People finally realize that coronavirus 2019-nCoV/SARS-CoV-2 is not a flu, but a virus of a completely different nature ('analogies create blind spots', to quote Peckham in his commentary in The Lancet of 2 March 2020). This virus, like any virus, should be taken seriously. Realism has nothing to do with panic. Some people let themselves be soothed by trusting that everything will function properly and that it will end with a hiss. I am in favor of more people being critical. A critical attitude is different from unfounded panic.
What is evident in the media storm that blows over our country is the need of the population for transparency about the risks of the virus, the measures being taken to limit further spread and the seriousness of the situation. Reports that people who transmit symptoms and despite submitting a request are not tested, reports that people coming from risk areas are not restricted from having intensive contact with third parties and the fact that 'privacy' is used as an excuse. People don't need numbers and statistics made up to provide them with a false sense of safety. People need transparency, even if the number of cases might be a shock. It's patronizing to hide truths and laugh actual threats off. Mystery must give the impression that everything is under control, but a lack of transparency causes suspicion.
I will illustrate this with two examples. In the initial phase, the responsible authorities issued the message that people from risk areas are only contagious when they show symptoms such as a high fever. It was already clear at the time of reporting that infected people were already contagious before the onset of the first symptoms. Also, people were not checked if they reported a sore throat, while they were indeed infected and a sore throat is listed as one of the first symptoms of infection with 2019-nCoV as well. The RIVM cites fever as the main factor to report a suspected infection, while fever can occur up to 8 days later in 11.5% of seriously ill patients.
In this report, I will discuss the importance of limitation and prevention of 2019-nCoV and its L and S strains, the complications caused by 2019-nCoV and the transmission routes of coronaviruses. Lastly, I will discuss to what extent governments have acted too late upon the global spread. I base my reporting solely on empirical and clinical studies that have been published in scientific journals such as The Lancet, Nature Magazine and AAAS.
What is evident in the media storm that blows over our country is the need of the population for transparency about the risks of the virus, the measures being taken to limit further spread and the seriousness of the situation. Reports that people who transmit symptoms and despite submitting a request are not tested, reports that people coming from risk areas are not restricted from having intensive contact with third parties and the fact that 'privacy' is used as an excuse. People don't need numbers and statistics made up to provide them with a false sense of safety. People need transparency, even if the number of cases might be a shock. It's patronizing to hide truths and laugh actual threats off. Mystery must give the impression that everything is under control, but a lack of transparency causes suspicion.
I will illustrate this with two examples. In the initial phase, the responsible authorities issued the message that people from risk areas are only contagious when they show symptoms such as a high fever. It was already clear at the time of reporting that infected people were already contagious before the onset of the first symptoms. Also, people were not checked if they reported a sore throat, while they were indeed infected and a sore throat is listed as one of the first symptoms of infection with 2019-nCoV as well. The RIVM cites fever as the main factor to report a suspected infection, while fever can occur up to 8 days later in 11.5% of seriously ill patients.
In this report, I will discuss the importance of limitation and prevention of 2019-nCoV and its L and S strains, the complications caused by 2019-nCoV and the transmission routes of coronaviruses. Lastly, I will discuss to what extent governments have acted too late upon the global spread. I base my reporting solely on empirical and clinical studies that have been published in scientific journals such as The Lancet, Nature Magazine and AAAS.
Why is it so important to limit the spread of the virus?
First, there is currently no vaccine against coronaviruses. Secondly, the spread of viruses must be limited to prevent successful mutations as much as possible. Coronavirus 2019-nCoV is a loot to the strain of a precursor that, according to calculations, existed 65 years earlier. 2019-nCoV most likely has this precursor in common with bat coronavirus RaTG13 (Mining coronavirus genomes for clues to the outbreak's origins, AAAS, January 31, 2020). On March 3, 2020, it is known that an L and S variant of the corona virus are active (On the origin and continuing evolution of SARS-CoV-2, National Science Review, nwaa036, published on March 3, 2020).
Pathogenecity and transmissibility are intertwined. Substantial and consistent interruption of transmission from one person to another (R < 1) is key to control and eradication of 2019-nCoV (Pathogenecity and transmissibility of 2019-nCoV- A quick overview and comparison with other emerging viruses, Microbes and Infection, published online on 4 Februari 2020).
Complications of SARS-CoV-2
The extent of the worldwide influence of the active virus mutations cannot be estimated right now. It is clear that SARS-CoV-2 can cause serious complications. In a patient population with severe symptoms, damage to the organ functions occurs: in a control group, 67% had ARDS (Acute Respiratory Distress Syndrome), 15% kidney failure, 23% heart failure and 29% liver failure. X-rays of the group examined show lesions in the tissue of both lungs (Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study, The Lancet, published on 24 February 2020). Edema occurs at an early stage of ARDS, characterized by the presence of nucleoli in the vesicles.
Coronaviruses have neuroinvasive capacities. Like respiratory viruses in general, they can cause permanent damage to the central nervous system. Coronaviruses can lead to encephalitis via the blood-brain barrier, as accumulation of interleukin-6 increases the permeability of the blood-brain barrier. The rapid replication of the pathogens of SARS-CoV-2 is a risk factor for initiating overreaction of the human immune system, where viral meningitis can occur (Human Coronaviruses and other respiratory viruses: Underestimated opportunistic pathogens of the Central Nervous System ?, Viruses 2020, 12 (1), 14, published December 20, 2019). In a young patient group with CoV, a slight accumulation of IL-6, IL-8 and MCP-1 in the brain fluid was observed. MCP-1 is involved in initiating inflammatory responses in the brain (Coronavirus infections in the Central Nervous System and respiratory tract show distinct features in hospitalized children, Intervirology 2016, vol. 59, no. 3, published in February 2017).
Based on pathological examination of one case of ARDS, it is recommended to treat severe cases with corticosteroids and artificial respiration (Pathological findings or COVID-19 associated with acute respiratory distress syndrome, The Lancet, published on February 18, 2020). The downside to medical treatment is that liver damage can occur, in addition to the risk of liver damage due to coronavirus infection (Liver injury in COVID-19: management and challenges, The Lancet, published March 4, 2020). Data on previous corticosteroid treatments of lung disease (including Dexamethasone) caused by SARS-CoV and MERS-CoV do not provide conclusive information on the effectiveness of corticosteroids. Because the potential benefits do not outweigh the damage caused by corticosteroids, researchers do not recommend treatment with corticosteroids (Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury, The Lancet, vol. 395, issue 10223, P473-475, 15 February 2020).
What are the transmission routes for SARS-CoV-2?
Contamination with 2019-nCoV can occur through the eyes (2019-nCoV transmission through the ocular surface must not be ignored, The Lancet, vol. 395, issue 10224, PE39, February 22, 2020). Because only 1 in 5 people wash their hands sufficiently, there is a high risk of people getting infected as a result of poo getting into the mouth (Enteric involvement or coronaviruses: is faecal-oral transmission or SARS-CoV-2 possible? The Lancet Gastroenterology & Hepatology, published on February 19, 2020). Breathing drops and poop particles end up on surfaces. Coronaviruses can remain active on surfaces for up to 9 days (Persistence of coronaviruses on inanimate surfaces and their inactivation within biocidal agents, Journal of Hospital Infection, vol. 104 issue 3, March 2020). But there's another, less visible transmission route: that of the aerosol transmission. Tiny particles may reach the tract of the host. The airborne or aerosol transmission route was also a major contributor to the SARS-CoV-1 epidemic in 2003, as a tower in the Amoy Gardens in Hong Kong was discovered to be a SARS-transmitting housing complex due to faulty ventilation.
Have international governments acted too late? Yes: delayed detection and reporting and a lack of restrictions in the first phase have seriously damaged global prevention
It is always easy talking in hindsight, but that is not the case this time: beforehand it was clear that unnecessary risks would be taken by not acting directly, but waiting, relying on sheer hope instead of taking measures. Lessons had already been learned from the SARS and MERS epidemics.
Containment must be applied immediately to curb the spread of corona viruses. Early detection and reporting of 2019-nCoV cases was delayed, the public was not informed in time about the first phase of the outbreak (Early lessons from the frontline of the 2019-nCoV outbreak, The Lancet, vol. 395, issue 10225, P687, February 29, 2020). A lack of medical resources and hospital beds has contributed to the inability to curb the outbreak of the virus in the first phase.
During Chinese New Year, 5 million people from the Wuhan epicentre were able to travel to other countries and to other areas within China. Outside of China, traveling to high-risk areas, traveling people from high-risk provinces in China to other countries (including northern Italy), the Venetian Carnival, German and Dutch Carnival, and other massive occasions have contributed to the worldwide spread of the 2019 coronavirus. After it was announced that northern Italy and South Tyrol were risky areas, tourists were still allowed to travel to these areas and return to their home country. Governments should have acted at this crucial stage. Only rapid detection and isolation of infected persons, including those with mild symptoms, can limit the further spread of the virus. It is not appropriate for a government agency to advise people to remain silent, to refuse to test people who show symptoms of SARS-CoV-2 and to resort to ill advice such as 'do not shake hands'.
