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The who, China has sent 25 international experts: key findings and new facts about the epidemic of coronavirus
Material posted: Publication date: 07-03-2020
The who, China has sent 25 international experts, and the main conclusions following the results of 9 days of work.

The who sent a team of international experts to China to investigate the situation with the spread of the coronavirus, which according to the latest data infected more than 90 870 people worldwide. 80 304 is with China, others 10 566 — to other countries. Among the experts was Clifford lane, clinical Director of the National Institute of health, USA. The findings of the joint mission by the who and China has been published in 40-page final report on the results of their visit to Beijing, Wuhan, Shenzhen, Guangzhou and Chengdu. We chose the basic facts about who is most at risk of Contracting the virus and some recommendations for countering the growth of morbidity.

  • Most people infected with the virus (80%) carry the disease in a mild form and recover. Around 13.8% of cases had severe symptoms, such as shortness of breath and oxygen saturation in the blood below normal, and 6.1% of patients are in critical condition (respiratory failure, septic shock and functional failure of many organs
  • The vast majority of infected people will sooner or later begin to show symptoms of the disease. Cases where people have discovered the virus, but they are not faced with symptoms rare — most of them sick for the next few days.
  • The most common symptoms of coronavirus — the fever (87.9%) and dry cough (67.7 per cent). Fatigue (38,1%), sputum cough (33,4%), dyspnea (18.6 percent), sore throat (13,9%), headache (13.6 percent), muscle pain (14,8%), vomiting (11.4 per cent) is also frequently encountered. Less common are nausea and vomiting (5%), stuffy nose (4,6%) and diarrhea (3.7 percent). A runny nose is a symptom of Covid.
  • The incidence in children. Children up to 18 years old sick quite rare: only 2.4% of all cases. An extremely small proportion of patients under the age of 19 faced with a heavy (2,5%) or critical (0,2%) form of the disease. Most of the children contracted the virus from an adult in your house, but it is impossible to determine the role that children play in transmission of the virus. In Wuhan, during the analysis of cases of illness similar to the flu, it turned out that no child was infected in November and December of 2019, as well as in the first two weeks of January 2020. Based on available data, it is impossible to determine what proportions the spread of infection among children, the role children play in transmission of infection, are children less vulnerable and whether there are clinical differences in the process they have the disease (that is, as a rule, in a milder form).Infected children were identified primarily through contact tracing in families of adults. It is noteworthy that the people interviewed by the mission could not remember cases when the infection could be passed down from child to adult.
  • Gender dependence. According to the report, females are infected as often as men, but men are twice as likely than women to die from the disease. 2.8% of infected Chinese women died from the disease, whereas among infected men died of 4.7%.
  • Pregnant women. The disease takes a more severe form in pregnant women than all the rest. In a study of 147 pregnant women (64 confirmed cases, 82 — with suspected coronavirus and 1 asymptomatic case of the disease), 8% had severe and 1% of women is in critical condition. 9 studied the cases of children born from infected women, children born by caesarean section and remained healthy, not infected themselves. Women infected during the last trimester of pregnancy. What effect infection has on the embryo during the first or second trimester, it is unclear, as these children were not yet born.
  • Dependence on age. In individual age groups, including people over 50 are much more likely to get sick with coronavirus, the authors of the report. Thus, the younger you are, the less the likelihood of being infected, and the less likely you are to get seriously sick if you get infected.
  • Comorbidities and mortality. The virus poses the greatest risk for people with diseases such as hypertension, diabetes, cardiovascular disease, chronic respiratory diseases and cancer. The mortality rate among infected people with chronic cardiovascular diseases in China accounted for 13.2%. He was equal to 9,2% for the infected with high blood sugar (uncontrolled diabetes), and 8.4% for people with high blood pressure, 8% — for people with chronic respiratory diseases, and 7.6% for cancer patients. Infected people with no relevant previous diseases died in 1,4% of cases.
  • Mortality. As of February 20, 2114 patients from 55 924 laboratory-confirmed cases have died (the estimated mortality rate of 3.8%). The overall mortality rate depends on the location and intensity of infection (for example, 5.8% in Wuhan city and 0.7% in other parts of China). In China, the overall mortality rate was higher in the early stages of the epidemic (17,3% for cases where the symptoms appeared in the period 1 to 10 January) and eventually fell to 0.7% for patients in whom the symptoms appeared after 1 Feb. The members of the joint mission noted that the quality of medical care has grown during the epidemic.

Source: The Epidemiological Characteristics of an Outbreak of Novel Coronavirus Diseases 2019 (COVID-19), China CCDC, February 17, 2020

  • Currently China can produce and distribute in a week 1.65 million sets for the diagnosis of the novel coronavirus. The test result can be found in the same day. Across the country, each addressed to the doctor with a fever is tested for the presence of virus in Guangdong province, which is located at a considerable distance from Wuhan, was tested 320 000 people, and 0.14% of their test results were positive.
  • A new virus is 96% genetically identical to the known coronavirus from bats and 86-92% identical to the coronavirus pangolin. Thus, transmission of the mutated virus from animals to humans is the likely cause of the emergence of a new virus.
  • Since the end of January the number of new diagnoses of coronavirus in China is steadily declining (here it can be seen on the chart), and in the last day, there were only 329 new cases a month ago, the figure was about 3,000 cases per day. "The reduction in the number of cases COVID-19 in China — the reality", — the report says. The authors make this conclusion from my own direct experience, reducing the number of visits to hospitals in the affected regions, growth in the number of seats available in the hospitals and challenges, Chinese scientists face when trying to attract a sufficient number of newly infected people to participate in numerous clinical drug trials. Here posted the relevant part of the press conference on the assessment of the reduction in the number of cases of infection.
  • Time occurring since the onset of symptoms until confirm the presence of infection by laboratory tests at the national level decreased from 12 days (range 8-18 days) at the beginning of January and 3 days (1-7 days) at the beginning of February 2020, and in Wuhan 15 days (10-21 days) to 5 days (3-9 days), respectively. This enabled early to identify cases of infection and contact, to isolate and treat patients.
  • One of the important reasons for the containment of the epidemic lies in the fact that China is talking to everyone infected people in the country about who they contact, and then checks these people. In Wuhan, doing it 1,800 groups, each of which consists of at least five people. However, outside of Wuhan has also developed large-scale activities. For example, in Shenzhen infected listed 2842 person with whom they came in contact, and they were all detected. Currently, 2,240 people have been tested, and 2.8% of them were infected with the virus. In Sichuan province was named 25 493 people with whom the infected have come into contact 25 347 of them (99%) was detected 23 178 people have already passed inspection, and 0.9% of them were infected. In Guangdong province was named 9939 people with whom the infected have come into contact, they were discovered, 7765 people have already passed inspection, and 4.8% of them were infected. This means the following: if you engage in direct personal contact with an infected person, the probability of infection ranges from 1% to 5%.

Who Director-General Tedros Aden Gebreyesus noted that despite the significant number of cases, out of a population of 6.3 billion people, the outbreak has not reached epidemic levels: "don't get me wrong: I do not underestimate the seriousness of the situation or the potential of it becoming a pandemic, because it has such potential", — said Hebraicus. — Perhaps the development of any scenario."

According to him, to combat the spread of coronavirus in the country should give priority attention to the protection of healthcare workers and to protect those who are at greatest risk, and to protect the most vulnerable in the country. "We are not just fighting for the containment of the virus and saving lives. We also struggle to restrain social and economic damage, which could cause a global pandemic," said the Director General of the who. Now is the time for global solidarity — political, technical and financial."

The report authors give the following recommendations for the public:

  1. Understand that COVID-19 — a new and dangerous disease, but the epidemic can be dealt with by special measures and the majority of infected people recover.
  2. Start with great care to apply the most important measures for the prevention COVID-19. Wash your hands frequently and always cover your mouth and nose when sneeze or cough.
  3. Continue to follow the news about COVID-19 and its signs and symptoms (e.g., fever and dry cough), because the strategy and methods of struggle will be constantly updated with the accumulation of every day new information about the disease.
  4. Be ready to actively fight COVID-19 different ways. In particular, keep a greater distance during social interaction and help to elderly people for which high risk of disease.

The majority of the world community is not yet ready, psychologically and financially, to the implementation of methods that were used to curb the spread of the COVID-19 in China. This is the only methods proven to interrupt or minimize the spread of infection among people. The fundamental aspect of these methods is extremely proactive surveillance for immediate detection of cases of infection, very rapid diagnosis and immediate isolation, and also the outstanding level of understanding and acceptance of these techniques by the population",

For countries where no cases were identified of the disease, the who recommends the following actions:

  1. Be prepared to immediately start the process of emergency response maximum of the scale so that operations were conducted at the Federal and society-wide level, necessary for the early containment of the outbreak COVID-19.
  2. Perform emergency testing of national preparedness plans in light of new knowledge about the effectiveness of non-pharmacological measures against COVID-19; include methods of quick diagnosis, extensive case-finding and provision of respiratory equipment, as well as careful monitoring and control of all contacts with national plans for preparedness and response COVID-19.
  3. Immediately strengthen surveillance COVID-19, as fast detection of the disease is crucial in whether it is possible to contain its spread; consider testing all patients with SARS with a virus COVID-19 and add a test for the presence of the virus to existing surveillance systems for influenza.
  4. Now, ensure strict compliance with measures for the prevention and control of infections in all health care institutions, especially emergency departments and outpatient clinics because that's where COVID-19 will be distributed in the health system.
  5. Do a quick assessment of how citizens are informed about COVID-19, and accordingly adjust medical materials distributed at the Federal level, as well as the action plan for the promotion of health; get communication with the media distinguished representatives of the medical industry.

COVID-19 is spread with astonishing speed. Epidemic COVID-19 in any environment, have very serious consequences, and now there is evidence that non-drug methods can reduce or even interrupt transmission of the infection. The worrying fact is that planning at the global and national level often do not employ such methods sufficiently. However, to reduce the number of cases COVID-19 and mortality short-term training should include large-scale use of high-quality non-medical methods of public health. These methods should include immediate detection and isolation of cases, careful monitoring of close contact and monitoring/quarantine, as well as direct community involvement/communities, experts say.

Barbara Pertsov


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