The Who’s and What’s of the Wuhan/nCoV virus

The world is in shock, twitter is in meltdown and China looks like the zombie movie World War Z (without Brad Pitt unfortunately). “Facts” and panic are disturbingly intertwined. To provide some guidance, here for all non-medical people (and maybe even some medical) a brief summary of what is going on and how worried you should be.

An old friend presented in a novel way

Coronaviruses have been around us for a long time. The name Corona comes from Greek meaning Crown because of how it looks under the microscope. There are different forms of coronavirus and we’ve known a few already:

– CoV: common cold, super common and mild symptoms

– SARS-CoV: Severe Acute Respiratory Syndrome

– MERS-CoV: Middle East Respiratory syndrome

And now with the new outbreak:

– nCoV: the not so creatively named “novel Coronavirus”

In your life you have been infected with many coronaviruses only not with the dreaded novel, SARS or MERS variant, … just the common cold.

Don’t push the Panic button (… yet)

A little perspective, yes, the world is on high alert but at this moment there is no need to panic yet. I say “yet” because we’re still in the outbreak and who knows what will happen next.

At this moment the majority of the misery is in China. They have the highest number infected and deaths. There was only one country outside China with one death (Hong Kong not counting as separate country…), no other countries have yet reported. If you look at this table you can see how nCoV relates to the other Coronavirus pandemics as well as the H1N1 pandemic.

	nCoV	MERS	SARS	H1N1
Year	2019	2012	2002	2009
Origin country	China	Saudi Arabia	China	Mexico
Source	Bats	Dromedary camels	Bats	Swines
Number of people infected to date	28.276	2.494	8.096	208.269
Case fatality	susp 2%	37%	9.6%%	4.20%
Countries with reported infections	25	27	27	175
Countries outside origin with reported deaths	1	16	8	124

You can see that although the infection is spreading fast in China, the spread outside is still rare as well as the number of deaths outside of China. This is all very reassuring for the rest of the world although it doesn’t helpt China much.

This is de guidance of WHO pandemic criteria and you can see we’re currently in phase 4. The big questions is, will we get to phase 5 or 6? In other words: will there be an outbreak of the nCoV in a different country than China? Time will tell…

source: https://www.peakprosperity.com/coronavirus/

No hahahatjooo, Do hahahahandhygiene

You never know what happens next so just be cautious. The most important way of prevention of most infectious diseases is hand hygiene. Not just a quick splash of water on your hands but a real soapy two-minute wash and dry your hands after. Do this after visit to the toilet, before eating and after coughing/sneezing and you will be alright. Also please cover your mouth while coughing and sneezing to protect your surroundings. And if you’re sick don’t go to work or a different place where you can infect many others (see also “8 things you though you knew about the flu“).

Facemasks: if it won’t help Spiderman and Batman, it won’t help you

Wearing an ordinary medical facemask, although you look super cool with it, doesn’t help against viruses. Sorry. You would need a special very tight mask that prevents you from even smelling perfume if it was sprayed on your face.

If you do wear a facemask, please put the outside on the outside. It seems a complete “duh” remark but trust me I’ve seen public health professionals getting it wrong. And finally dispose the mask yourself and don’t put others at risk.

Stay safe and keep informed!

For more information: https://www.who.int/emergencies/diseases/novel-coronavirus-2019

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How to tame your outbreak: 2, the fight against Malaria

In part 1 of How to tame your outbreak I have shared with you the three necessary steps to control an outbreak. These were: gather information, contain the spread and keep it safe. In theory it is as simple as opening a bag of crisps on a lonely and rainy Tuesday evening whilst sitting on the couch ready to watch Legally Blonde for the tenth time. Controlling an outbreak in practice is a whole different ballgame.

Now , I could share with you all the Outbreak control plans and actions about every Virus, Bacteria and what, but since I work closely with a Malaria Elimination Task Force (METF) at the Myanmar-Thailand border, let’s use Malaria as example.

So here we go: how to tame your Malaria Outbreak?

Step 1: gather information

Malaria is caused by a parasite and is transmitted via mosquito’s. They suck blood from a Malaria patient and inject that blood into a new patient, thus infecting them. We know what it is and also how it spreads. That was the easy part.

Step 2: contain the spread

To contain Malaria there are really three options we could take:

Option 1: eliminate the mosquito. In real life, super difficult, it is easier to erase the West African Black rhinoceros than these little biters.

Option 2: prevent it from biting you. DEET or bednets are helpful, but it’s not realistic for people living in remote areas to use DEET all the time.

Option 3: make sure everybody that gets infected is treated before a mosquito can bite them and spread it further. This means early detection and treatment with the anti malaria drugs that kill the parasite. With the upcoming resistance (here we go again) this option can also become very challenging.

So which option to choose? You could start with option 3: early treatment. Now this can be a tricky part. Especially in a rural area like right here on the border, there are many villages and people tend not to stay in just one place. They work in one place, live in a next and their family is somewhere else again. This means that in order to successfully contain the outbreak, you will have to map out all the villages that you need to target. In the case of METF this is over 1500 villages. Then you need:

• Healthposts where people can go to get tested and treated.
• Healthworkers, educated people to diagnose and treat patients
• Medication, power supply, charts, needles, tests, alcohol (not to party into the night but to disinfect), etc.
• Education of all people, including villagers. People need to understand what you’re doing and why they need to come as soon as they have fever.
• A way of communication between the health posts and the hospitals in order to be able to send the severe patients in time for care

METF currently has over 1200 health posts with more than 1600 health workers. Can you imagine the work goes in to an operation like that?! And how much money, perseverance, guts (especially in the remote and unsafe areas) and love for the people? In the meantime, you can try option 1 and 2 (kill the mosquito and prevent the bites).

Step 3: keep it safe

The WHO grants a certificate that a country is “Malaria Free” (like Paraguay recently) when:

“a country has proven, beyond reasonable doubt, that the chain of local transmission of all human malaria parasites has been interrupted nationwide for at least the past 3 consecutive years; and that a fully functional surveillance and response system that can prevent re-establishment of indigenous transmission is in place.”

This means that, although my wonderful colleagues at METF have done a tremendous job already, saving thousands of lives in at least two countries, we’re not getting the certificate yet.

Containing an Outbreak is newsworthy and is a certain money collector. Keeping it safe is the part of the “outbreak” that funders are least interested in. It’s not news anymore. No extra figures to show. It’s just being there and staying there and not going anywhere until you’re sure. And that could take years and years. However, don’t get your guard down. Venezuela was declared malaria free in 1960 but had a big outbreak in 2016 with 240,613 patients and 280 deaths. As soon as you stop being prepared, it will come back.

So thank you METF and keep fighting the good fight.

 

Picture: Suphak Nosten: In the middle of the border, the one crossing for care, the one to provide care, across the border

 

Endemic, Epidemic, Pandemic: Semantic

Doctors have this habit of using a different vocabulary, making easy things sound very complicated. An example: ‘melena can be an indication of peptic ulceration’ actually means ‘blood out of your ass can be caused by stomach ulcers’. Why use difficult words: a. the doctor wants to sound very important and smart or b. they just don’t know the subject well enough to explain it in normal words. Or, as it said on one of the tiles on the wall at grandma’s house: ‘It takes an assbleeder to talk about assbleeders’.
Even in this blog we go over so many infections and sometimes I can get lost in the semantics. So, this time no specific infection, it’s just about how you can sound smart whilst taking about them.

Endemic

Endemic refers to a disease or condition that takes place in a specific region. For instance, Malaria is endemic in sub Saharan Africa but is not endemic in Europe. At least, not any more. Some diseases become endemic in new places all the time, the flu for example or the common cold. Other endemic conditions don’t move unfortunately: like the scraping throats and spitting on the floor at 5AM at our neighbor’s place in Thailand. Endemic as such is in short not something to be really scared about, especially when you take precautions (anti-malaria pills, flu-shot, earplugs)

Epidemic/Outbreak

Turning it up a notch. Epidemic means that in a period of time, more cases than expected in a community/area/season are suffering from the same condition or are infected with a specific disease. Scary stuff right. For instance, the epidemic of Ebola in 2014. Or obesity in America. By the way, a different word for epidemic is ‘Outbreak’. Remember that movie with Dustin Hoffman? That sweet little monkey – a real one, not mr. Hoffman – that turned out to be a real badass decease carrier? Outbreak = epidemic. Choose whatever sounds more spectacular.

Pandemic

Now the real trouble is when an Epidemic becomes a Pandemic, in which case the infection has spread worldwide. We’ve seen this, for instance, in the H1N1 time. More notorious examples are the Black Death pandemic (1346-1353: up to 200 Million deaths), the (Spanish) Flu pandemic (1918 – up to 50 Million deaths) and the HIV/AIDS Pandemic (peak 2005-2012 – 36 Million deaths)

Another movie example, watch ‘Contagion’ and you’ll understand what I’m talking about (really nice movie actually with Matt Damon and Jude Law… need I say more?). Storyline summary: ‘As the contagion spreads to millions of people worldwide, societal order begins to break down as people panic.’ Panic! If you do, you know you’re experiencing a Pandemic… Other movie must sees in this genre are Twelve monkeys (not about twelve monkeys) and World War Z.

Epidemiology

All these terms are very important for people that study diseases, epidemiologists. You might need some practice to master that word. I followed a masters in epidemiology and my husband still can’t pronounce it different than “epidedemology”, or something like that. Anyway, an epidemiologist studies how a disease behaves, spreads, etc. It is not that I am wearing a T-Shirt that says “I Love Pandemics”, … but that is only because I didn’t find it yet…

There you have it, some new words to drop in any conversation when you’re ordering beers at a bar and try to impress someone. Choose your words wisely though, nobody wants to know about the Endemics in your pants, the Epidemic fail you had at work or the Pandemic boxes you want to open…