Nairobi News

The name and origin of the virus

The name of the virus has rapidly evolved since the first cases in early December 2019 and the recognition that it was a new virus in late December. RNA viruses have been traditionally named after their location of discovery, so the initial designation was Wuhan coronavirus. However, no-one wants it named after their place, so now the agreed on naming of the disease is COVID-19 (COronavirus VIrus Disease-2019) and the virus is coronavirus SARS-CoV-2. The sequence of the virus was released in January and made it clear that this virus is from a bat and related to SARS and MERS, but more closely to SARS; thus, SARS is part of the name. The other bat coronaviruses came to humans via another mammal (civet for SARS and camel for MERS) and that is also suspected for the new virus. The sequence also means that the conspiracy hypothesis about this being a lab-adapted virus are false. It also means that fish or snakes cannot be the intermediate hosts.

About the COVID-19 illness

How likely is it that the virus will reach Kenya?
As is commonly said, microbes don’t need visas. Despite the travel restrictions, the coronavirus has spread to multiple continents, so it unlikely that travel restrictions will prevent the infection from coming to other parts of the world. In view of the degree of secondary transmission in a number of countries outside China, the major question now is when rather than whether.

What are the symptoms of COVID-19?

The two main symptoms of COVID-19 are fever and cough. The initial case definition also included shortness of breath, but that is true only for those who are more seriously ill. Runny nose and sore throat are very uncommon, so their presence suggests a different virus.

How does SARS CoV-2 (COVID-19) spread?
SARS CoV-2 spreads through droplets which are released when people sneeze or cough. These droplets can only travel up to one meter and cause infection they contact the mucous membranes of the mouth, nose or eyes. Spread from contaminated surfaces may also occur, but plays a lesser role.

Why doesn’t a mask work for protection?

The virus leaves the other person in the form of respiratory droplets. They cause infection when they land on mucous membranes (mouth, eyes). They may land directly there or they may do it indirectly. That could be from those droplets getting on the infected person’s hand; he then touches you and you touch your mouth or eyes. Or he may cough on you and then you rub your eyes. Or it may be droplets that land on a counter next to you and then you touch it and then your face. The virus doesn’t survive a long time on an inanimate object.

The above means that the only thing the mask prevents is the virus coming in a droplet and landing on your mouth. It may make a bit of difference but there are so many exposures it doesn’t prevent that overall it isn’t worth using for routine purposes. For people taking care of COVID-19 patients, they wear a surgical mask and if doing high-risk procedures, they wear an N95.

How long is the incubation period for COVID-19?

The incubation period is the time between catching the virus and when the symptoms of the disease start appearing. The average is about 5 days and ranges from 2 to 12 days in most cases.

How do I know if I have COVID-19 and not regular cold or flu?

The only way to know if you suffer from COVID-19 is through a special lab test called PCR. The PCR test is currently available through the Ministry of Health and soon it will be done at AKUHN. However, COVID-19, being a lower respiratory illness does not typically have a runny nose or sore throat.

Can COVID-19 be treated with antibiotics?

No. COVID-19 is caused by a virus and antibiotics only work on bacterial infections.

Is there any specific treatment for COVID-19?

There is no treatment for COVID-19 yet. The disease is treated symptomatically, which means the symptoms (such as fever and cough) are treated rather than the disease itself.

How serious is COVID-19?

COVID-19 is usually a mild to moderate respiratory (lung) infection. In the elderly or those who are immunocompromised or have other chronic diseases, it may lead to a severe pneumonia and can be fatal. Children and young adults rarely develop serious disease.

What are the mortality rates?
So far, the mortality rates in China have been 2-3% but the true number may be higher or lower and will certainly depend on the level of care provided by the hospital. The mortality was higher in Wuhan than other places, possibly because the health system there was overwhelmed. Most of the people hospitalized in China have been over 40 (including none under 15) and half have had other medical illnesses such as diabetes, heart disease or stroke, making them more vulnerable. So far, 1.5% of those outside China have died. In fact, within China, the mortality has dropped to 0.7%.

What is the risk for health care workers?

There is definitely a risk but the magnitude of the risk is lower than initially thought. In China, the majority of HCW cases were actually acquired within their own households.

How are COVID-19 cases being transmitted in countries with many cases?

In China, about 80% of cases have been acquired through household contact and nearly all the others by close contacts of other types.

Is there anything I should do before it arrives?

The short answer is to do common sense things that will keep you in good health. People are frequently changing their diets, buying respiratory masks, etc. None of these things will help at this time.

How can I reduce the risk of getting coronavirus from infected humans?

It is likely that the transmission of coronavirus is similar to that of other respiratory viruses such as influenza. That means that the infection occurs from contact with respiratory secretions of someone who is infected. That can be from directly touching the infected person or from being coughed on. Then, the droplets from the person coughing land on you and establish infection. That means that the most important thing you can do is proper hand hygiene, either washing with soap and water or using an alcohol-based hand sanitizer when you have contact with someone who might have a respiratory illness. It is very unlikely that walking around with a mask (as many are doing elsewhere) will make any difference.

Will a normal flu shot help me avoid the worst symptoms?

The flu shot is for preventing infection from influenza and will not prevent coronavirus infection. However, the illness caused by influenza is similar to the coronavirus infection, so if influenza is prevented, there is less chance of suspecting that you have the coronavirus when in fact, it is influenza.

If I catch the virus what is the standard treatment?

So far, there is not a specific medication that treats the virus (as is true for most viruses). However, with good supportive care nearly everyone can survive. That includes oxygen when needed and even a ventilator for those who are really sick.

I have a bad cough and would normally not see a doctor for it—but with this going on, should I go?

As of the 9th of March, we have not had any cases of the coronavirus infection in Kenya. That means that for people without recent international travel, any cough is from another cause, usually a virus. If you are not sick enough to require medical attention, there are two advantages to not going in. First, by staying at home, you will spread the virus to fewer people. Second, it is common that doctors give antibiotics even when they won’t help, such as for a viral respiratory infection, so you can save yourself from an unnecessary antibiotic.

Given that the virus originated from animals should I stay away from meat and animal products? Should I worry how I handle animals?
The 2019-nCoV coronavirus is originally a bat virus but likely was initially transmitted to humans via another mammal. However, now all the transmission is human to human, so animal contact will not make any difference for this virus. However, do note that there are other infections that can be acquired from animals. For example, there is anthrax from dead cattle who are then butchered. There is brucellosis from goats, sheep and other animals, and Salmonella from chickens and eggs. And don’t forget dogs; if they haven’t been immunized, they can transmit rabies when they bite. That means we must be careful with animals, but it won’t affect our getting the coronavirus.

What is Aga Khan University hospital doing for preparation?

If patients come with a potentially contagious illness they will be screened on entry to the facility and when necessary, appropriate precautions will be used. This includes things ranging from TB to cholera to influenza. That same screening process will identify people who might have the coronavirus. In that case, they will be given a surgical mask and will be taken to an individual room to keep them from placing others at risk. If they require hospitalization, whether a regular room or intensive care, they will be placed in an individual room with proper ventilation.

What level of care will COVID-19 patients receive?

Patients with COVID-19 will receive the level of care that is required for their illness, including intensive care treatment and advanced medical treatment when needed, such as a breathing mechanical ventilation or kidney dialysis.

Where should a patient with suspected COVID-19 go?

First, those do not truly require medical attention should stay home. Those who do need medical attention should come to A&E where they will be triaged to room 18 for evaluation. The team there will evaluate the patient quickly and decide between discharge, admission to ward level (third floor), HDU or ICU. We anticipate that with the physical exam and pulse ox, the disposition can be done for most patients. Some may require blood gases or chest x-ray; these are also available in A&E.

Prof Adam, is the Chair, Infection control Taskforce, Aga Khan University Hospital