Since the start of the 2019 coronavirus disease (COVID-19) pandemic – caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) – the world has been plunged into economic and social crises of a magnitude unprecedented in the last century. However, this is the third pandemic in recent times caused by highly pathogenic coronaviruses.
A new article published in the journal Medication seeks to compare the current SARS-CoV-2 outbreak with the previous SARS-CoV outbreak to understand how best to respond to it with sensitivity and flexibility. This involves early detection, using multiple screening tests, followed by management of clinical features as needed, to prevent disease-related injuries.
The period of maximum transmission of SARS-CoV-2 is often the presymptomatic period, 48 to 72 hours before clinical presentation. The increased contact with people during this period and the less attention paid to protective measures, due to the lack of awareness of the presence of infectious diseases, predisposes to a higher rate of spread at this time.
A new mutation at the interface of the S1 and S2 subunits of the viral spike protein, introducing a furin cleavage site, makes SARS-CoV-2 more infectious than SARS-CoV, particularly at the onset of the infection. A classic example is the occurrence of 621 cases aboard a cruise ship, the Diamond Princess, starting with a single infected individual.
Transmission occurs by respiratory droplets, involving close contact between an index case and others. Although the virus has been isolated from feces, the importance of urine and feces in transmission remains uncertain.
Spread of the pandemic
SARS-CoV-2 was on the verge of causing a pandemic; that is, “infectious disease states which dramatically increase in populations around the world with infections occur more or less simultaneously”. While the previous SARS outbreak in Guangdong, China affected just over 8,400 people in 25 countries or regions around the world, the virus currently circulating has caused more than 109 million cases, with more than 2.4 million deaths, involving 192 countries and territories around the world.
SARS-CoV-2 looks set to persist around the world longer than the SARS epidemic that set in in seven months. More than a year after the first case was reported, infection rates remain high in many parts of the world.
An unusual feature of the COVID-19 pandemic is the way its epicenter continues to move, from Wuhan in China to other countries in Asia, as well as to Europe, then to the United States and the United States. Australia.
While the Chinese economy represented only 4% of the world economy in 2002, during the SARS epidemic, it now represents 17%, as the world’s second-largest economy. However, it has been severely affected by the current pandemic, raising the possibility of reaching a nadir not seen in the past three decades.
In the UK, universal credit is expected to be needed by 3.5 million more people than before. US stocks are at their lowest since 1987, with a ripple effect on 11 other countries and regions. With China being the world’s largest manufacturer and importer of crude oil, its economic slowdown is also expected to trigger a global recession.
Preventive and therapeutic measures
The mainstay of COVID-19 containment was non-pharmaceutical preventive interventions, including social distancing, regular and scrupulous washing of hands after possible contact with contaminated surfaces, disinfection of surfaces, wearing of masks in public spaces and self-isolation for contacts of infected people.
Chinese health authorities have developed a manual on the epidemiology of COVID-19, signs and symptoms, clinical classification and treatment, as well as the distinguishing features between COVID-19 and other upper respiratory infections or diseases flu-like.
This document, “Chinese Clinical Guidance for Diagnosis and Treatment of COVID-19 Pneumonia,” also helps identify cases and inform relevant authorities, in addition to proper management at all levels of severity. Discharge and follow-up criteria are also described, as well as the precautions to be taken to prevent the spread of the infection.
Chinese management of COVID-19
Unlike the belated realization of the SARS epidemic, which has led to misinformation and panic buying, the current pandemic has been characterized by a faster response with greater transparency. Immediately after the identification of the first case of unknown pneumonia in Wuhan, China in December 2019, appropriate epidemiological measures were put in place.
Virus samples were taken, the epidemiological trail was investigated and treatment guidelines were issued within 45 days of the first case, and a rapid response was initiated. “Eight rumors have been dealt with in accordance with the law,” the report said. A database was set up within a year of the first case in China.
Rapid development of test kits
Test kits were quickly manufactured and marketed by the Chinese National Administration of Medicinal Products (NMPA), with adequate efficacy and sensitivity. An acceptable polymerase chain reaction (PCR) test was made available only ten months after the first case of SARS, during the last outbreak in 2003.
In contrast, the NMPA Emergency Protocol brought a reverse transcription-polymerase chain reaction (RT-PCR) test kit to market within two weeks. With the incorporation of the real-time fluorescent RT-PCR test, it became possible to obtain test results within three hours.
Another innovation has been the mobile emergency hospital, built on a large scale to treat and follow less ill patients, reserving the main hospitals for severe COVID-19 patients. Dating from the 1960s, this concept offers medical and technological support on a platform allowing rapid deployment where necessary.
Although the concept originated in Vietnam, along with the US military, it was adopted for disaster situations and military operations not involving war. In the current situation, the government has taken over sports and exhibition halls and schools for mobile hospitals. The Wuhan outbreak was successfully contained in less than three months.
From the start of the pandemic to March 10e, 2020, mobile emergency hospitals were set up to treat more than 12,000 patients, and dismantled, having fulfilled their function. This contrasts with the less than 700 SARS cases that were treated in 2003.
Containment in China
SARS-CoV-2 triggered the first lockdown in more than 70 years in China, involving 16 cities. The pandemic emerged around the time of the Spring Festival, when nearly 3 billion visits were made to meet his family, usually in their hometown. This represents approximately 70 million trips per day over 40 days of the festival-related holiday season.
In view of the estimated spread of the virus to more than 50% of the population in nearly 370 other cities in China, from Wuhan, and almost the entire population of the four largest metropolises, the authorities have cracked down on public transport by road, rail, metro and air, to and from 16 cities.
A chain of command has been put in place to coordinate China’s response to COVID-19. Local governments were inspired by the special command group of the Chinese National Health Commission. In turn, they informed the district governments of the necessary arrangements.
Community leaders and volunteers helped carry out containment measures, from checking patient isolation temperatures, and delivering food to translating for strangers.
The biocontainer approach used by the US government will help protect those returning to China from overseas from infection until they can reach the right treatment center.
Accident insurance for medical workers
Although medical workers were not reimbursed by insurance for the risks they faced during the SARS epidemic, the current pandemic has seen temporary labor subsidies and increased subsidies for preventive health and work. containment of the epidemic. More than 20 insurance companies in China have donated large amounts of insurance to frontline medical workers, in addition to government grants.
Military and voluntary cooperation
Military-style management of a huge corps of student volunteers has helped contain the pandemic, compared to the previous SARS outbreak. More than 30,000 volunteers have been engaged in COVID-19 quarantine and prevention work, for a total of more than 18 million hours.
What are the implications?
The report hails China’s efforts to contain the epidemic within its border through its “rigorous containment and quarantine efforts”, citing them as responsible for China’s emergence from the active phase of the pandemic , the oldest among the countries of the world.
However, the notification from the Chinese Center for Disease Control came nearly two months after the first case of new pneumonia, delaying the possibility of controlling the viral spread at the start of the epidemic. This is a failure of the surveillance system put in place after the SARS epidemic.
Third, the level of readiness in terms of personal protective equipment (PPE) and other aids was too low, with most hospitals only keeping one month’s stock. This led to an initial severe shortage of medical supplies needed to deal with the spread of the virus and its treatment.
The process of distributing PPE from the centers where it arrived was often hampered by bureaucratic procedures, leading to local shortages despite being supplied from the national stockpile. As a result, some medical workers have also been unnecessarily exposed to the virus.
The researchers aim to disseminate their new early warning mechanism for future pandemics and to fill the gaps observed in local logistics units, enabling multi-channel distribution in an emergency while maintaining adequate stocks.