History of Major Pandemics


Disease and illnesses have always been  catastrophe to  humanity since ancient times. The magnitude of the illnesses and death rates have shown a  marked shift. The more civilized humans became – with larger cities, more exotic trade routes, and increased contact with different populations of people, animals, and ecosystems – the more likely pandemics would occur.

Despite the persistence of disease and pandemics throughout,   one trend that has emerged over time is the gradual reduction in the death rate. As the germ theory is discovered and there is a better understanding of the causative agents has led to better control. Healthcare improvements and control of infections have been powerful tools in mitigating their impact.

In many ancient societies, people believed that spirits and gods inflicted disease and destruction upon those that deserved their wrath. This unscientific perception often led to disastrous responses that resulted in the deaths of thousands.

Brief timeline for the major known pandemics :

165  AD  –  Antonine plague-  thought to be small pox or measles  and caused

around   5 million deaths.

735 AD –     Variola major virus–  Japanese smallpox  –     around 1 million deaths

541  AD-     Plague of Justinian – Yersinia pestis/ rat, fleas –   30- 50 million deaths

1347 AD-    Black death (Plague) –- Yersinia pestis/ rat fleas –   200 million  deaths

1520 AD-   Smallpox —                  Variola major virus—                  56 million deaths

1665 AD  Great plague of London–- Yersinia pestis/ rat fleas –     One lac deaths

1629 AD-         Italian plague          Yersinia pestis/ rat fleas –     death 30- 50 million

1817  AD– Cholera pandemic (6) – vibrio cholera: over 100 years-death one million

1850 AD – Third plague     –         Yersinia pestis/ rat fleas –              death –12  million

1880 AD-  Yellow fever –           Viral /     mosquitoes                    death 1 lac to 1.5 lac

1889  AD-        Russian flu-                   H2 N2 (bird)                           deaths    10 million

1918 AD–      Spanish flu  –                 H1 N1 (Pigs)                          deaths 30-50 million

1958 AD  –         -Asian Flu                                  H2 N2                                        1 million

1968 AD  –     Hong Kong flu                        H3 N2                                              1 million

1981 AD- continued -HIV/AIDS               viral/  chimpanzees                     30 -40 million

2002 AD-            SARS–                         corona virus  Civets / Bats-                     770

2009 AD              Swine Flu                        H1N1 – (pigs)                                     200,000

2014 AD –           EBOLA                                 Ebola virus  –                                       11000

2015 AD-            MERS                          Corona virus/ bats, Camel         death count 850

2019 AD           -COVID -19                         Corona virus                            -still continued

 

Novel Coronavirus (2019-nCoV); diagnosis, DO’s and DON’Ts, prevention


2019 Novel Coronavirus (2019-nCoV)-  WHO reported that a novel virus was identified by the Chinese authorities. It is a contagious virus, can transfer from human to human. WHO advisory

The virus is associated with an outbreak of pneumonia in Wuhan City, Hubei Province, China.

 

Clinical Features
Fever

Tightness of chest

Running nose

symptoms of lower respiratory illness

cough, difficulty breathing

Headache

Feeling unwell

Pneumonia

Kidney failure

Incubation period: 14 days

 

 

Mode of Transmission – Human coronaviruses most commonly spread from an infected person to others through

  • the air by coughing and sneezing
  • close personal contact, such as touching or shaking hands
  • touching an object or surface with the virus on it, then touching your mouth, nose, or eyes before washing your hands
  • rarely, faecal contamination

Prevention- How to reduce risk

How to protect yourself

There are currently no vaccines available to protect you against human coronavirus infection. You may be able to reduce your risk of infection by doing the following

  • wash your hands often with soap and water for at least 20 seconds
  • avoid touching your eyes, nose, or mouth with unwashed hands
  • avoid close contact with people who are sick

How to protect others

If you have cold-like symptoms, you can help protect others by doing the following

  • stay home while you are sick
  • avoid close contact with others
  • cover your mouth and nose with a tissue when you cough or sneeze, then throw the tissue in the trash and wash your hands
  • clean and disinfect objects and surfaces

 

Treatment

There are no specific treatments for illnesses caused by human coronaviruses. Most people with common human coronavirus illness will recover on their own. However, you can do some things to relieve your symptoms

  • take pain and fever medications (Caution: do not give Aspirin to children)
  • use a room humidifier or take a hot shower to help ease a sore throat and cough

If you are mildly sick, you should

  • drink plenty of liquids
  • stay home and rest

If you are concerned about your symptoms, you should see your healthcare provider.

 

DO’s and DON’Ts

DO’s:

  •   avoid close contact with others
  • cover your mouth and nose with a tissue when you cough or sneeze, then throw the tissue in the trash.
  • wash your hands and clean and disinfect objects and surfaces
  • take pain and fever medications (Caution: do not give Aspirin to children)
  • use a room humidifier or take a hot shower to help ease a sore throat and cough
  • drink plenty of liquids
  • stay home and rest- avoid crowded areas
  • consult a doctor

DON’Ts

-touching eyes, nose and mouth with unwashed hands

-Hugging, kissing, shaking hands while greeting

-spitting in public places

-taking medicines without consulting doctor

-excessive physical exercise

-disposal of used napkins or tissue papers in open areas

-touching surfaces usually used by public (railing, gates, etc)

-smoking in public places

-unnecessary testing.

 

For doctors and nurses

 CORONAVIRUS – DO’s in case of suspicion 

Obtain a detailed travel history for patients with fever and respiratory symptoms.

Is there a history of travel from Wuhan City, China on or after December 1, 2019?

Are there any Symptoms like runny nose, headache, cough, sore throat, fever and difficulty in breathing?

If yes to any or both questions above, then such patients to wear a surgical mask as soon as they are identified.

Healthcare professionals including doctors, nurses and others to conduct their evaluation in a private room with the door closed, ideally an airborne infection isolation room.

Personnel entering the room should use standard precautions, contact precautions, and airborne precautions and use eye protection (goggles or a face shield).

 

Recommendations for Reporting, Testing, and Specimen Collection

Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Patients Under Investigation (PUIs) for 2019 Novel Coronavirus (2019-nCoV)

Healthcare providers should immediately notify both infection control personnel and administration at their healthcare facility and their local or state health department in the event of a PUI for 2019-nCoV.

To increase the likelihood of detecting 2019-nCoV infection, collection of three specimen types, lower respiratory, upper respiratory and serum specimens for testing is recommended. Additional specimen types (e.g., stool, urine) may be collected and stored. Specimens should be collected as soon as possible once a PUI is identified regardless of time of symptom onset.

For biosafety reasons, it is not recommended to perform virus isolation in cell culture or initial characterization of viral agents recovered in cultures of specimens from a PUI for 2019-nCoV.

For further details on Guidelines for Collecting, Handling, and Testing and Laboratory Biosafety Guidelines refer – Information for Laboratories (https://www.cdc.gov/coronavirus/2019-nCoV/guidance-laboratories.html) This page includes interim guidance for laboratory professionals working with specimens from patients under investigation for human infections with 2019 novel coronavirus (2019-nCoV).

 

Infection Prevention and Control Recommendations for Patients Under Investigation

Airborne infection isolation

For additional infection control guidance you can visit CDC’s Infection Control webpage.

nurses and doctor at risk from mutated viruses

administrators prefer to refrain from  the risk to health workers

21 occupational risk to doctor and nurses

Corona Virus unmasks danger to nurses and doctors, which administrators prefer to refrain or oppress


 

Working of a doctor and nurses has never free from risk to themselves. The risk is generally underestimated, although it often involves major  risk  to their  life. Problem is that  majority of people, society, governing bodies  and even doctors themselves do not perceive or acknowledge  many times  the risks seriously.  Deadly Corona virus has unmasked and unveiled the danger to nurses and doctors,  the topic often suppressed, shunned by administrators and those who govern.

    An extreme example is the Chinese doctor, who was reprimanded, humiliated and made to apologize for doing right.  But this one example  is tip of the iceberg, for the Global phenomenon, where risk to front line workers is ignored routinely. They are just taken as  the routine workers, who have consented to be sacrificed. Chinese doctor Li Wenliang, one of the eight whistle-blowers who warned other medics of the coronavirus outbreak but were reprimanded by the police, died of the epidemic on Thursday,

 

  As per reports, 40 staff members of Wuhan hospital are  infected with Virus.

    Administrators and regulators refrain to study data that would establish and quantify the occupational hazards of being a doctor and nurses. Some of these hazards may be known, but there is no comprehensive analysis of workplace risk for physicians and nurses, like those that have been done for other professions. As physicians, we have a sense of the risk, and yet we remain engaged, continuing to care for our patients as we know  “these things” happen. Perhaps society prefers to remain blissfully ignorant of the sacrifice and risk their doctors  and nurses take on, comforted by the fantasy of the serene  hospital. Perhaps we  all despise to let reality and data shatter the illusion.

   But since  these risks are increasing exponentially every day, because of unknown and mutated germs (bacteria and viruses),  awareness is needed.  There are lesser set procedures, lack of awareness, not protective equipment or supportive society, governance and  laws, at most of  the places globally.  doctors  and nurses continue to work  in danger zones. These risks can be of varied types and contracting the diseases is just one of them.

Patients carrying specially unknown germs are  handled by doctor and nurses, who have no clue, what they are dealing with.   Time gap in such  patients coming to the  hospital  and  the exact diagnosis of finding a dreaded disease, may be  quite dangerous to doctors and nurses. To add to the problem, In  large number of patients, exact viruses cannot be diagnosed or even suspected. In many cases of ARDS, the causative organism cannot be  isolated or identified.  It is important for  doctors and nurses  to take universal precautions at every level. There can be many more viruses or germs which are yet to be discovered or mutated ones that  are unknown.

H1N1, Zika,  Ebola,  SARS  are few examples,  just to imagine that they existed and handled by health workers as unknown germs, till they were discovered.

Worst part is that our systems are not defined to prevent, treat or compensate or even acknowledge for these big disasters, if it happens to healers. These problems are not known to students, when they decide to take medicine, nor they are taught in medical school. Most of the time they have to fend for themselves, if problems occur.

Everyday globally, the doctors and the nurses  greet the new day and return to their work of taking care of their patients, knowing well the risk  involved.

Maybe it is time that we are little more aware  and acknowledge that even doing everything in best manner and honestly, they are in a  conflict zone and  are all in harm’s way. Just be careful and be mindful that  doctors, nurses, and healthcare workers,  may get  sickened, injured, disabled even  as they care for their patients in best manner.

21 occupational hazards to nurses and doctors

Corona outbreak Whistle-blower Chinese doctor was harassed; dies of infection


Chinese doctor Li Wenliang, one of the eight whistle-blowers who warned other medicsof the coronavirus outbreak but were reprimanded by the police, died of the epidemic on Thursday, official media reported. Li, a 34-year-old doctor who tried to warn other medics of the epidemic, died of coronavirus on Thursday in Wuhan, the state-run Global Times reported. He was the first to report about the virus way back in December last year when it first emerged in Wuhan, the provincial capital of China’s central Hubei province. He dropped a bombshell in his medical school alumni group on the popular Chinese messaging app WeChat that seven patients from a local seafood market had been diagnosed with a SARS-like illness and quarantined in his hospital. Li explained that, according to a test he had seen, the illness was a coronavirus — a large family of viruses that includes severe acute respiratory syndrome (SARS) which led to 800 death in China and the world in 2003. Li told his friends to warn their loved ones privately. But within hours screenshots of his messages had gone viral – without his name being blurred. 2/6/2020 Chinese doctor who first warned about coronavirus outbreak dies . When I saw them circulating online, I realised that it was out of my control and I would probably be punished,” Li was quoted as saying CNN recently. Soon after he posted the message, Li was accused of rumour-mongering by the Wuhan police. He was one of several medics targeted by the police for trying to blow the whistle on the deadly virus in the early weeks of the outbreak. Overall 564 people have died in China due to the virus and 28,018 confirmed cases have been reported from 31 provincial level regions, the National Health Commission reported on Thursday.

corona virus

doctor nurses at risk from mutated virus

21 occupational risk to doctor and nurses

Stools, diarrhea may be hidden risk of Corona Virus Spread


While most of screening for Corona virus is  focused on respiratory samples from pneumonia cases to identify corona-virus patients,  there is possibility that doctors might have ignored a less apparent and hidden source of the spread: diarrhea.

The new corona-virus was detected in faeces inthe first case confirmed in the United States and that finding could point to a hidden risk in the spread of the virus.

“It’s not only excreted in your respiratory secretions, it’s also secreted in your stool,” Scott Lindquist, the state epidemiologist for infectious disease at Washington State’s Department of Health, said on a conference call on Friday, reported Bloomberg.

Fang Li, an associate professor of veterinary and biomedical sciences at the University of Minnesota, said that the SARS and Wuhan viruses attach to the same protein receptors, which are seen in the lungs and intestines.

John Nicholls, a clinical professor of pathology at the University of Hong Kong, told Bloomberg that fecal material “would be a very likely place where you might get the transmission.”

“If it’s using the same receptor as for SARS, I can’t see why it shouldn’t be replicating in the gut,” he said.

Ten to 20 percent of SARS patients experienced diarrhea, according to the Centers for Disease Control and Prevention (CDC). Diarrhea was the source of a major outbreak of that coronavirus in a Hong Kong complex. The CDC said that coronaviruses most commonly spread through the air by coughing and sneezing or close personal contact. In rare cases, the viruses spread through fecal contamination.

risk to doctor and nurses from new and mutated germs

Corona virus

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