Covid-19, a current pandemic caused by novel Corona virus is airborne respiratory disease. It is classified as severe acute respiratory syndrome related corona virus 2(SARSr-COV2). Pandemic has started from wuhan (Hubei province) China.
There are 7 strains of corona virus family
     – 229E (alpha coronavirus)
     – NL63 (alpha coronavirus)
     – OC43 (beta coronavirus)
     – HKU1 (beta coronavirus)
     – MERS-CoV (the beta coronavirus that causes Middle East Respiratory Syndrome, or MERS)
     – SARS-CoV (the beta coronavirus that causes severe Acute Respiratory Syndrome, or SARS)
     – SARS-CoV

They have caused epidemic in different point of time 
– 23 March 2020 worldwide(WHO)       
Total case (332,930) Confirmed (40,788), Serious (14,510), Deaths (1,727)

– 25 march 2020 worldwide(WHO)
Total case (414,179) Confirmed (40,712), Serious (18,440), Deaths (2,202)

Outbreak or first case:
In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown beta-coronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed another clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. (source: The New England journal of medicine)

Wuhan(China) Market:
The Huanan Seafood Wholesale Market, also known as the Huanan Seafood Market or Wuhan market, is a live animal and seafood market in Jianghan District, Wuhan, Hubei, China. Many different kind of living creatures like rainbow lobsters, crocodile, dogs, bat, etc all are found here. This market is famous around the globe for its uniqueness.



Pandemic:
It is a disease epidemic that has spread across a large region, for instance multiple continents, or worldwide. A widespread endemic disease with an unstable number of infected people and growing uncontrollably.
Corona was announced as pandemic by WHO on 11th March 2020. The earliest case of infection currently known is thought to have been found on 17 November 2019 so the name Covid-19 was given .

Symptoms:
The following symptoms may appear in 2-14 days after exposure (based on the incubation period of MERS-CoV viruses).   
– Fever(>100.4°f)   
– Cough(dry cough)[ there is no runny nose ]   
– Shortness of breath   
– Malaise/ body-ache   
– Feature of multi-organ involvement 

Older adults and people of any age who have serious underlying medical conditions (HIV,Asthma) may be at higher risk. While news has also shown that a 95 years old women got recovered successfully from Corona.
emergency warning signs for COVID-19 that seeks immediate medical attention are,   
– Trouble breathing             
– Persistent pain or pressure in the chest
– Confusion or inability to arouse                       
– Bluish lips or face

Some facts a parts from myths:
– At this point, there is no genetic evidence of anything other than a naturally occurring virus. There isn’t any evidence that this virus has been engineered or is different from something that has been found in nature
– It is true that coronavirus can cause a sore throat and gargling with warm water may make it feel better, it has no direct effect on the virus.
– There is no evidence that you can boost your immune system by eating sweet potatoes, taking specific vitamins or supplements, or ingesting silver
– Children are not immune to disease

Who should be tested:
Not everyone needs to be tested for COVID-19. Below is some information that might help in making decisions about seeking care or testing.
     -Most people have mild illness so are able to recover at home.
     -There is no treatment specifically approved for this virus.

Management :
Preventive Measures :
   As there is no specific treatment available till date “Prevention is better than cure” is best tool. 
– Avoid crowd places  
– Use mask appropriately                   
– Use alcohol-based hand sanitiser only if soap and water are not available. It’s a good idea to always keep some with you when you travel.           
– Frequent hand washing with soap and water     
– Avoid  touching eyes, nose or mouth    
– Maintain distance of at least 1m between people
– Do not handshake or hug                  
– Drink plenty of lukewarm water                 
– Cover your mouth with hanky or arms to reduce  spread                  
– Avoid unnecessary travel to hospitals                  
– If you do not have symptoms but believe you were exposed to someone who was sick with COVID-19, report this information to local health authorities                  
– Clean and disinfect frequently touched surfaces like tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks daily to protect yourself against COVID-19. Avoid disinfectants that can cause an asthma attack.

Therapeutic measures :   
– There is no single drug that can treat this disease however it can be managed adequately diagnosed early.   
– O2 therapy( mechanical ventilator)   
– Hydroxychloroquine   
– Lopinavir/Ritonavir(ART)   
– Ramdesevir   
– Bronchodilators   
– Other symptomatic treatment

Why lockdown (un-socialization) could be the best we can do at this situation:
The size of this virus is larger than other air-transmittable viruses. Which makes it heavy and thus it cannot spread through air. The life time of this virus is less (6-24 hrs depending upon the environment), which make this virus to go in inactive stage if it does not find host body to replicate within that duration. Another thing, it does not shows its signs and symptoms for 4 to 14 days of contamination, hence one cant know whether he has got it. But the bad thing is, he can still transmit. The main cause of the transmission is being in contact with another. Followings are the main reasons of transmission of Covid-19,
– Talking, sneezing, yawning nearby to some one who is non-contagious,
– Touching places, foods or other things touched by infected people. (Infectious people might have unknowingly touched the same thing after touching his mouth.
– Sharing foods,
– Being near to infected people’s mouth, face.
– Normally speaking, the breath of a persons mouth sweeps 2-3 feet of front space from the mouth, hence 1 meter spacing came in action.
The lock down allows us to prevent touching and getting near to unknown person which may or may not have this virus. If this virus is out there, it will be neutralised itself in couple of days. And if it is inside any human host, it will show its symptom within a week or two max, preventing other people to come in contact and only few people near him will be affected.

CURRENT SITUATION IN  DEVELOPING COUNTRIES:-     
Do you think we are safe being in developing country like Nepal and India and why there is less severe or less cases in developing countries despite low resources? 
Initially it was transferred by zoonotic means but now human to human transfer is confirmed. Due to unhygienic food habit & rough handling of wild animals there might be animals transferring disease to humans and after so much of mutations it might have become human to human transferable with increased resistance  to treatment.

My hypothesis:- In developing countries like Nepal  & India, we are exposed to viruses, bacteria right from birth. As we know immunity towards viruses is the definitive treatment to that viral disease. More the exposed we are to viruses, more the immunity development ( if not immunocompromised) less the susceptible we become towards the disease. Birth here in developing countries is not under so much of hygiene/aseptic measures so there is more chance to get in contact to these organisms. Secondly here children playing in the soil also provides exposure to the most of the viruses. But in developed countries like Italy, Germany etc where there is so much of hygiene  maintained, high level aseptic environment is maintained right from birth. So they are less exposed to environmental stimuli or viruses. So they develops weaker immunity towards any viruses or external stimulus . And it is well known fact/data about more cases of autoimmune disease and viral disease severity in developed  countries than in here Nepal and India .

With this much of poor resources, poor control measures, poor checking people don’t get severe viral disease, cases are less, not increasing as much as any other countries like Italy, China or Germany. There are 3 confirmed cases in Nepal (who) by this date. Also these 3 people might have in contact with so many people but cases haven’t spread in vast rate. In Nepal and India despite  cases (which is very low) they are not severe enough as any other countries where mortality rate is high .

– Thought by Mr. Rajeev Sah, (MBBS final year, Manipal Hospital, Pokhara, Nepal)