Implications of Coronavirus Covid 19

Implications of Coronavirus Covid 19 - Over the past few decades, we have seen several outbreaks of zoonotic coronavirus infections. These viruses have the potential of inter-species transmission leading to pathogenesis in humans.

This particular respiratory coronavirus initially named 2019-nCOV, is known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).

Later, the World Health Organization (WHO) named this pandemic as Coronavirus disease 2019 (COVID-19).

Individuals who were exposed to a wet market in Wuhan, China, were initially diagnosed with the disease.

Similar to two previous outbreaks, Severe acute respiratory syndrome coronavirus [SARS-CoV] and Middle East respiratory syndrome coronavirus [MERSCoV], COVID-19 also causes respiratory illness.

The initial reports indicated that human-to-human transmission of this disease was limited, but soon it became evident that COVID-19 could spread through personto-person contact more harshly in communities where there are mass gathering.

Consequently, the disease was quickly transmitted to other geographical regions through infected travellers.

The clinical course, the spectrum of illness, and severity of COVID-19 include three significant patterns:

(1) mild illness presented with symptoms of upper respiratory tract infection

(2) non-life-threatening pneumonia and

(3) severe pneumonia manifested with acute respiratory distress syndrome which necessitates advanced life support.

The most common symptoms are fever, cough and shortness of breath. The current evidence suggests that the incubation period after exposure to the COVID-19 virus is supposed to be within two weeks, and the median incubation period with symptomatic presentation appears around 5 days post exposure.

It is known that the genome size of coronaviruses is largest among all identified RNA viruses and so these viruses arecapable of recombination (homologous and non-homologous), which makes them more vulnerable for mutations.

The initial genome sequence analysis of the nine patients with SARS-CoV-2 revealed 99·9% sequence identity which belongs to subgenus Sarbecovirus.

Recently, Zhu et al have isolated COVID-19 nucleic acid and characterized its complete genome by using high-throughput sequencing and bioinformatics.

The results of initial phylogenetic analysis, together with other studies, demonstrated that the novel coronavirus has 75-80% similarity with the SARS-CoV and is also closely related to the pathogenic coronavirus infecting bats and other wild animals.

Furthermore, structural analysis of various COVID-19 samples from China revealed two types of SARS-CoV-2 strains designated as ‘type L,’ which constituted 70% of the strains, while the remaining 30% accounted for ‘type S’ strain.

During the initial outbreak in China, ‘type L’ predominated mainly in the Wuhan region, and so, this strain was less likely to be identified outside of Wuhan.

The clinico-epidemiological implications of these findings necessitate further investigation. Current studies have also suggested that COVID-19 can be potentially transmitted through aerosol and fomite.

The virus could remain contagious in the aerosols for up to 3 hours and remains viable on hard Surfaces such as plastic and stainless steel for about 72 hours.

The WHO declared COVID-19 as a pandemic on the 21st of March 2020, when a total of 183,112 cases were reported worldwide in 163 countries with 11,890 deaths.

China, where the first cluster of COVID-19 patients was discovered, has reported 81,394 cases and 3,295 deaths as of March 28, 2020. Italy reported most deaths outside China; 10,023 deaths out of 92,472 cases. The United States is currently leading the total number of confirmed cases worldwide.

The overall mortality rate was 2.4 per million When compared to China, the incidence rate of COVID-19 (1,529 vs. 57 per million population) and mortality (166 vs. 2 per million population) was considerably higher in Italy. The median age of the patients was 47 years (IQR 35-58), and nearly 60% were males.

The majority (81%) of the cases were mild (no or mild pneumonia) 14% were severe with dyspnea, hypoxia, or >50 percent lung involvement on imaging within 24 to 48 hours. Patients with severe disease reported to have respiratory failure, shock, or multi-organ dysfunction (5%).

No deaths were reported among noncritical cases. Nearly a quarter of the patients (23.7%) were having underlying comorbidities, which included hypertension (15%), diabetes (7.4%), and coronary heart disease (2.5%).

The WHO stressed the need for immediate aggressive preventive measures to slowdown COVID-19 among South-East Asia to slow down the steady increase in disease transmission.

To date, the number of COVID-19 cases in South Asia has so far remained low, but there are predictions that this situation may get worst in the coming days.

Collectively, the South Asian countries have around 122274 confirmed cases of COVID-19 (Pakistan 32681 , India 70756, Sri Lanka 869 , 285 Afghanistan ,16691 Bangladesh , Maldives 862, Bhutan 10 and 120 cases in Nepal) as of 11,May 2020.

In India, the selective use of hydroxychloroquine for prophylaxis among high-risk healthcare professionals and caregivers has been recently approved by the Indian Council Medical Research. Many research are going on for the vaccine all over the world.

Recommendation

The management for COVID-19 primarily comprized of supportive care. So, home management may be possible for patients with mild illness who should be properly isolated.

To futher reduce the risk of transmission in the community, individuals should maintain hand hygiene, avoid touching eyes, nose, and mouth, cover the face while coughing or sneezing and avoid close contact with sick individuals. 

Due to short supply, face masks (preferably N95) are only advised for healthcare professionals and individuals with symptoms of respiratory distress. Unless appropriately worn, the face masks are ineffective for preventing the disease exposure.

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Social distancing is advised in locations that are at higher risk of community transmission, as one should keep at least 1.5 to 2 meters distance from another person.

The coronavirus (COVID-19) has challenged health professions and systems and has evoked different speeds of reaction and types of response around the world. The role of dental professionals in preventing the transmission of COVID19 is critically important.

While all routine dental care has been suspended in countries experiencing COVID-19 disease during the period of pandemic, the need for organised urgent care delivered by teams provided with appropriate personal protective equipment takes priority.

Dental professionals can also contribute to medical care. Major and rapid reorganisation of both clinical and support services is not straightforward.

Dental professionals felt a moral duty to reduce routine care for fear of spreading COVID-19 among their patients and beyond, but were understandably concerned about the financial consequences.

Amidst the explosion of information available online and through social  media, it is difficult to identify reliable research evidence and guidance, but moral decisions must be made.

In the current situation, abiding the general health guidelines is utmost important to maintain stronger immunity to fight infection and protection from other environmental hazards.

The healthy lifestyle practice includes good eating habits, regular exercise/Medication, control of stress and blood pressure level, avoidance of smoking and drinking alcohol and get enough sleep and we all have to learn to follow the path of Ahimsa.

Written by:

Mudit Sekhani

BDS II Year

Guided by:

Prof CS Bhan