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Super-spreader a must for becoming a hot spot of Corona

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Dr KK Aggarwal    28 February 2020

Without a super spreader the cases in the Country may die out of its own

Super-spreader are individual patients who pass on an infection to large numbers of people and is a feature of nearly every outbreak. Infact the primary case of every epidemic is a super spreader. China cases in Wuhan also might have started with a super spreader. 

On average, each person infected with the new coronavirus is passing it on to between two and three other people. But this is merely an average; few people will pass it on to nobody whereas others might pass their infection on to far more.

A super-spreading event led to 82 people being infected from a single hospital patient with Middle East respiratory syndrome (Mers) in 2015.

And in the Ebola epidemic in West Africa, most cases (61%) came from just a tiny handful of patients (3%).

Some just encounter far more people - either because of their job or where they live - and that means they can spread more of the disease, whether they themselves have symptoms. Others are "super-shedders", releasing unusually huge amounts of virus or some other bugs from their bodies, so anyone coming across them is likely to become infected.

Hospitals treating severe acute respiratory syndrome (Sars) became a major centre of super-spreading because the sickest patients were also the most infectious and they encountered lots of healthcare workers.

It plays a huge role at the beginning of any outbreak, while the virus is trying to get established. When it infects the first patient, the disease might disappear before causing a large outbreak. But if it finds its way quickly into a super-spreader, then it gives the outbreak a boost. The same rules are applied when such cases are imported into other countries.

"Typhoid Mary", Irish cook Mary Mallon (1869-1938), had unknowingly passed on typhoid fever while she had no symptoms and had to spend decades in exile and forced quarantine.

HIV person co-infected with STI becomes a super spreader.

A heterosexual man co-infected with HIV, hepatitis C virus, and herpes simplex 2 virus has unusually high semen HIV RNA levels.

As per 20/80 rule, a small percentage of individuals within any population was observed to control most transmission events. 

  1. China first case looks like was a super spreader
  2. The cases in Diamond Princess ship was a case of super spreader focal outbreak
  3. The lady in South Korea cult church was a super spreader. There were 28 confirmed cases of the coronavirus in South Korea on Feb. 13. Almost 4 days had passed without a new confirmed infection. President Moon Jae-in projected that this deadly outbreak would “fade before extended,” whereas the prime minister assured people that it was OK not to wear surgical masks outdoors. They probably missed the super spreader possibility. The virus had been rapidly spreading at the time through a large, secretive church in Daegu, with the presence of a super spreader, where it has since mushroomed into the biggest epidemic of the coronavirus outside China, with 1,766 cases, that includes 13 deaths. At present, the president is facing a political counterattack over his response as the number of cases continues to climb — 505 new infections on Thursday alone. 
  4. Iran outbreak is possibly from a super spreader

Possibilities of finding super spreaders

  1. Person with lower respiratory corona illness
  2. Person with coronas pneumonia
  3. Critically ill or terminal corona infected patients
  4. Immunocompromised persons with corona infection
  5. Person who have not suffered from any other corona illness in past with non-virulent strains
  6. Rapidly developing corona illness with very short incubation period
  7. Direct exposure to a super spreader compared to secondary or tertiary cases
  8. Co-infection with another pathogen
  9. Delayed identification and hospital admission of a super spreader

In India we got three cases and none of them was a super spreader. Lots of Afghanis are coming from IRAN, a possible source of super spreader. And if one super spreader come to India it will create a havoc. 

Summary

  1. Low grade transmission: Through a spreader
  2. High grade transmission: through a super spreader, usually will end up with community spread.

 

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

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