What is SARS-CoV-2 [COVID-19, Wuhan coronavirus, 2019-nCoV]?
It is a viral infectious disease caused by a recently discovered coronavirus. The outbreak began in Wuhan, China, in 8-12 December 2019.
What are the symptoms of COVID-19?
Fever and dry cough.
Aches and pains, nasal congestion, runny nose, or sore throat may be found in some patients.
Diarrhea occurs in a limited number of cases.
These symptoms are usually mild. Some people become infected but don’t develop any symptoms and don’t feel unwell.
Most people (about 80%) recover from the disease without antiviral treatment.
Around 1 out of every 6 people develop a severe disease with difficulty in breathing.
Older people (> 70 years), and those with underlying medical problems and chronic diseases are more likely to develop serious illness.
Is the virus a true killer and lead to high deaths and very severe infections?
The virus is not a true killer and there are many dangerous and more fatal viruses than the SARS-CoV-2 (COVID-19).
80% of the cases are mild to moderate, 15% are severe and 5% are critical cases.
Although the overall case fatality is around 3.7% worldwide, however, deaths are clustered mainly in aged people and immunocompromised patients (Fig.1)
Higher case fatality (6.6%) were detected in Italy (Fig.2).
Fig.1 Case fatality based on the first 44,672 cases in China [CDC-China].
Fig.2 Case fatality based on the first 12 462 cases in Italy.
How could one get infected?
Person to person through small droplets from the nose or mouth during coughs sneezing or exhales.
Touching contaminated surfaces that contain droplets from infected patients, then touching their eyes, eating without washing hands.
To be protected stay more than 1 meter away from a sick person.
What is the difference between the SARS-CoV-2 and influenza viruses?
Both have a similar disease presentation ranged from asymptomatic or mild through to severe disease and death.
Both viruses are transmitted by contact, droplets and fomites.
Disease transmission in influenza virus is faster than SARS-CoV-2
For SARS-CoV-2 seriously affect elderly people esp. those with underlying disease conditions while influenza induces serious disease in children, pregnant women and elderly people esp. those with underlying disease conditions
Patients who suffer from severe and critical infection is higher than that in influenza infection.
Case fatality of SARS-CoV-2 is 3-4%, while for influenza is below 0.1%.
How long does the virus live in the environment?
Generally, coronaviruses may stay viable for hours to days. This may vary based on the environmental temperature, humidity and presence of organic material around the virus.
Do hand wash or alcohol hand rub is enough?
Yes, alcohol-based hand rub and/or soap and water is enough.
Can the disease be transmitted from food?
The virus was found in the stool, it is important to clean hands regularly, after using the bathroom and before eating.
Although no current report of transmission from food handlers, however, in area where the disease is spread, and there is no strict hygienic measure in handling the food, it is not recommended to have fast food.
Should I wear a musk?
WHO recommends the use of masks for people who have symptoms of SARS-CoV-2 (COVID-19) and for health workers and people who are taking care of someone (at home or in a healthcare facility).
Can pet animals be infected?
A pet dog recently tested “weak positive” in Hong Kong. Pets are advised to be quarantined if their owners are positive to SARS-CoV-2 (COVID-19).
Is there any restriction for blood donation for people who recovered from COVID-19?
Based on the FDA, blood establishments may wish to consider retrieval and quarantine of blood and blood components collected in the 28 days prior to or after COVID-19 disease onset; or collected in the 28 days prior to or after possible exposure to patients with COVID-19 infection.
(see Advice on the use of masks).
Virus origin, reservoir and animal infections
Proximal origin of the virus
Bats| Bat origin of the SARS-CoV-2
Pangolin as a possible animal host of SARS-CoV-2 Paper 1 | Paper 2 | Paper 3
Dogs | A dog had tested positive to SARS-CoV-2 in Hong Kong after close exposure to its infected own
Genomic alteration of the virus
A 382-nt deletion of SARS-CoV-2 may lead to an attenuated phenotype of SARS-CoV-2
Virus stability in the environment
Stability of the virus
Remdesivir and chloroquine
High in vitro sensitivity to Remdesivir and chloroquine | Clinical trial of Chloroquine phosphate
Favipiravir [inhibitor of viral RNA polymerase]
Favipiravir was approved in China
Clinical antiviral experience form Chinese experience
Although there is no clinical evidence for effective antiviral drugs, herein a clinical experience from a single center in China.
Basic regimen: lopinavir/ritonavir (2 capsules, po q12h} combined with arbidol (200 mg poql 2h) were
The average time to achieve negative viral nucleic acid test for the first time was 12 days (95% Cl: 8-15 days).
The duration of negative nucleic acid test result was 13.5 days.
Alternative regimen:If the basic regimen is not effective, chloroquine phosphate was used in adults between 18-65 years old :500 mg bid for first
two days, 500 mg qd for following five days).
The treatment course of chloroquine phosphate should be no more than 7 days.
See also potential options from Korean experience