Background, Symptoms,Treatment and Recent Development

1. Novel Coronavirus (2019-nCoV)
Background, Symptoms,Treatment and
Recent Developments
Laurent Iyikirenga

2. Objectives of the presentation
At the end of this presentation, you will be able to:
Identify the origins of the novel coronavirus.
Outline the difference between general coronaviruses and the
novel coronavirus.
List the signs and symptoms of the novel coronavirus.
Define the current understanding about how the novel
coronavirus was transmitted to humans.

3. Signs and Symptoms of Coronaviruses - General Overview
• Common human coronaviruses usually cause mild to moderate
upper-respiratory tract illnesses, like the common cold. Most
people get infected with these viruses at some point in their lives.
These illnesses usually only last for a short amount of time.
• Symptoms may include:
• Runny nose
• Headache
• Cough
• Sore throat
• Fever
• General feeling of being unwell
Human coronaviruses can sometimes cause lower-respiratory tract illnesses, such as
pneumonia or bronchitis. This is more common in people with cardiopulmonary
disease, people with weakened immune systems, infants, and older adults.

4. Signs and Symptoms of the Novel Coronavirus
(2019-nCoV)
Based on what was seen with other coronaviruses, it is believed that symptoms of
2019-nCoV may appear in as few as 2 days or as long as 14 after exposure.

5. Transmission and Treatment
• 2019-nCoV is a betacoronavirus, like MERS and SARs, all of which have
their origins in bats.
• Chinese authorities have successfully sequenced the genome of the virus
allowing for effective detection. The US CDC confirmed the same genome in
the first two cases in the US.
• Early on, many of the patients in the outbreak of respiratory illness caused by
2019-nCov in Wuhan, China had some link to a large seafood and live
animal market (also known as "wet markets"), suggesting that initial spread
of the virus was animal-to-person.
• Subsequently it has become clear that human-to-human contact is able to
spread the virus.
• The complete clinical picture with regard to 2019-nCoV is still not fully clear.
Reported illnesses have ranged from infected people with little to no
symptoms to people being severely ill and dying.

6. Transmission and Treatment (Cont’d)1
How does the Novel Coronavirus spread from Person-to-Person?
Human coronaviruses most commonly spread from an infected person to others through:
 The air by coughing and sneezing
 Close personal contact, such as touching or shaking hands
 Touching an object or surface with the virus on it, then touching your mouth, nose, or eyes
before washing your hands
 Rarely, fecal contamination
• When person-to-person spread has occurred with MERS and SARS, it is thought to
have happened mainly via respiratory droplets produced when an infected person
coughs or sneezes, similar to how influenza and other respiratory pathogens spread.
Spread of SARS and MERS between people has generally occurred between close
contacts.
• It’s important to note that how easily a virus spreads person-to-person can vary. Some
viruses are highly contagious (like measles), while other viruses are less so.

7. Transmission and Treatment (Cont’d)2
Should you be tested for the Novel Coronavirus (2019-nC0V)?
• US CDC guidelines state: "If you develop a fever* and symptoms of respiratory illness, such as cough or
shortness of breath, within 14 days after travel from China, you should call ahead to a healthcare
professional and mention your recent travel or close contact. If you have had close contact** with
someone showing these symptoms who has recently traveled from this area, you should call ahead to a
healthcare professional and mention your close contact and their recent travel."
• * Fever may not be present in some patients, such as those who are very young, elderly,
immunosuppressed, or taking certain fever-lowering medications. Clinical judgment should be used to
guide testing of patients in such situations.
• ** Close contact is defined as:
 being within approximately 6 feet (2 meters), or within the room or care area, of a novel coronavirus case
for a prolonged period of time while not wearing recommended personal protective equipment ; close
contact can include caring for, living with, visiting, or sharing a health care waiting area or room with a
novel coronavirus case.– or –
 having direct contact with infectious secretions of a novel coronavirus case (e.g., being coughed on)
while not wearing recommended personal protective equipment. 4

8. Treatment
• According to the US CDC, there is no specific antiviral treatment recommended for the novel
coronavirus infection. People infected with 2019-nCoV should receive supportive care to help
relieve symptoms. For severe cases, treatment should include care to support vital organ
functions. People who think they may have been exposed to 2019-nCoV should contact your
healthcare provider immediately.
What happens in hospital?
• Those who get admitted to hospital are given treatment for their symptoms while their immune
systems try to fight the virus off. Hospitalisation also serves to isolate patients and stop the virus
spreading.
• In severe cases, the virus can cause pneumonia - an inflammation of the lungs. In those cases
breathing may need to be supported. Patients are given oxygen and in the worst cases may be put
on a ventilator. About one in four cases are thought to be severe.
• In milder cases, patients struggling to maintain blood pressure can be given an intravenous drip.
Fluids can also be given in cases of diarrhoea, and ibuprofen is also available for pain relief.

9. How Deadly is the Coronavirus?
• Based on data from 44,000 patients with this coronavirus, the WHO says:
81% develop mild symptoms.
14% develop severe symptoms.
5% become critically ill.
• The proportion dying from the disease appears low (between 1% and 2%)
but the figures are unreliable.
• Thousands are still being treated but may go on to die - so the death rate
could be higher. But it is also unclear how many mild cases remain
unreported - so the death rate could also be lower.
• To put this into context, about one billion people catch influenza every
year, with between 290,000 and 650,000 deaths.

10. How to Self-Isolate ?
• If you suspect you have coronavirus, have been in contact with someone who has it, or have
been to a place where there are a lot of cases of the virus, then the official advice is to self-
isolate.
• The top five methods to successfully self-isolate include:
1. Stay at home - Do not go to work or school, or other public spaces. Do not have any
visitors.
2. Call ahead - If you develop symptoms such as a cough or fever, then seek advice first by
phoning your local medical center or hospital. Don't just turn up as this could potentially
spread the virus if you have it.
3. Separate yourself - If you live with others then you should stay in a well-ventilated
bedroom with the door shut. If you share a bathroom then use it after everyone else. Don't
share towels and toiletries.
4. Dispose of waste carefully - Your waste should be double-bagged.
5. Order in food - Order food online or ask your family or friends to help. Ask the person to
leave food deliveries on the doorstep.

11. Coronavirus - Recent Developments
Overview
• Patients with 2019-nCoV infection, are presenting with a wide range of symptoms. Most seem to have
mild disease, and about 20% appear to progress to severe disease, including pneumonia, respiratory
failure and in some cases death.
• According to real-time data from Johns Hopkins University as of 8:00am (GMT) February 27th 2020,
the latest figures on the novel cornavirus are as follows:
82,171 cases confirmed globally with 78,497 of these cases confirmed in mainland
China.
2,804 confirmed deaths, with the first death outside of China reported in the
Philippines.
39,985 patients of the virus have been reported as having recovered fully.
The virus has now been confirmed in 50 countries and territories outside of China.
Of these confirmed cases, World Health Organization (WHO) has confirmed that over 8,204+ of these
cases have been classified as 'severe'. Due to the increased transmission of this virus, the WHO has
undertaken risk assessments which have concluded that China is now classified as "Very High" risk,
while the threat of the virus has been established as a "High" risk at regional and global level.

12. Recent Developments
How the Coronavirus has Spread in China ?
• Thousands of patients have been infected with the virus across China, with
central Hubei province being the worst-affected. Restrictions on travel are
affecting at least 20 million people across 10 cities - including the capital
Wuhan, where the virus emerged.
• In a bid to tackle the increased demand for medical services, the
authorities are building two makeshift hospitals, one with 1,000 beds and
another with a capacity of 1,500 beds. people have been asked to wear
face masks in public places.
• The Chinese government has also closed a number of temples, the
Forbidden City and part of the Great Wall.

13. Source: China National Health Commission,
BBC Research, January 2020

14. Locations with Confirmed Cases of Novel Coronavirus
China Japan
Republic of
Korea
Vietnam Afghanistan
Singapore Australia Malaysia Cambodia Norway
Philippines Thailand Nepal Sri Lanka Algeria
India US Canada France Georgia
Finland Germany Italy Russian Federation Denmark
Spain Sweden United Kingdom United Arab Emirates North Macedonia
Taiwan Macau Belgium Hong Kong Switzerland
Egypt Lebanon Bahrain Iran Brazil
Canada Kuwait Pakistan Romania Greece
Iraq Oman Croatia Israel Austria
As of February 27th 2020, 50 countries/territories outside of China have confirmed cases of the novel
coronavirus. According to data from Johns Hopkins University 5, these countries/territories include:

15. Distribution of Novel Coronavirus cases

16. Other Recent Developments
• Scientists in Australia have become the first to recreate the new coronavirus outside of China in
what they have called a "significant breakthrough". The discovery will be shared with the World
Health Organization (WHO) in the hope it may help efforts to diagnose and treat the virus.
• Scientists in China have also recreated the virus and shared its genome sequence.
• Chinese authorities have said the virus - like a normal flu - is able to spread during its incubation
period. According to the WHO, the incubation period can range from two to 10 days, however,
WHO said it remains unclear whether it is contagious before symptoms appear.
• A number of airlines have cancelled all flights to China.
• Russian Prime Minister Mikhail Mishustin said Thursday that Russia would be closing its land
border with China from Friday until at least March 1st. Singapore banned the entry and transfer of
travelers holding passports issued by China’s Hubei province from Wednesday onwards.
Mongolia’s official news agency has said the country closed border crossings with China on
Monday, according to the AP.

17. International Response
• Outbreaks of novel virus infections
among people are always of public health
concern. The risk from these outbreaks
depends on characteristics of the virus,
including whether and how well it spreads
between people, the severity of resulting
illness, and the medical or other
measures available to control the impact
of the virus (for example, vaccine or
treatment medications).
Overview
The World Health Organisation coordinates global responses in these case. Established in 1948, it is the directing
and coordinating authority on international health within the United Nations system.

18. WHO Statement 30 January 2020
• The Committee believes that it is still possible to interrupt virus spread, provided that countries put
in place strong measures to detect disease early, isolate and treat cases, trace contacts, and
promote social distancing measures commensurate with the risk.
• The Committee agreed that the outbreak now meets the criteria for a Public Health Emergency
of International Concern (PHEIC).
• Since 2009, there have been six PHEIC declarations: the 2009 Swine Flu pandemic, the 2014
polio declaration, the 2014 outbreak of Ebola in Western Africa, the 2015–16 Zika virus epidemic,
the Kivu Ebola epidemic, and the 2020 novel coronavirus outbreak.
• It is expected that further international exportation of cases may appear in any country. Thus, all
countries should be prepared for containment, including active surveillance, early detection,
isolation and case management, contact tracing and prevention of onward spread of 2019-
nCoVinfection, and to share full data with WHO.
• Countries should place particular emphasis on reducing human infection, prevention of secondary
transmission and international spread, and active participation in increasing knowledge on the
virus and the disease, as well as advancing research.
• The Committee does not recommend any travel or trade restriction based on the current
information available.

19. CDC’s Interim Recommendations for the Commercial
Airline Industry
The CDC has instructed airlines to report travelers with with specific symptoms arriving from
China.The criteria for reporting a suspected case of novel coronavirus includes travelers
arriving from China with:
1. Fever (person feels warm to the touch, gives a history of feeling feverish, or has an actual
measured temperature of 100.4°F [38° C] or higher) that has persisted for more than 48
hours; OR
2. Fever AND one of the following:
Persistent cough
Difficulty breathing
Appears obviously unwell
After arrival, a health assessment of the sick traveler’s symptoms and possible exposures will
be carried out, CDC will update the airline about the results of the testing and any need for
follow-up of exposed crew members or passengers.3

20. Quarantine in Northern Italy
• Italy has become Europe's first significantly impacted country. The outbreak in Italy centered
around a group of towns in the Lombardy and Veneto regions. By late Feb, 11 towns were
closed-off, in which more than 50,000 people are quarantined.
• There are signs the virus is spreading within Italy, as new cases have been reported in Tuscany,
Sicily and Liguria.
• Italian authorities have confirmed more than 530 cases and 14 deaths there.
USA is prepared for Covid-19 outbreak says President Donald Trump
• In the United States, President Trump has appointed his Vice-President Mike Pence to coordinate the
government response to the Covid-19 outbreak. Sixty cases have so far been reported in the US, but
President Trump expressed confidence that the US would be able to handle the Covid-19 outbreak.
• Alex Azar, the US health secretary, said the White House had developed a plan to focus on five priorities,
including better disease surveillance, local government response coordination, developing therapeutics,
and increasing manufacturing of personal health protection equipment, like masks.

21. In Summary
 On January 7th 2020, Chinese authorities confirmed that they had identified a new virus, which is believed
to have originated from Wuhan, China. The new virus is a coronavirus and was temporarily named “2019-
nCoV.”
• Coronaviruses are zoonotic, meaning they are transmitted between animals and people.
• Symptoms can include fever, followed by a dry cough and then, after a week, leads to shortness of breath
and some patients needing hospital treatment. Other symptoms can include sneezing, headaches, and
possible kidney failure.
• Early on, many of the patients in the outbreak of respiratory illness caused by 2019-nCov in Wuhan, China
had some link to a large seafood and live animal market, also known as "wet markets."
• Human coronaviruses most commonly spread from an infected person to others through: the air by
coughing and sneezing; close personal contact, such as touching or shaking hands; touching an object or
surface with the virus on it, then touching your mouth, nose, or eyes before washing your hands and
rarely, fecal contamination.
• If you develop a fever and symptoms of respiratory illness, such as cough or shortness of breath, within
14 days after travel from China, you should call ahead to a healthcare professional and mention your
recent travel or close contact.
• The CDC is closely monitoring this situation and is working with WHO and state and local public health
partners to respond to this emerging public health threat.

22. In Summary (Cont’d)2
• On January 27th, 2020 CDC issued updated travel guidance for China, recommending that
travelers avoid all nonessential travel to all of the country (Level 3 Travel Health Notice).
• CDC and the CBP (Customs and Border Protection) are continuing to conduct enhanced entry
screening of passengers who have been in Wuhan within the past 14 days at 5 designated U.S.
airports.
• The commercial airline industry has been instructed by the CDC to report travelers with with
specific symptoms arriving from China, which include a fever (of 100.4°F [38° C] or higher) that
has persisted for more than 48 hours; or fever and one of the following: persistent cough,
difficulty breathing and unwell appearance.
• If necessary, CDC staff will coordinate transport to a health care facility for medical evaluation
and testing. CDC will update the airline about the results of the testing and any need for follow-
up of exposed crew members or passengers
• As of February 27th 2020, 82,171 cases have been confirmed globally with 78,497 of these
cases confirmed in mainland China. WHO has now categorized China as "Very High" risk,
while the outbreak is classified as being a "High" risk at regional and global level.

23. In Summary (Cont’d)3
• A total of 2,804 people (February 27th 2020) so far have died following infection with the
novel coronavirus; with the first death outside of China reported in the Philippines. It has
also been reported that 39,985 people have so far recovered from this coronavirus.
• Thousands of patients have been infected with the virus across China, with central Hubei
province being the worst-affected. Restrictions on travel are affecting at least 20 million
people across 10 cities - including the capital Wuhan. The Chinese government has also
closed a number of temples, the Forbidden City and part of the Great Wall.