Dear Colleague

I have completed six months of my Presidentship of CMAAO which has 19 member countries. One of my biggest achievements has been the role played by CMAAO in COVID-19 coronavirus outbreak. As early as 7th January, CMAAO warned about the mysterious virus in China. Since then, I have been regularly writing about the update, I am reproducing the early writings from 7th to 25th January which makes the important role played by CMAAO in creating awareness about coronavirus in Asian countries evident.

26 December 2019: Viruses like SARS detected and Chinese scientists alerted the world about it.

3 January 2020: Human-to-human transmission raised concern

Despite this, on January 5, the Wuhan administration mentioned that the illness doesn’t seem to unfold from people to people. China lastly formally confirmed on January 20 that the coronavirus was spreading from human to human.

And on 7th January, CMAAO started reporting it to the Asian countries.

WHO to monitor Chinas mysterious pneumonia of unknown virus outbreak?

Dr KK Aggarwal, President CMAAO, HCFI and Past National President IMA

7th January: A mysterious lung infection in the central Chinese city of Wuhan is being monitored by the WHO. 59 people had been diagnosed with pneumonia of unknown cause. Seven people are in serious condition. Some of the infected worked at a fresh seafood and produce market in the city.

Pathogen studies have ruled out more common respiratory diseases, including influenza, avian flu and adenovirus. All the patients are being treated under quarantine.  Wuhan authorities said on Sunday they had excluded the possibility of SARS, Middle East respiratory syndrome (MERS), and bird flu.

According to the World Health Organization (WHO), symptoms of the pneumonia include fever, with several patients having difficulty breathing, and chest radiographs showing invasive lesions in both lungs.

The seafood market, which has since been closed, also sold live birds, pheasants, and snakes, along with organs of rabbits and other wildlife.

Authorities have denied any obvious evidence of human-to-human transmission so far, and no healthcare workers have been infected. At least 163 people who have had close contact with those infected have been put under medical observation.

If it only transmits from animals to humans, and the market having been shut down and sanitized, the chances for people to be infected will be low. However, the possibility of human-to-human transmission cannot be ruled out as respiratory viruses can be transmitted among humans. It is only a matter of how contagious it is.

Hong Kong steps up response:  It is reminding us of Severe Acute Respiratory Syndrome, or SARS, which killed almost 800 people about 17 years ago.  Its not known whether a SARS-like "coronavirus" has been identified. SARS spread to 37 countries worldwide, infected more than 8,000 people and killed 774 from November 2002 to July 2003. The illness is brought on by a coronavirus, and symptoms include fever, cough, severe headache, dizziness and other flu-like complaints. [Excerpts from CNN]

CMAAO warns Asian citizens travelling China over mystery pneumonia outbreak

Dr KK Aggarwal, President CMAAO, HCFI and Past National President IMA

8th Jan: Asians travelling in China should avoid animals and contact with sick people as the country fights with a mystery pneumonia outbreak, the CMMAO, Confederation of Medical Associations of Asia and Oceania warned.

The viral illness was first reported last week in Wuhan, a central Chinese city with a population of over 11 million, and has affected at least 59 people till now, said Dr KK Aggarwal, President CMAAO.

Though the Chinese health officials ruled out a resurgence of the SARS virus, which killed hundreds more than a decade ago, one should be aware and practice usual precautions and seek medical care if they feel sick after travelling to Wuhan.

The outbreak comes just a few weeks prior to Chinas busiest travel season of the year, when millions of people take buses, trains and planes for Lunar New Year.

Taiwans Centre for Disease Control advised residents planning to travel to or near Wuhan to wear masks and avoid contact with wild animals.

In Hong Kong, authorities say 30 people have been hospitalized after return from Wuhan in recent days and displaying flu-like illnesses, but none were confirmed to have the mystery new strain.

All are being treated in quarantine and no obvious evidence of human-to-human transmission has been found so far. [Excerpts from South China Morning Post]

It’s a new strain of coronavirus in the China pneumonia

Dr KK Aggarwal, President CMAAO, HCFI and Past national President CMAAO

10th January: Preliminary tests indicated that the cause of the mystery pneumonia that has infected almost 60 people in the Chinese city of Wuhan since December is a new strain of coronavirus (of the same family as SARS).

The scientists have found the "new type" of coronavirus by testing infected blood samples and throat swabs collected from 15 people.

The coronavirus can cause anything from the common cold to much more severe diseases. Notably, it caused an epidemic of the potentially deadly, flu-like SARS virus back in 2002-3, which killed more than 700 people around the world after originating in China.

WHO representative to China, said "further investigations" were required to "determine the source, modes of transmission, extent of infection and countermeasures implemented".

Singapores airport says it will initiate temperature screening of travellers from Wuhan and Hong Kong health officials said that they are also implementing checks on passengers. Authorities in Hong Kong have also stepped up the disinfection of trains and aeroplanes.

No cases of human-to-human transmission had been confirmed yet. [Excerpts from BBC]

About Corona Virus

1. Coronaviruses are the cause of 5 to 10 percent of community-acquired upper respiratory tract infections in adults
2. Coronaviruses are medium-sized enveloped positive-stranded RNA viruses, with their name derived from their characteristic crown-like appearance under electron micrographs
3. In temperate climates, coronavirus respiratory infections occur principally in winters; smaller peaks may be seen in the fall or spring; infections can occur at any time of the year.
4. Most community-acquired coronavirus infections are diagnosed clinically; reverse-transcriptase polymerase chain reaction is the diagnostic test of choice.
5. At present, no treatment is recommended for coronavirus infections except for supportive care.
6. Chloroquine has potent antiviral activity against the SARS-CoV; it has been shown to have similar activity against HCoV-229E in cultured cells and against HCoV-OC43 both in cultured cells and in a mouse model.
7. Severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus are also described. [Uptodate]

CMAAO News: Around the globe

Dr KK Aggarwal, President CMAAO, HCFI and Past National President IMA

13th Jan:  China Virus Outbreak Linked to Seafood Market: An outbreak of pneumonia has killed one person in China and infected 40 others. It seems to have its link to a single seafood market in the Wuhan and has not so far spread beyond there, as per WHO. The cluster of infections had raised fears of a potential epidemic after China said that the virus behind the outbreak was a previously unknown type but came from the same family of viruses that caused the SARS and MERS epidemics. The seafood market in Wuhan — a major domestic and international transport hub — is now closed and no cases have been reported elsewhere in China or internationally. [Excerpts from The Japan Times]

First Case China Pneumonia Virus Found Outside China in Thailand

Dr KK Aggarwal, President CMAAO, HCFI and Past National President IMA

15th Jan: One case has been reported outside China where 41 people with pneumonia-like symptoms have so far been diagnosed with the new virus in the central city of Wuhan.

The WHO confirmed Monday that the first case in Thailand of a new virus from the same family as SARS that is behind a Chinese pneumonia outbreak.

A person travelling from Wuhan, China, was hospitalized in Thailand on January 8 after being diagnosed with mild pneumonia.

Laboratory testing confirmed that the novel coronavirus was the cause.

WHO has not recommended any specific measures for travellers or restrictions on trade with China, but stressed that it was taking the situation seriously. [Excerpts from CNA]

New China coronavirus can spread between humans

Dr KK Aggarwal, President CMAAO, HCFI and Past National President IMA

21st Jan : A new coronavirus that has killed at least three people and sickened more than 200 in China can be transmitted between humans as per Chinese government fuelling fears about the possibility of a deadly epidemic as millions prepare to travel for the Lunar New Year holiday.

Zhong Nanshan, from Chinas National Health Commission confirmed that at least two cases had been spread. Zhong, who helped discover the severe acute respiratory syndrome-related coronavirus (SARS) in 2003, said the infectiousness of this virus was not as strong as SARS. SARS infected more than 8,000 people and killed 774 in a pandemic that ripped through Asia in 2002 and 2003.

The outbreak has spread to Beijing, Shanghai and Shenzen, hundreds of miles from Wuhan, where the virus first surfaced last month. Thailand has also reported two cases, while Japan and South Korea reported one each, taking the global total to 222.

There is only a 1 in 574 chance that a person infected in Wuhan would travel overseas before they sought medical care. This implies there might have been over 1,700 cases in Wuhan so far.

US Centers for Disease Control and Prevention announced three US airports -- in New York, San Francisco and Los Angeles -- will start screening passengers arriving from Wuhan to check for signs of the new virus, following similar measures taken by governments in Asia. [Excerpts from CNN]

New China virus now in US, Thailand, Japan, South Korea and Taiwan: Will India or other Asian countries be spared

Dr KK Aggarwal, President CMAAO, HCFI and Past National President IMA

22nd Jan: The Coronavirus has now spread to five countries. Is India or other Asian countries ready for this?

1. Coronavirus is still not being declared to be a notifiable disease
2. Anyone returning from China to India if has symptoms will not declare, take anti-histaminic and paracetamol and rush back to India. No one will tell that he or she is suffering from flu
3. Asymptomatic cases cannot be picked up at the airport which may still be infectious. If they carry infection and visit India, will bring the virus here
4. One symptomatic case will infect other travellers during the flight; all cannot be isolated
5. Unless the government announces that if someone develops flu like symptoms in the visiting affected countries, his stay and expenses will be taken care by India if they get treated there
6. High degree of suspicion and awareness is required
7. We have been talking about N 95 being included in the list of essential drugs and price-capped. It’s still not being done. Would control both the problem of pollution and such infection threats.

I have also written to the PM in this regard.

About the spread

The Centers for Disease Control said the virus, which originated in China, had been diagnosed in a US resident who arrived in Seattle from China. The virus, which spread from the Chinese city of Wuhan, has infected almost 300 people, and six have died.

North Korea has temporarily closed its borders to foreign tourists in response to the threat.

The patient sought care at a medical facility in the state of Washington, where the patient was treated for the illness. Laboratory testing of a clinical specimen confirmed the diagnosis on 20 January, the CDC statement continued.

The disease was first identified there late last year, and the outbreak is believed to be linked to a seafood market that also sells live animals. Aside from the United States, two cases have been identified in Thailand, one in Japan, one in South Korea and one in Taiwan. All those infected had recently returned from Wuhan.

Authorities in several countries, including Australia, Singapore, Hong Kong, Taiwan and Japan have stepped up screening of air passengers from Wuhan. US authorities last week announced similar measures at airports in San Francisco, Los Angeles and New York. They have now announced plans to introduce similar measures at airports in Chicago and Atlanta this week.

In Australia, a man who had travelled to Wuhan has been placed in isolation and is undergoing tests.

A report by the Centre for Global Infectious Disease Analysis at Imperial College, London, suggested there could be more than 1,700 infections. However, Gabriel Leung, the dean of medicine at the University of Hong Kong, put the figure closer to 1,300.

The virus, known also as 2019-nCoV, is understood to be a new strain of coronavirus that has not previously been identified in humans. Coronaviruses are a broad family of viruses, but only six (the new one would make it seven) are known to infect people. [Excerpts from BBC]

Coronavirus: Will it be declared as International Public Health Emergency by WHO

Dr KK Aggarwal, President CMAAO, HCFI and Past National President IMA

23rd Jan: WHO Director-General Tedros Adhanom Ghebreyesus said physicians need more information.

His committee, who held an emergency meeting in Geneva, Switzerland, Wednesday, will meet again on Thursday.

The coronavirus has killed at least 17 people and sickened hundreds of others in China.

GENEVA — WHO experts met on Wednesday to evaluate whether the new coronavirus outbreak constitutes an international emergency but decided more information was needed to declare the status of the outbreak and what recommendations should be made regarding it, including potential cross-border screening, greater surveillance and rolling out treatment programs.

Only five such emergencies have been declared in the past decade:

H1 virus that caused an influenza pandemic (2009)

West Africas Ebola outbreak (2013-2016)

Polio (2014)

Zika virus (2016)

Ongoing Ebola outbreak in the Democratic Republic of Congo (2019).

[Excerpts from CNBC]

Corona virus 1st Death Outside Wuhan Epicentre Is Reported

WHO DECISION: Coronavirus is spreading, but the organization says it is not a global emergency

Dr KK Aggarwal, President CMAAO, HCFI and Past National President IMA

24th Jan: 1.   At least 25 people have died and more than 800 have been sickened by the mysterious illness. The death toll increased by more than a half-dozen in 24 hours, while the number of confirmed cases jumped by more than 200.

2. The travel restrictions imposed on Wuhan were extended to at least four more cities. The Chinese authorities on Thursday morning closed off Wuhan by cancelling flights and trains leaving the city, and suspending buses, subways and ferries within it. Late on Thursday, the local authorities also announced that they would suspend for-hire vehicles and limit taxis, beginning at noon on Friday.
3. A patient died in the province of Hebei — more than 600 miles north of the city where the outbreak began.
4. After two days of deliberations, an emergency committee convened by WHO decided not to declare a global health emergency — but planned to meet again within 10 days, acknowledging the “urgency” of the situation.
5. Agency officials explained that although the disease has reached beyond China, the number of cases in other countries is still relatively small, and the disease does not seem to be spreading within those countries.
6. Currently, there is no evidence of human to human transmission outside China.
7. This is an emergency in China, but it has not yet become a global health emergency.
8. Roughly 30,000 people fly out of Wuhan on an average day, according to air traffic data. Many more leave using ground transportation like trains and cars. By evening, officials planned to also close off Huanggang, a city of seven million about 30 miles east of Wuhan, shut rail stations in the nearby city of Ezhou, which has about one million residents, and impose travel restrictions on the smaller cities of Chibi and Zhijiang. In Huanggang, public transportation and departing trains stopped at midnight. Residents are not allowed to leave the city without special permission, according to a government statement. In Ezhou, all rail stations were to be closed.
9. The new virus, which first emerged at the end of December, has sickened people in Taiwan, Vietnam, Japan, Thailand, Singapore, South Korea and the United States.
10. It has raised the spectre of a repeat of the SARS epidemic, which broke out in China in 2002 and 2003 and spread rapidly while officials obscured the seriousness of the crisis. That virus eventually killed more than 800 people worldwide.

[Excerpts from NY Times]

 Indian Govt should pay for the treatment of Indians trapped in China with Coronavirus

To Shri Narendra Modi ji, Hon’ble Prime Minister of India

Dear sir

25th Jan: Subject: Preeti Maheshwari the first Indian victim of coronavirus in China needs Rs 1 crore for treatment. The Indian Government should pay

The family of Indian national afflicted with the coronavirus pneumonia and battling for life has reached out to India for financial help reports The Mint.

Unable to fund Rs1 crore needed for Preeti Maheshwari’s treatment in China, her brother Manish Thapa, an employee at Amazon, Bengaluru has reached out to the Indian embassy in Beijing for financial help. He has also got in touch with a healthcare crowd funding platform in India to arrange for her hospital expenses.

Maheshwari, a primary art schoolteacher at the International School of Science and Technology, Shenzhen, is suffering from coronavirus pneumonia, type 1 respiratory failure, multiple organ dysfunction syndrome (MODS) and septic shock. She is undergoing treatment in the intensive care unit at Shekou Hospital in Shenzhen, China, and is on external respiratory support, ventilators, dialysis and blood purification process.

Currently the treatment is costing 10 lakh Chinese Yuan which is Rs. 1 crore in Indian currency.

The family is also considering shifting her to India for further treatment if needed.

Comments: In these situations, Indian Government should take the responsibilities of treatment of such cases and get them treated in the country where they get infected. If the same is not done Indians getting coronavirus infection in China will supress their information about fever and cough symptoms, take anti-fever and anti-cough medicines to dodge the immigration. This will be much more costly to the country than to treat people like Preeti.

An urgent policy decision is needed in this regard. When the country can support all Indians to get citizenship from neighboring countries during hardship this policy will be a goodwill policy for Indians trapped in China in need of treatment.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA