WhatsApp
WhatsApp

News : Coronavirus

UPDATED MEDICAL INFORMATION AND AMENDED RECOMMENDATIONS REGARDING CORONAVIRUS EPIDEMIC

Published June 2nd, 2020

The current bulletin will be updated regularly until the situation stabilizes. Find more articles about COVID19 in our blog.

Where is information sourced from:  the most reputable international sources (WHO, Chinese CDC, CDC, international media, medical journals etc …) and government websites.

 

Overview / Historic reminder

In December 2019 a cluster of an apparently new kind of infection was first recognized in a Wuhan market, initially transmitted from animals (most probably a bat according to the WHO’s April 23rd report) to men but man to man transmission quickly developed with a rapid deterioration into a local epidemic in Hubei province. While there have been allegations that the virus could originate from a research laboratory, the is no objective evidence in this regard. The unfortunate coincidence with the Chinese New Year and a large number of Chinese people travelling both in country and abroad contributed to the rapid spread of this novel virus. The outbreak deteriorated in China in mid-January and forced the Chinese authorities to take stringent measures to confine the people and reduce transport, first in Wuhan and Hubei province and then in the whole country. Exported cases started to be reported at the end of the month in countries such as South Korea and Japan, and individual cases, initially often of Chinese origin or having travelled to China, were notified in several countries. The situation evolved rapidly, and restrictions in air travel began to be imposed. On January 30th the WHO declared a Public Health Emergency of International concern. On February 11th 2020 to be coherent with international virus and disease naming rules the International Committee on the Taxonomy of Viruses renamed the virus SARS-CoV-2 and the WHO named the disease COVID-19. In late February and early March new major outbreaks occurred in Iran and Italy, seeing a huge growth in the epidemic, which was now affecting over one hundred countries and territories. The WHO declared a PANDEMIC on March 11th. At that time, and as the situation in China was starting to improve, many countries in Europe introduced lockdown measures starting by Italy, extending rapidly in Western Europe and on most continents including countries like India or more recently in the USA. In recent weeks the USA have remained the main area of growth of the numbers of affected people and deaths, with Russia recently becoming a concern, while Asia first and now Western Europe are starting gradual deconfinement.  Local outbreaks small outbreaks after deconfinement in South Korea, Germany and Wuhan are useful warnings that all protection measures are still very important to follow. Clearly this major health crisis has created a very significant economic crisis worldwide.

Clinical picture

The disease is highly contagious although it appears  that it may be less severe than other coronavirus diseases such as SARS or MERS at this stage.  Lockdowns measures have been shown to reduce contagiousness: a recent French study showed that it reduced the reproductive number (the number of people infected by each case) from 3.3 to 0.5 (84% reduction). The proportion of severe cases has stabilized at around 15% of the total number of cases. Deaths, at around 4% to 5 % overall initially but now just below 7 %, and with wide variation between high (UK, France, Italy, Spain) and low (Germany, Austria, South Korea, Japan), occur mostly in older people above 70 years of age, and at a higher risk with underlying diseases such as diabetes, chronic pulmonary diseases and cardiovascular diseases. The WHO just reported on May 10th a possible increase of the risk of worsened outcome in patients ACE (angiotensin converting enzyme) inhibitors. The signs and symptoms to watch for are first of all contact with a proven or potential case or environment, then respiratory symptoms like cough and shortness of breath, and feeling sick, with often head and muscle aches. Fever is very often but not always present. The WHO is stating that cases are the most infectious in the first three days of the symptoms. A significant incidence of anosmia (loss of smelling sensation) is now also reported. The incubation is usually 3 to 7 days, rare cases are transmitted from symptom free patients, and the maximum is currently thought to be 14 days although there may be cases exceeding this length. In cases requiring admission to the intensive care unit for assisted ventilation, the duration of stay is usually long , between two and three weeks, and is followed by a need for rehabilitation.  During the unlocking phase protection meaures must be in place. The WHO has published guidelines regarding unlocking , and in particular on re-opening of schools May 13TH and the need for a balance berween protection against COVID and attention to potential social and educational losses.

Key protection measures

The key preventive measures are targeted towards avoidance of contact with potential sources of contamination, hygiene and strictly restricting diagnosis and treatment to facilities designated by the authorities.  The key measures are to decrease contacts therefore travel has decreased over 90% and countries have introduced lockdowns that should last at least two months in most cases. Social distancing  and isolation at home are key measures to reduce contagion. In addition, hand washing, disinfection and wearing masks for care and service providers, as well as for the public when in contact with others, are the key. Wearing masks in public places and good availability of testing have been associated to better resistance to the spread and impact of the epidemic. In the unlocking phase it is important to maintain adequate distancing practices.

Treatment

Access to regular treatment of usual diseases is limited and a lot of elective interventions have been cancelled during lockdowns. There is also a concern regarding the decrease in accessibility to regular vaccination programs, which enhances threats such as for instance measles. This may have been a source of increased morbidity and mortality. Examination by family doctors and house call doctors are always preferable to attempting to visit crowded clinics, hospitals or emergency rooms. Access to testing is currently variable between countries, with some restricting the tests to public institutions, some to PR only and others more liberal and showing an opening to serology testing as well. Serological tests enabling the detection of antibodies are now being added and will help to determine immunity status and, indirectly, ability to return to work. Access to tests and masks is increasing after initial shortages. Similarly several scientific studies are underway to investigate the objective value of several treatment modalities such as antiviral drugs, or hydroxychloroquine. So far there is no clear evidence that any treatment works well enough to be recommended as a standard. Similarly many groups are conducting research on vaccines, and a few early successes have been mentioned. This said no vaccine should be available before the very end of this year at the earliest. Obviously due to the huge decrease of flight availability not only tourists and expatriates have trouble returning home, but also providing a challenging environment for assistance companies, specialising in repatriations. Exceptional evacuation of even COVID cases from isolated places or overwhelmed regions happens occasionally using air ambulances. Several companies offer specialized transport units, but clearly such evacuations are very complex to organize and expensive. Of course, sadly, the repatriation of mortal remains has also been a complicated task. The cases admitted to hospital can normally be offered especially oxygen supplementation and tight surveillance but many have to be admitted to intensive care. The duration of the stay as already mentioned is up to two or three weeks with heavy physical and psychological rehabilitation needs.

Current global situation

At this stage the latest modified data available, as of 15H00 May 29th China time, the total volume of confirmed cases in China was 84548, and 4645 deaths had occurred. A total of 5920097 cases and 362369 deaths have been identified worldwide, a continued marked increase that shows that the problem remains truly a pandemic and is currently still quite acute in the United States, which accounts for almost a third of all cases in the world but is active on all continents. China is now mainly concerned about imported cases especially along its north-eastern border at this stage and has stopped allowing foreigners to enter the country. The beginning of a post crisis situation is also noticed in Korea and some European countries, notably Austria. A “high plateau” situation followed by a steady decrease of cases is currently observed in western Europe including Italy, France and Spain. Several countries in Asia and Western Europe have initiated gradual deconfinement measures. As mentioned earlier local clusters even in highly performing countries like South Korea or Germany serve as a reminder that a high level of caution is still required.

Europe

Italy, with 231732 cases and 33142 deaths, Spain (284986 and 27119), Germany (182452 and 8570), France (186238 and 28662), the UK (269127 and 37837) and now Russia (387623 and 4374) have high numbers which have challenged the capability of the overwhelmed health care delivery systems in many areas before the current improvement. Unfortunately, many senior homes have become clusters for death cases in many countries.

Asia (without China)

Although it was hit early, right after China, Asia has resisted quite well with the early exception of Iran, which accounts for 143849 cases and 7627 deaths and a bit of a worrying growth in Turkey (160979 cases and 4461 deaths). Israel has a high number of cases, 16887 given its size but a remarkably low number of deaths, 284. South Korea has a fairly large number of cases (11402, very few of them recent except for a very recent small cluster) but relatively few deaths (289) as has Japan (16759 and 882) which nevertheless just tightened its lockdown rules given a small “second wave” like phenomenon. This is probably due to the strong health infrastructure response and access to easy screening as in Japan and SE Asia. India remains a question mark risk-wise: there is a rise in cases in India, with 165829 cases and 4713 deaths.

The Americas

The USA are now the country with the most cases, 1768461, as well as the most deaths 103330, and the government has acknowledged the extent of the challenge and began to restrict travel into the country, with week March 16 seeing the introduction of a travel ban to a number of European countries. California was the first state to introduce a lockdown, followed by others including New York, now the hardest hit state in the country. Some states are already loosening their lockdown despite high numbers and death every day. The numbers in South America are uneven but Brazil (438812 cases and 26764 deaths) and Peru (141774 cases and 4099 deaths) start having large numbers, and Mexico is growing as well.

Africa

Africa has a low but growing number of cases but is doing its best together with international MOF to prepare as the impact could be severe given the relatively weak public health infrastructures. So far South Africa, and four countries in North Africa, Egypt, Algeria, Morocco and Tunisia are the ones reporting the highest figures in the thousands.

GENERAL RECOMMENDATIONS

1. First and foremost realize that this pandemic is a worldwide phenomenon and the more all of us take it seriously the lesser the health, sociological and economical impact.

2. Avoid any contact with patients with COVID-19, and more generally with patients with cough and fever. When contact is required for help, protection by distance and if available masks and gloves is important.

3. Follow the usual hygiene precautions as a priority considering that regular handwashing, disinfection and adequate use of mask wearing, especially in public transport and crowded places, are part of these essential hygienic attitudes.

The use of masks in public places and especially public transport is more and more an approach countries favour with now scientific support.

4. Accept  the need for a worldwide push to reduce social interaction between people including long distance transportation to reduce contamination. From the corporate and company standpoint maximization of work at home is the key action when feasible.

5. Accept the drastic reduction in access to travel means when not required for functions such as international health programs.

6. Plan to maintain the current restrictions at least partially over time and take home the lessons learned regarding contagious disease prevention for the future

7. Support your local health care system and facilities helping fragile people such as the old people homes.

8. Maintain communications with colleagues, friends and families to reduce the risk of depressive reactions to the situation.

9. Carefully design deconfinement plans that should be gradual and supported by much increased preventive measures and carefully monitored. The use of both PCR and immunological tests to at least selected segments of the population may be an asset.