So, the vast majority of viral infections are self-limited and with mild manifestations. However, some viruses are highly pathogenic, contagious and with the potential to cause serious disease. Just as centuries-old infectious diseases, such as tuberculosis, still persist today, due to patterns of behavior (food, cleaning, management of food markets) and human transfer, new infectious contagious diseases have appeared that have even produced pandemics global. Such is the case of SARS-CoV-2.
Viruses are academically classified according to their nucleic acid structure, their capsid, and the presence or absence of envelopes. However, a more practical way of classification is by the clinical syndromes they present.
Classification: In the family of RNA type viruses is the classification of Coronaviridae, to which the coronaviruses belong, most of them causing mild upper respiratory tract infections (common cold), but also the SARS-CoV, the MERS and the current SARS-CoV-2 (Covid-19), all highly contagious viruses that cause severe infections.
Principles: Coronaviruses are single chain RNA viruses, there are different strains that cause diseases in humans, the vast majority of which are the common cold. However, Severe Acute Respiratory Syndrome due to Coronavirus (SARS-CoV-1) is a particularly virulent strain that appeared in southern China in 2002, which spread to 29 countries and produced an approximate mortality of 10%. The incubation period of this disease is from 3 to 10 days, the contagion method is by means of respiratory droplets in addition to touching contaminated surfaces. No cases of SARS-CoV-1 have been detected since 2004. In 2012 another new coronavirus caused international concern called “Middle East Respiratory Syndrome-coronavirus” (MERS-CoV) which is a virus with a very high mortality rate. and with transmission mechanisms still uncertain, however, both viruses (SARS and MERS) share many characteristics6.
The Coronavirus Study Group of the International Committee for Viral Taxonomy has decided to name this new coronavirus as SARS-CoV-2. It is important to mention that because this virus has interspecies transmission, which is not yet fully understood and that today there have been no effective ways to stop this type of zoonosis, the SARS-producing coronaviruses such as CoV-1 , CoV-2 and even a possible CoV3 in the future may continue to emerge and re-emerge2.
The first 450 confirmed cases reported in China, between December 2019 and January 2020, provide us with epidemiological data that allows us to model curves of the behavior and transmissibility of the disease. The incubation period was calculated to be approximately 5.2 days with a mean appearance of symptoms of 7.5 +/- 3.4 days. The percentage of dubbing cases is estimated every 7.4 days. It was determined that the greatest contagion capacity is from person to person3.
The ability of SARS-CoV-2 to remain on surfaces after exiting the infected person was also studied. 5 surfaces were evaluated: aerosol microdroplets, plastic, stainless steel, copper and cardboard. The virus can remain viable in plastic and steel for 72 hours. In copper, no viable viruses were detected after 4 hours and in cardboard, they were 24 hours in not being detectable4.
It was shown that SARS-CoV-2 can cause infection in children between 1 and 7 years of age with manifestations of moderate to severe disease, with fever (> 39oC) and cough as the most frequent manifestations5.
It was possible to demonstrate that patients who do not present symptoms can have high viral loads on the mucosa of their upper respiratory tract and be sources of contagion despite being asymptomatic and that they can also be contagious after recovery for several days.
Historian Charles Rosenberg developed the structural archetype of an outbreak. According to Rosenberg, epidemics and pandemics unfold as social dramas in three acts. The first demonstrations are subtle, whether due to the desire to maintain security or the need to protect economic interests, citizens ignore signs that something is wrong until the acceleration of the increase in cases and deaths forces recognition reluctant. This recognition begins the second act, where people demand and some also offer explanations, both mechanistic and moral. These explanations in turn generate public responses in society, it is these responses that can make the third act as dramatic and disruptive as the disease itself.
Epidemics are eventually resolved, either by the action of society or because potential susceptible victims end, it is for this reason that epidemics put great pressure on the societies it affects.
Another dramatic aspect in the historical study of epidemics is the desire to assign those responsible. This step where governments impose authoritarian measures, which are taken by people with power and privilege to be applied to people who have neither power nor privilege, is a dynamic that fuels social conflict.
Two already well-known aspects of governments’ responses to epidemics are especially hopeless, the first is the social stigmatization suffered by people who have been designated as responsible for the problem, and the second that epidemics can also take the lives of health workers. For this reason, pandemics that have already gone down in history offer us considerable information, but only if people know the history and respond wisely to combat the pandemic7.
Health anxiety is a phenomenon that all of society experiences, to a greater or lesser extent, the vigilance that it produces can help people recognize signs and symptoms of disease early, which would help them to have preventive behavior. However, this excess anxiety can be deteriorating.
It has been shown that high levels of health anxiety can manifest itself following exposure to disease-related issues in popular media and of which there is abundance at this time with SARS-CoV-2. Contemporary cognitive behavioral models propose that high levels of health anxiety are characterized primarily by catastrophic misinterpretation of bodily changes and symptoms, distorted beliefs about health and illness, and maladaptive coping behaviors.
People with these maladaptive behaviors, in the context of outbreaks of infectious diseases, take the general recommendations to the extreme, which may include excessive hand washing, complete social isolation, and compulsive shopping instigated by panic. For example, the false sense of urgency for products needed for a quarantine causes the person with health anxiety to overspend on accumulating resources unnecessarily. This in turn has an impact to the detriment of the community that needs those resources for other purposes.
It is worth noting that people with low levels of health anxiety also generate a deleterious impact since these people can ignore the recommendations and be possible sources of contagion8.
1.Seethela, R. Rosen’s Emergency Medicine, 9th edition, chapter 122 (Virus), page 1598-1618. Elsevier Spain.
2. Lancet, The. Wu, Y. Ho, W, et al. 2020-03-21. Volume 395, number 10228, page 940-950.
3.Li, Q. Guan, X. Wu, P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infects pneumonia. NEJM DOI: 10.1056 / NEJMoa2001316.
4. Aerosol and surface stability of SARS-CoV-2 as compared to SARS-CoV-1. 2020-03-17. NEJM DOI: 10.1056 / NEJMc2004973.
5. Detection of Covid19 in children in early January 2020 in Wuhan. 2020-03-12. NEJM DOI 10.1056 / NEJMc2003717
6.Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. 2020-03-05. N Engl J Med 2020; 382: 970-971.
7. History in a Crisis- Lessons for Covid19. 2020-03-12. NEJM DOI: 10.1056 / NEJMp2004361.
8. How Health Anxiety influences responses to viral Outbreaks like SARS-CoV-2. Journal of Anxiety Disorders. 2020-01-04, volume 71, article 102211.