Linked-in Sunil Wimalawansa, MD,PhD,DSc.,Executive MBA Professor of Medicine
Table of contents
- History of this new coronavirus:
- What is a coronavirus—(2019-nCoV)?
- Recent evolution of 2019-nCoV
- Similarity of 2019-nCoV to other common viruses:
- Comparison with other recent viral outbreaks:
- Incubation periods of Wuhan coronavirus and other recent viral outbreaks:
- Symptoms of Wuhan coronavirus:
- Contagiousness of coronavirus:
- What type of face masks are protective against viruses?
- Measures to prevent getting infected:
- Human-to-human transmission of 2019-nCoV:
- Transmission of the disease via air travelers:
- Mortality associated with the coronavirus:
- How long will it take to develop a vaccine?
- What can be done right now to reduce disease risk and severity?
- Can high-dose oral vitamin D use to reduce the risks and severity of Wuhan 2019-nCoV infection?
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This article is intended to provide a general description of the current situation related to the coronavirus outbreak and not as medical advice. It recently started in Hubei Province and has spread across virtually of China. Based on the rapidity and pattern of spread, it has become a serious public health concern in China and a few other countries. Precautions taken to prevent the spread of the common cold and flu-like illnesses, including minimizing exposure by limiting time in public places and public transportation and frequently washing hands, are applicable to follow to prevent acquiring this disease.
In December 2019, Chinese health authorities first reported to World Health Organization (WHO) a cluster of persons with peculiar viral-mediated pneumonia. Coronavirus belong to a large family of viruses, usually affecting some animals. It causes common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). Those who are with pre-existing disorders, especially that affecting the immune system or taking medications that suppress the immune system such a prednisolone or similar category of medications, are more vulnerable to develop severe forms of the disease and death.
The current outbreak of coronavirus—named 2019-nCoV or Wuhan coronavirus—was originated from Wuhan city, in Hubei province in China. Despite major travel restrictions, the virus rapidly spread to other provinces within China and later to other countries because of international travel. Travelers should be concerned about this outbreak, in part because of the potential travel-related exposure to the virus and flight cancellations, thus affecting travel plans.
It is important that the World Health Organization (WHO), Wuhan Health Department, United States Centers for Disease Control (US CDC), and China’s Center for Disease Control and Prevention (CCDC) work in collaboration to share data and provide frequent updates and advice to the other countries for the benefit of the public. This should include sharing reliable information and guidance using social media platforms. Few independent media, however, have disseminated exaggerated claims and outrageous predictions. For example, one Australian outlet claimed that the Wuhan coronavirus epidemic will lead to more than 65 million human deaths, in the absence of data.
A variety of coronaviruses have been identified, especially those causing common colds and other upper respiratory infections. Coronaviruses have been in existence for long time and are abundant among wild animals. The main reservoir in nature for the 2019-nCoV is bats (similar to rabies), while snakes and other animals can also be carriers: these animals act as a reservoir for these viruses.
This virus had been known to present among certain wild animals for decades. Based on genetic glycoprotein analyses, snake has been identifies as a key hosts. When certain exotic live wild animals and their flesh were sold in an animal market, as happened in Wuhan, the disease began to spread to humans. It is possible that the virus might have mutated and has acquired the capacity to spread to humans and then from human to human (i.e., become a zoonotic disease). As an attempt to control the spread of the virus, imposed strict travel restrictions within China were appropriate
Coronavirus belongs to a group of viruses, generally associated with common cold. Genetically, it is related to viruses causing severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS). The 2019-nCoV has typical genome structure of a coronavirus. It belongs to the cluster of betacorona-viruses, including Bat-SARS-like (SL)-ZC45, Bat-SL ZXC21, SARS-CoV and MERS-CoV.
January 2020, the World Health Organization temporarily named the new virus as, 2019 novel coronavirus (2019-nCoV) 5. Its gene sequences were reported (see, Genbank) on the same week. It is a single-stranded, positive-sense RNA (+ssRNA) (~30kb) with 5’-cap structure and 3’-poly-A tail; genome size of CoV (~30kb)] as illustrated in Coronaviruses: genome structure, replication, and pathogenesis. Coronavirus-related pneumonia leads to massive production of a variety of inflammatory cytokines, including TNFα (available on Virological.org) that significantly worsen the outcome.
When a certain gene mutation occurs within the virus genome, the virus acquires the capacity to spread to humans and also between humans. It might mutate again in due course, either decreasing or increasing in virulence. Possible recombination and transmission may have involved direct contact of flesh or consumption of raw or partially cooked meat from infected animal could transfer this virus to humans, as apparently happened in Wuhan epidemic in China.
2019-nCoV is part of a family of coronaviruses that includes the common cold, common cold, severe acute respiratory syndrome (SARS), and Middle East respiratory syndrome (MERS). MERS was first identified in Saudi Arabia in 2012 and around 34% of infected people died (i.e., 858 of 2494 cases). 2019-nCoV is less virulent that MERS 6. The SARS outbreak led to 8,098 identified cases and 774 deaths (9.6%). In 2002-3, SARS epidemic subside quickly.
The Wuhan coronavirus is considered moderately infectious and somewhat similar to severe acute respiratory syndrome (SARS), which became a local epidemic in China in 2003. SARS infected more than 8,000 people, and 774 died of it. Infectiousness determines how easily and rapidly a virus is transmitted from person to person. In the absence of proper precautions, based on the contact information, it has been estimated that one person with the Wuhan coronavirus could infect as many as four people through a single exposure event.
Few patients with this disease are now reported in Europe, Japan, Singapore, Taiwan, South Korea Thailand, Canada, Sri Lanka, and in USA—23 countries so far—for more information please see CDC and WHO updates: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
Name of the virus, the year of identification and the reported death rate of other communicable viral epidemics in the recent past:
- Marberg (first identified in 1967; fatality rate 80%);
- Ebola (1976; 40%);
- Hendra (1994; 57%);
- H5N-bird flu (1997; 53%);
- Nipah (1998; 77%);
- SARS (2002; 9.6%);
- H1N1 (2009; 17.4%);
- MERS (2012; 34,4%);
- H7N9-bird flu) (2013; 39.3%);
- 2019-nCoV(2019; ~3.0%) (based on CDC data).
Common diseases such as the cold and influenza are infectious to others for a period of a 2 to 6 day. Although there are few signs and symptoms present during the critical incubation period, persons can spread the virus during that time. Cough-associated droplets carry infectious virus particles that spread the disease to those who are nearby, especially when an infected person in travelling. Because of the potential of wider spread of infectious particles, it is difficult to isolate people who have such virus.
It is estimated that the incubation period, the time from infection to the manifestation of signs and symptoms of the Wuhan coronavirus, can be between 4 and 14 days. Because of this uncertainty and the lack of clear-cut manifestations, such as those associated with measles and chickenpox, this coronavirus can go throughout the entire incubation period.
Because of the above, the quarantine period for 2019-nCoV is 14 days. This is to make sure that the virus would not spread to others. A person who has been (or suspected to) exposed or in the incubation period should be quarantined /observed in a secure location. This is a standard measure carried out as with Ebola and similar viral diseases to prevent infecting others.
The symptoms of 2019-nCoV generally consist of cough, mild fever, and shortness of breath. However, these symptoms are similar to those of the common cold and flu and thus may be difficult to use for diagnosis having 2019-nCoV-virus. A smaller number of infected people present with non-respiratory symptoms, such as nausea, vomiting, or diarrhea, similar to those associated with enteric viruses.
With its incubation period, up to 12-days, most affected people recover within a few days with symptomatic and supportive therapy. A small minority of people, especially those with immune compromised status, those taking medications such as prednisolone, and infants and the elderly, could develop serious lung infection, such as infective bronchitis or pneumonia, and may also experience a secondary bacterial infection.
Coronavirus belongs to a group of respiratory viruses and is spread through the air and personal contact. Thus, exposure to affected people in crowded places and long-distance air travel are the most common routes of acquiring this disease. Coronaviruses can travel wrapped in tiny (oral) droplets that are produced when an infected person breathes, talks, coughs, or sneezes. These droplets/particles are typically suspended in the air and travel for less than six feet before scattering.
To acquire the Wuhan coronavirus, one needs to be in close contact with a person infected with the coronavirus for a certain period. In the absence of such contact, one with casual contact or visiting a shopping center is unlikely to contract the coronavirus. In contrast, measles or varicella (chickenpox) spread through smaller droplets over much greater distances and are highly infectious. Thus, the infectivity is less with 2019-nCoV-virus. Coronaviruses can also be present in the stools of affected individuals. However, transmission via the fecal–oral route root is less likely.
There are no approved or effective antiviral medications for the Wuhan coronavirus. Therefore, the current treatment is supportive therapy and keeping affected persons comfortable while, achieving natural recovery. A smaller number of people with high viral loads and/or compromised immune systems likely need to be cared for in intensive care unit (ICUs).
A respirator mask is a personal protective device (disposable particulate respirators) that is worn on the face, covers at least the nose and mouth. Many of the face masks currently sold, unless designed specifically to filter smaller particles such as viruses, are unlikely to prevent the inhalation of coronaviruses. Face mask types (respirator information) are categories and certified by the National Institute for Occupational Safety and Health (NIOSH), CDC and by the Occupational Safety and Health Administration (OSHA).
NIOSH-approved disposable respirators are rated as: N = Not resistant to oil; R = Resistant to oil; and P = strongly resistant (oil Proof). As per OSHA, any of these three types of masks can be used to filter virus particles. There are nine types of disposable particulate respirators. For more information please visit information on respiratory programs. For non-affected people, the use of a respirator with an exhalation valve is more tolerable and easier to use.
In most circumstances when one is not in close contact with an infected person, as per the CDC, wearing a face marks are unnecessary. However, when need to use on, it is recommended to use a mask/respirator with one of the following characteristics: N95; N99; R95; R99. While P100 masks are effective, it is not easy to use (uncomfortable) in normal travel circumstances.
Precautions must be taken just as for any other common viral diseases. During the winter times, people are much more likely to get influenza B (the flu) than any other viral diseases. Healthy people who are not in close contact with a person having Wuhan coronavirus (2019-nCoV) are unlikely to be at risk of developing this disease. Following the basic infectious disease prevention principles generally is thought to be sufficient to curtail the spread of this virus. Such principles include avoiding crowded places, regular hand washing with soap and water, the use of medical grade hand sanitizers (disinfectants), and covering the nose and mouth with disposable tissues or your inner elbow when coughing or sneezing.
In addition, one should not touching eyes, nose, or mouth (mucosal surfaces) without first washing hands thoroughly, staying at home when one has flu-like symptoms and/or an unexplained fever, and keeping distance from people who have signs of a respiratory tract infection, including runny nose, coughing, and sneezing.
Highly infectious viral diseases, such as measles and chickenpox, and bacterial diseases such as tuberculosis, organisms that can travel through the air or via droplets for more than 100 feet. As describe e above, 2019-nCoV usually does not travel more than six to eight feet. Other viruses, such as HIV and hepatitis, are transmitted only through direct contact with the bodily fluids of an infected person.
Human-to-human transmission can be curtailed by efficient public health procedures, such as efficient tracking of individuals who are in contact with an infected person, isolating sick people (quarantine measures), and large-scale public education. In this regard, health authorities and departments in many countries have taken effective public health measures to curtail this disease. Not taking effective precautionary actions likely to be deleterious for the populous and the county’s economy.
With the efficient public health measures implemented rapidly in many countries, the spread of the 2019-nCoV has been somewhat curtailed. Measures such as mandatory temperature checking and health screenings of suspected persons at major airports, especially those arriving from Wuhan and other affected regions from China, also are helpful.
In general, the virus has spread from China to other countries via tourists and those who are workers and visitors returning home from visiting Wuhan and other infected regions. In countries such as the United States, individuals arriving from areas where the coronavirus is present are quarantined for a period of two weeks to ensure they are not infectious or until the incubation period has ended. From such travelers, people can become infected even though they may not have visited places known to have the disease.
The number of people infected with the Wuhan coronavirus in China has exponentially increased over the past few weeks, faster than occurred with the SARS virus (SARS-CoV). Nevertheless, the average person should not panic, and there is no reason to cancel travel plans, except those related to visiting China. However, this restriction might be extended to other regions and countries if the disease spreads.
When more information becomes available, key global public health organizations, such as the US CDC and WHO and similar organizations in China, could improve understanding of the illness and the steps required to prevent its spread.
Currently, the estimated death rate associated with Wuhan coronavirus is approximately 3%, which is tenfold less than that associated with the SARS virus (see above). However, if the virus mutates further, it can develop virulent characteristics. Those who experience significant respiratory symptoms are likely to (should be) need an ICU-based care for a few days until their breathing difficulties are overcome.
Many might be infected with the coronavirus, but if their immune system is not compromised, they may never know that they have had the virus and may experience full recovery with only mild illness; yet they can be infectious to others. Considering this, the incidence and the true prevalence of the Wuhan coronavirus can be markedly underestimated. It is also possible that deaths caused by this coronavirus may be documented as caused by another disease, such as bronchitis or pneumonia, thus underestimating 2019-nCoV-related deaths.
At this early stage of this epidemic, the mortality rate associated with the virus is significantly less than that associated with SARS or Middle East Respiratory Syndrome (MERS), which is another coronavirus. Both are more harmful to lung tissue. SARS (with a 5-day incubation period) had a 10% death rate, whereas the death rate for MERS was 33%. Most who die of a coronavirus have underlying chronic health problems, especially deranged immune systems. Vaccination is an good option but it will take time to develop a safe and effective vaccine against 2019-nCoV.
In general, the development of an effective vaccine for a respiratory viral disease takes at least 1 year. By the time a good vaccine is developed, the current coronavirus outbreak is likely to be over. For the SARS outbreak (2003), it took 20 months to develop a vaccine that was ready for human clinical trials. However, by that time, the disease was well under control.
In contrast, it took only 6 months to develop a vaccine for the Zika virus, for which an outbreak occurred in 2015. The author estimates that researchers will generate an effective vaccine for the current coronavirus in about 6 months. In recent work, the genome of the coronavirus has been sequenced and candidate proteins have been already identified that can be used for the generation of a vaccine.
Preliminary data using animal models suggest that broad-spectrum antivirals, such as an RNA polymerase inhibitor, remdesivir as well as lopinavir/ritonavir and interferon-beta might be effective against 2019-nCoV and previously reported for MERS-CoV. Thus, researchers are experimenting the use of nucleic acid vaccine platform approaches that previously used for generating vaccines against SARS-CoV or MERS-CoV.
With severe infections of 2019-nCoV, needs to be diagnosis earliest possible, isolation patients and report to authorities for surveillance, provide supportive treatments, and provide dynamic guidance to avoid unnecessary panic. For individuals, good personal hygiene, fitted mask, ventilation and avoiding crowded places will help preventing Wuhan 2019-nCoV infection.
Adequate vitamin D levels have been associated with reduced incidence and the severity of enveloped viruses such as herpes zoster, Epstein-Barr, hepatitis, Ebola, HIV, dengue, measles, and mumps. Studies have reported administration of an oral dose of 50,000 IU of vitamin D reduces the risks of having influenza. Vitamin D adequacy also reduces severity of pneumonia, which is associated with Coronavirus infections. Being a natural vitamin, the risk to administering vitamin D is minuscule.
Those who are micronutrient deficiency, especially having hypovitaminosis D are at a greater risk of developing viral diseases, including coronaviruses. Thus, the most effective option is to take higher doses vitamin D supplements (now) and/or getting exposed to summer-like sun to bring serum 25(OH)D concentrations above 30 ng/mL (see next paragraph) to boost the immunity, prior to getting exposure. This approach should reduce not only coronavirus but also common cold–influenza and associated pneumonia, thus reducing deaths.
Vitamin D is known to improve the immune system and vitamin D deficiency increases vulnerability to viral infections, such as colds. Especially during the winter months, unless supplements are taken, serum 25(OH)D concentrations are low in most people. Levels begin to rise only at the beginning of the summer. Considering its many biological and physiological aspects, vitamin D and its immunoregulatory and stimulation effects via several mechanisms.
Author believes that vitamin D adequacy would help control and reduce the risks and the severity of Wuhan coronavirus and any similar virus. It is advisable to maintain serum 26(OH)D concentrations in excess of 30 ng/mL (75 nmol/L), preferably maintain more than 40 ng/L (100 nmol/L), together with other micronutrients such as zinc, selenium and antioxidants sufficiency.
Considering the inability to diagnosis this coronavirus during its several-day incubation period, people feeling unhealthy, exposed to an infected person, or having a fever might benefit from taking a loading dose of vitamin D of between 200,000 (four 50,000 IU capsules) or 300,000 international units (IU) as a single oral dose, with mentioned micronutrients to strengthen the immune system. This can be repeated after one week.
This would allow strengthening of the immune and other body systems within 3 to 5 days of administration. This highly cost-effective therapy, costing no more than $5 per person is expected to reduce the risks of developing the disease and if developed, reduce the severity and the mortality, and thereby speed up the recovery.
A single high dose or a higher dose taken a week apart as described, can be administered in hospitals, at community or home setting. In general, to cause adverse effects from orally administered vitamin D, one needs to take high doses, such as 25,000 IU daily, for several months or take one million IU for a few days. Thus, the described dose will not cause adverse effects, and potential benefits far outweigh any risk.
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Professor Sunil J. Wimalawansa, MD, PhD, MBA, DSc, is a physician-scientist, educator, social entrepreneur, and process consultant. He is a philanthropist with experience in long-term strategic planning--,-- and cost-effective investment and interventions globally for preventing non-communicable diseases recent charitable work. The author has no conflicts of interest and received no funding for this work.