•Case fatality rate (CFR) is an unknown, we only have estimates of 0·3–1 per cent
•There is an urgent need to develop effective diagnostics, therapeutics, and vaccines, priorities include development of new methods to fight the virus and diagnostic test that can be used in primary health care settings.
Yet again, the world, including Kenya, is experiencing a global viral epidemic of zoonotic origin.
Infections have risen above 100,000 in over 100 countries, including Kenya.
Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV).
The novel coronavirus (nCoV) - which has infected at least one person in Kenya- is a new strain that has not been previously identified in humans.
Coronaviruses are zoonotic, meaning they are transmitted between animals and people, several known coronaviruses are circulating in animals that have not yet infected humans. Detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans.
The virus is most likely spread from one person to another through: close contact with an infectious person; contact with droplets from an infected person’s cough or sneeze; and touching objects or surfaces that have cough or sneeze droplets, and then touching your mouth or face.
Some people will recover easily, and others may get very sick very quickly. People with coronavirus may experience fever, flu-like symptoms such as coughing, headache, sore throat and fatigue and shortness of breath.
Complications from the disease include acute respiratory distress syndrome, RNAaemia, acute cardiac injury, kidney failure and secondary infections. The incubation period for COVID-19 is 5–6 days and infected patients are largely adult males while underlying diseases such as diabetes, hypertension and cardiovascular disease present a higher risk of infection.
The course of this epidemic is defined by a series of key factors which are poorly understood at present. It is unclear whether the severe acute respiratory syndrome coronavirus (SARS-CoV)-2 outbreak will run its course or not. In the absence of large scale serology surveys, the case fatality rate (CFR) is an unknown, we only have estimates of 0·3–1%. The other unknown is whether infectiousness starts before the onset of symptoms. It is also uncertain whether there are a large number of asymptomatic cases of COVID-19 and the duration of the infectious period for COVID-19 is also unknown.
SARS-CoV-2 presents different challenges to all nations in view of weak health systems globally. Countries such as Nigeria, have so far successfully dealt with individual cases but large outbreaks could easily overwhelm countries.
As of February 3rd, 2020, only 2 African countries (South Africa and Senegal) had laboratories that could test SARS-CoV-2, WHO has since addressed this challenge by sending testing kits to 27 countries on the continent raising the diagnostic capacity to 40 countries.
Surveillance, exhaustive contact tracing, social distancing, travel restrictions, educating the public on hand hygiene, ensuring flu vaccinations for the frail and immunocompromised, and postponing non-essential operations and services will all play their part in delaying the spread of infection and dispersing pressure on hospitals.
Individual governments will decide where they draw the line on implementing these measures guided by ethical, social, and economic risks versus proven health benefits. Keeping morbidity as low as possible will be the highest priority to ameliorate the inevitable economic downturn and social fabric of communities.
There is an urgent need to develop effective diagnostics, therapeutics, and vaccines, priorities include development of new methods to fight the virus and diagnostic test that can be used in primary health care settings.
No vaccine or effective antiviral drug will be available soon; challenges of phase 3 trials are obvious and manufacturing at scale requires 12 -18 months. Mitigation measures include voluntary plus mandated quarantine, stopping mass gatherings, closure of institutions where infection has been identified, and isolation of households, and towns/cities. Epidemiological analysis should be part of mitigation strategies.
There is no treatment for coronavirus, but medical care can manage most of the symptoms. Surgical masks are only helpful in preventing people who have coronavirus disease from spreading it to others.
Everyone should practice good hygiene including: washing your hands often with soap and water or an alcohol-based hand rub; respiratory hygiene using tissue and covering your mouth when you cough or sneeze; avoiding close contact with suspected patients; avoid touching eyes, nose and mouth-hands touch many surfaces and can pick up and transfer viruses; maintain at least one metre distance between yourself and anyone who is coughing or sneezing; if you have fever, cough and difficulty breathing, seek medical care early; and stay informed and follow advice given by your healthcare authorities.
Dr Mugambi is a Public Health Expert Based in Nairobi