Читать книгу Viruses: More Friends Than Foes (Revised Edition) - Karin Moelling - Страница 17

The first cases of a new atypical lung disease were noticed in November 2019. Some newspapers mention the 17th of November 2019. The ophthalmologist Li Wenliang, in Wuhan, was one of the first to notice a SARS-like disease, and he tried to warn his colleagues. He later passed away at the age of 34. The Chinese government informed the WHO on December 31, 2019, when 41 patients had fallen sick with an atypical pulmonary disease between December 8th and January 1st. No patient had died yet. Patients had fever (90%), dry cough (80%), shortness of breath (20%) and dyspnea (15%). Seven of these patients later died.

Already on January 7th the virus from Wuhan had been sequenced and on January 12th the sequence was published. This took less than a week in Wuhan. One of the best virology institutes in China is located there, the Wuhan Institute of Virology (WIV), with the highest-level biosafety laboratory in the whole of China. The virus’s gene sequence indicates a close relationship with a coronavirus from a bat. The sequence allowed the development of a test kit based on the polymerase chain reaction (PCR), a standard assay for many diseases, pathogenic viruses and other microbes or genetic disorders. The sequence then immediately allowed the development of tests and a genetic vaccine. On January 18th there still was a big festival in Wuhan, and on the 20th it was reported that the virus can be transmitted from human to human. This is what makes a virus dangerous!

China started with the lockdown on January 23rd in Wuhan, and this was extended to the neighboring cities, to Hubei and to the provinces, just before the Chinese traditional New Year’s Day. This event leads to the year’s highest number of visitors going home for family reunions. Around 50 million people were isolated in their homes. Airports were closed and traffic was shut down. Already then, three visitors coming back from China were placed in quarantine in France, and tracing for contact persons was initiated. First patients were identified in Australia and other Asian countries. On March 6th it was announced that closing borders would be 90% effective in containing the virus. A Chinese visitor informed a company in Munich about an infection, and this initiated the German activities, tracing contacts and imposing two-weeks quarantine. Germany had a head start compared with other European countries, with an index case number of zero, while In contrast other countries still allowed events with high potential for viral spread to proceed — such as football matches, church services, street parades and winter sport at resorts. On March 18th measures were proclaimed in Germany for social distancing, hygiene, closing of schools, restriction of travelling, and tracing of contacts by telephone — and fax machines! — in Germany the shutdown and restriction of people was less severe than in other European capitals, which were deserted, also subsequently in the USA. Was that necessary or based on China as a model, where the population densities can be locally due to skyscrapers much higher?

Starting an epidemic with many cases, such as when infected people attend a football match, results in steep exponential growth curve, as it did in Lombardy. There, other factors may have contributed, such as air pollution, family structures, the presence of many guest workers in a highly industrialized area, and a high population density. Often, Italy was projected as a horror scenario that would soon play out in Germany, even though the parameters differed considerably. The death toll was high in Italy, partly owing to comorbidities of older people, aged between 70 and 80. Other countries have other risk factors such as diabetes, coronary heart disease, asthma and obesity — the latter affects about 40% of Americans. It enhances the severity of the disease. On April 6, 2020 the isolation measures in Wuhan were lifted and replaced by strategies for exit from the pandemic, and 11 million people tried to leave immediately. One still sees face mask protection and empty streets there. Individual infections occur sporadically, mainly imported by travelers. They are traced back by help of mobile phones to prevent spreading. This is also part of the successful containment of the virus in Korea. In Germany, hotlines have been installed and tracing is done by telephone or Fax follow-ups.

It is worth mentioning that Korea was one of the few countries where the MERS virus was detected in 2009, and perhaps it was this that warned Koreans more than other countries, as by then they had already twice gone through such an epidemic.

In Europe the exit strategy — how to get out of the shutdown — was adopted by several European countries individually to stimulate the economy again. Germany produced an incredible financial umbrella, initially up to 155 billion euros, to protect the economy, but this is constantly increased.

Meanwhile, the pandemic reached India, with 140 million people trying to reach their homes before shutdown. The pandemic has reached the southern hemisphere: it arrived in South Africa, where experience with the HIV/AIDS epidemic was well remembered and led to fast reaction. It has arrived in South America, in Brazil, and even on Easter Island (through tourism?) and has hit isolated indigenous tribes in Brazil. In spite of less health care systems in Africa and South America, it is a hope, that the younger average age of the population may be protective.