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Source: Thailand Medical News  Feb 10, 2020  2 months ago
MUST READ! Chinese Doctors Outline Stages In A Typical Coronavirus Infection
MUST READ! Chinese Doctors Outline Stages In A Typical Coronavirus Infection
Source: Thailand Medical News  Feb 10, 2020  2 months ago
The following article was based on observations by Chinese doctors and researchers at ground level in China coupled with data available from published research studies about the coronavirus. It is subject to contention and also changes as many variables about the new coronavirus is still unknown and gradually coming to light.


 
According to Chinese doctors in Wuhan, a person can initially contract the coronavirus thru contamination with droplets containing the virus that have been exuded by an infected person either through their coughs or sneezes or items they have contaminated. Also, there is a high possibility that an asymptomatic infected person can also spread the coronavirus through his exhaled air. Fecal transmissions are also a secondary source of transmission as confirmed by new studies.
 
As long is the coronavirus is contracted by a healthy person either through his eyes, nasal pathways or mouth, that individual now becomes infected.
 
It is important to note that studies have also confirmed that the new coronavirus is able to stay “active” outside of a host, on surfaces for as long as 9 days with the right temperature and humidity. Cool temperatures and high humidity favours the coronavirus extended survival.
 
According to Chinese doctors, once a person has contracted the coronavirus, during this so called incubation period of anything between 2 to 16 days  (the Chinese researchers have seen certain exposed individuals only developing symptoms after 16 days so far, the longest before exhibiting any symptoms but warn that there could be certain “super asymptomatic individuals” that can get infected but has not manifested a single symptom or progressed into a severe or critical stage yet.)
 
During this “incubation stage, the coronavirus multiples at a rapid rate in the host thus accounting for high viral loads that Chinese doctors have seen in most patients by the time they come to the hospitals exhibiting initial symptoms such as coughing and fever.
 
From here, the Chinese doctors describe the start of a 3 week progressive stage.
 
In the first week since materializing fever and coughs, the patient will start exhibiting breathing difficulty problems, abdominal pains and chills and about 20 per cent of patients also will suffer from diarrhea.
 
Depending on a person’s immunity, most patients in the second week will progress with severe pneumonia and also ARDS or acute respiratory syndrome.  Typically by the third week, should the patient immune system and drugs not be able to fight off the coronavirus, organ failure and sepsis typically occurs.
 
The Chinese researchers say that it’s the second week that is most crucial as if a patient is able to fight off the coronavirus during this stage, their chances of survival is high whereas most patients who progress in to the “week 3” type of conditions normally do not survive or are merely struggling to like in ICU conditions for a prolonged period.
 
The Chinese doctors also note that in s called recovered patients, all of them would need at least 6 months or longer to fully recover from the damage done to their lungs.
 
 All the Chinese medical experts confirmed their clinical observations that the disease usually takes three weeks to escalate to critical condition.
 
Dr Du Bin, director of the ICU at the Peking Union Medical College Hospital said that many patients in critical state suffered organ failures of the heart, renal function or circulatory system.
 
Dr Jiang Li, ICU director at Beijing Xuanwu Hospital who is currently in Wuhan told Thailand Medical News, “To date we  still understand very little about the pathogenesis of the coronavirus and are not clear about the actual cause of the multiple organ failures.  It makes the rescue and treatment of severe patients a challenge.”
 
As the effect from the coronavirus rapidly affects the patients, it means that intensive care professionals are the main force battling the coronavirus. As the epidemic continues unfolding, the number of critical patients is rising rapidly. According to official figures as of Monday, there were 3,782 patients in critical conditions. (but in reality there are much more.)
 
Dr Peng Zhiyong, the director of the Intensive Care Unit (ICU) at the South Central Hospital of Wuhan University, told Thailand Medical News, "We are racing with save patients from the coronavirus which turns aggressive  once in the second or third week.)
 
Dr Huang Xiaobo, ICU director at the Sichuan People's Hospital, arrived at Wuhan on the night of Jan 25 in the first wave of physicians to aid Wuhan's disease control. He was assigned to the Wuhan Red Cross Hospital where he said that here are hundreds in critical condition that are battling to live.
 
The death of Dr Li Wenliang, a 34-year-old ophthalmologist in Wuhan, illustrates the rapid deterioration the disease can cause. Dr Li was one of the whistleblowers who first set off alarms about the new coronavirus and was also infected while treating patients. He told media personnel in an interview on Jan 30 that he expected to recover and was determined to return to the fight. However six days later on the Feb 5, Dr Li sent a  message that his condition worsened. In the early morning of Feb 7, Dr Li died after an hours-long rescue attempt in the ICU.
 
Dr Jiang from Beijing Xuanwu Hospital added, "It evolves rapidly from good to bad. Sometimes changes come in hours."
 
Dr Wu Tianhe from Shanghai Central Hospital and Dr Huang from the Sichuan People's Hospital both also remarked upon the rapid development of the new coronavirus in patients. Unlike flu viruses such as H7N9 and H9N1, which often cause severe symptoms at the beginning, most patients infected with the new coronavirus first show mild symptoms but quickly deteriorate after a certain point.
 
Minor symptoms such as low fever and fatigue at early stages also make the new coronavirus more difficult to detect and control.
 
Again Dr Peng stressed that  it often takes three weeks for patients to develop from minor flu-like symptoms to critical or even fatal conditions.
 
"Individuals with strong immune systems may ‘recover’ after two weeks, but the elderly and those with basic health issues could worsen to respiratory failure and other organ failures. The second week is the watershed," commented  Dr Peng.
 
Dr Du of the Peking Union Medical College Hospital said that among patients with mild symptoms, 15 to 20 per cent seem to worsen in the second week, said For those whose conditions turn critical, the third week is the fatal test, doctors have observed.
 
Dr Peng added, "Some get through the third week, but others won't make it."
 
So far clinical records show that the average age of infected patients is 53 while those entering the ICU average 62, indicating older people are more vulnerable to the coronavirus. However this is not reliable as Dr Li Wenliang who passed away was only 34 years old and there have cases of young people with no underlying chronic disease between the ages of 17 to 28 years of age also dying.
 
Typically, the new coronavirus attacks people's immune system, resulting in a drop in lymphocytes, or disease-fighting white blood cells, as well as lung damage and respiratory failure. Some patients suffer multiple organ dysfunction, Dr Peng said.
 
Dr Peng added, "About 40 percent of patients I observed showed systemic inflammatory response syndrome that led to multiple organ failure and critical conditions. It happened in only two or three days for some patients."
 
So far, according to medical experts and frontline doctors, 20 to 30 per cent of new coronavirus patients could develop severe conditions, and among them 30 to 40 per cent worsen to critical condition.
 
To date, there has yet to be a widely agreed mortality rate for the disease. Several ICU doctors estimate that the death rate among patients in critical condition ranges from 30 to 55 per cent, meaning the overall mortality rate may be between 1.5 to 3 per cent.
 
However what is more worrisome is the coronavirus's damage to people's lower respiratory systems, causing serious consequences even after a patient recovers. Peking Union's Dr Du said it could take at least six months for patients to recover heart and lung function.
 
Dr Xi Xiuming, an intensive care medicine professor at Beijing Fuxing Hospital said that there are so many variables still as newer reports are emerging that the coronavirus is indeed mutating and already a new subtype has emerged.
 
To make matters worse, it also being reported by the doctors that the coronavirus is showing resistant to initial antivirals that were used in the early stages and to date there is no known drug that can really eradicate the coronavirus in the body.
 
 

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