts of Italy are Level 2 Travelers should take precautions
US cases are up to 66 with one death. The vast majority of these, 45 have been repatriated patients with known infections.
Most news agencies have been reporting an incubation period of 14 days. The JAMA article I mentioned above said average is less than that, with some people not showing symptoms for as long as 26 days from exposure. This makes halting its spread very difficult.
Clinically, patients present with upper respiratory tract infection symptoms that can progress to fever, cough and shortness of breath. Because of the significant changes to lung tissue the virus can be diagnosed by CT scan per a prominent radiologist who has published his findings.
Eighty percent of patients will have mild disease and will likely be treated in their homes.
Patients with mild disease will recover in two weeks. For those with severe disease, about 20%, recovery is three to six weeks.
A case study of 9 pregnant women who contracted the virus was published in Lancet and showed no transmission to the baby in mom’s uterus. This is a small sample size and should be approached cautiously.
The FDA is now allowing local labs to diagnose the virus. Clinical diagnosis from x-ray and CT will soon be accepted I anticipate.
The virus is spread through coughs and sneezes. When a patient coughs into their hand and then touches a surface they can place the virus on that surface. NOTE: It has now been documented to remain a live virus for 24 hours on a surface. If a person comes along and touches that surface and then their mouth or nose, or eyes, they can acquire the disease. The virus is also spread via the fecal – oral route.
What Americans Should Do to Prevent Spread:
*Avoid close contact with sick people
*Avoid touching eyes, nose and mouth
*Wash your hands after using the restroom
*Stay home if sick
*Cover coughs and sneezes, preferably with an arm, not a palm of your hand
*Disinfect often touched objects and surfaces
*Use hand sanitizer liberally
*Wash hands frequently
FOR THOSE WANTING MORE:
The virus is one of seven Coronavirus that infect humans. Four of these are safe and make up 25% of all common cold diagnoses.
The virus is an RNA virus which makes it a little harder to kill. Coronavirus is actually the longest chain RNA virus per one reference I checked. The virus has substantial number of proteins on its cap giving it a distinctive “crown” like appearance on electronmicroscopy. Hence the name… Coronavirus. RNA virus have fewer steps to replicate and thus there are fewer areas where drugs can interrupt the replication of the virus. They also mutate more frequently.
Coronaviruses originate in birds/bats and usually go through another animal to get to humans. The COVID-19 strain is believed to have gone from bat to pangolin, an animal that looks like a cross between an anteater and an armadillo. There is a pangolin coronavirus that is 96% identical to COVID-19.
The official R0, pronounced “R naught” has not been calculated but is believed to be 2.5, or R0 = 2.5. That means the average person will give the virus to 2.5 people. An R0 of less than 1 would mean the virus would die off on its own.
Here is a sample of other diseases R0 :
Hepatitis R0 = 2, Ebola R0 = 2, HIV R0 = 4, SARS R0 = 4, Mumps R0 = 10, Measles R0 = 18
Three drugs are showing promise at treating the disease:
Chloroquine used to treat malaria.
Ritonavir used to treat HIV.
Remdesivir a drug built to treat Ebola is being studied at the University of Nebraska. This drug incorporates itself into the RNA as it is being made and terminates the RNA replication process early.
Monaclonal antibodies also show some hope. The virus attacks the lung tissue directly so it is hoped that a patient given the antibodies will halt the lung tissue damage before it happens.
For more information, visit the Centers for Disease Control and the S.C. Department of Health and Environmental Control.
