Clinical aspects of 2019-nCoV-disease - high prevalence of infected health care workers is a problem...

_{2019-nCoV-Virus is further spreading all over the world - clinic of infection is causing devasting NCIP manifestations in many patients - picture source: pixabay modified by indextrader24}

Dear friends of freedom and peace,

dear friends of happyness and love,

dear coronavirus interested readers,

the devasting China pandemic caused by the Wuhan virus is further spreading all over the world. Current R0 basis replication estimate at Hubei province is at around 4-5 - this means one patient is in infecting nearly 4-5 additional persons. It seems to be that isolation of the people at Wuhan in the past two weeks isn´t able to diminish the occurrence of new infections at Hubei province.

There are great uncertainities about the case fatality rate which has been calculated in a simple manner at Hubei province of Wuhan where thousands of people are infected. The case fatality rate at Wuhan is at around 2.8 following official statements. Some observers think that the CFR of Wuhan is overestimated, while in other regions reports of Coronavirus related fatalities and infections are underestimated - caused by infrastructure availability of medical diagnostic tests, reporting procedures and many more. [24]

The treatment of infected patients remains a big challenge to healthcare systems worldwide

The Journal of American Medicin reported on friday current numbers of a cohort of 138 patients which are infected by the nCoV-Virus at Wuhan. The numbers and statistics of this treated patient population are sobering, despite the implementation of mothern therapy strategies in this patient cohort of Wuhan.

The median age of all patients with Novel Coronavirus infected pneumonia (NCIP) was 56 years (22-90 years range). 53.4% of them were men. 29% of the patients where healthcare workers - which is reflecting the high risk of infection to medical staff at hospitals with nCoV-infected patients.

All patients which has been hospitalized shown bilateral CT findings of viral pneumonia (shadow, ground glass). More than 98 percent of the patients developed fever, nearly 70 percent has fatigue and dry cough at nearly 60 percent of the cases. This clinical signs were accomonied by lymphocytopenia (70.3%) and prolonged PTT (58%) as part of blood clotting and increased LDH levels in around 39% of all patients.

As I wrote in my previous posts I doubt that patients with nCoV-infections will have significant benefit if they are treated with Oseltamivir and other neuroaminidas inhibitors, because it is well known that viral nsp-14 Exonuclease of Coronavirus is inactivating neuroaminidase inhibitors like Tamiflu.

However, at Wuhan hospital around 89 Percent of the patients has been treated with Oseltamivir, while many of them needed addional antibiotic therapy in order to treat the nCoV-disease. 44.9 percent has been treated additionally with glucocorticoids.

26.1 percent of the patients need intensiv care unit (ICU) treatment and overall mortality was 4.3%.

61.1 percent of the ICU-patients developed an acute respiratory distress syndrom (lung failure). Other findings are

• arrythmia of the heart (44%)
• shock (30.6%)
• median age of ICU patients (n=38) was 66 years versus 51 years of non-ICU Patients(101 patients)
• of the 36 patients of the ICU needed 11.1 percent needed high flow oxigen therapy
• 46.7 percent of ICU patients needed non invasive ventilation
• 47.7 percent of ICU patients needed invasive ventilaton, while 4 of them needed extracorporeal membrane oxygenation in the follow up ( around 3 percent of all patients)
• 6 patients died
• the median duration of treatment at hospital was 10 days.

Important clinical features of 2019-nCoV-disease

The median time from the fist symptom to dyspnea was 5 days, to hospital admission 7 days and to lung failure (ARDS) was 8 days.

In this study 41% of the nCoV-patients at the hospital were healthcare workers and patients which where at hospital for other reasons! 26.1% of all patients in this study needed ICU treatment and 15 percent of the ICU patients needed ECMO therapy. The mortality rate was 4.3%.

It must be pointed out that 57 of the 138 patients has been infected during the hospital settings. 29 percent of all patients were health care workers and 12.3% patients of the nCoV-patients where initially hospitalized for other reason.
So we can conclude that more than 41 percent of all nCoV-patients were nosocomial infections!

The most nosocomial infections of the healthcare workers occured in the general wards (77.5%) and 17.5% in the emergency area.

Own conclusions:

The high prevalence of healthcare workers at infected 2019-nCoV patients is pointing out that personal protection at this nCoV-pandemic is obviously not sufficinet in order to prevent nosocomial infections at hospitalized patient population.

The high numbers of infected health care workers is leading to deterioration in health care of the patients which has been infected by 2019-nCoV virus.

It is of high importance to improve the safety of healthcare workers in all areas of a hospital that participates in the care of nCoV patients.

SEND with LOVE!

PEACE!

_{[1] nCoV Übertragungskennzahlen - Studie
[2] Transmissionsdynamik des nCoV-Virus - Studie
[3]Studie zur Ineffiziens von Reisebeschränkungen in Wuhan als Versuch zur Eindämmung einer Pandemie
[4] [Bundesdrucksache 17(12051 vom 3.1.2013 Risikoanlayse eines Pandemie Modi--SARS Coronavirus Szenarios für Deutschland, Seite 5-6 und Seiten 55-88](http://dip21.bundestag.de/dip21/btd/17/120/1712051.pdf}
[5]Produktdatenblatt der Firma Hartmann zu den erforderlichen Einwirkzeiten der Händedesinfektionsmittel der Steriliumserie
[6] RKI Liste und Ausfährungen des Fachausschusses zur Desinfektionsmitteln und Viren
[7] Kritik des ehemalige Leiters des Robert Koch Institutes an der Seuchenpräventionsstrategie des BMG und RKI
[8] Protokoll der Rückholung von Deutschen mit einem Airbus A310 der Luftwaffe
[9] nCoV-Virus S-Protein mit homologen Strukturen zum viralen Spike Protein des HIV1-Virus
[10.] SARS-Impfstoffe erzeugen immunologische Schädigungen an der Lunge
[11.] Protein S vermittelte Fusion von Coronaviren
[12.] Lassa Fieber Virus und Zellfusion
[13.] Endosomen und ihre Funktion in einer Zelle - Spektrum der Wissenschaft
[14] [J Virol. 1998 Sep; 72(9): 7084–7090. PMCID: PMC109929 PMID: 9696801 Resistance to Murine Hepatitis Virus Strain 3 s Dependent on Production of Nitric Oxide}(https://europepmc.org/article/PMC/109929)
[15] Kaffee als Breitbandvirusmittel - Studie
[16] Glycyrrhizin aus der Süßholzwurzel als potentieller Kandidat zur Therapie von Viruserkrankungen
[17.] Deutsche Apotheker und Ärztezeitung - Wirkung von Glycyrrhizin gegen Hepatitis C, HIV1 und Coronaviren
[18.] Infektionsbehandlung von Verbrennungsopfern mittels Glycyrhizin
[19.] ECDC - Emfpehlungen der Europäischen Gesundheitsbehörde zur Infektionsprävention bei 2019-nCoV
[20.] Does ACE inhibition increase mortality of nCoV infected patients?
[21.] Chinesen lassen ihre Hunde und Katzen aus Angst vor nCoV Übertragung zurück
[22.] SARS und tierische Vektorthese - Artikel aus dem Lancet Jorunal 2003
[23.] Solar activity of the past 400 years and pandemic outbreaks
[24.] Case fatality rate of nCoV-Virus remains a challange
[25.] Journal of Medical Association: Klinische Aspekte der 2019-nCoV Erkrankung - aktueller Stand der Dinge}

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_{Important note: The information provided here is based on the author's conclusions and own considerations. The author's conclusions do not represent any kind of therapy recommendation for emerging dieseas or infected patients, since there are still no clinical efficacy tests for these theoretical considerations for therapy of infectious diseases, which would prove a benefit for this type of treated patient - also if the author of this article is personally convinced that such therapy can be of benefit to infected patients. As there are no clinical studies to date on the use of lysosomal substances for virus infections in humans, as far as I know, therapeutic treatments with these substances should only be carried out as part of a clinical trial in suitable centers. The use of drugs mentioned in this article as part of an off-label use in the case of coronavirus infection is explicitly discouraged due to the lack of data in human use until now, as long as the benefit of appropriately treated patients with consideration of the side effects of such therapies is proven in controlled studies could.}

_{This contribution is only intended to encourage scientists to make increased efforts to develop adequate antiviral therapies that have a broad spectrum of antivirals. They are to be understood by the author of this article as a medical-theoretical contribution to the improvement of medical care for people all over the world - but do not include any kind of trade request for their practical implementation in humans without prior clinical examination by appropriate centers.}

_{Off-label use of such experimental therapeutic strategies in the case of emerging viral diseases is at present not recommendet by the author of this article. The presented informations are only representing theoretical therapeutic strategies mentioned by the author to induce further clinical investigations in the field of emerging infectious diseases in future}

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