COVID 19 disease(Coronavirus), which appeared in China in late 2019, is caused by SARS-CoV-2, a virus belonging to the coronavirus family. Very frequent, they can well cause a simple cold like a serious respiratory infection like pneumonia, causing fatal epidemics like those of Sras, Mers, and now Covid-19. Symptoms, transmission, screening tests, treatment (chloroquine)… We take stock.
Coronaviruses, which owe their name to the crown shape of the proteins that coat them, are part of a large family of viruses, some of which infect different animals, others humans. They are likely to be the cause of a wide range of diseases. In humans, these diseases range from the common cold to a severe lung infection, responsible for acute respiratory distress.
Two deadly epidemics have already occurred in the 21st century, involving emerging coronaviruses , hosted by animals and suddenly transmitted to humans:
- SARS-CoV (2002-2003) , or coronavirus causing severe acute respiratory syndrome (SARS), which appeared in China: more than 8,000 cases were identified in 30 countries and 774 people died (almost 10% mortality).
- MERS-CoV (2012-2013) , or Middle East respiratory syndrome coronavirus, so called because it was first detected in Saudi Arabia. 1,589 cases and 567 deaths in 26 countries have been recorded (representing a mortality rate of around 30%).
The third fatal epidemic is that related to SARS-CoV-2 , which appeared in China in December 2019. The first cases identified are people who went to a local market, in Wuhan, in Hubei province. Virologically, SARS-CoV-2 is very close to SARS-CoV, which is why it was placed in the same species of coronavirus (followed by the number 2 to distinguish it from the previous one).
Coronaviruses are of animal origin : one species (“reservoir”) harbors a virus without being sick and transmits it to another species, which then transmits it to humans. In the cases of SARS-CoV and MERS-CoV, the reservoir animal was the bat . As Inserm explains, “the virus is asymptomatic in this animal. An intermediate host is therefore necessary for the transmission of these viruses to humans: the masked palm civet for SARS-CoV, sold on the markets and consumed in southern China, and the dromedary for MERS-CoV. “With regard to SARS-CoV-2, the reservoir could also be the bat. In early February, a team of Chinese researchers from the University of Agriculture in southern China estimated that the missing link could be the pangolin , a small mammal with scales, in danger of extinction. But caution is advised, pending a final confirmation. “One might think that human contamination occurred during the manipulation of these mammals whose scales are used in the traditional Chinese pharmacopoeia and whose flesh is consumed,” explained Professor Patrick Berche , professor emeritus of microbiology at the University of Paris.
Human-to-human transmission
The coronaviruses SARS-CoV, SARS-CoV-2, and MERS-CoV are transmitted not only from animals to humans but also from humans to humans. With regard to Covid-19 disease (formerly known as 2019-nCoV) due to SARS-CoV-2, it is transmitted by postillions (saliva droplets) projected by coughing or sneezing . Close and prolonged contact is therefore necessary to transmit it (family, same hospital or boarding room) or to have had contact within 1 meter of the patient, in the absence of effective protective measures.
Environmental transmission
One of the most important transmission factors seems to be hand contact with infected surfaces and then with the mouth, nose or eyes. Depending on temperatures and humidity, the virus can survive for a few hours or even a few days on various surfaces if they are not disinfected. Studies are underway to clarify these data. This is why it is essential to avoid touching your eyes, nose or mouth (which are possible entry points for the virus in your body) with dirty hands. So-called “barrier” measures are therefore essential to limit the impact of the virus: wash your hands frequently with soap or hydroalcoholic gel, sneeze and cough in your elbow, use disposable tissues, do not shake hands, do not kiss to say hello …
What Are The Symptoms Of Covid-19?
The most common symptoms of the virus are high fever (above 37.5 ° C) and dry or oily cough. Some people may also experience body aches, headaches, feeling of tightness or shortness of breath. These symptoms suggest an acute respiratory infection. Less frequent, the sudden loss of smell and loss of taste can also presage the disease. A website has been created to guide patients.
In more serious cases, the infection can indeed cause ” respiratory distress, acute renal failure, or even multi-organ failure that can lead to death,” says the Ministry of Health. Breathing difficulties can occur after a few days of illness, even when the first symptoms were mild.
As a reminder: the disease remains mild in 80% of cases; it is severe in around 15% of cases and critical in 5% of cases. Researchers estimate that the overall mortality rate from the virus is around 2 to 4%, with disparities depending on the country. Or a rate higher than that of the influenza virus which kills one person in a thousand (0.1%). In addition, some patients have an asymptomatic form of the virus: they carry the virus, without declaring the symptoms, but they are contagious and can transmit it.
How Is Screening Organized In France?
Currently, only a biological test(PCR) by nasopharyngeal sample can confirm a coronavirus infection. It can be performed at the hospital, or at a city laboratory, only on medical prescription. In fact, at stage 3 of the epidemic, the test is no longer systematically offered in the event of symptoms. Only patients with respiratory difficulties or chronic pathologies, the elderly, healthcare professionals, organ, cell or tissue donors and pregnant women can still be tested. More than 12,000 biological tests are carried out each joru.Thursday, March 26, the Minister of Solidarity and Health announced that “two million serology tests” would be made available in France in April. The objective of these tests is to identify the French who have had coronavirus or not and to “prepare the country for the phase of deconfinement” by limiting the “rebound” effect of the epidemic.
Is There A Vaccine For Covid-19?
Vaccines against pneumonia, such as the pneumococcal vaccine and the Haemophilus influenzae type B (Hib) vaccine, unfortunately, do not protect against the coronavirus. The COVID-19 is so new and specific that it is necessary to develop a vaccine of its own. Dozens of clinical trials are currently underway. Tests are also being conducted to assess the effectiveness of the BCG vaccine in the fight against the new coronavirus. Normally, the development cycle of a vaccine takes several years. However, in the current context, companies are accelerating the pace of their research and shortening development times.
Are There People At Risk Of Developing A More Severe Form Of The Disease?
The available information suggests that the virus can cause symptoms similar to those of the moderate flu, but also more severe symptoms. As with many infectious diseases, people with pre-existing chronic diseases (hypertension, cardiovascular disease, diabetes, liver disease, respiratory diseases like asthma …) are more likely to develop severe forms, as are elderly (over 70) and immunocompromised. Note that serious forms of the disease are observed, even in young adults. Children under the age of fifteen remain unlikely to trigger a severe form of coronavirus. But, remember: even if they present less serious, even asymptomatic forms of the disease, they are contaminants.
The treatment is said to be symptomatic (it aims to relieve the symptoms): medicines against fever (paracetamol)… In severe forms, sick people can receive antibiotics when a bacterial co-infection is present, be put on respiratory assistance…
So, the best thing people should keep in mind is respecting all preventive measures so as not to attract this dreaded virus.
As part of the health emergency, the government published Thursday, March 26, a decree authorizing the prescription of hydroxychloroquine, an antimalarial . Doctors will be responsible for prescribing this medication to patients with severe forms of Covid-19. The delivery of a treatment combining lopinavir and ritonavir is also authorized.
Anti-inflammatory drugs not recommended
To lower the fever, prefer taking paracetamol, the sale of which is now restricted in pharmacies. The Ministry of Health advises against starting treatment with anti-inflammatory drugs (ibuprofen, cortisone, etc.) or aspirin, which could worsen the health of people with coronavirus.Patients on anti-inflammatory therapy for chronic disease should not discontinue treatment without the advice of their doctor.
Four therapeutic combinations are being tested
Research to find an effective treatment is looking at both proven drugs in the treatment of other diseases, especially viral, as well as the development of an antiviral drug specific to Covid-19.A European clinical trial dubbed “Discovery” started on Sunday March 22 to evaluate four experimental treatments against Covid-19. It is coordinated by Inserm as part of the Reacting consortium and will evaluate the effectiveness of four antiviral molecules: remdesivir, lopinavir in combination with ritonavir, the latter treatment being associated or not with interferon beta, and hydroxychloroquine . Some 3,200 people participate in this trial, including 800 French.
How Many People Are Affected By Covid-19?
In the world
As of March 29, nearly 657,140 cases have been reported worldwide (including 574,798 outside of China), and 30,451 people have died. The countries most affected, excluding China, are the United States, Italy, Spain and Germany. 177 countries are concerned. With 331,122 confirmed cases, Europe has become a major epicenter of the epidemic.To follow the real-time evolution of the epidemic: consult this interactive map .
Now today 07/04/2020, we have about the following worldwide cases
| 1,348,628 confirmed cases | 284,802 recovered | 74,816 deaths |
In France
France is the sixth country most affected by the epidemic in the world and the fourth in Europe. The latest assessment shows 40,174 cases confirmed by PCR test since January 21, 2020, a figure probably underestimated since the screening of suspect cases is no longer systematic.Since the first cases were detected in the territory, 2,606 patients have died , a figure which does not take into account deaths in nursing homes because these establishments are not linked to the hospital system. The indicators for monitoring the Covid-19 epidemic by region are available on the GEODES site (Geo data in public health).
What Measures Are In Place At Stage 3 Of The Epidemic?
At stage 3 of the epidemic, France has been subject to strict containment measures since Tuesday, March 17. Confinement which has been extended until April 15 and may be extended again “if the health situation requires it”, announced the Prime Minister on Friday, March 27. Any Frenchman who has to travel must present a document attesting on his honour the reason for his displacement. This document can be downloaded from the website of the Ministry of the Interior or can be copied on free paper.
Places “not essential to the life of the country” (restaurants, bars, cinemas …), as well as schools, nurseries, colleges, high schools and universities, remain closed until further notice. The markets are also unless otherwise advised by the mayor or the perfect. Only certain trips are authorized: within the framework of work (if teleworking is not possible), to make essential purchases in authorized shops, to go to a health professional (only in case of “urgent care” or who respond to the summons of a doctor “), help vulnerable people or ensure journeys for the care of their children, and finally do physical exercise alone (no more than an hour and less than 1 km around your home). To enforce these measures, curfews are multiplying on the territory (Cannes, Nice, Valence, Puteaux, Arras, etc.).In addition, exceptional partial unemployment measures have been put in place. The white plan for hospitals and the blue plan for nursing homes are activated for exceptional mobilization of medical resources. Non-emergency operations have been postponed in hospitals and visits are prohibited in Ehpads and long-term care units. The Health Reserve has been mobilized to respond to the epidemic. The government also wanted to mobilize asocial reserved a civic reserve. Pharmacies can produce and sell their own hydroalcoholic gel solution, the price of which is regulated by a decree. They are exceptionally authorized until May 31, 2020, to renew an expired prescription as part of chronic treatment (order with immediate effect published in the Official Journal on March 15, 2020) or taking a contraceptive pill.
What Is The Procedure For Taking Care Of Patients In France?
The procedures for handling suspected cases have evolved since the introduction of reinforced containment. The healthcare system has been reorganized to increase local care and not to overcrowd emergencies and hospitals. General practitioners are now on the front line against the virus. The website, maladiecoronavirus.fr was put online by the Ministry of Health to help worried French people assess their symptoms. It allows anyone who thinks they are infected to complete an anonymous, free test for advice on what to do.
In case of symptoms
A person with mild symptoms of suspicion (cough, fever) must now call their doctor before going to their office. She can also benefit from a teleconsultation (100% covered by Health Insurance). If the doctor has any doubts, he can go to the patient’s home. The call to Samu (15) is reserved for people with severe symptoms (difficulty breathing). The obligation of systematic screening having been lifted, only patients with severe signs, residents of medico-social establishments, carers, pregnant women or organ donors remain subjected to the test. Patients most at risk of complications will be treated in the hospital. If the infection is proven, “mild” patients remain confined to their homes and are followed by their general practitioner who will prescribe a work stoppage. It should remain strictly confined to the home. The isolation will be lifted 48 hours after the complete resolution of the symptoms. This system aims not to saturate the hospitalization capacities of health establishments.
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