Coronavirus, the caveat

Coronavirus, the caveat


I am writing this as a fully retired pathologist, who had seen, malaria,cholera, dengue and leptospirosis as a District Medical Officer in charge of a remote hospital in Kegalle.


I was not a Medical Officer of Health and met a M.O.H in courts briefly where Police Officer, School Inspector, MOH, Gam-muladani (Grama Seavaka) and another guy was charged in a murder case.
The police officer who led the case for prosecution had a cock and bull story to cover up the murder.

He was demoted later and wanted me to change the evidence to look like probably an accidental death (I only lead evidence not conviction) to cover up the blue murder.

I told him if he challenges me in courts, I would introduce more incriminating facts to the preliminary report later.

Not withstanding, he tried to intimidate me in courts and I told the magistrate, this is only a preliminary report and I will give you detailed report and productions later.

The judge smiling asked, the police officer any more questions and he said NO, Sir.



Making a blood film for malaria was mandatory in our time. 

I even diagnosed and confirmed (imported from Malaysia) a case in New Zealand.

I do not curry favour the government who is willing to scapegoat Election Commission (washing government's handling and responsibilities) and the poor Citizen Punchi Sincho to suffer at the polling booth with his old Identity Card, that would be contaminated with a full dose of the virus by the election officials who are not protected by PPE of high standard.

I also do not curry favour the poor health officers who are not really overwhelmed by the work load who are NOW supervised by a retired army officer with putative credentials and star studded uniform.


Universal testing with a 80% specificity and sensitivity is yet to be identified and swabbing and antigenic testing would have more false negative results than positive results.
In serology test ONLY a paired sample will indicate current infection and PCR can be easily contaminated in rapid multiplication cycles currently used in Ceylon.
.
It is mandatory to test both contacts and the wider population at risk to determine the final outcome which is in my opinion would be counted by years and not by months of surveillance. 
 

Everybody forgets it has (both CHINA and WHO hold liability for not coming out with the full spectrum of symptoms and signs) an enteric mode of spread with long incubation period in a country where water supply is intermittent (rain or no rain) and washing the back or bottoms with left hand is a Cultural Trait and inadvertent rapid spread is fast and involuntary.

It spreads fast where density, mobility and human misbehavior are endemic.

The lockdown has temporary benefits and once the schools are opened (over 50% with no toilet facilities including private tutuories) one contact will infect over 100 or more.

The rain that has come would spread it out of control. 


Army cannot control it. 


Our poor health service guys and girls will fall victim, just like in Italy and Spain.


I believe TB vaccination (over 80% immunized unlike in USA) give protection to respiratory symptoms but won't mitigate enteric infection and spread.


This is food for thought for all.


I was in quarantine mode longer than many due to my full retirement, which is a blessing in disguise.
Mind you I have put on weight and my trousers fit well.

I prefer the short now and take a bath with full cloths moment I come out of a light city sojourn, even under the thundering rain in the open.

I finish with a hot pail of water (which my mother long gone gave me after a long village trail in Kandy) a habit I learnt in my childhood.



Reproduction

Coronavirus Can Invade Our Intestines As Well As Our Lungs, Study Finds

By Kashmira Gander

The coronavirus that causes COVID-19 can infect and replicate in human intestine cells, according to a study.
This may explain why some COVID-19 patients have gastrointestinal symptoms, Dutch researchers suggested in a paper published in the journal Science.
The coronavirus can invade and multiply in the human gut because the enzyme it uses to enter our cells is found in this part of the body, the team said.
The enzyme, called Angiotensin-converting enzyme 2 (ACE2), is also present in the respiratory system.

Why Are Some People With the Coronavirus Asymptomatic?

To reach their conclusion, the team took SARS-CoV-2 (the coronavirus which causes COVID-19) and cells from the human intestine and watched how they interacted in a lab.
After 24 hours, the virus had invaded some of the cells. After 60 hours "the number of infected cells had dramatically increased," the authors wrote.
Next, they examined which genes were at work in the intestinal cells using a technique called RNA sequencing. This revealed genes that fight off viral infections were active in the gut cells.
The project saw the team culture gut cells so they would have different levels of ACE2, to see if this would change their chances of being infected. They found cells were vulnerable whether or not they had high or low levels of ACE2.
Study co-author Bart Haagmans, a virologist at Erasmus MC University Medical Center Rotterdam, commented in a statement: "The observations made in this study provide definite proof that SARS-CoV-2 can multiply in cells of the gastrointestinal tract.

"However, we don't yet know whether SARS-CoV-2, present in the intestines of COVID-19 patients, plays a significant role in transmission. Our findings indicate that we should look into this possibility more closely."

Read more

The team aren't the first to explore whether the coronavirus not only affects the respiratory system, causing common symptoms such as a dry cough and breathing difficulties, but other parts of the body too.
Last month, a study published in The American Journal of Gastroenterology involving 206 people in China showed diarrhea may be the first or only symptom some COVID-19 patients experience.
An article published in the journal the BMJ involving 96 people with COVID-19 in China found the coronavirus appeared to linger longer in some patients' stools than their respiratory system.
Brennan Spiegel, professor of medicine and public health at Cedars-Sinai and co-author of The American Journal of Gastroenterology study, told Newsweek in April: "I think the main message is COVID-19 is not just cough.He said: "We're starting to learn from our colleagues in China and around the world now that there's a large group of people who may not ever report for care, or at home with digestive symptoms—diarrhea, nausea, vomiting, less so abdominal pain but that too, low appetite—who are struggling to determine if they have COVID-19 or not."
Since the COVID-19 pandemic is thought to have started in late 2019, more than 3.6 million people around the world have been diagnosed with the disease, according to Johns Hopkins University. 257,301 have died, and over 1.1 million are known to have survived. The U.S. is the country with the most cases, as the Statista graph below shows.

Centers for Disease Control and Prevention Advice on Using Face Coverings to Slow Spread of COVID-19

• CDC recommends wearing a cloth face covering in public where social distancing measures are difficult to maintain.
• A simple cloth face covering can help slow the spread of the virus by those infected and by those who do not exhibit symptoms.
• Cloth face coverings can be fashioned from household items. Guides are offered by the CDC.
• Cloth face coverings should be washed regularly. A washing machine will suffice.
• Practice safe removal of face coverings by not touching eyes, nose, and mouth, and wash hands immediately after removing the covering.
  

World Health Organization advice for avoiding spread of coronavirus disease (COVID-19)

Hygiene advice

• Clean hands frequently with soap and water, or alcohol-based hand rub.
• Wash hands after coughing or sneezing; when caring for the sick; before, during and after food preparation; before eating; after using the toilet; when hands are visibly dirty; and after handling animals or waste.
• Maintain at least 1 meter (3 feet) distance from anyone who is coughing or sneezing.
• Avoid touching your hands, nose and mouth. Do not spit in public.
• Cover your mouth and nose with a tissue or bent elbow when coughing or sneezing. Discard the tissue immediately and clean your hands.
  

Medical advice

• Avoid close contact with others if you have any symptoms.
• Stay at home if you feel unwell, even with mild symptoms such as headache and runny nose, to avoid potential spread of the disease to medical facilities and other people.
• If you develop serious symptoms (fever, cough, difficulty breathing) seek medical care early and contact local health authorities in advance.
• Note any recent contact with others and travel details to provide to authorities who can trace and prevent spread of the disease.
• Stay up to date on COVID-19 developments issued by health authorities and follow their guidance.
  

Mask and glove usage

• Healthy individuals only need to wear a mask if taking care of a sick person.
• Wear a mask if you are coughing or sneezing.
• Masks are effective when used in combination with frequent hand cleaning.
• Do not touch the mask while wearing it. Clean hands if you touch the mask.
• Learn how to properly put on, remove and dispose of masks. Clean hands after disposing of the mask.
• Do not reuse single-use masks.
• Regularly washing bare hands is more effective against catching COVID-19 than wearing rubber gloves.
• The COVID-19 virus can still be picked up on rubber gloves and transmitted by touching.