As the epidemic caused by the new coronavirus grows, the international response to counter its expansion is for now helping to limit the damage. Where are we?
Let’s first clarify THE point that worries you: in Canada, the risk of contracting the new coronavirus is almost zero. The virus is not circulating, the seven cases declared positive have been isolated, security measures are in place, patients at risk are screened. In fact, more Canadians are found infected on cruise ships than within the country.
From the first case reported in China on December 31, 2019 until today, through the detection of the first Canadian case on January 25, we can say that the system is working. No one should be afraid of catching the virus here. But like almost everywhere in the world, perhaps we should fear more the racist abuses which result from unfounded apprehensions.
We are well aware of the main issue: We must contain cases of COVID-19. And so far, it’s been working pretty well. The challenge is first for China, given its huge population, but also wherever the virus has spread. The fight against COVID-19 is therefore above all one of the largest quarantine operations in human history.
Tens of millions of people (mainly in China) cannot therefore leave Wuhan. Thousands more are confined to cruise ships-notably on the Diamond Princess, on which 218 passengers have so far tested positive – and hundreds of people confined in countries where cases are suspected or confirmed.
There are more concerns about the spread in parts of the world like Africa, where health systems are less developed and the detection and containment of cases is potentially problematic.
We do not rely on prayers, rather on proven methods, applied wherever necessary: identify potential cases with a questionnaire, then isolate them (treating them if necessary if they are very symptomatic), confirm the diagnosis using screening tests and then waiting for the infection to go away on its own. Despite some attempts, there is currently no specific treatment.
Most often, it is a respiratory support, which can go as far as intubation and putting on a ventilator, since the virus mainly attacks the lungs, like its cousin SARS in the early 2000s.
No vaccine is of course yet available. It will also take several years for the best teams, some Canadian, to achieve (perhaps) an effective vaccine, provided that the virus does not escape, as hepatitis C or HIV did before it. Unless the virus, confined, disappears from circulation, like SARS, and the need for the vaccine vanishes at the same time.
COVID-19, the disease
It should be remembered that COVID-19 is in fact caused by the “seventh born” of a family of viruses which has two nasty cousins (SARS and MERS) and four others rather harmless which are content to give common colds and infections.
We knew about SARS and MERS, which appeared in the news respectively in 2002 (first in China too) and in 2012 (especially in Saudi Arabia). They had caused public health alerts similar to COVID-19, which were carried out quite effectively. This is what we want.
SARS still killed about 800 people (including 43 in Canada, especially in the Toronto area), for 8,000 documented cases worldwide, which gives a mortality of nearly 10%, not trivial. In comparison, the flu kills only about 1 in 1,000 people, but because it is so widespread, a few hundred thousand people die of it each year.
As for MERS, the infection has been confined to less than 2,500 cases. Fortunately, since it caused 845 deaths, for an estimated death rate of 34%, much higher than SARS.
In general, the death rate of this type of virus can be both difficult to specify and easily overestimated, since not all cases are detected, minor infections often going under the “radar”. When the death rate is higher (as with MERS), the spread can be limited, with affected patients (unfortunately) too sick to transmit the virus to large numbers of people.
Mortality from COVID-19, still debated, is estimated to be somewhere between 0.2% (which would be close to that of influenza) and 2.8% (30 times higher than influenza). It therefore appears for the moment much lower than that of SARS and MERS. Among the 1,700 healthcare workers affected by the virus in China, mortality is said to be rather limited, around 0.3%.
But it’s not all about killing people. For a virus to spread, it also needs to be able to infect many people around each patient, which is more difficult when the disease is severe and quickly fatal.
In January, it was thought that the virus could be transmitted even before symptoms appeared. It appears that this hypothesis has not been confirmed and that COVID-19 is not so easy to transmit, requiring prolonged contact with a case with active symptoms.
By the way, what symptoms? They are primarily respiratory (cough, difficult breathing, fever, abnormalities on the chest x-ray). The virus is transmitted mainly through the airways or through direct contact with respiratory secretions.
What are the current impacts?
It is also through the enormous pressure on health resources that the virus can harm us. Thus, in Wuhan, where the first cases were observed, there are nearly 3,000 patients in municipal hospitals, in addition to thousands of others who are currently staying in hospitals that have been built in a few weeks.
However, these are not permanent hospitals, but rather a temporary solution allowing to face the wave of patients which would not have failed to paralyze – even to overwhelm – the health system of such cities where are concentrated in most cases.
A major and systemic risk that should not be overlooked, and which could have the same effect if the infection spreads to us, is the congestion of already saturated hospitals.
For healthcare staff, it is a question of avoiding contamination, which had caused several deaths in Canada at the time of SARS. The most recent information indicates that 1,700 healthcare workers have already been infected in China, which is very bad news. But only six deaths were seen in this group.
As with SARS, strict measures surrounding the identification and management of suspected and infected cases in our country are already in place, so that there is little risk of seeing a significant spread of the virus in Canada. Especially since we learned from the mistakes of SARS.
The guidelines were adapted as the nature of the cases was better understood. Thus, in all emergencies, people are asked questions as soon as they arrive, during the initial triage.
If the person has the symptoms mentioned and meets the criteria, they are considered potentially infected with COVID-19. A special approach is then immediately put in place: insulation in a negative pressure chamber (allowing all the air in the room to be directed towards filters that block the spread of the virus), protective measures (special masks, face shield, gown and masks) and in-depth assessment identifying positive cases.
The probability of escaping these filters is very low, so the risk of contracting the disease in us is almost zero. In Quebec, three cases are under observation (as of February 13). Currently, four hospitals are already designated in Quebec to receive patients whose diagnosis is confirmed.
And the rest?
What will happen next? No one can really answer that question right now. At least containment measures are known to be working and the spread outside China is limited, as the number of new cases decreases every day (without, however, taking into account the change in the method of counting this week).
Everyone is hoping that the containment measures will be enough to limit the “playground” of the virus, which could lead to the end of this epidemic, as with SARS. For more information and latest update about Corona Virous please, visit corona-teller.nl.