Coronavirus disease-2019: An update on third coronavirus outbreak of 21st century

Abstract

Dear Editor, We read with great interest the recent article by Fang et al.1 on novel coronavirus (2019-nCoV) infection published in February issue. It was in early December 2019, when the first case of coronavirus disease-2019 (COVID-2019) was detected in a patient who was admitted for pneumonia of unknown etiology (Figure 1). We would like to mention a few additional comments about this deadly virus which has been a matter of health concern worldwide. Timeline showing the index case detection in China and worldwide. 2019-nCoV has been found to be epidemiologically linked to the Huanan seafood wholesale market in Wuhan, China which is known for selling exotic animals.2 Although, the exact host is yet to be determined, but based on the genomic studies done till now it has been postulated that possibly bats may be one of the suspected hosts responsible for transmitting this virus to humans.2 This is not the first time when human life is in danger because of such outbreaks. Previously as well, severe acute respiratory syndrome-related CoV (SARS-CoV) outbreak (2003) and Middle East respiratory syndrome CoV (MERS-CoV) outbreak (2012) resulted in many deaths worldwide.3 Despite this, the exposure to the exotic animals knowingly or unknowingly continued thereby resulting in the ongoing third CoV outbreak of the 21st century. Up till 12th March 2020, 127 863 confirmed cases of COVID-19 have been reported worldwide, the majority from China (80 982 cases) with 4718 patients losing their life as shown in Table 1 (https://www.cdc.gov/coronavirus/2019-nCoV/index.html; https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6). When compared with China, in the rest of the world, the number of cases proportionately remains low (Figure 2). Both the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) are regularly issuing the latest updates and guidelines on 2019-nCoV infection (https://www.cdc.gov/coronavirus/2019-nCoV/index.html). It is important to note that, out of all the three CoV outbreaks of the 21st century, COVID-2019 has caused the maximum number of deaths till now and the count is still rising. However, when compared with the MERS outbreak (mortality rate of 35–40%) and SARS outbreak (mortality rate of 9–10%), the mortality rate of 2019-nCoV is significantly lower (1–3%). The possible reason postulated is the excessive cytokine release with MERS and SARS as compared with 2019-nCoV infection; however, this needs to be confirmed in further studies.4,5 Stacked Venn diagram showing comparative representation of disease load in Wuhan (epicenter), Hubei Province, China and Whole World. Total number of confirmed COVID-19 cases detected in top 25 countries with decreasing patient load (Data updated till 12 March 2020) Source: CSSE, Johns Hopkins University. Total number of confirmed COVID-19 cases detected in top 25 countries with decreasing patient load (Data updated till 12 March 2020) Source: CSSE, Johns Hopkins University. With regards to the identification, health care professionals should be aware of the diagnostic criteria laid down by WHO to evaluate any suspected case. Hence, detailed travel and sick contact history are of utmost importance to ensure that any suspect gets thoroughly evaluation to rule out 2019-nCoV infection. With regards to symptomatology, it has been reported that fever, fatigue and dry cough are the three most common reported symptoms related to 2019-nCoV.6,7 Interesting to note that as compared with previous CoV outbreaks, diarrhea is rarely reported with 2019-nCoV infection.6–8 Fang et al.1 did mention about the radiological findings in their patient. The study by Wang et al.7 on 138 hospitalized patients with COVID-2019 showed that 100% of the patients had positive radiological findings. The most common reported pattern seen in chest computed tomographic scans were bilateral patchy shadows or ground-glass opacities. The study also showed that comorbidities like hypertension, diabetes and cardiovascular disorders increased the likelihood of complications requiring intensive care. Based on similar studies and our experience, we believe that immunocompromised individuals like patients with active cancer, HIV, patients on steroids etc. hold a higher risk of having complications if they acquire viral infections like COVID-2019.9–12 Fang et al.1 gave Veletonavir to their patient as the antiviral agent of choice. We would like to emphasize that none of the antiviral agents available at this time has been proven to be effective to treat COVID-2019. Many drugs like Darunavir/Cobicistat and Lopinavir/Ritonavir are under trial to study their efficacy against 2019-nCoV (https://clinicaltrials.gov/ct2/results? cond=coronavirus). In conclusion, the current situation with regards to the 2019-nCoV outbreak is alarming as the number of cases is increasing day by day. At an individual level, every attempt should be made to follow all the civic responsibilities and mannerism in order to prevent the spread of this infection. Conflict of interest. None declared.

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