Novel Coronavirus Outbreak continues to spread increasing the Containment Operations significantly to strengthen the Health Security in China/Asia

Novel coronavirus (2019-nCoV) belongs to family Coronaviridae, which is a positive sense, RNA single stranded viruses capable of causing respiratory and enteric infections. Its NCBI genome ID is MN908947 and genome size is 30473. The first suspected cases were officially reported to WHO on 31 Dec 2019. The first outbreak was detected in Wuhan, China, in mid Dec 2019. The virus has eventually transmitted to the other provinces of China. 2118 cases are confirmed and out of that 2062 are within the mainland. Human to human transfer confirmed in Guangdong. Number of deaths are reported 56 in total by 26 Jan 2020. And now around 3000 people have contracted the virus by 28 Jan 2020.

Reported symptoms include fever, fatigue, dry cough, breath shortness & respiratory distress to advance in pneumonia, kidney failure and death. Vital signs for hospitalized individuals are low white blood cells and low lymphocytes. The patients who died/ or experienced disease severity also noted to have the other conditions, like impaired immune system, hypertension, diabetes or cardiovascular disease.

Wuhan novel coronavirus is SARS related coronavirus. It is possible to reconstruct the phylogenetic tree of the mutation history of a family of virus. The illness caused by the virus is from common cold to MERS Middle East Respiratory Syndrome and SARS severe acute respiratory syndrome. 2019-nCoV is the seventh virus to cause the infection, previous six viruses reported for severity were 229E, NL63, OC43, HKU1, MERS-CoV, and SARS-CoV. Wuhan beta -coronavirus is similar to bat beta-coronavirus.

The phylogenic analysis for the genome in samples is available through Nextstrain. Viral protein M(pro) was modelled for linked experiments.

No particular treatment is available at present, but existing anti-virals like indinavir, lopinavir, interferon beta etc., are being studied.

Coalition for Epidemic Preparedness Innovation (CEPI) supported 3 projects with company Moderna, University of Queensland and Inovio, to create a vaccine. NIH is collaborating with a company Moderna to implement strategies for making RNA vaccine (matching corona virus spike). University of Queensland is running a project, on a molecular clamp vaccine that genetically modified viral proteins to mimic coronavirus and stimulate an immune response. VIDO-InterVac aims to start the production and non-human animal testing in March 2020, and human testing in 2021.

Reservoir for this virus were the suspected food/ intermediate host animal as the incidence was reported in the food workers of “Hunan Seafood Market”. The virus continues to spread as China increases the containment efforts. 56 million people were affected by travel restrictions for their Lunar New Year Celebrations in almost 20 cities.

Updates are as follows:

-         China cracks down on wildlife trade. Ordered temporary ban on supermarkets, restaurants and e-commerce platforms.

-         China orders extended public holidays to restraint the epidemic.

-         To reduce the population flow. Buses, ferries, public transport and taxis will also be suspended.

-         To intensify the containment efforts, which have so far included transportation and travel curbs along with cancellation of big events.

-         To step up with the construction of specialised hospitals to deal with increasing infected individuals.

-         The pressure on supplies of medical goods such as protective suits, masks and glasses had largely eased, due to increased private donations.

-         Two Chinese provinces and three cities have ordered citizens to wear face masks in public to help control the spread of the virus.

-         China has indefinitely postponed its 2020 National Winter Games and Supercup match.

-         Bill and Melinda Gates Foundation announced to donate $10 million to the response to the virus. Half the money will be given to Chinese groups to help them in containment efforts. The other half will be given to the African Center for Disease Control to fund its efforts to help African countries prepare to cope with the new infection.

WHO has acknowledged the respiratory illness, but recognized as it is too early to declare it as public emergency of international concern. Health authorities are taking decisive, powerful, orderly, scientific and well-planned measures to stop the spread.

The newly identified coronavirus has created alarm because much about this is still unknown, as how much risky it is to spread between people.

Countries confirmed the cases of coronavirus are, China, Nepal, United states, Australia, Singapore, Vietnam, France, South Korea, Japan, Taiwan, Malaysia, and Thailand.

Taiwan has the close economic and cultural links with China and so far, reported four cases only. Hong Kong will ban the residents of the Hubei province, where the new coronavirus first outbreak was reported. But these rules don’t apply to the Hong Kong residents. Thailand’s health agency says that, “we can control the situation and confident in our ability to handle the break.”

Analysis of viral genome are already providing clues to the origin of outbreak and even possible ways to treat the infection, which is an urgent need.

Virus is changing and provide a road map for developing diagnostic tests and vaccines.

A molecular biologist Kristian Anderson of Scripps Research said that,” Genetics can tell us how the outbreak started from a single event of virus jumping from an infected animal to a person or from lot of animals being infected and what’s sustaining the outbreak- the new introductions from animals or human-to-human transmission.

The genome sequence of Wuhan virus is 29903 bases long, led the scientists to believe that it is very similar to SARS. There is a single introduction in genome sequencing from 24 genome samples with no diversity, suggesting that it was the one-time-only jump. Genetic analysis can’t identify what animal species the coronavirus jumps from. Genome of coronavirus is 96% identical with bat corona virus suggesting the original source, analysis done by Wuhan Institute of Virology. Angiotensin converting enzymes2 (ACE2) is a door receptor attached to the spike protein of the virus enabling the virus to fuse with the host cell. ACE2 targeting drugs should be used for 2019-nCoV patients.

Gene sequencing is crucially important in diagnosis and development of vaccines. Continuous sequencing helps making the decision on mutations whether virus is dangerous or not. Coronavirus can cause infections with no symptoms and sicken health people. Some aggressive planning should be made to develop vaccines as a control measure in the epidemic areas.

WHO and centre for disease control of China, observed the active surveillance processes, temp. screening at the airport, laboratory facilities, infection prevention, control measures in the hospitals and clinics and deployment of RT-PCR test kit to detect virus. The data collected showed human to human transmission. China’s plan to expand the 2019-nCOV case definition will provide the clearer picture to the international community, of the spectrum of severity of the novel coronavirus. Increment in the confirmed cases are to be expected as the testing increases. Both parties agreed as close attention should be paid to hand and respiratory hygiene, food safety & avoiding mass gathering. People with fever should avoid close contact and must seek medical help.

All the healthcare professionals should adhere to the infection control procedures even in the areas where they don’t deal with infectious diseases. The Chinese experts have developed the protocols to be incorporated in the international guidelines, including case definitions, clinical management protocol, clinical management protocols, and infection control among others. The challenges still remain regarding the transmission, epidemiology and virus behaviour, WHO and its partners will work together to respond to the outbreak.

China’s virus outbreak shows Asia needs to step-up for infection control preparation. This New Year wake-up call reminds to be vigilant against SARS, bird flu, dengue, measles, polio, influenza, Middle East Respiratory Syndrome, Zika and range of other diseases. The last four influenza pandemics began in the western pacific region- which is a home for 1.9 billion people. The 37 countries and areas that make up the western pacific region – from Mongolia to New Zealand, have made considerable progress in strengthening preparedness and response, guided by WHO.

Most of emergency operations and rapid response teams have introduced epidemiology program trainings and event-based surveillance system for early identification and monitoring. China’s quicker action on the rapid identification of coronavirus and sharing with other countries, is certainly testament to strength it’s approach, to take appropriate actions to make the region and world safer.

But we are not completely safe, due the climate change has increased the frequency of disease outbreaks, impact of natural disasters and also expanded the geographic reach of epidemic prone diseases.

For strengthening the health security systems, we need:

- To expand the and modernize the surveillance system at local level.

- To strengthen the decision- making systems to ensure the rapid response.

- To communicate effectively to engage all relevant sectors & communities, to be better prepared for rapid response to emergencies and outbreaks.

- To strengthen the animal and human health centres in the hot spot area for diseases including growing threat for antimicrobial infections with drug resistance.

- To strengthen the collaborations between countries for better public health outcomes will benefit all from clean air, water and protection from infectious diseases.

No one can take the journey alone; but working together to keep up the momentum to continue improving the health security.

https://www.who.int/westernpacific/news/commentaries/detail-hq/china-virus-outbreak-shows-asia-needs-to-step-up-infection-preparation

https://www.aljazeera.com/news/2020/01/china-battles-coronavirus-outbreak-latest-updates-200125233944134.html

Coronavirus: Hubei cities fearful as medical supplies run low

Which countries have confirmed cases of new coronavirus?

https://www.who.int/china/news/detail/22-01-2020-field-visit-wuhan-china-jan-2020

https://www.statnews.com/2020/01/26/containing-new-coronavirus-may-not-be-feasible-experts-say/

https://en.wikipedia.org/wiki/Novel_coronavirus_(2019-nCoV)

DNA sleuths read the coronavirus genome, tracing its origins and looking for dangerous mutations

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