Medical Tuesday Blog

We are writing the pages today for future publication. It won’t be pretty.

May 5

Written by: Del Meyer
05/05/2020 11:34 PM 

The SARS, MERS and novel coronavirus (COVID-19) epidemics,
the newest and biggest global health threats:
what lessons have we learned?

The Corona-Virus was first discovered in 1965 in a boy with the common cold. We’ve had several epidemics with corona viruses. It is in the same group of viruses commonly associated with the common cold and the “flu.”

The International Journal of Epidemiology published the above article in its February 2020 issue. The Objective of the article was to provide an overview of the three major deadly coronaviruses and identify areas for improvement of future preparedness plans, as well as provide a critical assessment of the risk factors and actionable items for stopping their spread, utilizing lessons learned from the first two deadly coronavirus outbreaks, as well as initial reports from the current novel coronavirus (COVID-19) epidemic in Wuhan, China.

“Utilizing the Centers for Disease Control and Prevention (CDC, USA) website, and a comprehensive review of PubMed literature, we obtained information regarding clinical signs and symptoms, treatment and diagnosis, transmission methods, protection methods and risk factors for Middle East Respiratory Syndrome (MERS), Severe Acute Respiratory Syndrome (SARS) and COVID-19. Comparisons between the viruses were made.”

The authors found inadequate risk assessment regarding the urgency of the situation, and limited reporting on the virus within China has, in part, led to the rapid spread of COVID-19 throughout mainland China and into proximal and distant countries. Compared with SARS and MERS, COVID-19 has spread more rapidly, due in part to increased globalization and the focus of the epidemic. Wuhan, China is a large hub connecting the North, South, East and West of China via railways and a major international airport. The availability of connecting flights, the timing of the outbreak during the Chinese (Lunar) New Year, and the massive rail transit hub located in Wuhan has enabled the virus to perforate throughout China, and eventually, globally.

The Severe Acute Respiratory Syndrome (SARS-CoV-2) occurring in the United States and Worldwide during November 2002—July 2003. A total of 8,098 probable SARS cases were reported to the World Health Organization (WHO) from 29 countries, including 29 cases from the United States; 774 SARS-related deaths (case-fatality rate: 9.6%) were reported, none of which occurred in the United States (6). Eight U.S. cases had serologic evidence of SARS-CoV infection. . . A total of 156 reported U.S. SARS cases from the 2003 epidemic remain under investigation, with 137 (88%) cases classified according to previous surveillance criteria as suspect SARS and 19 (12%) classified as probable SARS. Because convalescent serum specimens have not been obtained from the 19 probable and 137 suspect cases that remain under investigation, whether these persons had SARS-CoV disease is unknown.

Clinical Criteria for early illness was the presence of two or more of the following features:
            Chills, fever, rigors, myalgias, headache, diarrhea, sore throat, or rhinorrhea

Clinical Criteria for moderate illness
            Temperature of 100.4 F and one or more clinical features: Cough, S of B, difficulty breathing

Clinical Criteria of Severe Respiratory Illness
            Meets the above criteria + radiographic evidence of pneumonia, or
            Acute Respiratory Distress Syndrome (ARDS), or
            Autopsy findings of pneumonia, ARDS, and no identifiable cause.

The above has a lesson for today. There was no absolute diagnosis—it was all based on clinical features.

Etiologic diagnosis was not and is not required for treatment of ARDS (Acute Respiratory Disease Syndrome) the end stage of a number of respiratory diseases essentially unrelated to the diagnosis.

There still is no vaccine for SARS or MERS.

Middle East Respiratory Syndrome (MERS) is an illness caused by a virus (more specifically, a coronavirus) called Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Most MERS patients developed severe respiratory illness with symptoms of fever, cough and shortness of breath. About 3 or 4 out of every 10 patients reported with MERS have died.

After the emergence of SARS, MERS was the second coronavirus resulting in a major global public health crisis. It first emerged in 2012 in Saudi Arabia when a 60 year-old man presented with severe pneumonia.7 An outbreak of the virus did not occur until 2 years later, in 2014, with a total number of identified cases of 662 and a 32.97% case-fatality rate.8 From 2014 to 2016, 1364 cases were observed in Saudi Arabia. A total of 27 countries were affected by MERS during the outbreaks spanning Europe, Asia, the Middle East and North America. Cases that were identified outside of the Middle East, including the outbreak in South Korea in which 186 individuals were infected as a result of a super spreader, were transplanted individuals that had previously been infected in the Middle East.9 Since 2012, 2494 laboratory confirmed cases of MERS have been reported, and 858 associated deaths have occurred (34.4% case-fatality ratio).8,10

The novel coronavirus (COVID-19), the third corona-virus resulting in a major global public health crises, was first identified in Wuhan, China, in December 2019 among a cluster of patients that presented with an unidentified form of viral pneumonia with shared history of visiting the Huanan seafood market.1 Patients were assessed for viral pneumonia through the ascertainment and testing of bronchoalveolar-lavage fluid utilizing whole genome sequencing, cell cultures and polymerase chain reaction (PCR). The virus was isolated from biologic samples and identified as genus betacoronavirus, placing it alongside other Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).1

The major misinformation was from the World Health Organization which implemented the “social” distancing method of control. This was an effort to avoid medical control through various isolation techniques. This was a novel inadequate non-medical form of non-isolation for a novel new disease. As the above information indicates this disease was not novel and was not new,  The world was misled by the WHO saying that masks would not be helpful unless you were sick with the corona-virus or were caring for someone who was ill with the corona-virus.  The initial incubation period was given as 1-4 days. It was also known that the last several days of the incubation period was the most contagious, which was before the patient became ill. Hence, not wearing a mask unless you were ill was a serious lack of protection from becoming ill. This allowed a huge dissemination of the virus from infected people during the incubation period when they thought they were healthy. This method of spread from unknown people who were contagious was a serious medical error. This should have been picked up when China enforced wearing of face masks in Wuhan or be arrested. There were no new cases after two weeks.

Hence, the WHO information that masks would not be helpful, unless you were either sick or taking care of someone who was sick, was the very severely erroneous information that was picked up by the lay public, including Mayors, Governors, and even health departments.

If the governors and mayors had required the masks, our epidemic would have been terminated in two weeks as it was in Wuhan after the 3-month delay. Instead this misinformation allowed the epidemic to progress in this country, beginning with the first infection on Jan 20, 2020 to the present 3-month period with new outbreaks still occurring.

We are now finally looking at effective isolation control. The outbreak last week in a Yolo County  nursing facility, the adjacent county to Sacramento, has finally caused a mandatory wearing of mask in Yolo county whenever you are outdoors. Also this week all the airports nationwide are requiring a face mask in the terminal and in the airplane. Thus after three-months we are finally doing effective isolation to control the virus.

The current discussion on opening up the “closure” which has harmed many establishments, should never have been an issue. Except for restaurants, bars, salons, barbershops or any business where a mask would interfere with the business, all other businesses should have been allowed to remain open with the requirement to wear a mask posted on the main and only entrance. Businesses should have required the wearing of a mask with an employee or security guard at the door to enforce the wearing of a facial barrier covering the nose and mouth; a sanitizer dispenser at the door so everyone applies this to his hands; and the monitor measures the customers temperature with an infra-red thermometer which does not touch the person and if it’s over 100.4 deny entry. This, more likely than not, would allow business to have enough income to pay their rent, staff, product lines and avoid bankruptcy. To see neighbors with three adults stay at home all day, losing all three incomes, is devastating. Social Service establishments like the one in Sacramento with hundreds of cubicles should have remained open. The simple precautions mentioned would allow continued work wearing a mask until entering or leaving their cubicle.

If we have a major depression because of this epidemic, the cause should now be apparent.

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