The first American dies for coronavirus 0:55 in China
Editor’s Note: Dr. Tom Frieden is the former director of the Centers for Disease Control and Prevention. UU. and former commissioner of the New York City Department of Health. He is currently president and chief executive officer of Resolve to Save Lives, a global non-profit initiative funded by Bloomberg Philanthropies, the Chan Zuckerberg Initiative and the Bill and Melinda Gates Foundation and part of the Global Nonprofit Vital Strategies. The opinions expressed in this comment are only those of the author.
(WAB NEWS) – A study published Friday in the medical journal JAMA found that 41% of the first 138 patients diagnosed in a hospital in Wuhan, China, were reportedly infected in that hospital.RELATED
This is great news. In simple English, it means that almost half of the initial infections in this hospital seem to have spread within the hospital itself. This is called nosocomial transmission. (Doctors use big words to hide bad things: nosocomial means they were infected in the hospital).
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What’s more, the majority of the spread does not appear to have been the result of a so-called “superextensor event”, in which a single patient transmits the infection to many other people. In these events, a procedure such as bronchoscopy, where a doctor inserts a tube into the patient’s lungs, can cause many infections.
This would be a concern, but not as much as what seems to have happened: many health workers and many patients became infected in many parts of the hospital. In addition, since there is a broad spectrum of infection and that only sick patients were evaluated, it is very likely that there will be even more transmission in the hospital.
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So, like SARS and MERS, other coronaviruses, before, Wuhan’s coronavirus is spreading in hospitals.
What does this mean?
The virus seems to be quite infectious, health workers have an especially high risk and we urgently need more information about how infectious the virus is. It is possible that the virus is impossible to contain, just like the common cold and influenza cannot be stopped, but the effects on health and society can be cushioned.
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China’s extraordinary efforts to stop the spread of the virus, even if they are not successful, can slow its spread and improve the ability of China and the world to limit the damage caused by the virus.
What do we need to do now?
We must protect health workers and other people who care for sick people. This is done through a hierarchy of controls: source, engineering, administration and personnel.
Origin controls include encouraging patients who are mildly ill not to expose others; require all sick people to wear facial masks; limit hospital attendance of visitors who may be infectious; ensure that sick health workers do not work; and minimize the number, and ensure the safety of risky procedures such as bronchoscopy and sputum induction, when performed only in isolation rooms.
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Engineering controls include placing partitions in triage areas, ensuring that potentially contaminated air is not recirculated and surfaces are meticulously cleaned, and implement additional precautions for suspicious cases.
Administrative controls include asking all patients if they have symptoms and taking their temperature; require that people with a cough or fever wear a facial mask and isolate them from other people at least several meters until they are further evaluated. It is especially important to quickly recognize all potentially infectious patients and implement strict infection control procedures and early in all areas of all health care facilities.
Personal controls include hand washing and respiratory hygiene. But the use of masks by the general public (people without symptoms who are not caring for other patients) has little or no benefit and potentially great harm if people who need masks cannot get them. The masks will be scarce. The most important use is for health workers and those who care for sick patients. In health care settings, reusable safe respiratory protection that can be disinfected can be vital. Useful products include personal air purification devices and elastomeric respirators. Patients should also be able to cover their mouths to reduce the spread of the infection.
What else do we need to know?
We are learning more and more information, but unfortunately, the answer is that much remains to be known.
China has been working hard to keep up with the evidence, attention and social impacts of the virus. It is good to see that crucial epidemiological information begins to emerge.
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We still don’t know the basics about who has been evaluated, what proportion is positive, how this is changing over time and what are the positivity rates by location, test week and patient age. This is basic information.
Just one example: How many children have been examined? Does the fact that there have been few infections in children reflect lack of evidence or lack of infection?
Among those who test positive, what proportion develops and does not develop serious diseases, analyzed by age, sex and underlying medical conditions? What proportion dies, analyzed by the same factors?
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Among all patients using selected health facilities in Wuhan and elsewhere, what proportion of people with a cough are infected, as confirmed by polymerase chain reaction (PCR) tests of nasopharyngeal sample samples? What proportion of people without cough have coronavirus confirmed by PCR tests?
The answers to these questions will help determine if the virus is already circulating widely (i.e., it has become endemic and cannot be stopped), what proportion of all people with infection have a serious illness and if the epidemic is reaching its maximum point or not.
What’s next now?
Only time will tell. The next days and weeks will determine:
If sustained transmission begins in other countries, which unfortunately seems likely.
If it does, if it can be contained, which unfortunately seems unlikely.
The first American dies for coronavirus 0:55 in China
How serious the disease is among infected people, something we still don’t know.
Until we know this critical information, we cannot assess how bad this new coronavirus is going to be and what control measures have the best chance of slowing the spread.