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A walk in the Park

This blog is dedicated to everyone who has struggled with Community Medicine. Through my posts I hope to simplify and demystify community medicine. The emphasis will be on clarifying concepts rather than providing ready-made answers to exam questions.

Feedback is crucial for the success of this endeavour, so you are encouraged to comment and criticize if you cannot understand something.

If you want a topic to be discussed sooner rather than later, please let me know via

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http://www.facebook.com/groups/456698611060927/%5D

Twitter: @DocRoopesh

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A single example may not be able to explain 100% of a given topic, so multiple examples may be provided to explain different parts of a single concept.

If something doesn’t seem right:

a. Write to me about it (at communitymedicine4asses@yahoo.com), and

b. Cross check with another source (textbook, expert, etc.)

I hope that my exertions will make your experience with community medicine seem like a “Walk in the Park”

Note 1. Those who wish to contact me on facebook are requested to kindly send a personal message introducing themselves along with the request. This will help save time and effort of all concerned. Please do not expect me to visit your page to try and identify you/ your areas of work/ interest, etc. It is common courtesy to introduce oneself to another when interacting for the first time. I am merely requesting that the same civil courtesy be extended here, too. Henceforth, I may not accept any friend requests/ requests to join the group on facebook unless accompanied by a note of introduction (except when I already know the sender).  

Note 2. Please understand that this blog (and the corresponding facebook page/ group) is maintained in my spare time. I have a full time job, and am available to pursue these activities only after regular working hours (after 5 pm Indian Standard Time). However urgently you may wish to receive a response from me, I will be able to respond only upon returning home from work (I am offline the rest of the time).

Note 3. Please mind your language when interacting with me/ in the group linked to this blog. Rude/ offensive language will result in expulsion from both my friends list and the said group.

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Novel Coronavirus (nCoV) in China and Thailand: Essential Information

Background Information:

Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). A novel coronavirus is a new strain that has not been previously identified in humans.  

Coronaviruses are zoonotic, meaning they are transmitted between animals and people.  Detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans.

On 31 December 2019, a cluster of pneumonia of unknown etiology was reported in Wuhan City, Hubei Province of China. On 9 January Chinese authorities reported in the media that the cause of this viral pneumonia was initially identified as a new type of coronavirus, which is different from any other human coronaviruses discovered so far.

The clinical signs and symptoms of the patients reported in this cluster are mainly fever, with a few patients having difficulty in breathing, and chest radiographs showing bilateral lung infiltrates. From the currently available information, preliminary investigation suggests that there is no significant human-to-human transmission, and no infections among health care workers have occurred. More information is required to better understand the mode of transmission and clinical manifestation of this new virus. The source of this new virus is not yet known.

There are reports of confirmation of the novel coronavirus in a person in Thailand.

The person was a traveler from Wuhan, China, and was identified by Thai officials on 8 January, and hospitalized that day. The person is recovering from the illness according to Thai officials.

Key Messages:

Common signs of coronavirus infection include

  • respiratory symptoms,
  • fever,
  • cough,
  • shortness of breath and
  • breathing difficulties.

In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death. 

Standard recommendations to prevent infection spread include regular hand washing, covering mouth and nose when coughing and sneezing, thoroughly cooking meat and eggs. Avoid close contact with anyone showing symptoms of respiratory illness such as coughing and sneezing.

Infection prevention and control (IPC) guidance when a novel coronavirus (nCoV) is suspected.

Infection Prevention and Control (IPC) strategies to prevent or limit infection transmission in health-care settings are similar to those described for Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care, and include the following:

  1. Early recognition and source control
  2. Application of Standard Precautions for all patients
  3. Implementation of empiric additional precautions (droplet and contact and whenever applicable airborne precautions) for suspected cases
  4. Administrative controls
  5. Environmental and engineering controls

Standard precautions should always be applied at all times. Additional contact and droplet precautions should continue until the patient is asymptomatic. More comprehensive information on the nCoV infection mode of transmission is required to define duration of additional precautions.

International travellers: practice usual precautions

While the cause of the pneumonia seems to be a novel coronavirus, transmission potential and modes of transmission remain unclear. Therefore, it would be prudent to reduce the general risk of acute respiratory infections while travelling in or from affected areas (currently Wuhan City) by:

  • avoiding close contact with people suffering from acute respiratory infections;
  • frequent hand-washing, especially after direct contact with ill people or their environment;
  • avoiding close contact with live or dead farm or wild animals;
  • travellers with symptoms of acute respiratory infection should practice cough etiquette (maintain distance, cover coughs and sneezes with disposable tissues or clothing, and wash hands).

International traffic: no restrictions recommended

Wuhan city is a major domestic and international transport hub. Currently, there are no reports of cases outside of Wuhan City. Given the heavy population movements, expected to significantly increase during the Chinese New Year in the last week of January, the risk of cases being reported form elsewhere is increased.

WHO does not recommend any specific health measures for travellers. It is generally considered that entry screening offers little benefit, while requiring considerable resources. In case of symptoms suggestive to respiratory illness before, during or after travel, the travellers are encouraged to seek medical attention and share travel history with their health care provider. WHO advises against the application of any travel or trade restrictions on China based on the information currently available on this event.

Useful Links:

Link to WHO statement on nCoV in China:

https://www.who.int/china/news/detail/09-01-2020-who-statement-regarding-cluster-of-pneumonia-cases-in-wuhan-china

Link to WHO statement on nCoV in Thailand:

https://www.who.int/news-room/detail/13-01-2020-who-statement-on-novel-coronavirus-in-thailand

Link to WHO page on Coronavirus:

https://www.who.int/health-topics/coronavirus

Link to WHO’s Question and Answer page on Coronaviruses:

https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

MERS CoV image source: wikimedia