Coronavirus (COVID-19) Summary

Contents

  1. Coronavirus (COVID-19)
  2. COVID-19 description
  3. Transmission
  4. Epidemiology
  5. Symptoms
  6. Management
  7. General Prevention Methods
  8. Shielding
  9. Vaccination
  10. General Health and Exercise
  11. Mental Health
  12. Troubles with Quarantine
  13. Government Road Map
  14. Summary
  15. Timeline
  16. References

Coronavirus (COVID-19)

Coronavirus disease 2019 (COVID-19) is a severe acute respiratory infection. The virus was first identified as the cause of pneumonia of unknown cause in Wuhan City, Hubei Province, China, December 2019.

It's presented generally as a respiratory infection with symptoms ranging from a mild common cold, to a severe viral pneumonia.

Pneumonia is an infection in one or both lungs. Bacteria, viruses, and fungi cause it. The infection causes inflammation in the air sacs in your lungs, which are called alveoli. The alveoli fill with fluid or pus, making it difficult to breathe.

This is quite important as it could be dismissed as a standard pneumonia case and not be taken seriously due to the current Coronavirus pandemic, when in actual fact it is a serious problem and the patient should have been put into quarantine and treated right away.

COVID-19 description

COVID - 19 was an unknown coronavirus discovered in lung samples taken from a selection of patients who showed signs or had pneumonia of an unknown cause in Wuhan City, Hubei Province, China, December 2019.

  • The coronavirus is from a family of enveloped RNA (Ribonucleic acid) viruses
  • Some cause illness in people (eg common cold), while others circulate among mammals (eg bats and birds)
  • Animal coronaviruses can spread to humans who then pass it on to other humans during social (or otherwise) interactions
  • The virus is seen to be similar to severe acute respiratory syndrome (SARS) coronaviruses from bats back in 2002 and 2004
  • The full genome has been sequenced and recorded in the Gene Bank

In the beginning stages of this outbreak, many patients reported a link to the Huanan South China Seafood Market, a wet market, where live animals are sold, suggesting an animal origin of the virus.

While its actual origins have not been confirmed, COVID - 19 may be a virus deriving from a bat coronavirus and an unknown coronavirus.

Transmission

Evidence shows that human-to-human transmission happens via close contact with droplets produced when a person exhales, sneezes, or coughs, can include touching an unclean surface.(i.e. when touching an unclean table or bus handle). This is especially dangerous in large populated areas such as china as the chance of infection skyrockets.

There have been no reports of airborne transmission as of May 2020.

Self - Quarantine or otherwise is 14 days. On average, a quarantine period of 5 days is required. Transmission can still occur during this quarantine, so minimal contact with others is advised to reduce the chance of spreading.

The basic reproduction number (R0) of an infectious disease is the number of people get infected from an infected person. For a disease to spread, the reproduction number should be > 1. As of now, according to PM Boris Johnson, the R0 value of the virus is < 1. If this rate carries on, then the virus may be able to significantly reduce its infection rate. That is why it is important to follow social distancing rules and minimise spread.

Epidemiology

By 19 May 2020, over 4.5 million cases of COVID-19 were reported globally, with over 300 000 deaths.

However, there is variability on the data which suggests uncertainty over the exact case fatality rates. Reasons for this may be:

  • The number of cases detected by testing will continue to vary country to country, some countries are very heavily dense, e.g. China, while others are not, e.g. New Zealand
  • Selection bias, meaning the people who are mainly tested and recorded are ones that are already have it or are considered to have it
  • Other factors accounting for increased death rates such as patient demographics (e.g. Countries with aging populations may be more susceptible to the illness and therefore have a higher death rate like in countries such as Italy)
  • Increased rates of smoking or comorbidities (illnesses the patient has other than the primary one being investigated)

The chance of getting Coronavirus or dying from it seems to be higher for elderly patients (especially ones aged 80 and over), and in male patients. The risk is lower in younger people.

Figure 1: Comparison of respiratory infectious disease outbreaks; SARS, 2009 H1N1, MERS and COVID-19

Symptoms

The most common symptoms are:

  • Fever
  • Cough
  • Fatigue
  • Loss of smell/taste

Less common symptoms include sore throat, dizziness, headache, and stomach problems such as diarrhoea. People with it can have difficulty breathing and people with previous respiratory problems may have tachycardia. Tachycardia is where the heart beat speeds up which is dangerous for people with heart disease as it may lead to a heart failure.

Management

There are currently no cures for COVID - 19.

The main way of management is early recognition and supportive care to help the ones affected and be by their side as they fight the virus.

Suspected or confirmed cases are advised to be quarantined and helped by healthcare professionals.

The World Health Organization (WHO) suggests that mild cases without risk factors may be moved back home and cared for with self - isolation and home care.

In the UK, the recommended period of self-isolation is seven days. People in the same household should self-isolate for 14 days as well.

General Prevention Methods

The only way to prevent infection is to avoid exposure to the virus, and people should be advised to:

  • Wash hands often with soap and water, or an alcohol-based hand sanitiser that contains at least 60% alcohol, especially after being in a public place, blowing their nose, or coughing/sneezing. Avoid touching the eyes, nose, and mouth with unwashed hands

    • Initially anti-bacterial hand gel and alcohol wipes may have had a shortage however, currently there is an increase in stock making the products more available for consumers

  • Avoid close contact with people (i.e. maintain a distance of at least 1 metre) including shaking hands, especially those who are sick, have a fever, or show other virus-like symptoms. It is important to note that recommended distances differ between countries (2 metres is recommended in the UK and US)

  • Practice good hygiene (i.e. cover mouth and nose when coughing or sneezing, bin tissue immediately in a closed bin, and wash hands)

  • Seek medical care early if you have a fever, cough, and difficulty breathing

  • Stay at home if sick, even with mild symptoms, until recovered

  • Clean and disinfect household surfaces frequently

  • Currently, the World Health Organization (WHO) does not recommend face masks for healthy members of the public unless they are taking care of a person with suspected COVID-19 infection.

These methods can help reduce the R value so we can go back to how the world was before quarantine as soon as possible and be able to go outside without the extreme risk of catching an infectious disease.

Shielding

Shielding involves reducing all interactions between vulnerable people and the rest of society to protect them from coming into contact with the virus.

Extremely vulnerable groups include:

  • Solid organ transplant recipients
  • People with severe respiratory conditions (e.g. cystic fibrosis)
  • People with rare diseases (e.g. sickle cell disease)
  • People on immunosuppressive therapies
  • Women who are pregnant with significant heart disease.

To help in shielding, we need to keep providing essential food to those unable to leave their home and facilitate support volunteers.

  • Over one million food boxes have now been delivered in England by wholesalers to those shielding who asked for help with food, with hundreds of thousands more to follow in the coming weeks.

Those who are shielding can also directly request the support of NHS Volunteer Responders.

In the UK, these groups are advised to stay at home at all times and avoid any face-to-face contact. Currently the UK government is advising these people to shield until the end of June, but this advice is being regularly monitored and may change. Visits from people who provide essential support should continue, provided these people do not have symptoms and follow hand hygiene measures.

Vaccination

There are no current vaccines available globally as of May 2020, however several are in trials around the world.

General Health and Exercise

As of May 2020, the UK government has increased the time allowed outside to each resident of the country, allowing unlimited time to get their daily exercise with members of their own household.

Regular exercise for children and young people should aim for at least 60 minutes of physical activity a day per week to develop movement skills, muscles, and bones.

Regular exercise for adults should aim for 150 minutes of physical activity a day as well as do strengthening activities to work out your major muscle groups to avoid degradation of important muscle groups later in life.

Especially for students, regular exercise has scientifically proven to aid learning, reduce stress and provide better sleep which are both vital for revision and especially important during exam period, where stress is at an all-time high.

Personally, during exam time, I have noticed that a walk around the block is a good way to stimulate my muscles from sitting around all day, help keep me refreshed, distract myself from studying and help relax while feeling stressed.

Mental Health

Life can be tough, especially in quarantine. We are in very uncertain times and have been unable to see virtually anyone, especially loved ones, for an extended period of time. So for those suffering from mental health problems or are experiencing symptoms of potential mental health problems please visit the following website which will lead you to the hotline you require:

NHS Mental Health Helplines

Troubles with Quarantine

While the majority of people have understood the severity of COVID-19, a small minority of people still do not.

This is shown in the amount of people who do not wear protective gear such as disposable latex/ Nitrile gloves and face masks which is a big concern given the fact that the London TFL Tube trains are still full and are not going to decrease any time soon.

This puts not only the NHS and emergency services staff at risk but also the key workers who all put their lives at risk already by still entering the workspace to keep our society and economy alive and functioning.

If you do not have any then please purchase the following if possible:

*Prices may vary

However, it is advised that homemade face masks should be used, such as handkerchiefs or cloths, as this helps the healthcare sector get the equipment they need.

Government Road Map

Step One

The changes to policy in this step were applied from Wednesday 13 May in England. As the rate of infection may be different in different parts of the UK, this guidance should be considered alongside local public health and safety requirements for Scotland, Wales and Northern Ireland. Fortunately, this milestone has been achieved and the lockdown has reduced in severity. I am now able to bubble with another household and it has helped my mental state tremendously as I can now talk to people face to face (with a home-made mask on) and can interact socially to an extent.

Work

  • For the foreseeable future, workers should continue to work from home rather than their normal physical workplace, wherever possible.
  • All workers who cannot work from home should travel to work if their workplace is open.
  • Anyone who has symptoms, however mild, or is in a household where someone has symptoms, should not leave their house to go to work.

Schools

The rate of infection remains too high to allow the reopening of schools for all pupils yet. (As of May 2020).

The Government is also amending its guidance to clarify that paid childcare, for example nannies and childminders, can take place subject to being able to meet the public health principles.

Currently, the universities have closed down, however there are speculations that they may open in September and become a hybrid system of both online and real life lectures given that all guidelines are followed and the quarantine level has reduced from where it is now.

Travel

When travelling everybody (including critical workers) should continue to avoid public transport wherever possible. If they can, people should instead choose to cycle, walk or drive, to minimise the number of people with whom they come into close contact.

Social distancing guidance on public transport must be followed rigorously. As with workplaces, transport operators should follow appropriate guidance to make their services COVID-19 Secure; this will be published this week.

Face-coverings

As more people return to work, there will be more movement outside people’s immediate household. Homemade cloth face-coverings can help reduce the risk of transmission in some circumstances. Face-coverings are not intended to help the wearer, but to protect against inadvertent transmission of the disease to others if you have it asymptomatically.

A face covering is not the same as a facemask such as the surgical masks or respirators used as part of personal protective equipment by healthcare and other workers (e.g. N95).

Public spaces

  • People may exercise outside as many times each day as they wish.
  • People may drive to outdoor open spaces irrespective of distance
  • Do not travel to different parts of the UK
  • Protecting the clinically vulnerable
  • These clinically vulnerable people should continue to take particular care to minimise contact with others outside their households, but do not need to be shielded.
  • Those in the clinically extremely vulnerable group are strongly advised to stay at home at all times and avoid any face-to-face contact.

Step Two

The content and timing of the second stage of adjustments will depend on the most up-to-date assessment of the risk posed by the virus. The five tests set out in the first chapter must justify changes, and they must be warranted by the current alert level.

A phased return for early years settings and schools. Schools should prepare to begin to open for more children from 1 June. The Government expects children to be able to return to early years settings, and for Reception, Year 1 and Year 6 to be back in school in smaller sizes, from this point.

Opening non-essential retail when and where it is safe to do so, and subject to those retailers being able to follow the new COVID-19 Secure guidelines.

Permitting cultural and sporting events to take place behind closed doors for broadcast, while avoiding the risk of large-scale social contact. Re-opening more local public transport in urban areas, subject to strict measures to limit as far as possible the risk of infection in these normally crowded spaces.

Step Three

The next step will also take place when the assessment of risk warrants further adjustments to the remaining measures. The Government’s current planning assumption is that this step will be no earlier than 4 July, subject to the five tests justifying some or all of the measures below, and further detailed scientific advice, provided closer to the time, on how far we can go.

The opening of at least some of the remaining businesses and premises that have been required to close, including personal care (such as hairdressers and beauty salons) hospitality (such as food service providers, pubs and accommodation), public places (such as places of worship) and leisure facilities (like cinemas).

For more information on the government Guide Lines and further detail on the points gathered here please go the following link to read more:

COVID-1 Government Guidelines

If all these guidelines are followed on time and quarantine is abided by the population then we can go back to our normal lives one day. So far, the quarantine level and R value have both decreased, which may eventually lead to the pandemic being over in the not too distant future but of course all is uncertain right now.

Summary

  1. COVID - 19 was first identified in Wuhan, China in December 2019
  2. The transmission of COVID have allowed it to spread rapidly across the world
  3. As of May 2020, lack of options for treatment or vaccination means that in many countries, control of the virus relies on us. As we social distance, shield the vulnerable and stay inside, we help the future of this nation and the world

For me, life in quarantine has been difficult. It's an entirely new experience being confined to my house and not being able to interact with my friends and relatives. However, I remind myself that I am not isolating just for my benefit, I'm isolating for the benefit of the people who are being affected by this pandemic worse than me. Those who are susceptible to infection, those who want to go back to how it used to be, those who suffered due to people not isolating and have lost a loved one due to it. Therefore, I believe we should all quarantine and stick to the guidelines as they are there for a reason. They are helping us through these uncertain times.

To conclude, to all those reading this, stay home, stay healthy and above all, stay safe.

Timeline

December 2019

Cluster of pneumonia cases in Wuhan, China identified in a group of people associated with a live animal market

January 2020

Further cases reported from other regions of China and surrounding countries. Samples taken from bronchoalveolar lavage from five patients in Wuhan revealed a new strain of beta coronavirus. The new strain was rapidly sequenced and showed 79% nucleotide identity with the SARS-CoV virus, which was responsible for the sudden acute respiratory syndrome (SARS) outbreak that occurred in China and several other countries in 2003

11 January: First death of a patient from the original cluster of cases is reported in Wuhan, China

23-24 January: Wuhan and surrounding cities in China’s Hubei province go into ‘lockdown’. Person-to-person transmission documented within a family cluster in Wuhan

31 January: UK reports its first case

February 2020

7 February: Over 30,000 cases confirmed in China, with over 600 deaths. Less than 300 cases confirmed in countries outside of China, with 1 death

11 February: World Health Organization names the disease as coronavirus-2019, or COVID-19. SARS-CoV-2 is confirmed as the name of the virus

20 February: Iran reports its first case of COVID-19

23 February: Italy reports a spike of 67 new cases in the previous 24 hours, making a total of 76 cases with 2 deaths, and presumed local transmission

29 February: China reports more than 79,000 cases and over 2800 deaths. Italy reports nearly 900 cases with 21 deaths, and Iran reports nearly 400 cases with 34 deaths. Local transmission is also occurring on a smaller scale in the United States, Germany, France, Spain and the UK (20 cases)  

March 2020

7 March: Over 100,000 cases are reported worldwide. Transmission in China has slowed, with nearly 81,000 cases and just over 3000 deaths. Italy reports more than 4600 cases and 197 deaths, with nearly 800 new cases in the previous 24 hours

9 March: The government of Italy imposes a national quarantine 15 March: Italy reports over 20,000 cases and nearly 1500 deaths. Spain reports nearly 6000 cases with over 1500 new cases in the previous 24 hours. France, Germany, Switzerland, and the UK also report significant numbers of cases, with 1144 cases and 21 deaths in the UK

22 March: Italy reports over 50,000 cases and nearly 5000 deaths. Spain, Germany, France, Switzerland, and the United States each report tens of thousands of cases but widely varying numbers of deaths. Many countries in Europe have introduced enforced social distancing measures, or lockdowns, which include travel bans, school closures, and bans on gatherings

23 March: The UK reports more than 6600 cases and over 300 deaths and goes into lockdown. China reports 81,747 cases and 3283 deaths, with 147 new cases and 7 deaths reported in the previous 24 hours

31 March: Globally, more than 750,000 COVID-19 cases are reported to the WHO and over 36,000 deaths recorded. UNESCO reports more than 1.5 billion children are affected by school closures. The IMF acknowledges that the world has entered a global recession

April 2020

17 April: Over 2 million cases reported to the WHO, and over 130,000 deaths recorded

30 April: Over 3 million cases reported to the WHO, and over 200 000 deaths. Reports of new cases in many European countries have started to decline; new cases in the UK and US have plateaued

May 2020

6 May: The UK reports 29 427 deaths to the WHO, overtaking Italy as the country with the most COVID-19 fatalities in Europe. The US reports the highest figures globally, with over 1 million cases and more than 60 000 deaths

18 May: Over 4.5 million COVID-19 cases are reported to the WHO, and over 300 000 deaths. Transmission and fatality rates have peaked in much of Asia, Europe, and the US, and many countries have announced cautious easing of lockdown measures. Other countries including Brazil, Russia, Peru, and Mexico still report increasing numbers of deaths. Transmission in Africa appears to be slower and more variable

For an overall summary of COVID-19 cases globally and a real-time report of COVID-19 cases, please visit Covid Cures or John Hopkins University Of Medicine Covid Report .

References

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  • Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020;395(10224):565–574

  • Li Q, Guan X, Wu P, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med 2020;382(13):1199–1207

  • Ji W, Wang W, Zhao X, Zai J, Li X. Cross-species transmission of the newly identified coronavirus 2019-nCoV. J Med Virol 2020;92(4):433–440

  • Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395(10223):507–513

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  • Xie J, Tong Z, Guan X, Du B, Qiu H, Slutsky AS. Critical care crisis and some recommendations during the COVID-19 epidemic in China. Intensive Care Med 2020;1–4

  • World Health Organization (WHO): Coronavirus disease (COVID-19) Pandemic

  • Center for Systems Science and Engineering at Johns Hopkins University: {COVID-19 Dashboard}(https://coronavirus.jhu.edu/map.html)

  • Zhang JJY, Lee KS, Ang LW, et al. Risk Factors of Severe Disease and Efficacy of Treatment in Patients Infected with COVID-19: A Systematic Review, Meta-Analysis and Meta-Regression Analysis. Clin Infect Dis 2020 May 14. pii: ciaa576.

  • Ranucci M, Ballotta A, Di Dedda U, et al. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome. J Thromb Haemost 2020 Apr 17

  • Clerkin KJ, Fried JA, Raikhelkar J, et al. Coronavirus disease 2019 (COVID-19) and cardiovascular disease. Circulation. 2020 Mar 21

  • Ng JJ, Luo Y, Phua K, et al. Acute kidney injury in hospitalized patients with coronavirus disease 2019 (COVID-19): a meta-analysis. J Infect 2020 May 7

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  • US Food and Drug Administration. Coronavirus (COVID-19) update. FDA issues emergency use authorization for potential COVID-19 treatment. 2020

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