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Covid-19, the coronavirus that puts health systems to the test

On December 31, 2019, a notice was received at the headquarters of the World Health Organization (WHO) in China: 27 cases of pneumonia of unknown etiology had appeared in the city of Wuhan (Hubei province), several of they serious. Seven days later, the country’s health authorities announced that their scientists had identified a new strain of coronaviruses responsible for these infections. Your name: 2019-nCoV .

This pathogen has caused great alarm , given the rapidity of its expansion in China and its soon jump to other countries and continents and, above all, because it can be fatal. It has generated the largest international health alert in recent years. The Chinese authorities have put several cities in quarantine, some countries have recommended their citizens not to travel to that country and have canceled flights, and others – such as Spain – have evacuated compatriots living in Wuhan . Hoaxes about the disease emerge incessantly, and the WHO declared on January 30 an international public health emergency . How should countries deal with a crisis of this type and caliber?

The first thing they must do is take measures as quickly as possible , explains Benito Almirante, head of the Infectious Diseases Service at the Vall d’Hebron University Hospital in Barcelona. “You have to act – he says – very quickly in the first days to minimize the chances of the virus being transmitted to the rest of the world.”

The second step is for the information provided by the authorities and public administrations to be clear and truthful. “In the present case, it seems very possible that the Chinese Government raised the alarm when several weeks had elapsed since the beginning of the outbreak,” says the infectologist, who also thinks that “the information from the first days should not be correct ” , since the rate in the spread of 2019-nCoV has turned out to be much faster than the initial data indicated. The containment measures they have taken in China “would have been much more effective if they had been implemented three weeks earlier,” says the expert, who thinks that the most important thing remains: “Developing a rapid diagnostic test that allows isolating in a matter of hours to those affected “ .

Like other respiratory viruses, such as those that cause colds and flu, the coronavirus enters the body through the air , infects the cells of the respiratory tract and triggers an inflammatory defense response. This involves the production of fluid in the alveoli and bronchi, which leads to coughing and shortness of breath . If the immune system does not control the infection, it spreads and can lead to respiratory failure and sometimes fatal septic shock.

Symptoms of 2019-nCoV infection include persistent high fever, muscle pain, fatigue, shortness of breath, and the presence of invasive pneumonic infiltrates – bronchial inflammation – in the lungs, which can be detected by X-ray. To prevent the spread of the coronavirus, standard measures against other infections of this class are recommended: wash your hands regularly, cover your mouth and nose when coughing and sneezing, cook meat and eggs thoroughly, and avoid contact with anyone with symptoms of respiratory illnesses, such as coughing and sneezing.

The WHO has published guidelines so that health systems know how to tackle the coronavirus epidemic, which since February 11 has an official name: COVID-19, an acronym for coronavirus disease . They include how to monitor and treat patients, sample analysis methods, management of infection in health centers, how to ensure adequate supplies, and how to communicate news to the public. The threat is not to be taken as a joke, which is why the WHO declared an international emergency at the end of January . Its general director, the Ethiopian Tedros Adhanom, justified the decision by the possibility that the pathogen could spread through the countries with the weakest health systems.

It is the sixth time that the WHO has taken this type of measure. It already did with the 2009 swine flu epidemic; the resurgence of the poliovirus (which causes polio) in Pakistan in 2014, which spread to other countries in the Middle East; the 2014 Ebola crisis in the Democratic Republic of the Congo; the Zika virus epidemic in 2016 and during the new Ebola outbreak in 2018. Four criteria are taken into account to declare the international health alert: the serious impact on public health; that it is an unusual or unforeseen illness; that there is a risk of international spread; and that involves the risk of imposing international restrictions on travel or trade.

Most countries have epidemiological alert systems aimed at the early detection of diseases or public health incidents similar to that caused by the new Chinese coronavirus.

Justo Menéndez, head of the Emergency Service at HM Hospitales, in Madrid, recalls that the protocols recommended by the Health Alerts and Emergencies Coordination Center of the Ministry of Health include all the measures to be adopted from the beginning. “The first thing is to identify if a patient is a suspect, implement the recommended isolation measures and take samples to send to the laboratory and confirm whether or not they are affected by the coronavirus. If confirmed, the person is isolated in a separate room with air flow control (if available) or transferred to a center where this resource is available ”.

The person responsible for the outbreak of pneumonia that emerged in Wuhan was identified as a new coronavirus thanks to massive sequencing techniques applied to cultured viruses and samples of affected people, which obtain millions of genetic sequences at high speed. It belongs to the family of the Middle East respiratory syndrome (MERS-CoV) and severe acute respiratory syndrome (SARS-CoV) viruses . They are pathogens that infect mammals and birds: they are transmitted between members of the same species and sometimes they mutate and jump to humans. In this case, pangolins, mammals with scales, are suspected.

It is the typical spherical coronavirus, with protruding proteins that make it resemble a crown . Broadly speaking, the S protein (which in the image would be each one of the “florets”) attaches the virus to the proteins of the cell membrane and allows it to enter them, to which the HE protein also contributes. Protein E helps to release viral particles from the infected cell and spread them, and M determines the round shape of the microorganism.

The illustration shows the structure of the new coronavirus, which causes a type of pneumonia that can be fatal. It is what is called an enveloped virus , because its genetic material – RNA (ribonucleic acid) – is protected by a layer of lipids in which there are also proteins. Thus, the pathogen has a better chance of surviving, penetrating the cells of the host organism, replicating its RNA within them, and spreading.

By Sandra Pulido

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