Coronavirus Disease 2019

Published on 16/03/2020

PRIMA® Lab SA supports healthcare personnel during COVID-19 emergency.

COVID-19 Disease

Coronavirus: what is it?

In December 2019 a cluster of pneumonia cases of unknown aetiology was reported in Wuhan, Hubei Province, China. In January 2020, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), belonging to the β genus, was identified as the causative agent of this first outbreak and the related disease was defined as Coronavirus Disease 2019 (COVID-19).
The initial outbreak of COVID-19 in Wuhan spread rapidly, to the extent that, on 11 March 2020, the Director General of the World Health Organization declared COVID-19 a global pandemic. Coronaviruses are enveloped RNA viruses that are distributed broadly among humans, other mammals and birds and that cause respiratory, enteric, hepatic and neurologic diseases. As reported on the website of CDC, Centers for Disease Control and Prevention, six other species of coronavirus are known to cause disease in humans. The four prevalent species - 229E, OC43, NL63 and HKU1 - cause common cold symptoms in immunocompetent individuals. Two other strains - the Acute Severe Respiratory Syndrome Coronavirus (SARS-COV) and the Middle East Respiratory Syndrome Coronavirus (MERS-COV) - are of zoonotic origin (i.e. they are transmitted from animals to humans) and have shown higher mortality rates than others.

Symptoms associated to COVID-19

Common signs of infection include respiratory symptoms, fever and cough. In more severe cases, the infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death. These symptoms may appear after 2-14 days after exposure, 5 days on average.

Symptoms Coronavirus Cold Flu
Symptoms range from mild to severe Gradual onset of symptoms Abrupt onset of symptoms
Fever Common Rare Common
Fatigue Sometimes Sometimes Common
Cough Common (usually dry) Mild Common (usually dry)
Sneezing No Common No
Aches and pains Sometimes Common Common
Runny or stuffy nose Rare Common Sometimes
Sore throat Sometimes Common Sometimes
Diarrhea Rare No Sometimes for children
Headaches Sometimes Rare Common
Shortness of breath Sometimes No No

If you experience these symptoms, you should call your doctor or the emergency number provided in your country and follow the instructions.

How to protect from the outbreak

There is no vaccine to protect from the outbreak of the disease at the moment, so the best way to prevent a possible infection is to avoid contact with the virus itself. This generally spreads person-to-person, especially if in close contact and through respiratory droplets (coughing or sneezing). The most frequent way of transmission of the disease is represented by the breath droplets of infected people via:
- saliva (coughing and sneezing)
- hands, e.g. touching the nose, eyes and mouth with the hands not yet washed
- direct personal contacts.
It is also possible that some infections may occur during the incubation period of the virus, before the infected subject shows symptoms. It is therefore recommended to keep a safe distance in all cases.
Studies are underway to better understand how the virus is transmitted.

The main recommendations to prevent the spread of infection include:
1) Regularly wash your hands with soap and water for at least 20 seconds. Use a hand sanitizer containing at least 60% alcohol if soap and water are not immediately available;
2) Cover your nose and mouth with a handkerchief when coughing and sneezing, or do it inside your elbow;
3) Avoid close contact with anyone showing symptoms of respiratory illness.
It is also useful to clean and disinfect any frequently touched surfaces, such as: counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables.

Prevent and control infections spreading

At the beginning of 2020, the world began its struggle against the inexorable spread of COVID-19 among its population. Several months later many of the affected countries managed to stabilise, and progressively reduce, the infections increasing substantially. This is thanks to massive testing and quarantine, thereby reducing not only the mortality and infection rate but also the socio-economic impact of the pandemic itself.

Daily new confirmed COVID-19 cases updated on 02/09/2020

As we can see from the chart above, Our World in Data outlines that the differences between countries are substantial.
Basing on these results, it is possible to divide their achievements in two different groups:

1) The countries which have monitored the outbreak from the very beginning of the pandemic or rapidly caught up after an initial outbreak. They have been able to bend the curve and bring down the number of confirmed cases, while increasing the ratio of tests to confirmed cases.

2) The countries which have tested too little if compared to the relative size of the outbreak and they still report very high daily case counts.

The first group of countries was able to bend the curve by following the guidelines given by the World Health Organization - the SRPP, Strategic Response and Preparedness Plan, complemented with the Operational Planning Guidelines to Support Country Preparedness and Report. This document is intended to be a practical guide outlining the public health and essential health services measures needed to prepare for and respond to COVID-19. It defines the priority actions to be included in country-specific preparedness and response plans, towards a fully collaborative and coordinated response to the pandemic.

Flattening the infection curve was the main goal during the first phase of the pandemic, but it is equally important to keep the curve flat once a stable situation has been reached, thus avoiding overcrowding of the available structures. The challenge is renewed with the successive new waves of contagion, which have led to new safety measures implemented by many countries

Coronavirus Testing

When a communicable disease outbreak begins, the ideal response is for public health officials to begin testing for it early, in order to quickly identify the cases, begin treatment for those people and immediately isolate them to prevent spread. That’s why an early disease diagnosis is fundamental: nowadays, the positivity of a subject to SARS-CoV-2 virus is confirmed by a nose-pharyngeal swab, subsequently analyzed with a molecular biology technique called PCR - Polymerase Chain Reaction. This technique involves the duplication of RNA in the laboratory, allowing exponential growth of the filament in just over an hour. In this way it is possible to isolate and study any trait of RNA from a biological sample.

PCR methodology, as part of the official protocol indicated by the WHO, is the main reference system for in vitro diagnostic devices aimed at identifying the COVID-19 pathology. However, scientists have developed two different types of tests that are able to facilitate the diagnosis and tracking of newly infected people: the antigen test and the antibody test.

Antigen tests reveal whether a person is currently infected with a pathogen, such as SARS-CoV-2 virus. An antigen is a substance, or part of it, foreign to the body which can stimulate an immune response through the activation of lymphocytes: the white blood cells responsible for fighting ongoing infections. SARS-CoV-2, like all coronaviruses, has several known antigens, including nucleocapsid phosphoprotein and spike glycoprotein. These represent the visible protrusions on the surface of the virus and are the main proteins capable of attacking cells in the human body. These tests provide a result in about 15 minutes and can be performed anywhere. Find out the COVID-19 Antigen Rapid Test by PRIMA® Lab SA.

Antibody/Serology tests are diagnostic methods that are used to identify antibodies in a patient's blood, serum or plasma specimen. These make it possible to detect whether an individual has already been exposed to the infection. The results are usually available in about 10 minutes and can be performed anywhere. Find out the COVID-19 IgG/IgM Rapid Test by PRIMA Lab SA.

Vitamin D & COVID-19

In den letzten Monaten haben mehrere wissenschaftliche Studien gezeigt, wie der Vitamin-D-Spiegel im Körper die Schwere der Reaktionen auf die COVID-19-Krankheit beeinflussen kann.
Dieser Zusammenhang könnte insbesondere auf die wesentliche Wirkung der Vitamin D im Gleichgewicht zwischen Kalzium und Phosphat gebunden sein, die das Knochenwachstum und den Knochenumsatz beeinflusst. Es wurde auch festgestellt, dass niedrige Vitamin D-Spiegel mit anderen nicht übertragbaren Krankheiten und einer erhöhten Empfindlichkeit gegenüber Infektionskrankheiten verbunden sind; vor allem für diejenigen, die die oberen Atemwege charakterisieren. Eine wachsende Zahl von Studien hat heute das Bestehen einer Korrelation zwischen COVID-19-Positiven und Vitamin D-Konzentration nachgewiesen. In einer von D’Avolio et al. 25 (OH) D - das zur Bestimmung der Vitamin D-Konzentration bei Patienten verwendete Prehormon - stand im Zusammenhang mit einer positiven Wirkung auf das SARS-CoV-2-Virus, insbesondere bei männlichen Patienten über 70 Jahre.

In a cross-sectional analysis across Europe, COVID-19 mortality was significantly associated with vitamin D status in different populations. The most vulnerable group for COVID–19 is also the one that has the most deficit in vitamin D, the older population.

In a 2017 study, Martineau AR et al. concluded in a meta-analysis that vitamin D supplementation was safe and protective against acute respiratory tract infections. They described that patients who were severe vitamin D deficient experienced the most benefit. For all these reasons, we believe it is important to check the values of Vitamin D, above all in the older family members, in particular men over 70 years.