Statistics only include deaths of people officially diagnosed with Covid-19 with a test SEVERAL SCIENTIFIC CONSORTIA AROUND THE WORLD ARE SEEKING AN ANTIDOTE FOR SARS-COV-2
Most coronaviruses are non-dangerous and can be treated effectively THE ORIGIN OF THESE VIRUSES IS UNKNOWN, BUT CERTAIN ANIMALS CAN ACT AS RESERVOIRS
Just over a hundred years since the 1918 Spanish flu pandemic shook the world, another infectious disease is now sweeping the globe. We have gradually learnt more about coronavirus since the first Covid-19 cases began to appear in the Chinese city of Wuhan a few short months ago. Below are some of the main questions people ask about the current health crisis.
1. What is a coronavirus?
Coronaviruses are a family of viruses whose origin is still unknown. The different types cause different diseases, from a cold to severe respiratory syndrome. Most coronaviruses are non-dangerous and can be treated effectively. In fact, most people get a coronavirus at some point in their lives. Although they are more common in autumn or winter, they can be caught at any time of the year. The coronavirus owes its name to its appearance, as it is very much like a crown or halo. It is a type of virus present mainly in animals, but also in humans.
2. What is the SARS-CoV-2?
SARS-CoV-2 is the name of the virus that causes the disease called Covid-19. The cases reported already far exceed those of the 2002-2003 SARS epidemic. Although SARS-CoV-2’s lethal rate is lower, it has caused many more deaths because the number of people infected with it already runs into the millions. The World Health Organization (WHO) declared the coronavirus outbreak to be a pandemic on March 11. Since then, most countries have decreed a state of mergency, obliging people to stay at home in order to contain transmission of the disease.
3. When did it appear?
On December 31 2019, the WHO was informed of pneumonia cases with an unknown cause in Wuhan City in China. The Chinese authorities identified a new coronavirus as the cause of the outbreak on January 7, 2020. At first, it was given the name “2019-nCoV”, with the outbreak declared a Public Health Emergency of International Concern on 30 January 2020.
4. What are the theories about its origin?
The origin of these viruses is unknown, but certain animals, such as bats, are known to act as reservoirs. As in other viruses that cause pneumonia, when they are transmitted to humans, the infection usually occurs through the respiratory route. Everything indicates that the new coronavirus that causes Covid-19 is of animal origin. In fact, the first cases have been related to a live animal market in Wuhan, in China.
5. How is it transmitted?
The main route of transmission is by air, through small droplets that occur when an infected person coughs or sneezes. It is also spread by touching the eyes, nose, or mouth after contact with contaminated surfaces. While this contagion route does not seem to be the most effective, a laboratory study found that SARS-CoV-2 can remain viable on some surfaces for a few days. Recent evidence has also shown that, unlike SARS, which is transmitted only when the person has symptoms, this new coronavirus can be transmitted before the appearance of symptoms or even if the person has no symptoms.
6. Is it very contagious?
SARS-CoV-2 can be transmitted from one person to another quite easily. The WHO estimates that the rate of contagion (R0) of the virus is 1.4 to 2.5, although other estimates speak of a range between 2 and 3. This means that each infected person can in turn infect two to three people, and there may also be “superspreaders”, who are people capable of infecting up to 16 people. To control an epidemic, R0 needs to drop below 1.
7. How is Covid-19 diagnosed?
The virus is found mainly in the body’s airways. That is why current diagnostic tests, which include amplifying PCR virus gene sequences or detecting proteins, require a nose, throat or pharynx smear to detect the infection. Another type of diagnosis being developed is a test that detects antibodies to the virus. In this case, a blood sample is enough. This test has the advantage of detecting not only individuals with active or recent infection, but also those who were previously exposed to the virus and who may therefore be immune to it.
8. What are the symptoms?
The main symptoms are fever, coughing, and difficulty breathing. However, in a small percentage of patients, the first symptoms may be diarrhoea, nausea, or headaches. Loss of taste and smell seems to be common and could be one of the first signs of the disease. The WHO estimates that the incubation period (between infection and the onset of symptoms) is between two and 14 days, although the vast majority of sufferers develop symptoms between five and seven days. As with the influenza virus, the most severe (and highest mortality) symptoms are reported in both the elderly and those with immunosuppressive or chronic illnesses, such as diabetes, some types of cancer, or chronic lung disease. In severe cases, they may cause respiratory failure. The Covid-19 pandemic has shown that about 80% of infected people have mild symptoms.
9. How many people have died?
The data so far points to a mortality rate of about 2%, although it is still too early to know with any certainty. It could decrease if there are a lot of asymptomatic cases or with very mild symptoms that have not been diagnosed. It could increase if the virus mutates (for the moment this has not been observed). In any case, the mortality rate is lower than that of SARS (10%) and could be about 10 times higher than that of seasonal flu (which is below 0.1%). A recent study estimates that the adjusted death rate in China was 1.4% for confirmed cases and 0.66% for infected but undiagnosed cases.
10. Who is most at risk from coronavirus?
It has been shown that older adults (people over 60) and those with severe chronic medical conditions, such as heart disease, diabetes, lung disease, kidney disease, and HIV, are at increased risk of developing more severe symptoms once infected with Covid-19. Early research suggests that older adults are twice as likely to exacerbate Covid-19. This is due to the fact that as people age, their immune system changes, making it difficult for their body to fight diseases and infections. Many older adults are also more likely to have underlying health problems, which aggravates their recovery from Covid-19.
11. Are pregnant women more at risk?
At present, there is no scientific data to prove pregnant women are more susceptible to becoming infected by the virus. In fact, this new coronavirus seems to affect men more than women. It is true that pregnancy involves changes in the immune system that may increase the risk of getting viral respiratory infections or developing them more seriously, but for now the published data shows that no more severe forms of Covid-19 have been reported in pregnant women.
12. Are smokers more at risk from the disease?
Smokers are more vulnerable to Covid-19 as the act of smoking means that fingers (and possibly contaminated cigarettes) are in contact with lips, which increases the possibility of transmission of the virus from hand to mouth. Smokers may also already have lung disease or reduced lung capacity that would greatly increase the risk of serious illness. Smoking products such as water pipes often involve the sharing of mouth pieces, which could facilitate the transmission of Covid-19 in communal and social settings. Conditions that increase oxygen needs or reduce the ability of the body to use it properly will put patients at higher risk of serious lung conditions such as pneumonia.
13. How are the deaths due to Covid-19 counted?
The fatality figures sent by states are collected by the WHO, which compiles and publishes global statistics. However, the way they are collected varies from country to country. Also, this statistic only includes those deaths of people officially diagnosed with Covid-19 through a test. There are entire regions where this is impossible, such as in some African countries. Right now in the US and most of Europe, those who die outside the hospital – and until a few weeks ago in nursing homes in Spain — are not counted because they haven’t been tested.
14. How has the pandemic evolved?
It was not until March 11 that the WHO officially declared the spread of Covid-19 to be a pandemic. The declaration did not lead to an extra level of action, but it was official recognition that this coronavirus had in just a few weeks infected every corner of the planet. The previous reported pandemic was Influenza A, in 2009. The Chinese authorities registered a 55-year-old person as the first case of Covid-19 infection on November 17 2019 in the Hubei region. The outbreak is believed to have originated in a market where wild animals were being sold in Wuhan City, and on December 31, the WHO reported the first cases. In mid-January, the first cases were imported from China to Thailand and Japan. On January 24, the first infected people in Europe were reported in France. Globalization carried the virus everywhere in just a few weeks.
15. What measures have been taken to stop the pandemic?
China, the ground zero of the pandemic, enacted massive, two-month-long confinements that affected about half the population: first in Wuhan and its region, where the outbreak began, and then in other cities in the country. This same model has been replicated with local varieties in India, Russia and most European states, where quarantine has generally been less stringent than in China. In the US, the response has been uneven and uncoordinated among the various states.
16. Why have some states not chosen to restrict people to their homes?
There are states that do not believe in the effectiveness of mass quarantine. South Korea, for example, has chosen to test its citizens to see if they are carriers of Covid-19 and whether they must be isolated or immunizedin order to control the spread of the disease. Other countries, such as Sweden, rely on “herd immunization”, a controlled transmission of the virus that avoids overloading the healthcare system, as has happened in many other countries.
17. Can we get immunity from this virus?
Once the disease has been overcome, antibodies capable of blocking the virus can be generated for a few months. Studies are not definitive yet, but it does indicate that, as with the flu, we must be vaccinated every year, but the immunity is for a while but not permanent.
18. Why is staying at home important?
The battle against coronavirus is not only fought in hospitals. Staying at home is one of the most effective measures to stop the spread of the virus that causes Covid-19, along with frequent hand washing and maintaining a safe distance of one and a half metres between people. The sole purpose is to reduce the transmission rate and minimise the impact of Covid-19 on the public health system.
19. Why is it recommended to wash your hands?
One of the best prevention measures against coronavirus is to wash your hands with soap and water. It is recommended by all health authorities, from the WHO to the Spanish health ministry to the Catalan health department. Viruses can stay active for many hours on the surfaces we touch with our hands; then if we touch our face, the odds of being infected multiply. That is why it is so important to wash your hands often. And you don’t have to do it with miraculous, expensive, or hard-to-find products – soap is the worst enemy of the SARS-CoV-2 coronavirus (and viruses in general).
20. Do face masks protect you from infection?
It is not necessary to use a face mask in public spaces unless you have been told to by a healthcare professional. However, that is according to the latest instructions from the health department, which may change in the future because there are differences between what experts in this field think. The cases in which a face mask is needed are whenever directed to by healthcare staff, if you are in isolation and have contact with other people in your environment or who share the same space.
21. What is social distancing?
One of the most important ways to stop Covid-19 contagion is to maintain social distance, or to maintain a physical distance from other people. This must be taken into account in public places, where a good number of people may still gather, such as food shops or supermarkets. Quarantine is the maximum expression of social distancing.
22. What should I do if I notice some of the symptoms?
If you notice muscle aches, coughing, fever, and shortness of breath you should call 061, and in the event that the symptoms persist, call 112. From the outset, safety precautions must be taken: not to leave the house and to sleep at home, living in a single room, and cleaning clothes and household linen (towels, sheets) apart from the other people you live with and with whom direct contact should be avoided. The monitoring of the symptoms can be done through the COVID19 CAT app.
23. Is there any sort of vaccine? What is the timeframe for having one?
At present there is no vaccine for Covid-19. However, from the outset, several scientific consortia around the world are seeking an antidote for SARS-CoV-2. Developing one is a slow process that will not come in time for this pandemic. The forecast is to have it in a minimum period of a year or a year and a half.
24. Are there any medications that help stop the progression of the disease?
There is currently no evidence from controlled clinical trials to recommend a specific treatment for coronavirus. There are some clinical trials with two retrovirals for HIV treatment but they are still in the experimental phase and need the patient’s consent. Hydroxychloroquine, a drug used to fight malaria, has also been used successfully, but all the necessary studies still need to be performed because, among other things, it has significant side effects in patients.
25. What is the forecast for the end of the pandemic?
There is no date as yet. However, the virus will no longer spread when almost all the population is immunised. The authorities have different options on the table, although none of them is easy. The first would be keeping the public confined to their homes for months, which is hardly feasible, especially economically; a second option would be to decree periodic confinements until everyone is immunised; and a third option is to test the entire population in order to isolate individuals who have not yet had the disease. The prospects of a complete solution depend on a vaccine, and also on the hope, known by scientists of other pandemics, for the natural remission of the infections.
26. When is the home quarantine due to end?
The total confinement of everyone in Spain has already been lifted. Non-essential workers have now been allowed to return to work. The schedule for lifting the rest of the restrictions has not yet been decided. The Catalan government has commissioned a report from researcher Oriol Mitjà that will serve as a basis for deciding how to go about returning to social and economic activity while minimising possible new outbreaks of the virus.
27. Can coronavirus be transmitted to animals?
According to Spain’s health ministry, it appears that people can transmit SARS-CoV-2 to animals such as cats, dogs, and ferrets, but it is not certain that it can go the other way. In China, two cases of dogs with Covid-19 symptoms have been reported, as has a cat in Belgium, while large felines at the Bronx Zoo have tested positive for coronavirus. However, scientists say that the transmission of diseases from humans to animals is not uncommon.
28. Does heat affect the virus?
Most infectious diseases have a seasonal component. When it’s cold, we spend more time indoors, making it easier for them to spread. One of the hopes for the end of the crisis is that, as with influenza viruses, the hot weather will diminish its incidence. But Covid-19 is a new virus, and there is no unanimity about the effects of hot weather on it, so we will have to wait and see. Seasonality would mean that the new coronavirus would reappear each season, but many people would already be immunised.
29. What other coronavirus epidemics have there been in recent years, and what were their effects?
Coronaviruses were first described in the late 1960s. Since then, seven major coronavirus strains related to respiratory disease have been identified in humans, but most have only had mild effects. The most significant epidemic before Covid-19 was SARS-CoV-1, which occurred in Southeast Asia in 2002 and, until 2004, infected 8,422 people in 30 countries, causing 916 deaths.
30. Could the pandemic resurface in the autumn?
Some experts say yes, and that the virus is here to stay. They add that it could even lead to even higher mortality rates in the future. This is because climate change favours the spread of all kinds of viruses. The positive side is that the vaccine should be here before that happens.