Coronavirus is a “once in a century” pathogen, says Bill Gates

Philanthropist Bill Gates on Friday urged wealthy nations to help low- and middle-income countries strengthen their health systems in hopes of slowing down the spread of coronavirus, which according to Gates started acting like a pathogen “once in the century” .

“By helping the countries of Africa and South Asia to prepare now” we can save lives and also slow the global circulation of this virus, “Gates, former president and CEO of Microsoft Corp, wrote in a New England editorial Journal of medicine.

The coronavirus novel that first surfaced in China and has now spread to 46 countries is much more difficult to block than similar viruses that have caused Middle East respiratory syndrome (MERS) or severe acute respiratory syndrome (SARS). ), wrote Gates. The Bill and Melinda Gates Foundation has already promised $ 100 million to fight the epidemic.

Gates’ appeal was reiterated on Friday by the World Health Organization, which said the risk was very high that the virus would spread and have a global impact.

WHO implored governments to take action to contain the virus before it becomes widespread. Such actions could slow down the virus, giving nations more time to prepare, officials said.

“Health systems around the world are not ready,” said Dr. Mike Ryan, head of the WHO emergency program, at a press conference.

Gates said the world needs to invest in disease surveillance and better technology to accelerate the development of safe and effective vaccines and drugs.

In addition to technical solutions, Gates called for more diplomatic efforts to drive international collaboration and data sharing and an increase in public spending on drugs and vaccines that would give incentives to private companies to undertake such efforts.


Diabetes, CVD linked to the worst prognosis for COVID-19 infection

The indications so far are that people with diabetes and other chronic medical conditions, such as cardiovascular disease (CVD), will have a worse prognosis if they become infected with COVID-19, the new coronavirus that has emerged from China.

There is also evidence that diabetes can increase the risk of COVID-19 infection two to three times, regardless of other medical problems, such as CVD.

Although more detailed analyzes are needed to show a clearly defined connection between conditions such as diabetes and a worse prognosis with COVID-19, statistics suggest that this virus affects the hardest among the most vulnerable, namely, the elderly and people with multiple medical problems, especially those with long-lasting diabetes that has not been well controlled.

“The message we want to emphasize is that emergencies unmask the vulnerabilities of diabetes. The old and the sick are the most vulnerable,” said Juliana C. N. Chan, MD, Medscape medical news in an interview.

Chan is director of the Hong Kong Institute of Diabetes and Obesity at the Chinese University of Hong Kong.

Chan and other experts therefore ask that diabetic patients, those with CVD and patients with other chronic medical conditions be more vigilant in their efforts to avoid contact with the virus, although they also note that individual responses vary widely.

In the past, epidemics of infectious diseases, including severe acute respiratory syndrome (SARS) and H1N1 flu, people with diabetes were at increased risk of serious disease and death.

“I don’t think it’s an exaggeration to say that people with diabetes … are at greater risk of developing COVID-19, because the data is suggestive,” Chan observed, although he warned that long-term research will give a lot more photos. clear.

Poor control of diabetes is a risk factor for infection

Chan was a senior coauthor of a study published in Diabetology, as reported by Medscape medical news, who found that mortality rates among people with diabetes in Hong Kong have plummeted in recent years, with the exception of young people, who may be more likely to have poorly controlled diabetes.

And – especially in the context of the COVID-19 epidemic – although in that study deaths from most conditions such as CVD and cancer decreased among people with diabetes, deaths from pneumonia among people with diabetes remained virtually unchanged. .

In severe cases of infection, the COVID-19 virus invades the cells that line the respiratory tract and lungs and enters the mucus, causing pneumonia. Severe lung damage from pneumonia can cause acute respiratory distress syndrome (ARDS), which in turn can cause septic shock.

ARDS and septic shock are the leading causes of death from COVID-19.

To date, Hong Kong has had only 70 confirmed cases of COVID-19, although the first Hong Kong resident to die from the virus was a 39-year-old man with diabetes. That death was soon followed by a second death – a 70-year-old man with diabetes and other medical problems, including hypertension and kidney disease.

“Our message is to ask people with diabetes to do things early to protect themselves and reduce the risk of having problems if something happens,” Chan told Medscape.

Although the mechanism for this increased susceptibility remains unclear, research suggests that high blood glucose levels can lead to impaired immune system function.

Not yet pandemic, but Virus has claimed many more lives than SARS

By February 25, COVID-19 had infected around 80,000 people and had caused nearly 2,500 deaths worldwide.

Although the vast majority of these infections and deaths have been in China, there are now pockets of infection in Iran, Italy, Japan and South Korea, as well as a handful of cases in many other countries.

The World Health Organization (WHO) yesterday stopped calling the epidemic a pandemic, but stressed that status could change at any time.

Although COVID-19 appears highly transmissible, only a small percentage of people seem to develop a serious disease and an even smaller number die from the infection.

A recent study of 44,672 confirmed cases of COVID-19 that had been reported until 11 February and which have been analyzed by the Chinese Centers for Disease Control and Prevention (CCDC) shows that 80.9% of people at who was diagnosed with COVID-19 had a mild illness.

So far, the overall case death rate (CFR) in China is 2.3%, lower than the previous coronavirus outbreaks caused by SARS (CFR: 9.6%) and Middle East respiratory syndrome (MERS) (CFR: 34.4%).

That being said, since COVID-19 has infected many more people than SARS or MERS, the latest coronavirus on the block has already caused many more lives.

This in turn raises the question: who is most at risk of serious disease and death from COVID-19?

Case mortality rates vary based on factors such as age, gender, basic medical conditions, and geography. Outside the Hubei province in China, the epicenter of the epidemic, the CFR can reach 0.4%, compared to 2.9% within the province.

The mortality rate for diabetes is high, but the interpretation is complicated

So far, for all age groups, the highest CFR is among people aged 80 or over, at 14.8%. CFRs were higher in people with other medical conditions than in healthy people.

CVD and diabetes are high on the list, in the event that mortality rates of 10.5% and 7.3%, respectively, compared to 0.9% for people without any previous disease, according to the latest CCDC report above.

Prior to the publication of this report, two relatively small case series of COVID-19 hospitalized patients in Wuhan also suggested that older men with underlying medical problems, especially CVD and diabetes, are more likely to develop disease. serious from the virus.

However, experts warn that for COVID-19 and similar infections, several factors can distort the data, making interpretation difficult.

“The identified cases tend to be in patients who have a more serious disease than younger and healthier individuals who stay at home and do not seek medical treatment,” said Preeti N. Malani, MD, an infectious disease and health specialist. principal officer of the University of Michigan medical school, Ann Arbor.

“This is also the case for individuals who are sick enough to be hospitalized. There are more people with more chronic conditions, including diabetes [among hospitalized individuals]”Malani told Medscape via email.

“Overall, diabetes can be an indicator of other chronic health conditions such as heart disease and obesity, which could contribute to an increased risk of infection,” added Malani.

“Diabetes is also much more common with age and will continue to be an indicator of poor results [all of] these reasons, “he said.

Every person with diabetes is different; Use common sense

All this makes it difficult to make fun of the individual contribution of diabetes to the risk of infection.

“The percentage in which each medical condition contributes to … the risk of infection is difficult to analyze,” explained Andrea Luk, MBChB, FHKCP, FHKAM.

Luk is an associate professor at the Chinese University of Hong Kong and is the other senior coauthor of the study Diabetology.

“Certainly a person with diabetes and cardiovascular disease would have more risks than a person with diabetes and good glucose control and without other comorbidities,” he continued.

But because every person with diabetes is different, it’s important to consider the whole package, he stressed.

If someone with diabetes succumbs to infections, it has a lot to do with glycemic control, the duration of diabetes and the comorbid conditions related to diabetes, such as heart disease, kidney disease and stroke, as well as their age, weight and if they smoke.

Chan further clarified: “We have to judge this case by case. It is not possible to apply it across the board to all people with diabetes. A person with well-controlled diabetes is very different from someone with poorly controlled diabetes. They have a different set of factors. of risk and complications “.

Pending more detailed analysis, Chan, Luk and Malani all suggest common sense measures for patients with diabetes, CVD and other chronic conditions: stay up to date with vaccinations, avoid large crowds, wash hands frequently, avoid touching the eyes or the mouth (the so-called T zone) and wearing facial masks in the areas where COVID-19 is prevalent.

People with symptoms should also wear a mask to avoid spreading the infection to others.

Even a bad year for the flu, difficult to distinguish between the two

Malani added: “Although there is a lot of attention and concern for COVID-19, this one has [also] it has been a terrible year for seasonal flu. I recommend flu shots, especially for … patients with diabetes. “

He also suggested being considerate of the trip.

“This may not be a good time for a non-essential trip to Asia as the situation is evolving. The COVID-19 risk is still low, depending on where you go, but the risk of an interrupted trip is real,” he said. observed.

Even without an emergency like COVID-19, Chan and Luk say they can’t emphasize enough the importance of optimal glucose control for people with diabetes.

“People with diabetes or other chronic conditions should be much more careful about protecting themselves from infections,” reiterated Luk.

They should also have a lower threshold for seeking treatment if they feel they are developing symptoms of infection, he noted.

“At first, it’s hard to tell if it’s flu or COVID-19 because it looks the same way,” he said.

Chan, Luk and Malani have not disclosed relevant financial reports.

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Coronavirus could have leaked from China’s highest biosecurity laboratory alongside the market

Coronavirus may have emerged from a Wuhan laboratory leak, which studies deadly pathogens such as the SARS virus, scientists suggest.

Health officials believe the severe acute coronavirus 2 respiratory syndrome (SARS-CoV-2), which causes coronavirus disease (COVID-19), originates from wild animals sold in the Huanan seafood wholesale market in Wuhan city. , which is home to 11 million residents.

Now, a team of scientists from the Xishuangbanna Tropical Botanical Garden of the Chinese Academy of Sciences, the University of Southern China and the Chinese Institute for Brain Research has written in an article published on ChinaXiv, on an alternative source of coronavirus that is currently spreading around the world.

Scientists say they have found genomic evidence that the fish market is not the true source of the epidemic. Instead, they point to the source of the viral epidemic towards a laboratory that studies powerful viruses.

The Wuhan Virology Institute, located a few meters from the fish market, researches some of the world’s most dangerous pathogens. It is the first Chinese biosafety level 4 laboratory, the highest level of safety needed to isolate hazardous biological agents in a closed facility.

Image Credit: Connect World / Shutterstock

Image Credit: Connect World / Shutterstock

The spread of the virus

Scientists at the study speculated that the virus outbreak started before December 2019, probably starting in late November. In addition, the fast-paced fish market may have facilitated the transmission of the virus to buyers and from buyers to residents across the city.

In the study, the researchers collected whole-genome information from 93 new coronavirus samples shared on GISAID EpiFlu, which is an international database that stores information about the flu virus. The team has studied the evolution and human-to-human transmission of coronavirus in the past two months.

The samples were taken from 12 countries, where 54 came from China before January 22nd and the other 39 samples came from France, Australia, Japan and the United States after January 22nd.

The team also found that while the virus had spread to the Wuhan fish market, there had also been two major population expansions, dated December 8 and January 6. In addition, scientists believe that the virus originated outside the market, but the crowded market had favored coronavirus circulation, spreading it across the city by December 2019.

The first case showing symptoms emerged on 8 December and most of the following cases were linked to the fish market. On January 1, the seafood market was closed, but the virus had already spread to the city, suggesting that the epidemic started through human-to-human transmission by the end of November.

Notice about new virus

“The study of whether the huanan market is the only birthplace of SARS-CoV-2 is of great significance for finding its source and determining the intermediate host to control the epidemic and prevent it from spreading again,” the researchers said.

The researchers also said that while at the start of the epidemic in Hubei province and surrounding areas, the Chinese National Center for Disease Control and Prevention issued a level 2 emergency notice on the new outbreak on January 6, the information was not widely shared. The team said that if the warning had received more attention, the number of cases in China and around the world would have been reduced.

The government blocked the city of Wuhan on January 23, a few weeks after the outbreak was reported. Before the inhabitants were prevented from leaving the city in fear of spreading the virus, millions have already left.

The Wuhan Institute of Virology, which is the only laboratory in China that is equipped to study with these deadly infectious diseases, issued a statement stating that the rumors had caused serious harm to the laboratory’s researchers.

The origin of the new coronavirus is still unknown, but scientists and the World Health Organization (WHO) have claimed that it is most likely a tank of animals.

Coronavirus by numbers

Coronavirus (COVID-19) has already spread to 30 countries, with South Korea reporting the highest number of infections after China. At the time of writing, there are 763 people in South Korea who test positive for the deadly virus.

Coronavirus infected nearly 80,000 people, most of them in mainland China, and the death toll reached 2,670, which is more than double the number of SARS-related deaths in 2003.

Countries around the world, especially those that fear the rapid spread of the virus, have imposed travel bans from countries that have confirmed coronavirus cases. In the meantime, Italy also reported a peak in cases, with 155 people tested positive while three patients succumbed to the disease.

The World Health Organization (WHO) has reported that no new countries have reported confirmed cases in the past 24 hours.