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| At the beginning of the 2003 SARS outbreak, an infected Chinese doctor unwittingly passed on the virus to 12 other people while staying at a hotel in Hong Kong. The 12 people then traveled abroad and spread the infection to Southeast Asia, Western Europe, and North America. The resulting chain reaction accounts for most of the more than 8000 cases worldwide (NCBI, 2004). From Hong Kong, the infection spread to 5 countries within 24 hours, and to more than 30 countries on 6 continents within the following 6 months (WHO, 2003). The rapid spread was made possible by the ease of globalized travel from Hong Kong, a major airline hub, despite the virus having a lower transmission rate (R0) than many other infectious diseases. | At the beginning of the 2003 SARS outbreak, an infected Chinese doctor unwittingly passed on the virus to 12 other people while staying at a hotel in Hong Kong. The 12 people then traveled abroad and spread the infection to Southeast Asia, Western Europe, and North America. The resulting chain reaction accounts for most of the more than 8000 cases worldwide (NCBI, 2004). From Hong Kong, the infection spread to 5 countries within 24 hours, and to more than 30 countries on 6 continents within the following 6 months (WHO, 2003). The rapid spread was made possible by the ease of globalized travel from Hong Kong, a major airline hub, despite the virus having a lower transmission rate (R0) than many other infectious diseases. | ||
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| - | {{ :sars_hk_epidemic_curve.png?650 |}} | + | {{ :sars_hk_epidemic_curve.png?600 |}} |
| </box| Figure 4: Epidemic curve by infection cluster for the 2003 SARS outbreak in Hong Kong (Leung et al., 2004).> | </box| Figure 4: Epidemic curve by infection cluster for the 2003 SARS outbreak in Hong Kong (Leung et al., 2004).> | ||
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| Like SARS, MERS-CoV most likely spreads from an infected patients’ respiratory secretions like coughing and large droplets of bodily fluids (Zumla et al.,2015). Unlike SARS-CoV and Covid-19, MERS-CoV has a different receptor, DDP4, which further leads to transcription in the body (Zumla et al.,2015). All MERS-CoV cases have been linked to countries near the Arabian Peninsula (CDC, 2019). Most patients either lived in the Arabian Peninsula or traveled to Arabian Peninsula. 27 countries have been reported to have cases or MERS-CoV in their countries. However, the reproductive rate (R0) of MERS-CoV was relatively low, R0=0.7. This is substantially lower than the epidemic potential (R0=1)(World Health Organization, 2019). Therefore, the only country that was heavily affected by MERS was South Korea in 2015 with 186 confirmed cases and 38 deaths (largest outbreak outside of Arabian Peninsula)(Kim et al.,2017). | Like SARS, MERS-CoV most likely spreads from an infected patients’ respiratory secretions like coughing and large droplets of bodily fluids (Zumla et al.,2015). Unlike SARS-CoV and Covid-19, MERS-CoV has a different receptor, DDP4, which further leads to transcription in the body (Zumla et al.,2015). All MERS-CoV cases have been linked to countries near the Arabian Peninsula (CDC, 2019). Most patients either lived in the Arabian Peninsula or traveled to Arabian Peninsula. 27 countries have been reported to have cases or MERS-CoV in their countries. However, the reproductive rate (R0) of MERS-CoV was relatively low, R0=0.7. This is substantially lower than the epidemic potential (R0=1)(World Health Organization, 2019). Therefore, the only country that was heavily affected by MERS was South Korea in 2015 with 186 confirmed cases and 38 deaths (largest outbreak outside of Arabian Peninsula)(Kim et al.,2017). | ||
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| </box| Figure 6: Distribution of MERS cases around the world, Orange label represents camel to camel transmission, blue label represents human to human transmission and red label represents camel to human transmission (WHO,2018).> | </box| Figure 6: Distribution of MERS cases around the world, Orange label represents camel to camel transmission, blue label represents human to human transmission and red label represents camel to human transmission (WHO,2018).> | ||
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| Significant epidemiological features of Covid-19 are summarized as follows: | Significant epidemiological features of Covid-19 are summarized as follows: | ||
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| </box| Figure 8: Spread of Covid-19 from Wuhan, the provincial capital of Hubei Province, to the rest of China as of Jan. 30, 2020 (China National Health Commission & BBC, 2020).> | </box| Figure 8: Spread of Covid-19 from Wuhan, the provincial capital of Hubei Province, to the rest of China as of Jan. 30, 2020 (China National Health Commission & BBC, 2020).> | ||
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| SARS and SARS-Cov-2 belong to the same family of virus, coronavirus, which invades the respiratory tract and causes atypical pneumonia. Patients develop breathing difficulties due to inflamed alveoli of the lungs. Atypical pneumonia, also known as walking pneumonia, differs from typical pneumonia as it is caused by viral agents or atypical bacteria that lack normal cell structure. Patients with atypical pneumonia experience milder symptoms and resistance to normal antibacterial medications (Cleveland Clinic, 2019). | SARS and SARS-Cov-2 belong to the same family of virus, coronavirus, which invades the respiratory tract and causes atypical pneumonia. Patients develop breathing difficulties due to inflamed alveoli of the lungs. Atypical pneumonia, also known as walking pneumonia, differs from typical pneumonia as it is caused by viral agents or atypical bacteria that lack normal cell structure. Patients with atypical pneumonia experience milder symptoms and resistance to normal antibacterial medications (Cleveland Clinic, 2019). | ||
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| </box| Figure 11: Number of confirmed cases of Covid-19 worldwide as of Feb. 21, 2020 (WHO & BBC, 2020).> | </box| Figure 11: Number of confirmed cases of Covid-19 worldwide as of Feb. 21, 2020 (WHO & BBC, 2020).> | ||
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| During the SARS epidemic in 2003, hospitalized patients received the same treatment as recommended for severe atypical pneumonia (CDC, 2005). Antiviral medications are sometimes given to reduce the swelling of the lungs but there are no studies that prove this is effective for every individual affected by SARS. No effective pharmacological interventions against the virus exists at this time. However, antiviral medications were later developed to combat the MERS outbreak in 2012. | During the SARS epidemic in 2003, hospitalized patients received the same treatment as recommended for severe atypical pneumonia (CDC, 2005). Antiviral medications are sometimes given to reduce the swelling of the lungs but there are no studies that prove this is effective for every individual affected by SARS. No effective pharmacological interventions against the virus exists at this time. However, antiviral medications were later developed to combat the MERS outbreak in 2012. | ||
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| + | </box| Figure 19: Possible receptors on the coronavirus that can be targeted by antiviral drugs (“Coronavirus – Simple Precautions to Take care for loved ones,” 2020).> | ||
| ==== Remdesivir ==== | ==== Remdesivir ==== | ||
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| - | </box| Figure 19: Possible receptors on the coronavirus that can be targeted by antiviral drugs (“Coronavirus – Simple Precautions to Take care for loved ones,” 2020).> | ||
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| Remdesivir is known to be an effective drug against the coronavirus, specifically the one related to the Middle Eastern Respiratory Syndrome (MERS-CoV). Studies in the past have shown that Remdesivir prevented MERS in monkeys when it was administered before exposing the monkeys to the virus. Furthermore, when the drug was administered after the infection, it reduced the severity of the disease, virus replication and the amount of damage to the lungs (Wit et al., 2020). | Remdesivir is known to be an effective drug against the coronavirus, specifically the one related to the Middle Eastern Respiratory Syndrome (MERS-CoV). Studies in the past have shown that Remdesivir prevented MERS in monkeys when it was administered before exposing the monkeys to the virus. Furthermore, when the drug was administered after the infection, it reduced the severity of the disease, virus replication and the amount of damage to the lungs (Wit et al., 2020). | ||
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| Remdesivir functions by inhibiting the replication of MERS-CoV in respiratory tissues and preventing the formation of lung lesions. In vitro studies involving mice infected with the hepatitis virus suggests that Remdesivir works against the coronavirus by interfering with the viral polymerase responsible for replication to occur (Wit et al., 2020). | Remdesivir functions by inhibiting the replication of MERS-CoV in respiratory tissues and preventing the formation of lung lesions. In vitro studies involving mice infected with the hepatitis virus suggests that Remdesivir works against the coronavirus by interfering with the viral polymerase responsible for replication to occur (Wit et al., 2020). | ||
