TOPIC: CORONAVIRUS/MALARIA FEVER NIGERIA’S RACE AGAINST TIME

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BY

DR. IZUAGBA KELECHI U.

OUTLINE:

  1. Introduction
  2. Definition
  3. Epidemiology
  4. Aetiology and mode of transmission
  5. Clinical presentation
  6. Types/classification
  7. Treatment
  8. Prevention
  9. Complications
  10. Prognosis
  11. Conclusion
  12. Sources
  1.  INTRODUCTION
  2. The current outbreak of coronavirus disease (COVID-19) was first reported from Wuhan, China on 31st December 2019.
  3. COVID-19 is the infectious disease caused by the most recently discovered coronavirus. This new virus and disease were unknown before the outbreak began in Wuhan, China in 2019.
  4. Coronavirus outbreak has become a public health emergency of International concern; as declared by WHO
  5. The first case of COVID-19 can be traced back to 17th November according to media reports an unpublished Chinese government’s data.
  6. The report had identified at least 266 people who contracted the virus last year and who came under medical surveillance, the earliest case was 17th November – weeks before the announcement of the new virus.
  7. The Chinese government was criticized over attempts to cover up the outbreak in the early weeks including backlash on doctors who tried to warn colleagues about a new sars-like virus emerging in the city of Wuhan in Hubei Province.
  8. The virus which is now a pandemic has currently infected at least 128,343 people across the world, killed 4,702 and 68,324 people have recovered from the virus since it began.
  9. Almost 81,000 of the cases occurred in China, mostly in the province of Hubei.
  10. Chinese government to WHO reported that the first confirmed case had been diagnosed on 8th of December 2019.
  11. Doctors who tried to raise the alarm with colleagues about the new disease in late December were reprimanded.
  12. Li Wenliang, a Chinese ophthalmologist at Wuhan central hospital who on 30th December 2019 warned fellow colleagues about a possible outbreak of an illness that resembled SARS (Severe Acute Respiratory Syndrome), later acknowledged as COVID-19
  13. He was reported to have died due to the infection on 7th of February, 2020 in Wuhan, China.
  14. There are now more than 100 cases recorded in countries in Africa. The countries with reported cases according to WHO includes; Algeria – 20, Burkina Faso – 2, Cameroun – 2, Democratic Republic of Congo – 1, Egypt – 59 (including 1 death), Nigeria – 2, Senegal – 4, South Africa – 13, Tunisia – 5, Togo – 1.
  15. The Federal Ministry of Health confirmed a coronavirus disease (COVID – 19) case in Lagos state Nigeria on 27th of February, 2020.
  16. The Government of Nigeria through the Federal Ministry of health have been strengthening measures to ensure an outbreak in Nigeria is controlled and contained quickly through the multi-sectoral coronavirus preparedness group led by NCDC (Nigeria Centre for Disease Control).
  17. This isn’t the first time a coronavirus has made news. The 2003 SARS outbreak was also caused by a coronavirus.
  18. As with the 2019 virus, the SARS virus was first found in animals before it spread to humans.
  •  DEFINITION
  • Coronavirus (COV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases E.g. Middle East Respiratory Syndrome (MERS-COV) and Severe Acute Respiratory Syndrome (SARS-COV).
  • A novel coronavirus (nCOV) is a new strain that has not been previously identified in humans.
  • Coronaviruses are zoonotic, i.e. are transmitted between animals to human.
  • Recent study showed that SARS-COV was transmitted from civet cats to humans and MERS-COV from dromedary camels to humans.
  • Several known coronaviruses are circulating in animals that have not yet infected humans.
  • The exact time that the virus can survive on surfaces is not yet known.
  • The word corona means “crown” and when examined closely, the round virus has a “crown” of proteins called peplomers jutting out from its centre in every direction.
  • These proteins help the virus identify whether it can infect its host.
  •  EPIDEMIOLOGY
  • The new coronavirus first detected in China has led to major public health responses in multiple countries.
  • The new coronavirus has continued to spread with more than 24,000 cases in China and nearly 200 cases reported in other countries.
  • So far this season, in the U.S, there is been a mortality rate from flu-like illnesses and pneumonia of about 7%.
  • What is more indicative of severity is the case of fatality rate of the viruses. SARS killed 10% of infected people for every 50 people infected, 5 died. MERS killed 35% of those infected, so for every 50 people infected, 17 died.
  • The 2019 n-COV has so far killed about 2.2% for every 50 people infected, only 1 has died.
  • AETIOLOGY AND MODE OF TRANSMISSION
  • Caused by RNA single-stranded (positive sense) virus of family coronavindae.
  • It has a crown – like appearance when viewed under an electron microscope.
  • The nCOV – 2019 causes various illnesses to people e.g. common colds, SARS and MERS.
  • It also affects animals which can rarely spread to humans and then causes human to human transmission.
  • Studies to date suggest that the virus that cause COVID-19 is mainly transmitted through contact with respiratory droplets rather than through air.
  • The disease can spread from person to person through small droplets from the nose or mouth which are spread when an infected person coughs or exhales.
  • These droplets can land on objects and surfaces around and by touching these objects/surfaces then touching eyes, nose, and mouth. One can get infected.
  • CLINICAL PRESENTATION
  • Most estimates of the incubation period for COVID-19 range from 1-14 days most commonly around 5 days.
  • Clinically, most patients present as a viral pneumonia which ranges from mild to severe in presentation with 20% case progression to become a severe disease.
  • Affected individuals present with:
  • Fever
  • Cough
  • Shortness of breath (severe cases)
  • Myalgia
  • Fatigue/tiredness
  • Confusion
  • Hemoptysis         in severe cases
  • Diarrhoea
  • Nausea/vomiting
  • Runny nose and sore throat
  • Nasal congestions
  • Some patients maybe Asymptomatic.
  • Some may present with complications of ARDs (Acute respiratory distress syndrome), Acute respiratory injury, Acute kidney injury, septic shock etc.
  • These symptoms are usually mild and begin gradually.
  • About 1 out of every 6 persons who gets COVID-19 becomes seriously ill and develop difficulty in breathing.
  • Most people (about 80%) recover from the disease without needing special treatment.
  • Older people and persons with underlying medical problems e.g. hypertension, DM are more likely to develop serious illness.
  • TYPES/CLASSIFICATION:
  • Coronaviruses are named for the crown-like spikes on their surfaces.
  • There are 4 main sub-groups of coronaviruses:
  • Alpha
  • Beta
  • Gamma
  • Delta.
  • The human coronaviruses were first identified in the mid 1960s.
  • The 7 coronaviruses that can affect humans include:
  • 229E (Alpha coronavirus)
  • NL63 (Alpha coronavirus)
  • OC43 (Beta coronavirus)
  • HKU1 (Beta coronavirus)

others:

  • MERS – CoV (A beta coronavirus that causes Middle East Respiratory Syndrome)
  • SARS – CoV (A beta coronavirus that causes severe Acute Respiratory Syndrome)
  • SARS – CoV-2 (The novel coronavirus that causes coronavirus disease 2019 or COVID-19)
  • People around the world usually get infected with human coronaviruses 229E, NL63, OC43, HKU1.
  • But sometimes, coronaviruses that infect animals can evolve and become a new human coronavirus.
  • The recent examples are the 2019 – nCov, SARS – COV, MERS – COV.
  • What makes the novel coronavirus so newsworthy is that a treatment or cure hasn’t yet been developed to help prevent its rapid spread from person to person.
  • TREATMENT
  • Till date, there is no vaccine and no specific anti-viral to prevent or treat COVID – 19.
  • However, affected persons should receive medical care to relieve symptoms.
  • Possible vaccines and some specific drug treatment are still under investigations and study. They are being trested through clinical trials.
  • Hence, the WHO have advocated various ways to protect oneself and others against COVID-19 and are making efforts to develop vaccines and drugs to prevent and treat COVID-19.
  • Prevention has remained the current main-stay of curbing this public menace.
  • WHO does not recommend self medication with any medicines including antibiotics as a prevention or cure for COVID-19.
  • There are several ongoing clinical trials that include both western and traditional medicines.
  • The WHO has pledged to continue to provide updated information as soon as clinical findings are available.
  • PREVENTION
  • You must always wash your hands with soap and clean water at least for 40 – 60 seconds or clean your hands with an alcohol – based hand rub/sanitizer rub for 20 – 30 seconds. This kills the viruses that may be on your hands.
  • Adopt a good respiratory hygiene. This involves covering your mouth and nose with bent elbow or tissue when coughing or sneezing (cough etiquette). Then dispose the used tissue immediately into the refuse bin. This will help to protect the people around you and to prevent the disease from spreading or transmitted.
  • Maintain at least 1 metre (3ft) distance between yourself and anyone who is coughing or sneezing. This will also reduce spread via inhalation of tiny droplets through the nose or mouth.
  • Avoid touching the eyes, nose and mouth with unwashed hands. The hands touch many objects and surfaces and can pick up the virus. Disinfect common surfaces as frequently as possible e.g. phones, computers, door handles etc.
  • Stay at home (self-isolate) if you feel unwell. In extreme cases where you have fever, cough or difficulty in breathing please seek medical care and call in advance as this will allow the health care facility to give you the maximum attention and care that you require and help protect others.
  • If possible, avoid travelling to areas where COVID-19 is spreading widely especially if you are elderly or have an underlying medical problem.
  • Wear a face mask (disposable) if you are looking after sick people who have COVID-19 symptoms or if you have fever, cough or runny nose. The health care personnels must always apply universal precautions while attending to patients. The use of PPEs (Personal Protective Equipment) cannot be over emphasized especially at this time.
  • Always stay informed on the latest development on COVID-19 via social media, television and radio channels.
  • High Index of Suspicion (HIS), early detection and rapid confirmation are important for prevention of spread and to facilitate supportive treatment to affected individuals.
  • Eat only well – cooked food. Avoid close contact and travel with animals that are sick.
  • At the tri age area, implementation of infection prevention and control measures should be done. Though most countries are implementing isolation of suspected and confirmed cases, during triaging of patients. They use screening questionnaires as a guide and include travel history.
  • Consult national travel advice before going on business travel or trips. Share previous travel history with your health care provider. Stay healthy while travelling.
  •  COMPLICATIONS

Early complications:

  • Pneumonia (SARS – CoV-2 infection). A type of pneumonia that’s been called 2019 novel coronavirus – infected pneumonia (NCIP).
  • So far, NCIP is the only complication
  • To date, there is no specific medicine recommenced to prevent or treat the new coronavirus (2019-nCOV). However, those infected with the virus should receive appropriate care to receive and treat symptoms and those with severe illness should receive optimized supportive care.
  • Some specific treatments are under investigation and will be tested through clinical trials.
  • The researchers are trying to develop a vaccine against 2019-nCOV and WHO is supporting their efforts. Vaccination against respiratory illnesses is highly recommended to protect your health although these vaccines are not effective against 2019 – nCOV.
  • Some chemical disinfectants have been identified to kill the 2019-nCOV on surfaces. These includes bleach/chlorine – based disinfectants, ether solvents, 75% ethanol, peracetic acid and chloroform. However, they have little or no impact on the virus if applied on the skin or under the nose. It can even be dangerous to put these chemicals on your skin.
  • Prevention has significantly remained the mainstay of reducing the risk of coronavirus through frequent hand washing, coughing, etiquettes, avoiding close contact with anyone with respiratory illness etc specifically linked to the 2019 coronavirus. However, researches noted the following complications in people with COVID-19:
  • Acute respiratory distress syndrome (ARDS)
  • Irregular heart rate (Anhythmias)
  • Cardiovascular shock
  • Severe muscle pain (Myalgia)
  • Heart damage.
  1. PROGNOSIS
  2. The case fatality rate of 2019-nCoV is 2 – 3%.
  3. Most of the deaths are older persons and or had underlying health conditions.
  4. Case fatality for SARS  is 10% and MERS 35%.
  1.  CONCLUSION
  2. People of all ages can be infected by the new coronavirus (nCOV – 2019).
  3. Older people with pre-existing medical conditions e.g. DM, heart diseases, asthma appear to be more vulnerable to becoming severely ill with the virus.
  4. No antibiotic is effective. Therefore, antibiotics should not be used as a means of prevention or treatment.
  5. The government must establish plans and procedures to detect and isolate the cases of COVID-19 as they emerge in Nigeria through supporting rapid development of specific tests for coronavirus in partnership with WHO and other global network of laboratories. This will enhance faster confirmation of positive diagnosis.
  6. Strategic use of protective equipment for health care workers must be ensured. Expert teams and highly trained staff should be ready to receive and care for affected individuals across all hospitals and community settings to minimise the overall impact of the disease on society, public services and the economy.
  7. Thanks to the Federal government through the Ministry of health for providing latest information and public health advice on ways to protect oneself, and prevent spread of the disease.
  8. Emergency and urgent care facilities must be accessible to enable identify, isolate and contain cases, separate from other patients and the public in order to cope with the outbreak.
  9. The government must ensure effective means and provide practical and concrete support to its citizens to help contain the spread of COVID-19.
  10. The initial confirmed patients should be cared for by specialist units with expertise in handling this disease by using tried and tested infection control procedures to rapidly trace, monitor and isolate close contacts with the aim of preventing further spread.
  11. Detection of early cases, follow up close contacts and prevent the disease from taking its hold in this country for as long as it is reasonably possible. These fundamental objectives will help deploy phased actions to contain, delay and mitigate the spread of the disease in our society.
  12. Be active global players – work with WHO, CDCs, and neighbouring countries in supporting international efforts to detect the emergence of a pandemic and early assessment of the virus by sharing scientific information.
  13. Guidance by the evidence and regularly review research and development needs in collaboration with research partners to enhance the preparedness and response must be maintained.
  14. We must ensure dignified treatment to all affected individuals.
  15. The 2019 coronavirus probably seems scary especially on news about deaths, travel bans, etc.
  16. Extensive news coverage of the new coronavirus outbreak can make the situation seem much worse than it actually is.
  17. Experts also emphasize that this outbreak is significantly less dangerous than previous coronavirus epidemics like SARS and MERS.
  18. Our public health infrastructure must be well equipped and the government must provide all possible resources to contain this virus and prevent widespread infection.

STAY CALM, DO NOT PANIC, FOLLOW YOUR DOCTOR’S INSTRUCTIONS AND PROTECT YOURSELF

THANK YOU!!!

12. SOURCES

  • WHO
  • CDC

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