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Everything we know about #coronavirus #Covid19 so far.
A thread by a doctor. /thread
[Declarations: I am a heart doctor, not a virus specialist, all of this information is from published papers and scientific resources (links below).]
“Coronavirus” is a family of viruses which also includes Middle East Respiratory Syndrome (MERS), and Severe Acute Respiratory Syndrome (SARS). Under a new naming system, this current strain is called #COVID19.
There is no relationship between #coronavirus and Corona beer. The word “corona” just means “crown” in Latin, which for the virus refers to the appearance of the virus particle itself.…
Most of the data we have about #covid19 is from the Wuhan, China outbreak, and it is still incomplete. Most notably it isn’t clear how many very mild or asymptomatic cases have been tested for, potentially giving us a skewed view of how the virus behaves.
Having said that there have been some contained outbreaks, for example, the cruise ship "The Diamond Princess", which had 705 (latest) cases, and 4 deaths.…
So what do we know so far? It’s a respiratory virus with a range of symptoms. 80% have mild disease, around 14% have severe and 5% have critical disease requiring intensive care.
Reported symptoms from HOSPITALIZED patients are fever (98%), dry cough, and headache. Shortness of breath and pneumonia develop in 10-15% of cases. 10% have abdominal symptoms: diarrhoea and pain.…
[Caveat: if you decide to test or hospitalise a patient for #Covid19 based on symptoms, then the profile of symptoms will then be biased - i.e there are likely even milder cases that never get diagnosed at all, especially if they have no fever (possibly 15%)]
The “incubation” period, from the time you are exposed to producing symptoms, is reported as between 3 and 24 days. It has been shown asymptomatic patients in this phase can still pass the virus on to others.…
The virus is spread primarily by droplets, either sneezed out and inhaled by another person or probably less commonly, onto a surface that is then touched and introduced to the mouth or nose by your own hands. ("fomite spread")…
Studies of other Coronaviridae have suggested virus droplets can remain infectious, viable, on a surface for up to 9 days. They can be disrupted by alcohol-based cleaning fluid.…
Hence you can see why WASHING YOUR HANDS can reduce the spread dramatically. Here is a model of pandemic spread showing dramatic. HT @fryRsquared
Hand sanitiser is probably not as good, but if it’s alcohol-based (60% at least) it can disrupt the virus droplets. This isn’t true of all viruses, but please ignore the “scientist” on Twitter about “anti-bac” meaning doesn’t work on viruses. It does.
Based on this, infectious diseases have a number called R0 which is an index of how many people 1 infected person will go on to expose. An epidemic needs an R0 > 1 to get bigger. R0 < 1 means the cases will dwindle and disappear.…
There have been lots of comparisons to another respiratory virus; influenza. Influenza has an R0 of about 1.3 (depending on strain) and causes death in around 0.1% of patients. Each year there is a vaccine based on the strain predicted for the winter. We also have some medicines.
#Covid19 has an R0 of between 2-3, and causes death between 1-3%. There is no vaccine or current antiviral medicine yet, and probably not for 12 months minimum.

Here is a table:
Again, take these numbers with a pinch of salt, especially the mortality figures: it heavily depends on how you define what a “case” is, which has changed several times and may still be missing infections that cause no or very mild symptoms.
The other comparison has been with SARS. Another coronavirus, SARS was however slower to grow and easier to contain, as nearly all transmission was when there were symptoms. Here’s another graph: COVID19 is worse.
The mortality rate also depends on the size of the outbreak and the ability of local healthcare to cope. In small contained outbreaks with lots of resources, mortality will be lower as more survive ICU. Where it is larger, this may be overwhelmed with a higher rate of death.
Those most at risk of severe disease appear consistently to be the elderly, especially with pre-existing heart or lung problems. With a rate of 8% mortality in >65 and 14% in the over 80s. Young children seem to be less affected, again unlike influenza.
We are now seeing local spread in non-travellers in many countries, UK included. With an R0 of between 2-3, this suggests that for each case we do identify as coronavirus we are missing 1-2 more, who potentially will infect 2-3 more people.
Currently, we aren’t testing routinely all-comers with suggestive symptoms, the current pathway remains for travellers only. The US has been even slower than us at responding to this.
The CMO has suggested in the worst-case scenario 80% of the population could be infected.

To look after the majority of patients will mean staying home and not contacting others. Hand washing. Avoiding unnecessary travel.…
The real challenge will be caring for severe cases. The UK has very few intensive care beds and even fewer doctors and nurses per head, compared to Europe or the USA. Creating beds, cross-training existing staff will be very difficult.
So in summary: these are the facts about #Covid19.

There is no “media hysteria”, there has not been a comparable situation in the U.K. in a hundred years.
Wash your hands, self isolate if you are unwell, avoid unnecessary travel. Wash your hands again. Take the threat seriously, as much to protect others as far as possible as yourself.
We live in an age of “post-truth” selfishness - #covid19 #coronavirus is the ultimate challenge to that.

The facts are deadly serious here, as they always were.

Be informed, be kind, stay safe. /end
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