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COVID-19.  A  Lesson and reminder.   


Fatema Miah:

 

Coronavirus is nothing new.
The “coronavirus” and “COVID-19″ interchangeably,  one is actually a subset of the other. The coronaviruses include Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).  COVID-19 is noble or new range of both or all viruses  (SARS, MERS, COV).  Here is a UK A&E case of a  26-year-old chap who came in with flu-like symptoms, decompensated heart failure with pulmonary edoema.
This case was tested  coronavirus positive. NOTE: not COVID 19, on his throat swab and he’s had an echo which has shown some severe LV impairment. And over the next 24 hours or so he’s shown some improvement with a furosemide infusion and high flow nasal oxygen.  Patient was on 60% oxygen and  gases was acceptable PO2 of over 8, and  furosemide infusion was  going, it  was cardiovascularly  unsupported. Patient had managed to eat and drink. It was alert and orientated in a negative fluid balance of a litre and he wasn’t on any antibiotics. The COVID-19 cases are more acute, goes on high cardiovascular support, patients are unable to eat or drink.  In the previous article I wrote somethings  about what is COVID-19.
At what point someone with COVID-19 becomes infectious, Was it only after developing symptoms like in SARS or could they transmit before developing symptoms?  Studies in Germany and in China have shown that people whose only contact with COVID-19 was with patients during the incubation period can get the disease. So transmission can happen during the incubation period. Transmission can certainly happen from those with symptoms and is probably more likely than those with more severe symptoms, accounting for the spread health care workers. It’s not yet clear how long people remain infectious after recovery. It’s not clear whether transmission can happen from those who are infected and never show symptoms, asymptomatic cases.
The virus gets detected from throat samples of  asymptomatic cases and in a case cluster  in China the only known source was someone with no symptoms, so the maximum incubation period, 14 days, gives the maximum time of quarantine following exposure. Unlike SARS transmission can occur before symptoms develop, this means that you cannot rely on screening symptomatic cases to detect all those who may transmit.
Social distancing implication or recommendation, from suggestion to order in some places isn’t just mere political agenda, its health management and safety requirement from prior knowledge of  understanding. Lockdown has been announced globally, even curfew been declared in some capitals. Curfew is matter of political method for controlling mass public movements, that’s can be both positive and negative by circumstantial of political motivation.   Whereas, Restricting movement of people to prevent the spread of disease has been used for thousands of years, long before the cause of infectious diseases was understood. Word quarantine comes in handling diseases.
The book of Leviticus in the Bible refers to restrictions for leprosy and the word quarantine derived from the 40 days used to try and prevent spread of the Black Death in the 14th century.  Ships were routinely quarantined to prevent the spread of infections, including cholera. Though, the scale of the quarantine restrictions in China is unprecedented. In this step, Dr Judith Glynn said:  “we will look at the science behind quarantine. There is always a period of time between acquiring an infection and beginning to show symptoms. That period is known as the incubation period.”
“There’s a characteristic incubation period for each disease. There is always variation between people so each disease has a characteristic median, minimum, and maximum incubation period. The distribution of incubation periods is usually roughly as shown here, rising quickly to a peak with a long right tail. For some diseases the incubation period is shorter after a larger infecting dose. Because COVID-19 is new, we didn’t initially know the incubation period. It was estimated from direct observation of people with COVID-19 with known dates of exposure and from travellers from Wuhan as we knew the last possible date of exposure.”
“Together with models of the likely distribution of incubation periods based on the typical shape and comparison with what was known for SARS from 2003, this gave a median of six days with a range of two to 14 days. This tells us how long we would need to wait to know someone is going to develop COVID-19 after exposure and forms the basis for the duration of quarantine for travellers. But another important consideration is when is someone infectious? Remember the incubation period is the time between acquiring an infection and beginning to show symptoms. There’s also a period of time between acquiring an infection and becoming infectious, that is when you can transmit to someone else.”
This outbreak of COVID-19, has become a havoc worldwide, causing suffering of health, Hunger,  stress, and so is causing high rate of  mass deaths, also it has became a cause of  big crises, further its leading to economic crash heading  to recession what will take long time to over come.  COVID-19 brought a sudden sharp turning to a new world to be emerged inevitably. World is forced to a new awakening, with a u-turning.
The recent fast accelerating global digital world of lazy, ignorant and rushing around are forced to slow down under COVID-19 lockdown.  In lockdown, from my location I witnessed people are more well mannered, polite and respective under guided distancing regulation and are highly responsive too. Surely, people will appreciate more of Privileges were at display per forced to  pause and to realise how much we have been taking for granted, and wasted and caused of damages and sufferings to the environment. May be time for a lesson for a balance.
WHO has been coming on the way of veccine decision,  for Covid19 pandemic veccine couldn’t be aggreed upon.  Is WHO positive and unbias for world health and welfare?  And what about WHOs members do they  all have equal high voice? However, Our world is aligning to re-adjusting and it starts with us. As well as economic crush the growing generation will face education short fall because of covid-19 pandemic.  Civilization advanced in the recent past,  2 steps forwards and now its been forced to  4 steps back.
Butlers education system likely to be  brought back in, anyway, vocational qualification systems shall be brought back to suit the time management for Covid-19 time and space management procedures.  Civilization was way much advanced in the past, tens of millenniums ago, and reverted back by decelerating back to 0 and reignited back to acceleration, there had been many  cicles of new worlds order in the past that the evidence remerging up by themselves.  .  Fatema Miah, Solihull, uk. fatemamiah@mail.com