- Published in the first issue of E-magazine by Health Junction (M) Sdn Bhd on the 1st of April 2020
- Article was written on 21st March 2020
Explosions thundered across the Klang Valley. Bursts of coloured flame ripped through the air just outside my apartment window, ending in a flowery shower of light. My husband and I sipped coffee as our phones vibrated silently in a corner - New Year 2020 greetings creeping in.
As a new decade dawned, something else was creeping deep in the heart of China’s Hubei Province - a group of people developed a type of pneumonia (lung infection) that did not respond to usual treatment. Initially they were found to be linked to the Seafood and Live Animal Market in Wuhan - suggesting it came from animals -but within weeks, the new disease had spread between humans.
Thousands in Wuhan - healthcare staff included - fell to the new disease, which today has spread to over 275,000 people in 185 countries, and moved - like the Mongol Conquerors of old - from China to Europe, killing more than 11,000 people along the way.
As couples around the globe prepared to celebrate Valentine’s Day, the World Health Organisation (WHO) named the new agent of fear - COVID-19. Within a month, the WHO Director General was declaring COVID-19 a global pandemic.
Amid memories of panic buying, the Movement Control Order that started on March 18 and the anticipation of the army swooping in to assist the police tomorrow, fear is widespread among our people. When he took the White House before the second World War, Franklin D Roosevelt said that ‘the only thing to fear is fear itself’.
And so I am here to shine a light on COVID-19 - not to pacify - but to inform, for from light comes hope.
COronaVIrus Disease - 2019 (COVID-19) is the name of the infection caused by a new or novel coronavirus, SARS-CoV-2.
Coronaviruses are microscopic particles shaped like a sphere with genetic material (the stuff that helps the virus to grow more virus) in the centre, surrounded by a protein envelope that protects the virus. Spiky proteins on the envelope give the coronavirus the appearance of a crown (Corona is crown in Latin).
Coronaviruses-as a group - have caused mild infections in humans and animals for years, ranging from gastrointestinal (bowel) infections to respiratory diseases as mild as the common cold - to severe pneumonia (lung infection).
Image courtesy of observerbd.com
Most coronavirus infections are mild. Some - including SARS CoV (Severe Acute Respiratory Syndrome Coronavirus) in the early 2000s and MERS CoV (Middle East Respiratory Syndrome Coronavirus) in 2012 - however have been deadly.
SARS and MERS CoV - although deadly - were limited in their geographic distribution. They did not spread as far as COVID-19 - which the WHO classifies as a pandemic.
Different ways diseases spread:
Endemic diseases (like Dengue fever in some parts of Malaysia) consistently occur at a predictable rate.
Outbreaks are when there is a sudden rise in the number of infections (for e.g. Leptospirosis in Kelantan during the bad floods in 2014).
Epidemics are outbreaks that spread to a larger areas (much like COVID-19 before March 11 - when it achieved pandemic status)
A Pandemic is a disease that spreads nearly all over the world, crossing international boundaries and affecting large numbers of people.
Some common questions I have been asked are :
Q : Where did the virus come from?
A: Coronaviruses circulate in a range of animals - sometimes these viruses can make a jump from animals to humans. This is called a spillover and it is sometimes due to mutations (sudden changes in the genes) in the virus, and increased contact between humans and the animals that carry the virus.
For example, MERS CoV was originally from camels - SARS CoV from civet cats. There is plenty of speculation, but animal reservoir of the COVID-19 has not yet been confirmed - so protect yourself by avoiding direct contact with animals and surfaces in contact with animals if you visit a live animal market. Handle raw meat or milk with care to avoid contamination of uncooked foods and avoid consuming raw or undercooked animal products.
Q: Can a person get infected with COVID-19 from a pet?
A: There has been one report of a dog being infected with SARS-CoV-2 in Hong Kong, but- to date- there is no evidence that a dog, cat or any pet can transmit COVID-19. There are feline and canine Coronaviruses, but these do not spread to people.
COVID-19 is mainly spread through droplets produced when an infected person coughs, sneezes, or speaks. To protect yourself, wash you hands regularly and practice physical distancing i.e.Be at least 1.5 meters away from other people in social situations.
(The WHO calls it physical distancing because with modern technology, we can interact closely through social media etc despite being physically distant)
Q: What are the symptoms of COVID-19?
A: Symptoms can range from mild (fever, cough, sore throat) to severe (shortness of breath). Severe cases have developed lung fibrosis (hardening of the lungs) and kidney failure which led to death.
The worldwide death rate from COVID-19 is between 3-4%, but some countries (like Italy) has seen over 8% of people with COVID-19 die.
Some infected people don’t develop any symptoms and feel normal- this is why physical distancing is important even though we may not feel sick.
About 80% of those infected will recover without any special treatment. One out of every six people with COVID-19 becomes seriously ill and develops difficulty breathing - for now it
seems as if people aged over 65 years, and those with medical conditions like high blood pressure, heart problems, diabetes, lung disease and immunocompromised states eg. cancer are more likely to develop serious illness.
This may change in the future, with younger, and healthier people becoming seriously ill. Health-care providers (HCPs) are also at risk because of higher exposure to the virus.
Q: Are there any red flags to know when I should see a doctor immediately?
We are still learning about COVID-19 every day. The alarm bell signs of course, are sudden breathing difficulties, high spiking fever and severe weakness. Those are clear red flags.
If you have recurrent symptoms after a period of apparent recovery, (If you are unwell, start to recover, and then the symptoms start again all of the sudden ) that could be a cause for concern.
COVID-19 symptoms:
Fever
Tiredness
Dry Cough
Aches & pains
Nasal congestion (blocked nose)
Runny nose
Sore throat
Diarrhoea
These symptoms are usually mild and begin gradually Q: How does the disease spread?
A: Medically, it is known as droplet spread.
Someone who is infected with COVID-19 coughs, sneezes, or even just talks or breathes out, creating virus filled droplets (from the nose or mouth). These droplets come into contact with us (usually when our hands touch a surface and we then unthinkingly touch our faces).
We know that the SARS-CoV-2 virus can remain on surfaces for days, during which time, anyone who touches those surfaces can possibly infect themselves. We mentioned it before in the last question, but it’s worth repeating: Even someone who doesn’t feel sick or has minimal symptoms can spread the virus and is potentially contagious.
Although we are healthy, we should behave as if we are a significant risk to elderly family members/ friends, and those with medical conditions. Provide a protected space for vulnerable household members and have only one person care for sick family members.
Q: How long does the virus survives on surfaces?
A: Studies are still being done. It may be able to survive on surfaces for a few hours up to several days.Different materials (e.g. plastic, metal etc) and differing surface temperatures and humidity may affect the ability of the virus to survive, but the general rule is to clean surfaces that may be infected with a simple disinfectant, wash your hands with soap and water regularly and avoid touching your eyes, mouth, or nose.
Disinfecting surfaces should be a constant process. We touch our smartphones more than any other surface, so it’s vital to disinfect our phones regularly, otherwise- even though we wash our hands - our hands get contaminated each time we touch our phones. Other commonly contaminated objects are door handles, wallets and keys, and money. Thank goodness for electronic payments and E-Wallets in these times.
Q: Is it dangerous to receive packages from any area where COVID-19 has been reported?
A: No. The SARS-CoV-2 virus cannot survive for a long time outside a host, so the delivery process and exposure of the parcel means the likelihood of getting an infection from the package is low. However, you may catch the infection if the person who passes you the parcel is infected - if both of you don’t practice the recommended hand or cough hygiene.
Q: What is the incubation period of COVID-19?
A: The “incubation period” is the period between the time the virus enters your body and the start of symptoms of the disease. It’s important because it allows us to decide how long the quarantine period should be, and also how long to monitor people for possible infection. COVID-19 has an incubation period ranging from 1-14 days, most commonly around 5 days. When the virus gets into your body, it needs to grow into a significant number (of virus particles) inside you before you start to feel unwell.
During the time that the virus has not yet reached levels that make you feel sick, you can still be contagious.
Q: Should I be tested for the of coronavirus?
A: If a patient comes to me with fever, dry cough, and tiredness, i will need to determine how severe her symptoms are, check her temperature, and ask about recent travel and known contact with a positive COVID-19 patient.
Not every person with a respiratory infection has COVID-19, so we need to be judicious about who gets tested. Part of the issue now is the lack of testing facilities, so they need to be saved for those that need them the most.
If you are a healthy person you don’t need a test.
Q: How is the COVID-19 test done (the variant of Polymerase Chain Reaction)?
A: The test involves taking a throat swab (a small cotton bud like stick is touched to the back of your throat (inside your mouth) and then processed chemically in a tube to strip the genetic material of the virus. In the lab, your throat sample is divided into two vials - a control, and an actual test to see if the SARS-CoV-2 virus is present using a Reverse Transcriptase Polymerase Chain Reaction.
It’s a good test it has a low false negative rate (around 3%).
This means it is accurate, as only 3% of people who are really positive for COVID-19 will have tests that wrongly say negative. Because this test still takes 1-2 days, scientists are developing faster ‘rapid’ tests - but they are not yet as accurate and still being tested. So far, any rapid COVID-19 tests you might hear about online have not been fully tested.
If you use them, and the test wrongly shows negative, but you actually have the infection, you will still be spreading the disease to those around you without knowing it- which is terribly dangerous.
Q: How do we prevent the transmission of the virus?
A: Standard hygiene practices have been recommended to protect against the spread of the infection. Cover your mouth and nose when sneezing or coughing with a flexed elbow or tissue ; avoid close contact with those who are unwell, use masks and personal protective equipment correctly (especially in health care providers); wash your hands regularly with soap and water, or sanitise them with an alcohol-based hand rub; create new habits and reminders to NOT touch your face, and disinfect surfaces regularly.
The basic rule is to stay home (especially if you are feeling unwell), but seek medical attention early if you have a high fever, cough and breathing difficulties. Always be honest with your health-care provider about your travel and contact history.
__________
As COVID-19 spreads, so does misinformation, fear and panic. During a pandemic, unnecessarily visiting local hospitals drains resources when doctors and nurses really need to focus on the seriously ill.
‘Pandemic’ sounds a lot like ‘panic’, so it’s not surprising that’s what many people do. During the 2009 H1N1 pandemic, basic strategies like behaviour changes, keeping a distance from one another, avoiding handshakes and hand-washing saved the day.
Dr. Robert Redfield, the director of the Center for Disease Control and Prevention (CDC) says the SARS-CoV-2 virus will probably not go away. Eventually, it may find a foothold in our community and it may start to behave like a seasonal flu. In the meantime, what we need during a public health crisis is to be calm and process the information we have.
Instead of social media, rely on credible sources like the CDC or WHO websites (which are updated daily) for guidance.
Scientists around the world are working on creating a vaccine for the SARS-CoV-2 virus, but - aside from a miracle -this is not likely to be ready within the next 18 months. Vaccines go through extensive research and development - including animal and human tests- before they can be widely used.
In recent weeks, China saw the largest quarantine world history - which helped reduce the spread. COVID-19 is extremely infectious- each infected person can spread the virus to 2 or 3 people. Once 1% of the population of a country gets infected, spread becomes explosive.
Some Malaysians complain that the Movement Control Order is an over-reaction. If our number of infected patients continues to rise, there will come a day when hospitals will simply not have enough life-support equipment to save lives. Terrible decisions will have to be made - like they are in Italy as I write this. Less than a month ago, people were going about freely in Italy. Now, as the country with the most COVID-19 deaths in the world, Italy is in a total lockdown.
None of us has the wisdom to decide who should be given a chance to live, and who must die. Only God should make these decisions, and yet- when we don’t have the ability to treat everyone - these high pressure decisions fall into the hands of doctors, and it breaks our hearts - because we know it didn’t have to be like this. It could have been prevented.
To those who ask if a lockdown is really effective, the answer is yes - we have learned that much from Wuhan and China.
There is good news - 84000 people with COVID-19 are now free of the virus. The city of Wuhan, where the initial outbreak started has seen no new cases since March 18.The virus is on the decline in some areas - people have recovered.
Our aim now should be to reduce spread as much as possible (which has gained fame as #flattenthecurve. It simply means we need to reduce the numbers of people infected). This buys precious time for hospitals to get prepared for more patients and for our country to gather enough resources to fight COVID-19. There’s only one way to do this - our behaviour has to change.
Times of crisis come with a silver lining - we have an opportunity for all of humanity to work together, and to grow into the light of the future. Let’s do it.
“COVID-19 is taking so much from us, but it is also giving us something special - the opportunity to come together as one humanity, to work together, to learn together, to grow together.”
Tedros Adhanom Ghebreyesus Director General , World Health Organisation 20 March 2020
Citations:
1. Coronavirus disease (COVID-2019) situation reports. Geneva: World Health Organisation, 2020 (https://www.who.int/emergencies/diseases/novel-coronavirus-2019/ situation-reports/)
2. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1 -Van Doremalen, Bushmaker, Morris March 17, 2020, at NEJM.org.
3. Presumed asymptomatic carrier transmission of COVID-19. Bai Y, Yao L, Wei T, et al. JAMA 2020 February 21 (Epub ahead of print) https://jamanetwork.com/journals/jama/fullarticle/ 2762028
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