CORONA VIRUS OUTBREAK IN CHINA

HIGH POPULATION DENSITY and DISEASES

The current epidemic outbreak of  coronavirus 2019 (2019-nCov) does not constitute a new or ultimate experience in Asia, so the steps to counteract this type  of virus looks well established (Remember: 2012 (2012 MERS-Cov, 2002-2003 SARS-Cov) The current coronavirus 2019, has a 85 % coincidence with the genome of its cousin SARS-Cov, lacking to know the areas of mutation. Coronaviruses that infect humans now have 7 members, characterized by producing mild flu-like infections (most), evolving according to circumstances to pneumonia and/or to exitus letalis. And although the emerging Chinese power knows what   to do, the constant increase in the number of infected and dead patients represents a challenge to its  health procedures If China  control the epidemic outbreak,  will pass the end-of-course exam, consolidating worldwide management guidelines for these epidemic outbreaks.  Analysis until 08.03.2020: 1) Chinese scientists have sequenced the coronavirus genome, having no identification problems of the virus (although the predictive value + and - of the tests is lacking). Researchers know their access routes to the human body and the organs where they like to stay to replicate respiratory tract, lungs, kidneys and death. However, after 2 months (including the incubation period estimated at 12 days), from the first infected case detected, dense people queues continue to form for blood samples, being observed in narrow hospital corridors, cohabitation of infected patients, carriers and not infected  people, turning these areas into potential outbreaks spread  of coronavirus.  To counter this difficulty China builds in Wuhan at the speed of light: 2 prefabricated hospitals each with just over 1000 beds. 2) The signs and symptoms are known initial flu that resolves favorably in 97% of cases, followed by 3% of complicated cases with respiratory, renal and death failure. Only for this minimum proportion of cases, isolation is carved into strictly conditioned hospital units. Despite the isolation, in Hubei province (which includes Wuhan), there have been 105,000  infected cases and  3500 deaths. Also, in  South Korea there are 7041 infected cases and 48 deaths. One observes that the costumes of the health personnel have areas with exposed skin (wrists), the suits are not safe, they lack protective glasses, lack masks, surgical gowns, disinfectants. A Chinese doctor has died, and 15 health workers   have been infected from a single patient. Contrary to the management of 2 infected patients in the USA, carried out with robots to perform chest auscultation and take samples, avoiding physical contact. Americans doctors and nurses wear costumes similar to those wearing astronauts, so the doctor-infected patient contact is nil. China has to improve their health procedures. Despite the above, with a 3% mortality (56 deaths from pneumonia) and 2000 infected, China shows progress with respect to the epidemic outbreak of 2002-2003 (SARS-Cov), which had 8890 infected, and 770 people dead (10 %).  On 2020, the coronavirus: (2019-Cov), looks so far less aggressive which inspires confidence in the Chinese health system that expects to control the epidemic outbreak soon. But then why is the number of people infected in Hubei province (which includes Wuhan) increasing day by day, and internationally? What is failing? Each epidemic outbreak has its peculiarities, and, in this case, everything indicates that the central problems of the management of 2019 (2019-Cov), is to overcome the difficulties of high population density and the scrupulous monitoring of the contacts of those infected. Let us see a) population density: Wuxan, the city where the outbreak began 2 months ago, has 11,000,000 inhabitants, being an obligatory crossing area of ​​several nearby cities that total 56,000,000 people. Given such high population density, the most efficient measure is to disperse as much as possible to the population while ensuring the therapy of the infected and b) monitoring the contacts of the infected. That is why the Chinese health system has arranged the execution of quarantines (insulations at home, hotels and lodges), restriction of the traffic of trains, airplanes and buses, temporary closure of centers for recreation of people for 15 days. The streets are empty and everything would be fine, except for the growing number of international (29 countries), infected  patients  in: Thailand, Australia, Belgium, Cambodia, Canada, Finland,  France, Germany, Hong Kong, India, Iran, Italy, Japan, Macao, Malaysia, Nepal Philippines, Russia, Singapore, South Korea, Spain, Sri Lanka, Sweden, Taiwan,    Thailand, UAE, United Kingdom, United States, Vietnam, which were infected in health and commercial centers in Wuxan,  reflecting problems of identification of carriers and infected in the entry and exit of foreigners in China. Are the tests already validated? Is there capacity to detect carriers in incubation period, with no apparent signs and symptoms?? And what about the congestion of people in the corridors of 20-story apartment buildings? 3) As there is no specific cure, mild and severe cases receive symptomatic treatment, while preparing a vaccine that should have been ready in 3 weeks. However, once ready, vaccines face the challenge of mutations in the course of human infections. With the knowledge of epidemic outbreaks caused by previous coronaviruses and the relations   between them, it is time to produce 2 types of vaccines one for the current coronavirus and another for when the virus mutates, calculated using computational models and probability theory (mutant vaccines). Given the threat of the outbreak spreading throughout the world, it is necessary to proceed quickly in these cases, all of the above should have been done in 4 weeks. Today, after 8 weeks the Chinese health system shows flaws, so China   need to contact international experts with what the missing processes would be faster, winning China and all mankind. 4) In summary, the most important thing in the province of Hubei (the most affected) is to decrease population density by dispersing people even in open spaces, where the mutated virus will become inactive. In the environment it is impossible for a virus to survive 2 seconds. And what about the congestion of people in the corridors of 20-story apartment buildings? As there is no specific cure, mild and severe cases receive symptomatic treatment. The high number of cases is due to infections by person-person contact in cities with high population density. It is necessary to improve the strategies for identifying infected people without signs or symptoms and to follow up contacts of infected cases. The low mortality (3%) has influenced the decision of the WHO not to consider this outbreak as an international threat until today. However, the governments of the USA, Jordan and France, have announced that they will withdraw their diplomatic personnel from the province of Hubei, while the Chinese government has demanded that their health system be faster and more effective and, if possible, establish a centralized quarantine  (Nobody enters, nobody leaves Wuxan), to control the outbreak. epidemic. Finally, there is suspicion of underreporting of infected patients due to lack of transparency or existence of not so accurate diagnoses in some health centers.