Part 1: Coronavirus: Updates in an Evolving Story

COVID-19, first discovered in Wuhan, China, in late December of 2019, is a serious and continuing threat for people, businesses, and governments around the world.

As both emergency management and continuity software providers and practitioners, we understand the positive impact all information can have over the course of a response or activation.

To help those responding to the pandemic, we’ve partnered with Marie Louise Landry, M.D., from the Departments of Laboratory Medicine and Medicine (Infectious Diseases) at Yale New Haven Hospital and Yale School of Medicine, to provide accurate information about the coronavirus and enable responders fighting its spread.

Below is an account of the webinar Dr. Landry gave, the first in a multi-part series on COVID-19.

What is a Coronavirus?

Coronaviruses are characterized by large petal-shaped spikes on the surface of their envelopes, which gives them a crown-like morphology. This feature also lends them their name, as the Latin word corona translates, among other things, to “crown” in English.

The spike proteins play a key role in the ability of these viruses to infect animals and humans. The proteins bind to receptor sites of the cell, allowing a virus to enter. From there, the virus uses the internal machinery of the cell to replicate itself.

“One cell becomes a little virus factory, and may make 100-1,000 virus particles that may go on to infect other cells,” Dr.Landry said

In the 1930s, veterinarians and researchers began studying outbreaks of disease in livestock. After some time, they found the outbreaks were due to coronaviruses, and vaccines were developed for the animals as time went on. Coronavirus infections were subsequently identified in companion animals (dogs and cats), and laboratory mice.

All types of livestock seemed to be affected by the illness. We now know why this is possible: Coronaviruses have a very variable genome due high mutation and recombination rates. This allows the pathogens to make quick transitions between animals and, in some cases, humans.

There are only a handful of known coronaviruses that infect humans. The first two were discovered in 1965 (229E and OC43) as causes of the common cold. Two other coronaviruses identified in 2004, strains NL63 and HKU1, also cause the common cold.

Two other known coronaviruses are far more severe than the others listed above. Severe Acute Respiratory Syndrome (SARS)surfaced in 2002, and killed 774 people out of the known 8,096 cases, a death rate of about 10%.

Middle East Respiratory Syndrome (MERS), first recognized in 2012, is less infectious than COVID-19 and SARS, but has a higher fatality, killing 858 people in 2,494 cases, a 34.4% death rate. Unlike SARS, MERS is still active, but can’t infect humans as well as other coronaviruses do.

Transmission of a Coronavirus

In 2005, several years after the SARS outbreak, researchers were able to fully pinpoint the origin of the deadly coronavirus.

Bats are the hosts to hundreds of coronaviruses, which, when they’re placed in tight quarters with other animal species, allows some of the viruses to jump species. In the case of SARS, the virus transmitted from bats to civets in a wet market in China, eventually infecting the people who visited and worked in the market. The virus spread locally, then internationally via travel and in healthcare facilities by superspreaders.

MERS took a somewhat similar path as SARS.Bats, again, hosted the virus originally. The virus then started infecting dromedary camels, an animal many people in Saudi Arabia and the Arabian Peninsula interact with daily. Due to the virus’ poor ability to adapt to humans, people with contact with camels were at greatest risk of coming down with MERS infections. Those in close proximity to infected people can also contract the illness.

The birth of COVID-19 is still a bit of a mystery. The coronavirus appears to share a 96.2% RNA similarity with a bat coronavirus. Initially, the intermediate species was thought to be pangolins, as preliminary research pointed to a 99% RNA similarity between COVID-19 and a coronavirus found in the scaly anteaters. However, after more detailed studies, other investigators found that the pangolin strain of the virus was only 90%similar. This casted doubts on the odd mammals being the intermediate species.The search for the answer still continues.

Symptoms and Stats

To many, the most important data points are the symptoms of COVID-19, how it spreads, and what we’re doing as a global community to prevent the disease from infecting and harming more people.

The known symptoms of COVID-19 are:

  • Fever
  • Dry cough
  • Shortness of breath
  • Pneumonia
  • Diarrhea
  • Nausea
  • Myalgias
  • Headaches
  • Sore throat

The median age of victims is 49-56 years old.84% of known cases are said to be mild, while 14% are serious and 4% are critical. Pneumonia contributes to the serious and critical cases and may progress to Acute Respiratory Distress Syndrome (ARDS). One third of critical cases of COVID-19 appear to develop ARDS.

The people most susceptible to COVID-19 are the elderly and immuno-suppressed. Smoking and underlying heart and lung diseases can contribute to one’s vulnerability to the virus as well. At this time, it also seems males can be hit harder by the virus, but this has not yet been verified. The current mortality rate in Wuhan, China (where COVID-19 originated), is about 2-2.5%, but appears to be lower in other parts of China and Korea, where extensive testing has been performed.

Transmission of COVID-19

In the webinar, Dr. Landry presented an interesting chart from the New York Times.

The chart compares various viruses, placing them on a plot in respect to both their fatality rates and ability to spread.In the chart, we see familiar diseases like SARS, MERS, Ebola, chicken pox, smallpox, and measles. What the data gathered on these viruses suggests is more potent viruses tend to be less infectious than the milder ones.

The exact stats on COVID-19 won’t be known until the current outbreaks across the world begin to subside and fewer cases develop. But right now, it appears COVID-19 could be as fatal as the Spanish flu, and just a bit more infectious than polio. It’s currently estimated that one person can spread the infection to between 2-4 more people.

Individuals who contract the virus will start showing symptoms within 2-14 days of being infected, with an average of 5 days.One of the most troubling facts about COVID-19 is that infected individuals can transmit the virus whether they’re symptomatic or asymptomatic. It also more readily transmits from person to person than SARS and MERS.

COVID-19 is transmitted through two primary methods.

The most common method is thought to be via respiratory droplets. When infected individuals with the coronavirus sneeze or cough, the infectious pathogens in the person’s respiratory tract make their way into the environment.

The droplets stay land on persons nearby or fall to surfaces.  If someone contaminates their hands with the live COVID-19 virus on a surface and then touches their mucous membranes (mouth, nose, or eyes), they can contract the illness.

The coronavirus can also transmit via the fecal oral route, which works similarly to that of the respiratory droplet. Namely feces can contaminate hands or water, which in turn can contaminate food, drink or by hands touching one’s mouth. In this way, the virus can be spread. Poor hygiene practices can allow this method to be successful.

In some cases, nausea and diarrhea precede other symptoms.

Asymptomatic transmission and mild cases make containing COVID-19 more challenging, said Dr. Landry. Asymptomatic individuals and those with mild cases may not seek healthcare, and spread the virus as they go about their normal daily routines. This can lead to a chain of transmission, causing more and more people to become infected.

What Can We Do About COVID-19?

At the time of writing, there is no direct way for doctors and medical professionals to treat patients suffering from COVID-19.

The most we can do for those individuals is provide supportive care, which includes providing oxygen and fluids and using respirators. Antibodies gathered from recovered patients may also be an effective way to combat the virus in infected individuals. In cases where the coronavirus allows bacterial infections to take hold, antibiotics are being used.

Healthcare providers are also trying repurposed antiviral drugs, namely:

  • Tamiflu (flu) plus Lopinavir/Ritonavir (HIV)
  • Arbidol (flu drug used in Russia and China) plus Darunavir (HIV)
  • Inhaled interferon
  • Remdesivir (new nucleotide prodrug from Gilead)

It’s important to note that the results of these treatment courses have not yet been reported, and the efficacy of them is unknown.

The natural question to ask next is “Where’s the vaccine?”

A vaccine is, relatively, far away. Vaccines, and medications in general, must pass rigorous tests and clinical trials before they reach the market and can be widely used to treat illnesses and diseases.

While many parties are hard at work to develop a working vaccine, one is most likely at least 18 months from being ready (and that’s fast for the process). At this time, the best we can do is practice good hygiene, heed the advice of medical and health professionals, follow quarantine orders from government officials, and self-quarantine and/or seek treatment if we suspect we’ve contracted the coronavirus.

The Future and COVID-19

How this pandemic will develop as the next couple months pass is impossible to predict. However, for those in charge of responding to this threat, the facts are important. This webinar provides abase information many response and continuity professionals can use to shape their plans appropriately.

Next in this series in part 2, where Dr. Paula Kavathas, from the Departments of Laboratory Medicine and Immunology at the Yale School of Medicine, will discuss what viruses are in depth, how the body responds to them, and how the doctors, researchers, and drug manufacturers work together to protect people from some of the world’s most harmful pathogens.

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