I recently read the WHO (World Health Organisation) report on the coronavirus and thought I would provide a brief synopsis of this report. I have also attached the report for those of you who would like to read it in its entirety. It has some illustrative charts which presents the issue at hand quite succinctly.
Please click the link below to access the entire report.
The overall goal of the Joint Mission was to rapidly inform China and the rest of the world for planning on next steps in the response to the ongoing outbreak of the novel coronavirus disease (COVID-191). This included looking at the next steps in readiness and preparedness for geographic areas not yet affected.
This mission was headed by Dr Bruce Aylward of WHO and Dr Wannian Liang of the People’s Republic of China. The group consisted of 25 national and International experts from China, Germany, Japan, Korea, Nigeria, Russia, Singapore, and the US.
Below are some of their findings taken directly from the report:
Among 55,924 laboratory confirmed cases reported as of 20 February 2020 in China, the median age is 51 years (range 2 days-100 years old; IQR 39-63 years old) with the majority of cases (77.8%) aged between 30–69 years. Among reported cases, 51.1% are male, 77.0% are from Hubei and 21.6% are farmers or laborers by occupation.
Routes of transmission
COVID-19 is transmitted via droplets and fomites during close unprotected contact between an infector and infectee. Airborne spread has not been reported for COVID-19 and it is not believed to be a major driver of transmission based on available evidence; however, it can be envisaged if certain aerosol-generating procedures are conducted in health care facilities. Fecal shedding has been demonstrated from some patients, and viable virus has been identified in a limited number of case reports. However, the fecal-oral route does not appear to be a driver of COVID-19 transmission; its role and significance for COVID-19 remains to be determined. Viral shedding is discussed in the Technical Findings (Annex C).
In China, human-to-human transmission of the COVID-19 virus is largely occurring in families. The Joint Mission received detailed information from the investigation of clusters and some household transmission studies, which are ongoing in a number of Provinces. Among 344 clusters involving 1308 cases (out of a total 1836 cases reported) in Guangdong Province and Sichuan Province, most clusters (78%-85%) have occurred in families. Household transmission studies are currently underway, but preliminary studies ongoing in Guangdong estimate the secondary attack rate in households ranges from 3-10%.
As COVID-19 is a newly identified pathogen, there is no known pre-existing immunity in humans. Based on the epidemiologic characteristics observed so far in China, everyone is assumed to be susceptible, although there may be risk factors increasing susceptibility to infection. This requires further study, as well as to know whether there is neutralising immunity after infection.
The signs, symptoms, disease progression and severity
Symptoms of COVID-19 are non-specific and the disease presentation can range from no symptoms (asymptomatic) to severe pneumonia and death. As of 20 February 2020 and based on 55924 laboratory confirmed cases, typical signs and symptoms include: fever (87.9%), dry cough (67.7%), fatigue (38.1%), sputum production (33.4%), shortness of breath (18.6%), sore throat (13.9%), headache (13.6%), myalgia or arthralgia (14.8%), chills (11.4%), nausea or vomiting (5.0%), nasal congestion (4.8%), diarrhea (3.7%), and hemoptysis (0.9%), and conjunctival congestion (0.8%). People with COVID-19 generally develop signs and symptoms, including mild respiratory symptoms and fever, on an average of 5-6 days after infection (mean incubation period 5-6 days, range 1-14 days). Most people infected with COVID-19 virus have mild disease and recover. Approximately 80% of laboratory confirmed patients have had mild to moderate disease, which includes non-pneumonia and pneumonia cases, 13.8% have severe disease (dyspnea, respiratory frequency ≥30/minute, blood oxygen saturation ≤93%, PaO2/FiO2 ratio <300, and/or lung infiltrates >50% of the lung field within 24-48 hours) and 6.1% are critical (respiratory failure, septic shock, and/or multiple organ dysfunction/failure). Asymptomatic infection has been reported, but the majority of the relatively rare cases who are asymptomatic on the date of identification/report went on to develop disease. The proportion of truly asymptomatic infections is unclear but appears to be relatively rare and does not appear to be a major driver of transmission.
Individuals at highest risk for severe disease and death include people aged over 60 years and those with underlying conditions such as hypertension, diabetes, cardiovascular disease, chronic respiratory disease and cancer. Disease in children appears to be relatively rare and mild with approximately 2.4% of the total reported cases reported amongst individuals aged under 19 years. A very small proportion of those aged under 19 years have developed severe (2.5%) or critical disease (0.2%). Mortality increases with age, with the highest mortality among people over 80 years of age (CFR 21.9%). The Crude Fatality Rate (CFR) is higher among males compared to females (4.7% vs. 2.8%). By occupation, patients who reported being retirees had the highest CFR at 8.9%. While patients who reported no comorbid conditions had a CFR of 1.4%, patients with comorbid conditions had much higher rates: 13.2% for those with cardiovascular disease, 9.2% for diabetes, 8.4% for hypertension, 8.0% for chronic respiratory disease, and 7.6% for cancer.
China’s bold approach to contain the rapid spread of this new respiratory pathogen has changed the course of a rapidly escalating and deadly epidemic. A particularly compelling statistic is that on the first day of the advance team’s work there were 2478 newly confirmed cases of COVID-19 reported in China. Two weeks later, on the final day of this Mission, China reported 409 newly confirmed cases. This decline in COVID-19 cases across China is real.
For the international community
1. Recognize that true solidarity and collaboration is essential between nations to tackle the common threat that COVID-19 represents and operationalise this principle;
2. Rapidly share information as required under the International Health Regulations (IHR) including detailed information about imported cases to facilitate contact tracing and inform containment measures that span countries;
3. Recognize the rapidly changing risk profile of COVID-19 affected countries and continually monitor outbreak trends and control capacities to reassess any ‘additional health measures’ that significantly interfere with international travel and trade.
Therefore, to all our Elixir Private Wealth readers, stay healthy and please follow the preventative measures listed below:
- Clean your hands with soap and water for 20 seconds, or an alcohol-based hand rub.
- Cover your nose and mouth when coughing and sneezing with tissue or a flexed elbow
- Avoid close contact with anyone with cold or flu-like symptoms.
- Practice cough etiquette (keep away from other people, cover coughs and sneezes with disposable tissues or clothing, and clean your hands.
- Travelers to Asia should not visit live bird and animal markets, including ‘wet’ markets. (markets selling fish, meats, and other perishable goods)