Understanding the COVID-19 pandemic

People all over the world are beginning to come to terms with the adjustments they have to make in the way they live, work and socialize, with such terms as social distancing, telecommuting and flextime becoming a part of life.

In the Philippines, the President has placed Metro Manila under a one-month community quarantine with travel restrictions imposed, mass gatherings prohibited, classes suspended and other measures implemented to prevent the further spread of the virus. 

My friend Tony Lopez, publisher of BizNews Asia, sent me a copy of his column titled “No country can cope with COVID-19” that provides a comprehensive and well-researched information on the new coronavirus. The numbers and statistics give people a better handle of the situation, with the data culled from a study conducted by a team of doctors from WHO and China on 55,924 cases of COVID-19 in China mainland last February – the largest study ever of the coronavirus infection.

Tony asserts that “No country, however, rich or resource-endowed, can contain it. Except China – with its wealth, its authoritarian government, its health care resources, and the singlemindedness to impose draconian measures.”

Many agree that “no country under attack can take it easy.” However, parents would find it reassuring to know that among the major findings of the WHO-China joint mission is that COVID-19 is mild, and does not attack children. 

The study also showed that incubation period is five days, not 14 as has been asserted in some reports which has also contributed to the confusion among people. Infected patients can also recover within two weeks (provided however that they do not have underlying medical conditions like diabetes or asthma).    

Below are some of the other key findings highlighted by Tony which we condensed due to space limitations: 

Symptoms, including mild respiratory symptoms and fever, appear 5-6 days after infection (mean incubation period 5-6 days; range 1-14 days). Most people infected with COVID-19 virus have mild disease and recover.

Approximately 80 percent of patients had mild to moderate disease, which includes non-pneumonia and pneumonia cases, 13.8 percent have severe disease, 6.1 percent are critical (respiratory failure, septic shock, and/or multiple organ dysfunction/failure).

Individuals at highest risk for severe disease and death include people aged over 60 years and those with underlying conditions such as hypertension, diabetes, cardiovascular disease, chronic respiratory disease and cancer.

Disease in children appears relatively rare and mild.  About 2.4 percent of cases were under 19 years. A very small proportion of those aged under 19 years have developed severe (2.5 percent) or critical disease (0.2 percent).

Of 44,672 infections, only 965 (2.2 percent) were under 20 years of age and there was just one recorded death (0.1 percent) in this age group.  About 78 percent of cases were in the 39-63 year-old age bracket.

The median time from onset to clinical recovery for mild cases is approximately 2 weeks; 3-6 weeks for patients with severe or critical disease.

COVID-19 is transmitted via droplets and fomites during close unprotected contact between an infector and infectee. Fomites are objects that carry infection like clothes, utensils, and furniture.

COVID-19 is a newly identified pathogen. There is no known pre-existing immunity in humans. Everyone is assumed to be susceptible.

The main signs and symptoms of COVID-19 include fever, dry cough, fatigue, sputum production, shortness of breath, myalgia or arthralgia, sore throat, and headache. Nausea or vomiting has been reported in a small percentage of patients (5 percent).

There are no specific anti-viral or immune modulating agents proven (or recommended) to improve outcomes. All patients are monitored by regular pulse oximetry.

Patients were treated according to China’s National Clinical guidelines. The guidelines include supportive care by clinical category (mild, moderate, severe and critical), as well as the role of investigational treatments such as chloroquine, phosphate, lopinavir/ritonavir, alpha interferon, ribavirin, arbidol.

China capitalized on the use of technology, big data and AI for COVID-19 preparedness, readiness and response. Authoritative and reliable information, medical guidance, access to online services, provision of educational tools and remote work tools have been developed in and used across China. These services have increased accessibility to health services, reduced misinformation and minimized the impact of fake news.

China practiced meticulous case and contact identification for COVID-19.  From 1 percent to 5 percent of contacts were found infected. In Wuhan, 1,800 teams of epidemiologists with a minimum of five per team were deployed to trace tens of thousands of contacts a day.

?Contact follow up is painstaking, with a high percentage of identified close contacts completing medical observation. Between one percent and 5 percent of contacts were subsequently confirmed cases of COVID-19.

?In Shenzhen City, near Hong Kong, 100 percent of the contacts of 2,842 infected persons were traced – underscoring the importance of efficient and rapid contact tracing. Of the 2,842 contacts, 2,240 (72 percent) completed medical observation.  Among the close contacts, 88 or 2.8 percent were found infected. In Guangdong province, 99 percent of 25,493 COVID-19 cases were contacted. About 479 (4.8 percent) were found infected.

The infected were tested for influenza-like illness and severe acute respiratory infection. All their visitors were tested for fever.

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