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A sober, fact-based piece on the coronavirus threat

THANK God for social media, or I wouldn’t have chanced upon the following sober, knowledgeable and concise piece posted in Facebook on the 2019 novel coronavirus (2019-nCoV) threat,.

Well-researched and written, it beats any article or bulletin here and abroad I’ve read in informing the layman what the 2019-nCoV novel coronavirus is, and the threat it poses. It’s not that usual for a busy physician to write on a scientific topic that makes it understandable and concise enough for a busy layman.

The author is Bien Manlutac, an internist at prestigious hospitals in Manila. He should be the next health secretary.

Because of the topic’s extreme relevance at this time I am devoting this column’s space to his Facebook piece, which was entitled, “Should we push the panic button on the 2019-nCoV threat in the Philippines?”

Manlutac piece
“I am sharing this as an unsolicited advice based on my research from very credible, updated sources as of Jan. 31, 2020. For disclosure, I am an internist-nephrologist with 22 years of clinical experience as a physician, but not an infectious disease specialist, so please take my advice with that grain of salt and keep yourself updated as new information and discoveries come along. To those with more correct and new data, please supply me with such so that we can relay as much useful news to the public as necessary and defuse unwarranted panic.

The 2019-nCoV was discovered in 2019 from an outbreak of mostly mild to sometimes severe respiratory diseases in Wuhan, China, hence the designation “2019” and “n” for novel or new. It belongs to the family of coronavirus, one of about seven known, including those that cause the common colds, flu and the deadlier severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), to infect animals and humans.

The medical world does not know a ton about it yet but scientists are working on the new phenomenon that now surprisingly has become newsworthy because precisely it was not known before and new, and projected as a seemingly major health threat to humans by media.

The 2019-nCoV are fairly common in many species, including cats, cattle, camels, civets and bats but the Wuhan (market) experience has recently suggested that the virus has evolved and had caused animal-to- human transmission and infection resulting in clinical disease. Person-to-person transmission has since been the major source of infection.

Once a person gets infected, he can spread the virus mainly through aerosolized respiratory droplets when he sneezes or coughs out the virus, much in the same way as the common flu, SARS and MERS are transmitted.

Theoretically, the main route of infection is through the respiratory route meaning by inhaling the virus, but as discovered can be contracted through direct mucosal contact from exposed bodily parts or contaminated sources but apparently less likely from clothing and objects.

There is no robust data yet as to how long the virus can survive outside of the body and become infective but initial studies report it can only survive for less than six hours, even less in warm conditions. It is also not known yet how soon one can get infected but analysis of confirmed cases who were with close contacts of infected persons suggests that one can contract it from two to14 days from an infected person, whether symptomatic or not, who is sneezing or coughing from 3 to 6 feet away.

The World Health Organization (WHO) estimated the “R0 (R-nought)” of the new virus at between 1.4 to 2.5, meaning on average 1 sick person would be likely to infect 1.4 to 2.5 persons. In comparison, it pales in transmissibility to the measles virus, which is highly contagious with a R0 of 12 to 18 unprotected persons.

So, what are your chances of having been exposed or will be exposed to an infected person? As of the time of writing, available health department data says there are 29 patients under investigation, meaning suspected of having the virus — (1 Eastern Visayas, 4 Central Visayas, 3 Western Visayas, 1 MiMaRoPa, 1 Northern Mindanao,1 Davao, and 18 NCR) — and only 1 confirmed case.

The woman from Wuhan who came to the Philippines last January 25 via Hong Kong went to San Lazaro Hospital with a mild cough and at present is asymptomatic. Of the 29 patients under investigation, one has died but the cause of death is unknown yet. There are sporadic cases in Asia, Australia, Europe and US but majority of the 7,700 plus cases are in Wuhan or have come from that area or got exposed to patients with the disease.

As of Feb. 2, 2020 (From worldometers.info. RDT’s addition not in the Facebook post).

Having said these, the chances of you getting infected in the Philippines is really very low at the moment unless you traveled to Wuhan recently, or was in the same plane as the Chinese woman who arrived last January 25, or was in close contact with her.

The disease presents as mild respiratory illness just like the common flu with cough, colds and fever but can get worse to include difficulty of breathing and respiratory failure in worst cases. As of this writing, there have been 180 reported deaths attributed to the virus out of 7,700 plus cases many of whom had mild disease only and have fully recovered already. Just like many other viral illnesses, it appears to be self-limiting as well as to abate with or without specific treatment.

Given these figures, the chance of one dying from the virus is under 3 percent, meaning the 2019-nCoV is not even close to being as deadly as the virus that caused SARS (10 percent) or MERS (35 percent) that originated from civets and camels, respectively. The more common H. Influenza (bacteria that causes ear infections in children and bronchitis in adults is even deadlier with a case-fatality rate of 3-6 percent in children and a higher mortality rate in adults >65 years old who develop invasive disease.

The following are deemed at higher risk of contracting the virus when exposed to a sick person: young children (>5 years old), >65 years old, diabetics, those with chronic kidney disease, COPD, organ transplant patients and immuno-compromised states such as HIV, asplenia, or on chemotherapy. Doctors and hospital personnel are at a greater risk of getting in contact with the virus than the general population at large because of the nature of their work.

Treatment is mainly supportive. Many of the deaths from confirmed cases were in the susceptible groups and older patients. If and when you get infected, relax, there is a high 98 percent chance you will live happily ever after.

Being novel, a vaccine has not been developed yet for the 2019-nCoV. Hence, protecting yourself by improving your immune system and wearing personal protective equipment are imperative. Being the largest virus in the coronavirus family, an ordinary surgical mask is enough to confer “protection” from the extremely small possibility of inhaling the nCoV given there has been only one case.

The N95 mask is designed to prevent inhalation of smaller organisms. In order to protect yourself, a surgical mask would suffice for now (if it’s needed at all), plus frequent washing with soap, or using alcogels or 70 percent alcohol. N95 masks may be better suited and more useful for health care workers at the moment. Remove work clothes as soon as one gets home and wash with detergent and sun dry. If you have a respiratory illness, or insanely suspect you have the virus even when you did not even have close contact with the one confirmed case or have not traveled to Wuhan recently, you are likewise advised to cover your cough or sneeze not with your hands but with a tissue paper and dispose of it immediately and properly. When you don’t have tissue paper, use your sleeve as a shield to lessen the chance of depositing the virus on surfaces that you may handle.

I will periodically edit this post as new/correct data trickle in. In the meantime, if you read this and you belong to the general public and not the susceptible groups, is not a doctor or hospital personnel, don’t have symptoms, or didn’t have contact with at least a PUI or the Chinese woman, or did not leave the country recently, do not stress yourself with undue worry because of these aforementioned statements now known about the virus. In Tagalog, “Huwag kang ma-praning.”

Do not fear or panic when you read the negative news and vibes generated by mainstream media as well as social media from shared and forwarded posts/messages. Derive, share and believe scientific info coming from credible sources like DoH.gov.ph or CDC.org, and not from invalidated, incredible ones.”



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