What is COVID-19?

Coronavirus Disease 2019 or as known for short COVID-2019 is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). It is genetically similar to the SARS Coronavirus Outbreak in 2002.

Yet coronaviruses are not new viruses, as mistakenly being thought of. Coronaviruses which have been circulating among humans for a very long time are typically benign and they cause about a quarter of all common cold illnesses. Yet occasionally, coronaviruses, like COVID-19, circulate in an animal reservoir and mutate just enough to where they’re able to start infecting and causing disease in humans.

In the case of COVID-19 there was a coronavirus going around bats. Bats are natural animal reservoirs. This coronavirus mutated to such an extent that it was enough to start infecting an intermediate host- a pangolin which looks like a cross between an ant-eater and an armadillo. In late 2019, the coronavirus mutated again and started causing disease in humans. The outbreak began in China but has now spread all around the world.

Symptoms of COVID-2019

More than 80% of the world’s population with COVID-19 has a mild infection, and some people do not even develop any symptoms at all. For others, they may experience symptoms which range from fever and/or cough and/or shortness of breath and can also precipitate to a serious condition-pneumonia i.e. lung inflammation.

Severe lung damage can result in Acute Respiratory Distress Syndrome (ARDS). This is a condition which is so severe that fluid builds in and around the lungs. This severe condition can cause septic shock which happens when the blood pressure falls dramatically and the body’s organs do not have adequate amount of oxygen and start to “starve” to death. ARDS and Septic Shock are the main cause of death for patients with COVID-19. The risk of ARDS and Septic Shock tends to increase in people who are older than 60 years of age, smokers and those who suffer from medical conditions mentioned in Figure 2.

For COVID-2019 the mortality rate differs by group. The fatality rate, to date, is relatively low in ages below 60 years old but increases as one gets older than 60 years of age. Therefore it is our parents and/or grandparents who are at a greater risk and it is our love and respect as a community for these people mostly, for whom we should try our utmost to prevent further spread as a means to protect them.

Therefore from a Medical perspective why should I worry more about my Parents and Grandparents than my children?

Evidence is showing that when children get infected with COVID-19 they have a higher viral load. Yet COVID-19 does not develop severely when compared to older adults. This is because as one ages, his immune system undergoes senescence and loses its capacity to respond or be regulated as effectively. Also Perlman, an immunologist in Kingston Mills of Trinity College Dublin proposes that young children produce higher amounts of a type of T cell (our soldiers which protect us from infection) called Th2. Therefore this decreases severity of an infection including COVID-19. In order to enter into cells, COVID-2 uses receptors called ACE2.

One can imagine these receptors as keys which enable the virus to enter the cell. A higher abundance of these receptors are present in the lower aspect of the lungs. This explains why COVID-19 patients experience higher frequency of pneumonia and bronchitis. In our body we also have an ACE2 enzyme (a molecule which increases a rate of reaction) which protects us against the virus. A fall in ACE2 activity in the elderly is partly to blame for human’s poorer ability to fight the infection.

Why is COVID-2019 an Emergency Pandemic?

COVID-2019 is capable of spreading quickly. Usually the virus is spread when the person coughs or sneezes and tiny droplets containing the virus are released. These droplets can fall on another person’s mouth, nose or eyes and that allows the virus to enter a new host i.e. a new person.

When the virus enters a non-affected area this is called an Imported Case. When the imported cases start spreading the disease to their family, friends and those close to them this becomes a Local Transmission. To become a Local Transmission the virus is isolated to a small area and can easily be traced back to the original person. Yet when people start to contract the disease without a clear source it is known as Community Transmission. To prevent or contain Community Transmission, schools, businesses and restaurants have shut down. Conferences, sporting events and other large gatherings have been postponed or cancelled. Once a person is affected symptoms develop around 5 days later. This is called the Incubation Period. To date, having no scientific studies, there is a debate on how much symptomatic and/or asymptomatic people i.e. people who are in the incubation period, are spreading the disease.

Is COVID-2019 like Influenza?

Both Influenza and COVID-19 are caused by viruses. It is important to bear in mind that viruses are given a reproductive number or an R0 based on how quickly they spread. R0=1 means that the person transmits it to 1 new person, R0=2 means that the person transmits it to 2 new people and so forth.

if the R0 is < 1, the infection metres out. If the R0 is =1 than it remains steady. If R0 is >1 than it continues to spread. The current estimate for COVID-19 is R0=2.2. The R0 of the Influenza Virus is R0=1.3. Therefore COVID-19 spreads a little more easily than Influenza.

Treatment

Treatment is based on supportive care including fluids, oxygen and ventilator support only in cases of highly sick people. Right now experimental studies are focusing on Remdesivir. Remdesivir, an anti-viral drug previously tested against Ebola and right now it is being tested in clinical trials in the US and China. Unfortunately, to date, there is no vaccine currently available for COVID-19 yet there is one vaccine currently studied in clinical research and is likely to be ready in 2021.

Why is it fundamental to Quarantine?

The main goal right now is to avoid person to person transmission. This is being done in all countries around the world including Malta right now. People living in Malta, irrespective of what nationality he/she is, who have just arrived from abroad after Saturday 14th of March 2020 are under mandatory quarantine for 14 days. Other people living with that person are also under mandatory quarantine. If a person who has arrived from abroad, or people in contact with that person who has arrived from abroad or a person who has come in contact with a known positive COVID-19 case or whose job requires meeting a lot of people start to experience symptoms of fever and/or shortness of breath and/or coughing, they are asked to call the COVID-19 Helpline 111 immediately to check whether they are eligible for a swab test.

Therefore how can I reduce the risk of getting sick?

Surgical Masks are not recommended because they are specialised to catch droplets from a cough or sneeze going out rather than from preventing one from inhaling the virus. Also wearing an N95 mask is not recommended because they should be worn only by health-care professionals who are trained to do so. Wearing a mask and constantly arranging the face mask with your hands in fact is considered of higher risk to become infected with any virus, irrespective of COVID-19 than wearing one. In fact cleaning and sterilizing handles, keyboards, surfaces, keys and other common areas frequently touched is a better idea. Yet in order to effectively prevent COVID-19 transmission one should: Perform hand washing with soap and water or alcohol based products for 20 seconds and prevent touching the T ZONE i.e. Forehead, Nose, Chin, and Area Circling the mouth.

Since this is the primary entry zone of viruses into the body. Therefore let us all keep safe and take care of one another and bear in mind that washing our hands prevents disease and puts everyone else at ease.