Senior medic Kailash Chand: the facts, not fears of the coronavirus outbreak

BMA honorary vice-president Kailash Chand OBE lists what is known so far about the coronavirus pandemic and provides advice on how to protect against transmission

This article was originally published on the Tameside Radio website. It is reproduced with the permission of the author.

Former Ashton GP, chair of Tameside and Glossop Healthwatch and Honorary Vice President of BMA, Dr Kailash Chand OBE offers advice and guidance following the coronavirus outbreak.

The global coronavirus outbreak has now reached pandemic proportions.

The worst countries affected to date remain China – where it began – Italy, South Korea and Iran – but now more than 120 countries across the world are dealing with the infection – including the UK.

Statistics show that coronavirus causes mild illness in 82 per cent of those with the virus, severe illness in 15 per cent, critical illness in three per cent and death in 2.3 per cent of cases.

It affects all ages, but predominately males (56 per cent, and 87 per cent in the 30-79 age bracket).

Incubation is variable, but the mean time to symptoms is five days, the mean time to pneumonia is nine days and mean time to death 14 days.

Clinically, all patients suffer a fever, 75 per cent have a cough; 50 per cent weakness and 50 per cent breathlessness.

The elderly and the sick are particularly at risk because they may have an immune response that is dangerous. It’s called a “cytokine storm,” when immune cells are overproduced and flood into the lungs, causing pneumonia, inflammation and shortness of breath.

People with mild cases recover in about two weeks, while those who are sicker can take anywhere from three to six weeks to get better. 

COVID-19 was declared a Public Health Emergency of International Concern on January 30, which means it is mandatory to report to the WHO each human and animal case.

The spread of coronavirus from person to person is predominantly from droplets of saliva or mucus from coughing or sneezing, or through viral particles transferred when shaking hands or sharing a drink with someone who has the virus.

Hence the answer for the public and health workers is to limit close contact.

We need to recognise that the virus is advancing and so it is really important to try and take the heat out of transmission, and that means helping people to stay further away from each other and reduce the risk of infection. 

Very importantly, if you have symptoms that suggest you might have Covid, you absolutely must not be in contact with others. 

We must then look at the staging of events. Some are already being cancelled, but it is not just big events. Gatherings in community halls, in religious spaces and services, and also in pubs will all be scrutinised by the Government in an effort to continue the delay of the spread of the virus.

It’s time for facts, not fear; for rationality, not rumours and for solidarity, not stigma.

Precautions for the general public are:

• strict self-quarantine if sick with flu like illness: two weeks (govt has now recommended).
• wash your hands often and for at least 20 seconds with soap and water or use an alcohol-based hand sanitizer.
• avoid touching: eyes, nose, and mouth with unwashed hands.
• avoid close contact: (3-6 feet) with people who are sick with cough or breathlessness
• cover your cough or sneeze with a tissue, then throw the tissue in the trash.
• clean and disinfect frequently touched objects and surfaces.

What is coranxiety?

Amid the outbreak and so much coverage, ‘coranxiety’ is unsurprising – and our own mental health is a genuine concern.

‘Coranxiety’ is the anxiety about falling ill and possibly dying; avoiding or not approaching healthcare facilities due to the fear of becoming infected during care; a fear of losing one’s livelihood; fear of not being able to work during isolation; the fear of being dismissed from work if found positive; fear of being socially excluded; fear of getting put into quarantine; fear of being separated from loved ones and caregivers due to quarantine; refusal to take care of unaccompanied or separated minors; refusal to take care of people with disabilities or elderly because of their high- risk nature; feeling of helplessness; feeling of boredom; feeling of depression due to being isolated; stigmatization of being positive with the infection; possible anger and aggression against government; possible mistrust on information provided by government. relapses of mental illness in already mental patients; overstress on people to cover work of infected colleagues, quarantined for 14 days and insufficient or incomplete information leading to myths and fake news.

What are the possible modes of spread? Myths and facts

• Person-to-person: Yes, the virus can spread from one person to another, most likely through droplets of saliva or mucus carried in the air for up to six feet or so when an infected person coughs or sneezes, or through viral particles transferred when shaking hands or sharing a drink with someone who has the virus.
• Casual exposure: No, Human to human contact requires prolonged contact (possibly ten minutes or more) within three to six feet. But with contact transmission this may not be applicable.
• Currency notes: The central banking authorities of China are disinfecting, stashing and reportedly even destroying cash to stop the spread of the coronavirus. People’s Bank of China says that the cash collected by commercial banks must be disinfected before being released back to customers.
• Fabric, carpet, and other soft surfaces: Currently, there’s no evidence.
• Hard surfaces: Virus could be on frequently-touched surfaces, such as a doorknob, although early information suggests viral particles would be likely to survive for just a few hours (WHO).
• Kissing: kissing scenes have been banned in movies in China.  France have advised to cut back on “la bise,” the custom in France and elsewhere in Europe of giving greetings with kisses, or air kisses, on the cheeks.
• Public gatherings: Affected countries have banned death ceremonies, people gathering.
• Uncovered eyes: The transmission is through mucus membrane contamination. One case got infected while using gown, but eyes not covered.
• Eating meat, fish or Chicken: Its not a food borne illness but a respiratory illness. It cannot occur by eating any food or meat. However, it is always advised not to touch raw meat, eat raw meat or eat partially cooked meat to prevent meat related food borne illnesses. Eating fish and chicken is safe.
• Handling wild animals or their meat: Yes, if their secretions are handled by the animal handlers.
• Semen: We do not know, in patients infected with Ebola, the virus may persist for months in the testes or eyes even after recovery — and can infect others and keep the epidemic going.
• Sex like EBOLA and ZIKA: We have no evidence yet
• Goods for affected areas: People receiving packages from China or other affected areas are not at risk of contracting the COVID 19 as the virus does not survive long on objects, such as letters or packages.
• Pipes: Ventilation system connects one room to the next. There has been previous concern that the coronavirus can spread through pipes.
• Stress: Stress and anxiety are known to suppress the immune system, making people more susceptible to contracting the virus.
• Patients without symptoms: Both SARS-CoV and MERS-CoV infect intrapulmonary epithelial cells more than cells of the upper airways. Consequently, transmission occurs primarily from patients with recognized illness and not from patients with mild, nonspecific signs. Though NEJM has reported a case of COVID 19 infection acquired outside of Asia in which transmission of mild cases appears to have occurred during the incubation period in the index patient but the same has been challenged now.
• An infected person with high infectivity, can infect hundreds of cases in no time. What causes a person to become a super spreader is not known.
• The examples are the first case in Wuhan, a female in the S Korea Daegu fringe Christian group Shincheonji Church where she (61 years) infected more than 51 others.

Which countries one should not travel?

Travel advisory

• Level 1 in all countries (Exercise normal standard hygiene precautions)
• Level 2 in all affected countries (Exercise a high degree of caution)
• Level 3 in all countries with secondary cases (Reconsider your need to travel)
• Level 4 in affected parts of China and S Korea, Iran, Italy (Do not travel)

What are other dreaded corona viruses?

COVID 19 is one of the three deadly human respiratory coronaviruses. Others are severe acute respiratory syndrome coronavirus [SARS-CoV] and Middle East respiratory syndrome coronavirus [MERS-CoV]). 

COVID 19 virus is 75 to 80 per cent identical to the SARS-CoV

Will this virus survive heat?

Virus is likely killed by sunlight, temperature, humidity. SARS stopped around May and June in 2003 due to more sunlight and more humidity.

What are the different precautions?

• Droplet precautions: Three-layer surgical mask by patients, their contacts and health care workers, in an adequately ventilated isolation room, health care workers while caring with the secretions should use eye protection, face shields/goggles. One should limit patient movement, restrict attendants and observe hand hygiene.
• Contact precautions: When entering room – gown, mask, goggles, gloves – remove before leaving the room; Dedicated equipment/ disinfection after every use; Care for environment- door knobs, handles, articles, laundry; Avoid patient transport and Hand hygiene
• Airborne precautions when handling virus in the lab and while performing aerosol-generating procedures: Room should be with negative pressure with minimum of 12 air changes per hour or at least 160 litres/second/patient in facilities with natural ventilation. There should be restricted movement of other people and all should use gloves, long-sleeved gowns, eye protection, and fit-tested particulate respirators (N95 or equivalent, or higher level of protection)

What are the lab tests?

There are two ways to detect a virus: through the genetic material DNA or RNA or to detect the protein of the virus. The rapid tests look at the protein. It takes 8-12 weeks to make commercial antibodies. So right now, for the diagnostics tests they are using PCR which give you a turnaround in 1-2 hours.

Who is more vulnerable?

People with pre-existing medical conditions (such as asthma, diabetes, heart disease) appear to be more vulnerable to becoming severely ill with the virus.

What is the role of 14 days quarantine?

Quarantines and travel restrictions now in place in many counties, including the US, are also intended to help break the chain of transmission. Public health authorities like the CDC may recommend other approaches for people who may have been exposed to the virus, including isolation at home and symptom monitoring for a period of time (usually 14 days), depending on level of risk for exposure.

Should I wear a face mask to protect against coronavirus?

Currently, face masks are not recommended for the general public. Some health facilities require people to wear a mask under certain circumstances, such as if they have travelled from the city of Wuhan, China or surrounding Hubei Province, or other affected countries or have been in contact with people who did or with people who have confirmed coronavirus.

If you have respiratory symptoms like coughing or sneezing, experts recommend wearing a mask to protect others. This may help contain droplets containing any type of virus, including the flu, and protect close contacts (anyone within three to six feet of the infected person).

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