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March 01, 2020 "On December 31, 2019, the Chinese health authorities have announced the presence of an outbreak of feverish syndrome, associated with pneumonia of unknown origin, among the inhabitants of Wuhan, a city of about 11 million inhabitants located in the province of Hubei. , in central-southern China, at the confluence of the Blue River and the Han River, about 1,100 kilometers from Beijing, 800 from Shanghai, 1,000 from Hong Kong ". So begins the guide prepared by Spallanzani of Rome on the epidemic, with advice for the population."The starting point of the infection was identified in the fish and other live animals market (so-called 'wet market') in Huanan, in the center of Wuhan city, which was closed on January 1, 2020", continues the guide . "On January 7, the pathogen responsible for the epidemic was isolated: it is a new betacoronavirus, which WHO first called 2019-nCoV, then, following a research meeting held on February 10 and 11, SARS-CoV-2, indicating the similarity with the SARS virus, which in 2002-2003 caused a global epidemic with 8,096 confirmed cases and 774 deaths - continues the guide -. In the same meeting, the WHO called COVID-19 the disease caused by the new virus. "
Why coronavirus
"Coronaviruses, so called because of the characteristic coronet shape visible under the microscope, are a family of viruses that cause infections in humans and in a variety of animals, including birds and mammals such as camels, cats and bats. They are well known by researchers: these are in fact very common viruses in nature, which can cause diseases ranging from the common cold to more serious diseases such as Middle Eastern respiratory syndrome (MERS) and severe acute respiratory syndrome (Sars) ".
From animal to man
"Coronaviruses are conveyed to humans by intermediate hosts, which for Mers were the dromedaries, for Sars perhaps the civet. The contagion, also in this case, was of the zoonotic type, that is caused by the transmission of the virus by animal for humans, it is no coincidence that the epicenter of the epidemic is a market where live wild animals were also sold. We do not yet know exactly what the animal transmitted the virus to humans: it is still probable, even in light than what has happened in the epidemics that have occurred to date, that the coronavirus reservoir was a mammal. Science magazine hypothesized that the animal that transmitted the virus to humans may be the pangolin, a protected mammal covered with scales whose Illegal trafficking is unfortunately widespread in China, where it is used in traditional medical practices. "
From man to man
"WHO recently stressed that there is always new scientific evidence for the link between Sars-CoV-2 and other similar coronaviruses (CoV) circulating in bats, and more specifically in Rhinolophus, commonly known as horseshoe. Inhuman transmission of the virus has been demonstrated, given the absence of epidemiological links between many of the infected, including those of the Italian outbreaks in Lombardy and Veneto, and the area of China in which the infection originated ".
How it spreads
Sars-CoV-2, like other coronaviruses, is transmitted through the droplets of the breath of the infected person, which can be transmitted by coughing or sneezing, or by direct personal contact, or by touching the mouth, nose or eyes with contaminated hands.
"In practical terms, it is recommended to keep at least one meter away from people who cough, sneeze or have a fever, and frequently wash their hands with soap or an alcoholic solution. When you have respiratory symptoms you need to practice the 'label cough 'by keeping your distance with other people, covering your cough and sneezing with disposable fabrics or clothing or, in their absence, with the crook of your elbow, and of course washing your hands frequently "
The decalogue of behavior
The Ministry of Health and the Istituto Superiore di Sanità, in collaboration with the State-Regions Conference and with various professional associations, have created a decalogue to promote correct information on the behaviors to follow to prevent coronavirus infection: 1. Wash often hands; 2. Avoid close contact with people suffering from acute respiratory infections; 3. Do not touch your eyes, nose and mouth with your hands; 4. Cover your mouth and nose if you sneeze or cough; 5. Do not take antiviral drugs or antibiotics, unless they are prescribed by your doctor; 6. Clean the surfaces with chlorine or alcohol based disinfectants; 7. Use the mask only if you suspect that you are sick or are caring for sick people; 8. Made in China products and parcels received from China are not dangerous; 9. Contact the toll-free number 1500 if you have a fever or cough and have returned from China for less than 14 days; 10. Pets do not spread the new coronavirus.
Symptoms and people at risk
"The virus can cause mild, flu-like symptoms, but also serious diseases such as pneumonia - reads the guide -. People with pre-existing chronic conditions, such as hypertension and other cardiovascular disorders, diabetes, liver disorders and respiratory diseases, seem to be At risk An epidemiological study recently published by China Cdc, the Chinese National Agency for Disease Control and Prevention, examined all the approximately 45,000 confirmed cases in China until February 11, and found that: 86.6% of cases involved people aged between 30 and 79; 80.9% of cases had mild symptoms; 14% of cases were in serious conditions, with pneumonia or difficulty breathing; 5 % of cases were in critical condition, with respiratory failure, septic shock, multi-organ failure ".
"However, it is still too early to be able to provide accurate estimates of lethality, and only with the evolution of the epidemic will it be possible to collect more detailed data. The lethality rate of just over 3% that is obtained by dividing the number of deaths by the the number of confirmed cases returns a photograph that may be inaccurate: on the one hand, in fact, since the diagnosis precedes the recovery or death of the patient by days or weeks, the number of deaths should be compared to the number of cases in place at the time to which the patient had contracted the infection, and therefore in this case the lethality rate would currently be underestimated; on the other hand, however, it is possible that many mild or even asymptomatic cases have not entered the statistics; in this case therefore the rate of lethality would be overestimated. "
Therapies
"The symptoms are typically respiratory - experts continue - fever, cough, cold, sore throat, severe lung fatigue. At the moment there are no specific therapies: the disease is treated like cases of severe flu, with supportive therapies (anti-febrile , hydration), but contrary to influenza, specific antivirals are not available, and in severe cases patients are given mechanical breathing support.
Experimental treatments
"Based on the available data, WHO suggested experimental antiviral therapy, which was also used at Spallanzani for the first virus-positive patients, and which is based on two drugs: lopinavir / ritonavir, an antiviral commonly used for HIV infection and showing antiviral activity also on coronaviruses; and remdesivir, an antiviral already used for Ebola Virus Disease, potentially active against new coronavirus infection ".
There is no vaccine
"During the research meeting held on 10 and 11 February in Geneva, the director general of the World Health Organization, Tedros Adhanom Ghebreyesus, said that the first vaccine could be ready in eighteen months. In a recent statement, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, the branch of the NIH that deals with infectious diseases, recalled that the NIH had developed a vaccine for Sars, leading it up to the trials on men (the so-called 'phase 1'). But after the Sars emergency ended, there was no interest in carrying out tests on the new vaccine. The global numbers of the epidemic are constantly changing. "
Prevention measures
"The Chinese government has put in place massive measures to try to contain the spread of the epidemic - experts say -. Starting from 23 January, first in the city of Wuhan, then in numerous other cities in the province of Hubei, they have been suspended. public transport, closed ports, railway stations and airports, blocked access roads. In fact, in the Hubei region about 60 million people were quarantined ".
International state of emergency
"On January 30, WHO, regarding the coronavirus infection, declared the Pheic (Public HealthEmergency of International Concern), or the international state of emergency. Pheic is declared when an extraordinary event occurs in a state that constitutes a public health risk for other States through the international spread of diseases and which potentially requires a coordinated international response '".
"The Pheic declaration facilitates the sharing of information for risk assessment, allows the WHO emergency committee to give Member States temporary recommendations and, above all, facilitates diplomatic, public health, safety and logistics, as well as allowing the use of more financial resources. To date, Pheic had been declared five times: for swine flu in 2009, for polio in Central Asia, the Middle East and central Africa in 2014, for Ebola in West Africa in 2014, for Zika in Central and South America in 2016, and again for the Ebola epidemic in Congo in July 2019 ".
The emergency in Italy
"On January 21, the Ministry of Health created a task force that meets daily and coordinates health interventions and relations with international organizations, mainly WHO and ECDC. On January 30, the Italian government decided to proclaim the state of emergency and to suspend all direct air connections to and from the People's Republic of China, including the island of Taiwan and the Special Administrative Regions of Hong Kong and Macao. On February 23, following the emergence of two outbreaks of local transmission of the virus in Lombardy (province of Lodi) and Veneto (province of Padua), the government has issued a decree authorizing the institution of extraordinary measures to contain the spread of outbreaks, including the prohibition of removal and entry into the areas concerned, the closure commercial activities, the prohibition of cultural, sporting and recreational activities, the closure of schools, and other similar measures. eto also provides the quarantine obligation for individuals who have had close contact with confirmed cases of illness, and the obligation of fiduciary home stay for individuals who have entered Italy from areas that WHO considers to be at epidemiological risk " .
How to identify a suspect case
"According to the ECDC recommendations - the doctors explain - because there is a suspected case of coronavirus, the patient must have symptoms of cough and / or sore throat and / or breathing difficulties; and also, in the 14 days preceding the onset of symptoms, you must have performed at least one of these activities: have had close contact with a confirmed or probable case of Covid-19, have traveled to areas where there is, or is presumed to be, the community transmission of the virus; have visited or worked in healthcare settings where Covid-19 patients were treated. "
"In these cases, the Ministry of Health recommends contacting the toll-free number 1500. If the symptoms are mild, you have not recently been in China or other areas with community transmission of the virus, and there have been no contacts with confirmed cases or probable, the advice of the Ministry of Health is to stay at home until the symptoms have been resolved by applying hand and respiratory hygiene measures. In Italy a capillary surveillance network of serious acute respiratory infections (Sari) has been active for years and of acute respiratory distress syndromes (ARDS). The situation is constantly monitored by the Ministry, which is in constant contact with the WHO and the ECDC, and promptly publishes any new updates on its Portal ".
Scientific research and patient management
"The intervention and response capacity of our National Health Service has been improving over the years in the light of the experiences gained with other epidemics, such as Sars, avian influenza, Ebola. In particular, the National Institute for Diseases Infectious Lazzaro Spallanzani (INMI), national reference center for research and treatment on infectious diseases and WHO Collaborating Center for highly contagious diseases, is as always ready to implement all the procedures for any emergencies with the assessment of the levels of risk and the isolation of any suspected cases. The virology laboratory, just 48 hours after the diagnosis of the first two cases in Italy, has isolated the virus, making it available to the scientific community. Having the virus available allows you to study better the mechanisms of the disease, facilitating the development of diagnostics and research on possible treatments and vaccine ".
"As far as the clinical management of patients is concerned, the Institute has many years of experience in the management of patients suffering from infectious respiratory diseases, with departments equipped with highly insulated beds. The IMI staff is constantly trained on the correct use of the individual protection devices, which allow to provide assistance to infectious disease patients in safe conditions. The timely isolation of any suspicious cases in structures with a high level of protection allows to reduce the risk for the community ".