Coronavirus (2019-ncov): The origin of the epidemic is a "leap of species"

The origin of the transmission of the new Coronavirus, the infection responsible for the pneumonia epidemic that broke out in China. We talk about it with Dr. Fabrizio Facchini, Italian pneumolgo in Dubai.

Acute respiratory disease 2019-nCoV (2019-nCoV acute respiratory disease is the provisional name given to the virus by the World Health Organization where "n" stands for new and "CoV" for coronavirus, ed) in addition to causing victims and numerous infections in China, it is also spreading to other countries in the world, including Italy and the United Arab Emirates.

For theWHO it is an international health emergency and recommends that all countries strengthen surveillance in line with international health regulations (2005) for respiratory infections and communicate to the Organization itself any suspected or confirmed case of new coronavirus infection.

What is the origin of the transmission of the Chinese 2019-nCoV virus? 

"It is animal and has affected humans through a genetic mutation. It is, as it is defined in virology, a leap of species".

The words of the Dr. Fabrizio Facchini, specialist in pneumatology and DDirector of the Department of Pneumology at a semi-governmental multi-specialty hospital and research center in Dubai.

Dr. Fabrizio Facchini

"The first clue to the origin of the infection - she explained - emerged from an epidemiological study, published in the prestigious New England Journal of Medicine, which found that the 55% of infected cases in 2019 had somehow come into contact with the wholesale fish market in Wuhan, the outbreak city, closed by the Chinese authorities for disinfestation on 01 January 2020. Thanks to the prompt release by the Chinese authorities of the genomic sequences of the virus, also freely available on the Global Initiative on Sharing All Influenza Data website (GISAID), an Italian study carried out a genetic evaluation of the origin of the virus concluding that it is a mutation of the surface glycoproteins of the SARS-like virus native to bats (Journal of Medical Virology ). Another possible source of the infection are snakes. These animals are also present in Chinese markets, so this hypothesis is also plausible, but it must be verified by isolating the infection in the animals themselves ".

With the new coronavirus there are five viruses, three of which belong to the coronavirus family, which in 16 years have made the "species leap" from animal to animal and then to man. The first coronavirus mutation that led to Severe Acute Respiratory Syndrome (SARS) was in 2003, an infection transmitted from bats to civets and then to humans. Another epidemic of Coronavirus respiratory infection was subsequently identified, the Middle East Respiratory Syndrome (MERS) transmitted to humans by dromedaries and camels.

Dr. Facchini, a what are these mutation phenomena related to?

Viruses mutate by their nature, mutations also occur in the human genome, but mutations of viruses and bacteria occur more frequently due to their large number. It is an absolutely normal biological phenomenon intrinsic in the evolution of all living beings: microbes, plants, fungi or animals, whatever they are. I am perplexed about the fascination that conspiracy theories have on many people about a military or alien origin of these natural phenomena.

What are the containment criteria

The World Health Organization has long established criteria for the containment of human-to-human infections from Coronavirus and has also given specific indications for this case of epidemic. However, even though the mortality of this new Coronavirus is lower than the two previous human-infected coronavirus outbreaks, its contagiousness seems much greater. In fact, the confirmed cases of 2019-nCoV have already far exceeded the cases of MERS and in a few weeks documented cases of SARS infection.

What causes the greater contagiousness of this epidemic compared to the previous ones?

The average incubation period of the new Coronavirus is 5.2 days, but the 95 percentile, ie the period within which the 95% of the infected manifested its symptoms is 12.5 days. The duplication time of the infection has so far been 7.4 days. Considering that contagiousness could also be present during the incubation period, and that the incubation period without any symptoms can reach 2 weeks, the potential difficulty of hindering the infection is evident.

So can the infection occur even in the absence of symptoms? 

Yes, but precise data are not yet available, epidemiologists are at work. In all probability the contagiousness during the incubation period is low or very low, and then increases when the first symptoms appear. 

What are the symptoms?

The most common symptoms are cough and fever, more precisely: fever in 65%; difficulty breathing 55%; cough 53%; muscle aches and / or fatigue 44%; 28% phlegm; headache / headache 8%; cough with blood 5% and diarrhea 3%. Furthermore, lymphocytopenia, ie a reduced number of white lymphocyte cells and therefore a reduced immune capacity, was observed in more than 60% of patients. The most common clinical presentation is pneumonia which can subsequently worsen with acute respiratory distress syndrome (ARDS) and other serious complications such as kidney or heart failure.

Who are most at risk?

As with many debilitating serious infectious diseases, the virus has a higher lethality in the elderly and in people with chronic diseases. Even if no relevant data are available, the pediatric population must probably also be considered at risk.

The WHO standard recommendations to prevent the spread of infection include regular hand washing, covering of the mouth and nose during coughing and sneezing, thorough cooking of meat and eggs. Avoid close contact with anyone showing symptoms.

Dr. Facchini, are these behavioral recommendations effective in preventing the spread of the infection? 

If applied correctly, the indications of the WHO are effective, however the knot of contagiousness remains before the clinical identification and the failure and correct application of the indications. Images were broadcast from hospitals in China where health workers, while fully dressed and with visors, wore completely inadequate masks to protect themselves from a respiratory infection.

At the suggestion of masks, are they an effective prevention tool or not? 

It depends on the mask: the most popular surgical mask can filter particles suspended in the air up to 60%. Although it is more effective than a handkerchief, which filters from 10 to 30%, it is still inadequate in terms of protection. In terms of prevention, you can certainly use a mask with filtering characteristics of 95% (FP2 or N95), if, on the other hand, you are in contact with infected people or healthcare personnel, you must use higher protections with filtering capacity of 98 (FP3, N98). ) or 100% (N100). It must be said that the masks must also be worn all day and correctly and those with side slits are of little use. But the question is another: what is the point of wearing masks, often inadequate, if the cases in the country of residence are limited to some people who arrived from China and immediately isolated?

To combat the 2019-nCov conoravirus, 5 companies, including one Italian, have set to work to create a vaccine that is not classic but based on the information contained in the genetic material of the virus. Anthony Fauci, director of the American Institute for Infectious Diseases (Niaid) of the National Institutes for Health (Nih) announced that “We have already started, along with several of our collaborators. It is a long and uncertain process, but we are proceeding as if a vaccine were to be produced "

According to her it is possible to develop and make available a vaccine in a short time?

I am not aware that effective vaccines have been developed for SARS and MERS. Even though vaccine development technology is rapidly evolving and development times are drastically shortening, I don't expect the time frame to become available within months. This is not to say that not all the necessary resources should be used to achieve this desirable goal. Vaccines train our complex immune system and if developed could be our most effective weapon to defend us against infection with these viruses.

What is the current treatment to reduce the impact of the infection?

Since there is no therapy with proven efficacy, the recommendation is supportive therapy for the organs compromised by the infection. However, we are not starting from scratch and as in other cases of serious coronavirus pathology there is a treatment that, although not having proven clinical support data, has shown in the laboratory an action that could reduce the clinical impact of infections. The therapy that is prescribed in these cases is multifarmacological and consists of a combination of the antiviral Ribavirin combined with Interferon (alpha2b or beta2) and a second antiviral such as Lopinavir or Ritonavir.

How dangerous is the new Coronavirus?

The danger of the virus lies in the potential risk of universal contagion. If a lethal virus is not capable of spreading, the deaths from that particular disease in the world will be very few, but if the pandemic, i.e. potential risk of universal contagion, were to occur even with a mortality not as high as that of the new Coronavirus it would cause a very high number of deaths among the world population. Ponderemic risk does not mean that the contagion will occur because in addition to the containment measures other factors influence. However, the statistical estimates give a much more dangerous scenario than that drawn by the cases ascertained in the laboratory. One confirms it study published in the prestigious scientific journal The Lancet 

In conclusion: attention yes, but do not panic?

Great attention, but don't panic. The mortality of this virus is 2,4%, it is certainly lower than similar viruses such as SARS 10%, MERS 35%, and far lower than that of other much more lethal viruses, also with reserve in the animal world, such as that of the Ebola virus 90% and it is comparable to the mortality recorded by the initial spread of the H1N1 influenza virus.


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