Coronavirus outbreak: answers to the most asked questions

Since its outbreak in Wuhan, the coronavirus, termed as Covid-19 (earlier 2019-nCoV), has caused more than a thousand deaths and many more thousands of infected cases globally, the majority being in China.

Here’re answers to some of the most frequently asked questions on the coronavirus outbreak and all that you need to know about Covid-19.

Coronavirus is not a single virus, but a family of at least 23 related viruses, further subdivided into four groups. Till date, just six of the coronaviruses are known to infect humans, including the MERS-CoV and SARS-CoV. The new 2019-nCov is a new form of the coronavirus capable of infecting humans.

Covid-19 (Coronavirus disease-19) is the official name assigned to the novel coronavirus disease under commonly agreed guidelines between WHO, the World Organisation for Animal Health, and the Food and Agricultural Organisation of the UN. It was earlier being called 2019-nCoV.

The coronavirus infection was identified as a SARS-like virus around late-November 2019 in Wuhan, Hubei Province, China.

No, approximately 80% of the cases have occurred in Hubei province, while in many other provinces, very few cases are reported as is the case with other countries that’ve confirmed cases.

Coronaviruses are highly contagious and can spread from person to person. Some coronaviruses are found only in animals but may evolve to cause infection in humans. Such viruses are called zoonotic.

Coronaviruses normally cause mild to moderate upper respiratory tract infection. The symptoms are mostly similar to common flu such as headache, runny nose, cough, fever and sore throat. In some people with compromised immunity, infants, and elderly people, it can cause lower respiratory tract infections such as pneumonia and bronchitis.

One of the most severe complications in patients infected with the novel coronavirus (Covid-19) is pneumonia in both lungs.

Laboratory testing on respiratory specimens and serum of the patient are used by healthcare professionals for the diagnosis of coronavirus in humans.

The coronavirus is tested for by PCR, which was initially available in Atlanta, US, through CDC, but now has been made available globally. The CDC is shipping laboratory test kits for 2019-nCoV to global laboratories for detecting the virus.

The WHO has shipped 250,000 test kits to more than 159 reference laboratories globally to facilitate faster diagnosis and research, as of early-February.

Yes. The CDC developed a real-time Reverse Transcription-Polymerase Chain Reaction (rRT-PCR) test for the 2019-nCoV diagnosis, using respiratory and serum samples. An Emergency Use Authorization (EUA) package was submitted to the US Food and Drug Administration for the test by the CDC, which was approved on 4 February 2020.

The CDC’s rRT-PCR diagnostic test is being distributed to qualified domestic public health laboratories and to international public health partners through International Reagent Resource (IRR).

Coronavirus attacks the respiratory tract through the nasal passage and shows signs and symptoms similar to common flu after the incubation period of about three days. The incubation period is up to 14 days. A study by Chinese researchers led by Nan-Shan Zhong, an epidemiologist and pulmonologist who discovered the SARS coronavirus in 2003, however found that the incubation period can be up to 24 days.

R0 is a basic reproduction number that refers to a contagious individual who can infect other people when exposed to a susceptible population. It determines the infecting capability of the disease. The R0 for coronavirus is approximately 2.2, which is considered high for the disease. It is, however, not the only parameter to be considered to measure the intensity of an outbreak.

Similar to other respiratory infections, the most common way of coronavirus transmission is respiratory droplets, which are fluids particles that are generated by coughing and sneezing of an individual. Such droplets contain the virus present in the respiratory lining of an infected individual. These particles do not stay for long in air but in case of air-borne disease transmission, the virus particles remain in air for some time and can infect the other person sharing the space. It is still not clear whether coronavirus can be air-borne or not. CDC, therefore, recommends healthcare workers to use N95 respirator masks, while treating coronavirus patients.

The novel coronavirus (nCoV) is believed to be able to spread from animals to humans including dogs, cats, camel, bats, and cattle. The connection is, however, yet to be established completely.

Elderly people with underlying conditions are at the most risk of getting coronavirus infection. Many of those infected with the 2019-nCoV died due to multi-organ failure not directly because of the virus but due to the impact and shock that the virus caused on the body generally. Many patients can, therefore, survive if provided with adequate support and care.

No, WHO says, coronavirus can’t survive for very long on inanimate objects under variable temperature and route and, hence, people receiving posts and packages from China are not at risk of contracting the coronavirus.

Few cases of asymptomatic carriers have been reported.

The CDC has recommended to avoid travelling to People’s Republic of China. The US Department of State issued Level 4 travel advisory, which means advice against traveling to China.

Travellers arriving from China are undergoing health screening and will have additional health assessment in case of no signs and symptoms. In the US, for instance, they can enter only through one of the 11 specified airports, where the screening iswill be done by US Customs and Border Protection agents.

Public Health Authorities are screening suspected individuals with coronavirus infection regularly, in case of any symptom. They will be monitored for 14 days since last exposure, after which they will be considered risk-free.

In case of unavoidable travel to China, the CDC recommends to avoid contacting with sick people, plan your travel to China with healthcare professionals, avoid animal and animal products and markets, and wash your hands frequently with soap.

No specified treatment exists for coronavirus infection to date except in China, which recently approved the use of an anti viral drug called Favilavir. People may get better with proper rest and care. Symptomatic relief can be provided by over-the-counter (OTC) fever, cough, flu, and pain-relieving drugs and proper hydration of the body by sufficient intake of fluids.

Certain antiretroviral drugs are being studied for the potential treatment of the infection. Fapilavir, an antiviral drug, was recently approved for the treatment of coronavirus by China, following a clinical trial in 70 patients. Researchers are also working to develop vaccines to develop immunity against the coronavirus.

HIV drugs such as Kaletra and LOPIMUNE (lopinavir and ritonavir) that are approved protease inhibitors are being repurposed to potentially cure the 2019-nCoV infection.

Although wearing goggles can partially protect from the coronavirus reaching the eyes, it's not alone enough to prevent an infection.

The Covid-19 has claimed more than a thousand lives globally after its outbreak in Wuhan, China. The disease, although, can’t be termed as deadly based on the current death toll, the intensity may increase before a treatment is available.

Ebola virus disease was a global epidemic that emerged between 2013 and 2016. It has an average fatality rate of about 50%, whereas the fatality rate of the 2019-nCoV epidemic is less than 3%.

Ensuring proper protection is crucial for prevention from the disease, which includes minimising exposure by staying at home, wearing N95 respirator, washing hands with soap and water frequently, avoiding touching face and mouth with unwashed hands, avoiding crowds and public places, and wearing goggles.

It will depend on multiple factors including the R0 that determine how contagious is the virus, the incubation period of the virus, how far it has spread, whether air-borne transmission of the virus is possible, the frequency of asymptomatic carriers, the scenario of animal to human transmission, and how long the coronavirus vaccine development will take.

Approximately 80% of the reported Covid-19 cases have mild disease, 15% have severe disease, mostly pneumonia that requires hospitalisation, and between 3% and 5% will need intensive care.

The current mortality rate of the Covid-19 is approximately 2.35%.

The number of coronavirus-affected countries, as of 11 February 2020, are 26 including China.

The WHO is working closely with Chinese Government to address the coronavirus outbreak and, thus, slow down the spread across continents. The strategical and scientific advisory group is communicating the precautionary measures to people. WHO has released millions of dollars from its own contingency fund for the emergencies and is sending personal protective equipment (PPE) such as gloves, masks, respirators, and isolation gowns from its warehouses.

Currently, there are no proven therapeutics for coronavirus and the existing drugs are being tested for their activity against the virus and can be used off-label or for compassionate use or in clinical trial on higher regulatory and ethical standards. These drugs are also part of other protocols that are used for MERS-CoV, but they are not approved and are in research stage.

China is carrying out randomised clinical trials on Gilead's remdesivir and expects result shortly. China has also approved an antiviral drug named Fapilavir in February 2020 to treat coronavirus.

Current standard of care for coronavirus depends on the severity of the disease. Symptomatic treatment is being provided in mild cases. Cases with more severe condition require treatment with optimised supportive care such as oxygen therapy and close monitoring. For patients with severe infection, delivery of intensive care such as safe mechanical ventilation and resuscitation is indicated.

Fapilavir is the first antiretroviral drug approved for coronavirus treatment in China

No, coronaviruses belong to a large family of viruses, some of which may infect humans, while others only affect animals such as bats, dogs, and cats. The newly emerged Covid-19 is different from the previous MERS and SARS coronaviruses, but is believed to be genetically close to the 2003 SARS virus.

PUI is the person under investigation, who has signs and symptoms of fever and flu and has been to Wuhan or Hubei Province in the last 14 days or had contact with a person infected with Covid-19.

The first coronavirus case in China was confirmed in December 2019.

Coronavirus affects only few provinces in China, but the fear of spread and growing intensity has been affecting the country in a number of ways.

The first confirmed coronavirus case in Hong Kong was reported on 23 January 2020.

India's Ministry of Health & Family Welfare confirmed the first coronavirus case on 30 January 2020 in the state of Kerala.

The first novel coronavirus infection (Covid-19) in the US was confirmed in Washington on 21 January 2020.

Australia confirmed its first case of the Covid-19 on 25 January 2020, in Melbourne.

Japan reported its first confirmed coronavirus case on 16 January.

The UK reported confirmed coronavirus cases first on 31 January 2020.

Yes, multiple coronavirus cases have been reported in Thailand.

Thailand reported its first confirmed coronavirus case on 13 January 2020.

Thailand, like many other countries, could see few industries impacted due to the coronavirus outbreak. The government is, however, taking necessary measures to minimise the impact.

No vaccines have been approved for coronavirus as yet, while few are being studied for development.

The Thailand government is assuring tourists and travellers from all countries except China that it's safe to tour Thailand. The government is taking preventive measures to control spread and distributing masks to travellers.

Yes, Philippines reported its first confirmed coronavirus case on 30 January 2020.

The 2019 novel coronavirus outbreak (Covid-19) death toll crossed 1,300 on 13 February 2020 and is expected to rise further.

The risk of novel coronavirus infection depends on exposure. Close contact with infected people increases the disease risk.

Yes, according to Tan Chorh Chuan, Chief Health Scientist in Singapore, the likelihood of survival of coronavirus is more indoor than outdoor. People should, therefore, switch off air-conditioner and breathe in fresh air to reduce the risk of infection, advised Tan Chorh Chuan.

The countries with no testing capability send the samples to COVID-19 referral laboratories designated by World Health Organisation (WHO) for testing. For rapid and free-of-cost samples shipment, WHO is utilising Shipping Fund Project established by the Global Influenza Surveillance and Response System (GISRS).

No, according to a study performed in nine pregnant women in Wuhan. No case of vertical transmission of coronavirus from pregnant women in their third trimester to their foetus has been reported so far.

Pregnant women diagnosed with COVID-19 can deliver healthy babies without infection by taking proper isolation practices and care during and after childbirth, says Wei Zhang, associate professor of preventive medicine at Northwestern University Feinberg School of Medicine. The results may not be true for early-stage pregnancies, however, Wei Zhang adds.

No report on the effect of COVID-19 on breast milk is available currently. The UNICEF recommends coronavirus-infected mothers to breastfeed after consulting with healthcare providers to understand the unknown risks.

Precautions should be taken to reduce the risk of transmission from mother to infant during feeding through respiratory droplets and direct contact. UNICEF recommends the feeding mothers to wear a mask while feeding and wash hands before and after feedings. Care should also be taken to avoid spreading of infection indirectly through contaminated surfaces by regularly cleaning and disinfecting the surfaces. Mothers who are too ill are advised to express milk and feed the child through a clean cup or spoon rather than breast feeding.

The exact way in which the Covid-19 virus affects children is unknown. Reports of children being diagnosed with the disease, however, have emerged although no fatalities have been reported.
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