(With regular inputs from Dr Monica Vasudev)

Asymptomatic transmission has made controlling the spread of the disease all the more difficult

In order to control the disease, even asymptomatic cases need to be tested in varied population settings such as prisons, mental health facilities, homeless shelters, hospitalized inpatients and other congregate living situations,  argue researchers in an editorial published in the The New England Journal of Medicine (NEJM) on April 24.

These factors support the use face masks by general public when in crowded outdoor or indoor spaces. The only strategy for a resource limited country is symptom-based case detection followed by testing to guide isolation and quarantine.

In an editorial in NEJM, the researchers from University of California, San Francisco pointed out that there are differences in transmission and spread of SARS-CoV-1 and SARSCoV-2

SARS was controlled within 8 months after SARS-CoV-1 had infected nearly 8100 persons in limited geographic settings. SARS-CoV-2, on the contrary, has infected a greater number of people within five months and is still spreading around the world very rapidly.

A major factor in the transmissibility of COVID-19 is the high level of SARS-CoV-2 shedding in the upper respiratory tract, even among presymptomatic patients, which differentiates it from SARS-CoV-1, where replication occurs primarily in the lower respiratory tract.

Viral loads with SARS-CoV-1, that are tied to symptom onset, peak a median of 5 days later than viral loads with SARS-CoV-2, which makes symptom-based detection of infection more effective in the case of SARS CoV-1.

NHS warns of rise in children with new illness that may be linked to coronavirus

Sent By Dr Reddy, Telangana: NHS have written to doctors alerting them that children are falling ill with a new and potentially fatal combination of symptoms apparently linked to COVID-19, including a sore stomach and heart problems. The children affected appear to have been struck by a form of toxic shock syndrome.

In a letter to GPs in North London, reported by the Health Service Journal, NHS bosses said: “It has been reported that over the last three weeks there has been an apparent rise in the number of children of all ages presenting with a multi-system inflammatory state requiring intensive care across London and also in other regions of the UK.” 

“The cases have in common overlapping feature of toxic shock syndrome and atypical Kawasaki disease with blood parameters consistent with severe COVID-19 in children.”

 “There is a growing concern that a SARS-CoV-2-related inflammatory syndrome is emerging in children in the UK, or that there may be another, as yet unidentified, infectious pathogen associated with these cases.”

The NHS letter continues: “Abdominal pain and gastrointestinal symptoms have been a common feature, as has cardiac inflammation. This has been observed in children with confirmed PCR positive SARS-CoV-2 infection as well as children who are PCR negative. Serological evidence of possible preceding SARS-CoV-2 infection have also been observed.” 

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA