Covid-19: Global Corona Carnage

Within the worldwide apocalypse on account of Corona scare for the last over two months now, I had been wondering what would happen if my worst fears come true! No I am neither talking about commotion or pandemonium on account of the colossal plasma surrounding the Sun and other stars nor the spontaneous corona discharges naturally occurring in high-voltage systems, the Corona cross-platform for the mobile users or even the world fame Corona beers. Instead, this is about the Covid-19 disease with acute flu-like symptoms caused on account of the Corona group of viruses, which the World Health Organization (WHO) has declared as an outbreak of a global pandemic. When it started in China and spread in Italy, Iran and South Korea, I only wondered how long India could avoid it’s outbreak with few cases reported in January and February 2020. Finally, this week it’s signs and symptoms have spread touching the figure of 100 compelling the government to declare it a national disaster with many public services in the national capital Delhi and other places suspended to minimize social interaction and avoidable congregation of people.

Though the Indian government has been quite sensitive and alert since the threat reported in China and had issued advisory at national level as back as on 9 January 2020 for the prevention and symptomatic management of the disease, the virus has potentially a far greater risk and implication in India due to its vast population and rather weak and inadequate public health system. Besides, unlike the virtual lockdown imposed in China and some other smaller countries by virtue of their socio-political system, similar measures in India with high density population and diversity may have its own complexities and repercussions with sly negative impacts. Further, the health hazard on account of Covid-19 not only has its socio-political impact but also a potential to cause economic disaster. This is evident from the fact that during the last two months the Sensex is already down by 9,175 points with highest ever of 41,953 on 14 January to 32,778 on 12 March 2020. Similarly, the Indian Rupee too has hit its lifetime low 74.48 vis-à-vis US dollar by the same date.

Origin of Corona Virus and Covid-19

Corona viruses are actually a large family of viruses which can cause a host of diseases among the humans and animals. Some earlier commonly known Corona viruses among the humans caused illnesses like Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) mostly relating to respiratory infections usually with common cold to acute flu like symptoms. The recently discovered Corona virus in China causes the disease named Covid-19. Any virus is typically an infectious agent of non-cellular and non-living nature with a central core of nucleic acid encased by a protein coat called capsid. Their multiplication or reproduction ability is only on account of the nucleic acid core (genome) which is activated only inside a living host cell. Covid-19 is a highly infectious disease which was unknown until its outbreak in Wuhan, China in December 2019.

It was in late December 2019 that a bunch of pneumonia like cases on account of unknown causative agents were reported in Wuhan, Hubei Province of China. The most of initial cases had links to the Huanan Seafood Wholesale Market and, consequently, the virus was considered to have a zoonotic origin i.e. a disease primarily existed in animals and secondarily transmitted to humans. The virus that caused the outbreak was identified as SARS-CoV-2, a new virus closely related to such viruses found in bats. It is generally believed that the virus possibly originated in bats of the Rhinolophus genus. However, the same has not been conclusively established or proved so far. When in early January 2020, the virus started spreading in other Chinese provinces, Wuhan reported a complete lock-down from the rest of China. By the third week of January, more than six thousand people were reported with the corona symptoms.

Although as on 14 March 2020, China has reported maximum numbers of infected patients and casualties, it is very difficult to certify accuracy of these figures. Some leaked out reports that cannot be confirmed indicate a far grave situation than the reported one. This is because of the secrecy and rigid government control over the media and press whereby the external world will know only what the Chinese Communist government decides to share with other countries. The Google search engine and the global social media utilities Facebook, Twitter and Instagram are blocked for over a decade now by the Chinese government along with the thousands of other foreign websites, including major global news sources like The New York Times as also Chinese Wikipedia. Similarly, the popular messaging application WhatsApp and such other Apps like Telegram, Snapchat and Line too are not allowed. Accordingly, the response of the world community about Chinese handling of the epidemic too has been mixed with both criticism and praise so far.

Worldwide Coronage and Its Impact

Ever since first identified in Wuhan, Hubei, China in December 2019, the Covid-19 has spread globally and the outbreak has been endorsed by the WHO as a pandemic on 11 March 2020. As on date, over 156,766 confirmed cases with 5,839 deaths have been reported in about 145 countries and territories, with the major outbreaks in the mainland China, Italy, South Korea, and Iran. The aforesaid is a dynamic information changing on daily basis. While spread in more areas and reporting of fresh cases have been drastically controlled in China by now, the Western Europe appears to have become the current epicenter for the pandemic. The worst affected nations after China are Italy, Iran, South Korea, Spain, Germany, France and USA in the same order, both in terms of the total number, active cases and number of casualties.

Although the first person reported ill on account of new Corona virus in Wuhan of Hubei province was on 17 November 2019, China officially issued a public memoramdum on the outbreak on 31 December and the WHO was also formally informed on the same day. By first week of January 2020, the Chinese Government started prevention and control measures of Covid-19 with quarantine announced by 23 January by blocking Wuhan for in and out travel. Several restrictions were imposed on travel by flights, trains, metros, public buses as also on large gatherings and group tours. Many other Chinese cities too had undergone similar restrictions. Universities and schools were closed and remote working measures were put in force in many Chinese regions. A much publicized specialty hospital with 1,000 bed facility was constructed with pre-fabricated material in a record time of two weeks and many other commensurate measures were also taken. With the result, the maximum number of cases 67,760 with 3,024 deaths were contained in Hubei province with other states remaining least affected. So far, total number of COVID-19 disease cases in China is 80,844, with 66,913 cases recovered, 3,199 reported deaths and some 10,732 active cases.

The position of China and South Korea appears to be stable but the Corona coronage is rapidly gripping the Western Europe. Besides China, two other worst affected countries from Covid-19 disease are Italy and Iran. In Italy, initially two Chinese tourists tested positive with the virus on 31 January 2020, following which the Italian government suspended all flights to and from China and declared a state of emergency. Following the death tally reaching near 100, the Italian government ordered the closure of all schools and universities nationwide on 4 March and suspended all major sporting events and nearly all commercial activity except supermarkets and pharmacies by the following week with quarantine expanded to entire Italy. So far, Italy has total reported 21,157 cases with 1,441 deaths and 17,750 active cases. Iran is yet another country facing serious crisis on account of this disease, which also gained notoriety as the centre of the spread of virus after China. So far, Iran has reported 12,729 cases with 611 deaths and 7,779 active cases.

The number of Corona cases is showing steep increase in West European countries with Italy, Germany, France, Spain and Switzerland being most affected. The first death on account of this disease in the United States was reported on 29 February in Washington, following which the Washington governor declared a state of emergency. Two other states, California and Florida declared a state of emergency in early March. Major US corporations like Amazon, Facebook, Twitter and Goldman Sachs etc. have imposed employee travel restrictions and have cancelled scheduled conferences/meets. Some companies, such as Microsoft, have mandated employees to work from home. Many major US sports leagues stand cancelled; some universities, colleges and schools have also been closed. American President announced suspension of travel from Europe (excluding UK) for a month on 11 March and only two days later on 13 March, he declared a national emergency to combat the viral outbreak. Till date, 2,995 cases have been reported in USA with 60 deaths and 2,879 active disease patients.

The focus of Corona carnage appears to have shifted from China to Western Europe and US now. The position of nine worst affected countries globally as also India on date on account of the Corona pandemic is indicated in the following table*.

* https://www.worldometers.info/coronavirus/#countries
  https://en.wikipedia.org/wiki/2019%E2%80%9320_coronavirus_pandemic

Position of Covid-19 in India

So far the virus has been largely contained due to proactive measures and smart response of the Indian government ever since the reports of the outbreak from Wuhan, China emerged in January 2020. However, with the rapid spread of virus across the globe and WHO formally declaring the disease as a pandemic, the government has virtually quarantined the country from the rest of the world even without formally declaring a national emergency. Except for the diplomatic/official/UN-international organizations/employment and project visas, all visas for the international travel have been suspended till 15 April 2020. Even the visa-free travel facility to Overseas Citizens of India has been held in abeyance for the same period. All in-coming travellers including Indians from China, Italy, Iran, South Korea, France, Germany and Spain will be quarantined for a minimum period of 14 days. Similarly, international traffic through land borders has been restricted to designated posts with robust screening facilities.

Public health being a concurrent list subject, the state governments have also taken simultaneous action to fight and contain the Corona virus. The schools and colleges in many states have been closed in many states up to 31st March 2020. Public gatherings, cinema halls, gyms, swimming pools and public parks have been closed at many places. Big sports events like the popular cricket Indian Premier League (IPL) scheduled from 25th March has been postponed to 15th April 2020 and ongoing Indo-South Africa cricket series cancelled. So far, the country has airlifted about a fourteen hundred Indians stranded abroad and over ten lakhs people have been screened for the virus. India is also only fifth country to isolate the Corona virus in lab that will facilitate her to develop necessary vaccine and medicines for the COVID-19 disease in future. To put it in a nutshell, the government and public health authorities have responded with necessary speed, scale and determination to the threat posed by COVID-19 with a view to control the impact of cases of foreign origin and restrict the localized spread.

According to the Indian Health Minister, effective measures are already put in place at entry points like airports, seaports and international border crossings to ensure screening and stringent contact surveillance of all incoming passengers. Ever since the outbreak was reported in Wuhan, the government started preparing for a massive capacity building exercise in epidemiology, surveillance, laboratory support, clinical management, non-pharmaceutical interventions, infection prevention and risk communication. Apart from critical care facilities, a large number of isolation beds and supplies have been catered in tertiary facilities across India. About 17,500 isolation beds and some 66 testing labs been put in place. Besides a massive SMS campaign, the Dos and Don’ts are being played as pre-call tune to educate people. The network of the National Disaster Management Authority too has been activated to increase awareness and utilize their services on as required basis. So far about 100 Corona virus cases with 2 deaths of elderly patients have been detected with the majority of cases reported from the states of Kerala, Maharashtra and Uttar Pradesh.

Symptoms of Covid-19 and How It Spreads

According to information released by the WHO, the most common symptoms of COVID-19 are fever, fatigue and dry cough while some patients may report headache, pain in muscles and joints, shortness of breath, nasal congestion, runny nose, sore throat, chill, nausea/vomiting, and even diarrhea. The acute symptoms may include high fever, coughing up blood, decreased white blood cells and occasional kidney failure. The incubation period ranges from 1-14 days, and most commonly around five days. This is the time between catching infection of the virus to showing up of the symptoms of the disease. The aforesaid symptoms are usually mild to severe in different people. Few people become infected but may neither develop any symptoms nor feel unwell but majority others (say about 80%) show usual flu like symptoms and recover from the disease without requiring any special attention and treatment. Roughly, around 14-15% suffering with Covid-19 becomes seriously ill and inter alia develop difficulty in breathing needing isolation and special care.

A relatively small percentage of people who show severe symptoms of the disease and run a greater risk of sufferance and even death are those who are already in a poor health with a weak immune system. For the same reason, the older people are more prone to disease and those with prior medical problems like high blood pressure, heart problems or diabetes, run the greater risk of developing serious illness. People with constant fever, cough and difficulty in breathing must seek urgent medical attention and treatment. Incidentally, unlike many other viral and micro-organism based illnesses, the COVID-19 does not require a vector; instead, people catch Corona virus infection from other known or unknown patients through contact. The virus spreads from person to person through small droplets from the nose or mouth which fan out when a person with the Corona infection coughs, sneezes or exhales.

These droplets land on objects and surfaces such as hands, clothes and other open surfaces around the infected person. Other people catch COVID-19 by touching the objects or surfaces followed by touching own eyes, nose or mouth. Besides, people can also catch virus if they breathe in droplets from a person with COVID-19 who coughs out or exhales droplets. For this reason, the WHO has recommended that a healthy person must stay away at least one meter from a sick person. There are apprehensions and fears among the people about the mode of the transmission of the disease particularly through air but the studies till date suggest that the virus that causes COVID-19 is largely transmitted through contact with respiratory droplets rather than through the air. Also the risk of catching infection from a person without Covid-19 symptoms is almost negligible but it is possible to catch it just from a mild cough from the person who may not feel ill but is infected.

Mechanism of Virus Multiplication

The coronaviruses are so named due to corona like spikes on its sheath enveloped in a bubble of lipid molecules. After the virus enters the human body through the nose, mouth or eyes, it gets attached with the healthy cells of the human windpipe. The oily membrane of the virus fused with the healthy cell membrane pushing snippets of the viral genetic material Ribonucleic Acid (RNA) in the latter. The Corona genome is small comprising of just about thirty thousand genetic codes compared to human cell genome of over three billion codes. Now the infected human cell, pitted against its own immune system, starts decoding the viral genome and making new spikes and other proteins to assemble new copies of virus. Each cell is capable of producing millions of new copies of virus before it disintegrates and dies. New viruses similarly keep on infecting nearby cells with similar cycle leading virus droplets ready to escape lungs.

As the immune system fights to clear the infection, the fever and other related symptoms grow, and sometime it even overreacts attacking own cells. In the process, the lungs become obstructed with fluid and dying cells making breathing difficult. In few cases, this situation may lead to an acute respiratory distress syndrome culminating in death of the patient. The coughing and sneezing releases virus laden droplets to nearby surfaces including human beings, if any, which remain active for several hours to days. Hence the need for infected people to wear a mask and those engaged in their care. Other than the genome, the viruses has no other feature of a living being, hence antibiotics do not work against them. Only specific anti-viral drugs may disrupt the viral proteins, neutralize and stop its multiplication. 

Precautions and Preventive Measures

Most of the countries where the virus has made inroads have already taken the threat seriously with the necessary preventive and symptomatic management measures. Therefore, every citizen should endeavor to stay aware and updated as also educate others with the current information on the disease as advised by their national and local public health authorities. In addition, as the WHO has declared it a global pandemic, they are also regularly updating with useful information available through their website. People could minimize their chances of being infected or spreading the Corona virus by taking some simple precautionary measures:

• Hands should be regularly and thoroughly cleaned with an alcohol based sanitizer or washed with soap and water. This helps in neutralizing and removing viruses that may be present on hands.
   
• As the virus enters the body through eyes, nose and mouth, one should avoid touching them with hands which may be unknowingly contaminated.
   
• The WHO has advised that at least 1 metre (a little over 3 feet) distance should be maintained with everyone who is coughing or sneezing. This is because when someone coughs or sneezes, small jets of liquid droplets come out which might contain virus. A person too close is likely to breathe in these infected droplets if the other person has the disease.
   
• As a healthy practice of a good hygiene, one should cover his mouth and nose with the flat of the hand or a tissue while coughing and sneezing and the used tissue should be disposed of to protect other people around.
   
• A person who is unwell with any of the suggested symptoms must stay home with adequate rest. In the event of fever, cough and difficulty in breathing, medical assistance may be sought and such directions scrupulously followed. Necessary helplines have already been notified by the most governments, hence the health care provider would guide a person with necessary information and advice including the nearest health facility.
   
• It’s advisable to avoid public exposure till the precautionary and preventive measures notified by the national and local health authorities are in operation. This will protect the person and help preventing spread of viruses or other infections. Such precautions are especially relevant for people in the old age and those with diabetes, heart and lung disease.
   
• People who have recently visited an area where the disease is prevalent or living in that area must self-isolate by staying home for about two weeks and seek medical assistance if feeling unwell even with mild symptoms like headache/muscle or joints pain, low fever and runny nose.
   
• According to WHO, a mask is necessary only for those who are ill with COVID-19 or those looking after someone ill; for others, it is a sheer waste. In other words, masks should be used by the health workers, caretakers, and people with respiratory symptoms such as fever and cough. Hence if someone still wants it as an abundant precaution, he (or she) may use it at crowded places rather than routinely wearing it.
   
• Although some suggestions and fear emerged from the Chinese experience, any firm possible animal sources of COVID-19 have not yet been established. However, in countries experiencing the spread of disease the WHO has advised avoiding visit to animal markets, particularly direct contact with animals and surfaces in contact with animals for personal safety and protection. Similar advisory also exists for handling of undercooked or raw meat, milk and animal organs with care.

Treatment and Cure

As already indicated earlier, the impact of this strain of Corona virus infection is mild in majority cases and it causes serious illness needing hospital care in only about 1:6 ratio. Hence it is important that preventive measures are scrupulously followed as also the government’s restrictions on travel, movement and gatherings and advice affected by the health authorities are adhered to. While some allopathic, traditional and home remedies may be useful for the symptomatic management of COVID-19, so far there is no established medicine that can conclusively prevent or cure the disease. The WHO has not recommended self-medication with any medicines, including antibiotics, as a prevention measure or cure for the disease. Since the outbreak of the epidemic, many ongoing clinical trials have commenced including both western and traditional medicines but any conclusive findings are not available as yet.

People with serious symptoms are needed to be hospitalized. Although any vaccine or specific medicine has not arrived, yet the symptomatic and supportive care in hospitals has been found effective and successful in most of the cases. Most people have many misconceptions and apprehensions about the use and effectiveness of antibiotics. The fact is the antibiotics do not work against viral infections and they are effective only in bacterial infections. Hence antibiotics should neither be used for prevention nor cure of the Corona infection. As the elderly people and persons with pre-medical conditions are more prone to acute illness, they and their families need to take special care for the prevention as well as treatment. In India, the Ministry of Health and Family Welfare had issued an advisory some time back inter alia recommending use of some Ayurvedic, Unani/Homeopathic medicines, apart from the personal hygiene, for the symptomatic management of the disease; however, such medicines should be taken only with prior consultation of the medical practitioner in that discipline.

Conclusion

In the context of the Covid-19 global outbreak, at one end there is a country like India which has quietly prepared to fight all possible exigencies due to the virus since its outbreak reported in Wuhan, China in January 2020 so much so that even a senior leader and bitter critic from the main rival political party is on record to appreciate measures taken by the Modi government; on the other end there is world’s most powerful country USA which was almost caught unprepared and the President had to declare it a national emergency now. Some others have started blame game; the reasons are largely political and not very difficult to fathom or explain: Earlier, American President had called the Corona as “foreign virus” blaming China for engineering the outbreak and the European Union for their failure to spread it to the US. In retaliation, the Chinese media and diplomatic sources too actively propagated the idea that the virus originated in US and their Army implanted it in Wuhan. Similarly, some Arab countries are attaching faults with Iran for inaction too long while Iran is passing buck on US sanctions for its miserable state.

Portraying serious domestic threats like spread of coronavirus to external agencies are not going to help nations in anyway. While China’s initial secretiveness about the disease is indeed deplorable, her subsequent success in isolating the virus genome and sharing information would help WHO and other countries with testing kits and further research to develop a vaccine and effective medicines. In fact, coronaviruses were responsible for the Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) too that occurred in the past decades and were far more deadly with casualty rate of 9.6% and 36%, respectively. The Wuhan virus is just another strain of the well-known coronaviruses with a rather low fatality rate of 3.7% but a high potential of spreading fast. Actually more than loss of human life, the real threat on account of the global Corona crisis seems to be an imminent economic disaster leading to 2008-09 like recession, the way share markets are crashing world over including India, and business activities including tourism have been hampered with cancellation and closure of travel, gatherings and establishments following the Corona scare.

Fear is the deadliest enemy of man. In the age of information technology and social media bloom, the misinformation travels hundreds time faster than any virus and the majority people are addicted to quickly share any message that is spicy and scary. In the case of Covid-19 too, the major fear and damage has been done by the barrage of cheap and ill-informed messages and the WHO has rightly called it “infodemic”. In fact, data available so far suggest that the global mortality rate of 3.7% due to Covid-19 is on account of high number of deaths (5.8%) in Wuhan, else it would be much less in other countries including remaining Chinese states and most people died are in the elderly age group with weak immune system and/or previous history of heart, lung or kidney disease. Like many other epidemics and disasters in the past, the man will undoubtedly win and survive the Covid-19, even if we call it a holocaust. So there is no need to fear or panic but to face the threat like a brave-heart with due precaution and care.

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Dr. Jaipal Singh

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