The Novel Coronavirus
The Novel Coronavirus|Photo credit: University of Southern California
Kerala

First Novel Coronavirus Case Reported From Kerala

Don’t panic, say doctors, be calm and follow hygiene tips

The Union Health Ministry has on Thursday confirmed the first case of Novel Coronavirus in the country from the southern state of Kerala. The affected person is a student studying at the Wuhan University in China who recently returned with a group of students from Wuhan after the virus outbreak in the Chinese province.

The information was conveyed to the state Health Department by the Union Health Ministry on Thursday afternoon. The initial tests done on one out of twenty samples had turned positive. These samples had been rushed by the state to the National Institute of Virology (NIV) in Pune early this week.

While 10 samples had returned negative the results of a few others are still awaited.

Meanwhile the state Health Department has initiated a meeting of the Rapid Response Team (RRT) under the leadership of the state Minister of Health KK Shailaja who chaired an urgently called press briefing in Thiruvananthapuram to outline the various steps the state is taking to ensure that Coronavirus does not spread in the state.

“The student who has been found positive for Coronavirus was quarantined a few days ago along with four others after they had shown early symptoms of the virus right after they reached Kerala. So the patient is now under complete isolation at a special centre created for the same at the Thrissur Medical College. The good news is that the patient’s condition is stable now,’’ Kerala Health Minister KK Shailaja told media persons in Thiruvananthapuram.

The Minister also added that it was only the first stage results that had returned positive for Coronavirus on the student and that a secondary test is underway to further confirm the virus in the patient.

“Since we do not want to take any chances, we have already started the quarantine and treatment procedure on the student,’’ said the Minister whose recent efforts in fighting the Nipah virus in the state was lauded by one and all including the international medical fraternity.

The Minister after chairing an emergency meeting in the state capital has rushed to Thrissur Medical College with other experts and would be monitoring the situation in the state from there.

The Thrissur Medical College would be acting as the nerve centre for all anti-Coronavirus operations in the state.

Meanwhile chief minister Pinarayi Vijayan who is regular touch with the Union Government over the issue has called upon all to be calm.

“We are taking all precautions that is necessary. There is no need to have any sort of panic as the state Health Department is in full control. They key here is to remain alert,’’ Vijayan told media persons outside his office in Thiruvananthapuram.

Kerala Students Under The Scanner

As per state government records, 806 students from Kerala who have been studying at the Wuhan University have been under the scanner after they had returned over the past few days.

Out of this around 20 students had reported to the state government with various symptoms like fever, headache and shortness of breath. Out of these 20 students whose samples has been rushed to the Institute of Virology in Pune, 10 have retuned negative. One among the other ten has now turned positive while the results of the rest are still awaited.

Field officers of the state Health Department are closely monitoring all those who had returned from China for possible symptoms of the virus. These people have been asked to remain home quarantined till they do not show any visible symptom for a period of time.

Regular visits are also being made by health workers to houses of such people to ensure that no one goes unchecked if any symptoms are shown.

“We are also requesting anyone who has returned from China to report to the local medical officer so that the state is aware of the situation,’’ added the Health Minister.

Meanwhile the biggest challenge before the government now is to trace all those people with whom this particular student, who has been found positive with the virus, might have interacted before she had reported her symptoms to the state government.

“The challenge before us is to trace all the people that this patient and the rest of the three isolated cases would have come into touch with which is vital to contain a spread. Even during Nipah time we had to face similar problems. So at the moment we are moving on a war footing to identify all such people,’’ Heath Secretary Rajan Khobragade told media persons.

Since Sri Lanka has already confirmed one case of Coronavirus the state is also taking extra precautions on the arrival of tourists and others from the island nation since it is geographically very close to Kerala.

Meanwhile the state is also looking at the option of doing tests in Kerala itself rather than waste precious time waiting for results to arrive from NIV Pune.

During the Nipah outbreak too in 2018 the state had adopted similar measures in association with the NIV which had enabled it to save precious time.

This had ensured that more people could be treated in lesser time helping the state contain the virus with considerable ease.

The state is looking at replicating the same to fight Coronavirus, the Minister added.

What Is Novel Coronavirus?

Dr V Ramasubramanian is an Infectious Diseases Specialist who practises in Apollo Hospitals as well as the Capstone Clinic in Chennai. Speaking to The Lede, Dr Ramasubramanian said that the Coronavirus is named for the shape of the virus – it has spikes, like a crown. “Corona means crown so that is how the virus got its name,” he smiled.

Dr Ramasubramanian says that the SARS, MERS and Ebola viruses are all coronaviruses. What is now doing the rounds is yet another strain of the coronavirus which has become virulent and pathogenic.

“These viruses are usually present in animals and they mutate and affect humans. For instance, SARS or Severe Acute Respiratory Syndrome which broke out in 2002 came from bats, went to civets and then came to humans. MERS or Middle East Respiratory Syndrome which originated in Saudi Arabia in 2012 came from bats to camels to humans. Now Novel Coronavirus, we suspect, has come from bats to snakes to humans,” he said. All of these viruses, SARS, MERS and Novel Coronavirus are coronaviruses – cousins, in a sense.

The origin of the virus is said to be at the large Wuhan market in China, a place filled with exotic animals and birds. The market sells salamanders, civets, bats and even camels for takers.

“The Novel Coronavirus affects the upper respiratory system, resulting in breathing difficulties,” said Dr Ramasubramanian. “It presents as flu-like symptoms with a fever, cough, body pain and diarrhoea in 3% of affected patients. If untreated, over 5-7 days it develops into pneumonia with breathing difficulty and can result in multiple organ failure. It can be fatal for the elderly or those with compromised immune systems. People who have heart disease or lung disease are especially at risk,” he said.

There are two types of viruses – one that are spread only from animals to humans but not between humans. An example of this kind of infection is the H7N9 virus also called Avian Influenza. This illness spreads from birds to humans but does not go further than that.

The Novel Coronavirus though does spread from human to human.

“When we look at such viruses, we have to look at the risk of secondary infection,” said Dr Ramasubramanian. “For instance, a person infected with measles has transmissibility of 12 to 18, meaning that one person with measles can infect 12 to 18 more people. This is a very high number.

If you look at SARS, one infected person can pass it on to three people. MERS is less than one person, which means it was not too contagious. Ebola is between 1.5 to 2.5 persons. Novel Coronavirus is between 1.5 and 2.5 – it is not as bad as measles or SARS – in fact it is only a bit higher than the common flu in terms of being contagious, but this in itself, is bad enough,” he said.

“There are four groups of coronavirus which are present in animals – alpha, beta, gamma and delta. Of these, alpha and beta coronaviruses affect humans.

Of these, the 229E and NL63 are strains from the alpha group which affect humans.

OC43 and HKU1 are strains from the beta group which affect humans. Both MERS and SARS were from the beta group of coronavirus.

Novel Coronavirus is another strain from the beta group which has turned virulent,” he said.

How Bad Is Novel Coronavirus?

“Certainly worse than the flu but not as bad as Ebola, for instance,” said Dr Ramasubramanian when The Lede put this question to him.

“You have to look at mortality rate – For the common flu it is 0.02% to 0.4%. With SARS it is 10% while for MERS it is between 30-35%. Ebola has the highest mortality rate – 65% to 70%.

Novel Coronavirus, in comparison, is better – it is between 3.6% and 4%.

But now, as the number of affected people around the world is on the rise, mortality rate is coming down and is at 2% now.

It is not as nasty as SARS or MERS,” he said.

Can Novel Coronavirus Be Treated?

While there is no specific cure or vaccine for Novel Coronavirus, it can be eased with supportive treatment. Managing the symptoms of respiratory distress and offering fluid support is usually effective.

“The anti-retroviral Lopinavir with boosted ritonavir, usually used in treating HIV-AIDS, seems to be having an effect on the Novel Coronavirus,” said Dr Ramasubramanian. “Remdesivir is another anti-viral that is being tested in labs in China and around the world to find out its efficacy,” he added.

The Novel Coronavirus is detected by taking swabs from the inner cheek and running samples through a PCR (polymerase chain reaction) molecular test. The results can be availed in a few hours. Currently all samples in the country are being taken to the National Institute of Virology in Pune as there is no commercial test available for this virus.

The World Health Organisation has issued guidelines for health workers and doctors who handle suspected Novel Coronavirus patients. These include guidelines on how to identify, quarantine and treat patients. Health workers are also asked to take specific precautions while dealing with suspected patients of Novel Coronavirus so that they do not catch the infection themselves.

For instance, the WHO recommends that “patients should be placed in adequately ventilated single rooms. When single rooms are not available, patients suspected of being infected with nCoV should be grouped together. All patients’ beds should be placed at least 1 m apart regardless of whether they are suspected to have nCov infection. HCWs should use a medical mask. HCWs should wear eye protection (goggles) or facial protection (face shield) to avoid contamination of mucous membranes. HCWs should wear a clean, non-sterile, longsleeved gown. HCWs should also use gloves,” it reads. HCWs means health care workers and nCOV refers to Novel Coronavirus.

The WHO also provides advisories to governments and local administrative bodies on educating and informing the public. For instance – “establishing a surveillance process for acute respiratory infections potentially caused by nCoV among HCWs. Ensuring that HCWs and the public understand the importance of promptly seeking medical care. Monitoring HCW compliance with standard precautions and providing mechanisms for improvement as needed.”

The complete set of guidelines issued by the WHO can be found here.

How Do You Prevent Spread Of Coronavirus?

“It is actually very simple,” said Dr Ramasubramanian as he proceeded to outline the precautions.

  • Don’t travel to China or the far East unless it is absolutely essential

  • Learn flu etiquette – when you cough, cough into your elbow, so that the droplets do not spread the virus

  • If you are infected, you need to wear a mask; otherwise there is no need to

  • A triple layered surgical mask is sufficient; the N95 mask is only used when a patient is intubated

  • Hand hygiene is most important; use a hand sanitiser regularly and do not take your hands close to your mouth or nose

At the end of the day, it is important for people to stay calm and not panic, says Dr Ramasubramanian.

“If you have symptoms, go to the nearest hospital and get yourself tested. Otherwise practice basic hand hygiene and you should, by and large, be alright. This is going to spread, that is the nature of a viral infection. But it will die down in a few months. So stay calm and take the basic precautions,” he said.

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