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Why coronavirus in Lebanon is no reason to panic

Separating myth from reality

by Khalil Diab

A video shared on Twitter by Sky News Arabia’s Larissa Aoun shows an adult, clad in full protective gear, spraying an unknown substance over school age children as they walk in line into their school. Aoun notes in her tweet that spraying alcohol or chlorine will have no effect on viruses already in your system, but can be harmful in of themselves, particularly to mucous membranes such as the eyes and the mouth.

Since the announcement on February 21 that the first case of the novel coronavirus had been discovered in Lebanon, reactions have skewed toward the panicked and misinformed, with some Lebanese donning surgical masks or gloves in public, and the more extreme case as cited above.

This is not to say that the novel coronavirus—officially known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the disease of which is called COVID-19—should not be treated seriously. Since it was first discovered at the end of last year in Wuhan, China, COVID-19 has spread to 48 countries, and, at the time of writing, there have been 82,166 cases diagnosed worldwide, 2,804 deaths, and 32,832 recoveries. The World Health Organization (WHO) declared COVID-19 as a global health emergency at the end of January.

With seven cases of coronavirus confirmed locally in February and more likely in the near future, it is important to separate the myths from the reality and make sure that reactions to the virus are based on facts rather than fears.

What is a coronavirus?

Coronaviruses are a family of viruses that more often than not cause nothing worse than a regular cold in humans. Certain strains of coronavirus, however, can evolve and become more dangerous. Examples of coronaviruses that evolved into a more severe and deadly strain include Severe Acute Respiratory Distress Syndrome (SARS), which emerged in 2003 in China, and Middle East Respiratory Virus (MERS), which emerged in 2014 in Saudi Arabia. This new strain of coronavirus is another example that can cause a more severe illness than the common cold.

Timeline on the discovery and initial spread of COVID-19

December 26: Four unusual cases of pneumonia were noticed by Dr. Jixian Zhang in Wuhan, the capital of the Hubei Province in China.

December 27: Dr Zhang reported the cases to the local Center for Disease Control.

December 28: Another three cases were detected.

December 31: The national Chinese Center for Disease Control and the WHO were made aware of the virus.

January 1: The Huanan fish market was closed due to suspicion the virus started there. 

January 7: COVID-19 was identified.

January 13: Testing kits became available.

January 23: Due to the rapid spread of cases, Wuhan was declared under quarantine with no travel in or out the city.

January 24: Another 15 Chinese cities were placed under quarantine

January 30: The WHO declared “a public health emergency of international concern.” 

When was the first case of COVID-19 reported in Lebanon?

The first case of coronavirus was confirmed in Lebanon on February 21. A female passenger had arrived the night before on a plane from Qom, Iran. All passengers on the plane had been screened on arrival by officials from the health ministry after Iran had reported its own cases of COVID-19. The woman in question had tested positive for cold symptoms and had been transferred to Rafik Hariri University Hospital with a suspected case of coronavirus. A second case was confirmed on February 26, another passenger on the plane. This was followed by a third on February 27, an Iranian male who flew from Iran in three days prior; a fourth on February 28, the first case of local transmission; and a further three cases through contact with infected patients on February 29.

Can hospitals in Lebanon house COVID-19 infected patients?

Currently all confirmed and suspected cases of COVID-19 in Lebanon are to be isolated at Rafik Hariri University Hospital. No other hospital is allowed to keep patients with the disease at this time. The WHO helped set up the quarantine department at the hospital, and it was reported on February 26 that the head of the health committee in Parliament, Assem Araju, said that Lebanon has asked the WHO for help establishing similar quarantines across Lebanon.

How does it spread?

The virus can be spread from person to person through a variety of ways. If an infected person coughs or sneezes near you this can put you at risk. It can also spread through objects or surfaces that have been touched by an infected person, if you touch these and then your own face, especially by rubbing your eyes or putting your fingers in your mouth.

What are the symptoms of COVID-19?

You can carry the disease from two to 14 days before you develop any symptoms. In most people (81 percent), the symptoms are mild, including a cough, shortness of breath, and a low grade fever that increases over time. For others, symptoms can be more severe, or even critical, requiring hospital admission.

How would I know if I have COVID-19 and who would I report my symptoms to?

If you develop cold or flu-like symptoms and have been to China or another endemic country in the past 14 days, or have been in close contact with someone who visited these countries, then you should report your symptoms to your doctor right away.

How is COVID-19 diagnosed?

Typically, a doctor or lab technician takes a swab from your throat or a blood sample and then sends it for a polymerase chain reaction (PCR) test in the lab. This identifies whether COVID-19 DNA is present.

What is the available treatment?

If you receive a positive diagnosis of COVID-19, you will be placed in isolation for the duration of your symptoms. So far, treatment is mostly supportive as there is currently no cure for the disease. In severe and critical cases, admission to the intensive care unit may be necessary and you may be placed on an artificial respirator.
There are ongoing studies on several drugs as potential treatments for COVID-19. Chloroquine, an anti-malarial drug, is showing promise in a study in China.

Is COVID-19 dangerous?

The death rate from the disease so far is between 2.3 to 2.7 percent of infected cases, meaning for every 1,000 people infected by COVID-19, 23 die due to the virus (although these numbers may change). What is important to note, however, is that most people infected by COVID-19 suffer symptoms very similar to a common cold—81 out of every 100 people infected. In children under the age of nine, no deaths from COVID-19 have been reported. Those more at risk seem to be the elderly and those with underlying conditions. The death rate increases to 8 percent in people aged 70 to 79, and to 14.8 percent in people aged 80 and above. People with diabetes and heart disease are also at increased risk of death. Those who die after contracting COVID-19 usually develop pneumonia (an infection in their lungs). But it bears repeating, for the vast majority of those infected, the death rate is very low.

What can I do to avoid contracting or passing on the infection?

  • If you have the infection, always wear a mask when around people.
  • If you are caring for somebody who has the infection who is not wearing a mask, wear an N95 mask (the model used when caring for or around people with tuberculosis).
  • Frequent hand washing preferably with soap and water for at least 20 seconds is recommended, especially when touching surfaces that could be infected. A sanitizer with an alcohol content of more than 65 percent may also be used. If your hands are dirty, however, always use soap and water.
  • Frequently wipe surfaces that could be infected with an environmentally friendly disinfectant.

Should I wear a mask in public?

There is no reason whatsoever to wear a mask in public. The risk of infection in outside spaces is low, and a regular mask will still allow particles to pass through the sides. Bear in mind that the availability of masks is limited at this time. Hoarding masks at home may limit the availability of masks in pharmacies and at hospitals. If healthcare workers taking care of sick patients are unable to secure their own supplies, this could put them at risk.

Wearing an N95 mask (see box) would certainly be effective, but it is not necessary and it makes it hard for you to breathe.

Should I travel on a plane? If so, should I wear a mask on the plane?

The risk associated with airplane travel is similar to that of train or bus travel. In fact, some people say that the HEPA filters on airplanes may help prevent a viral infection. Regarding mask use on an airplane, the same caveat applies, it may not be effective as the virus can still enter through the sides. Sitting within one to two rows of somebody who is coughing and sneezing leads to the highest risk of infection. Surfaces are the biggest risk. Try to wipe the back pockets of airplane seats with sanitary wipes before touching the airline magazine and regularly wash your hands.

Why close schools? If they reopen should I send my children?

At this time in Lebanon, there is no COVID-19 epidemic. Seven cases were reported in February, and the education ministry made the decision on February 28 to close all schools and universities until March 8. On the face of it, this decision was perhaps unnecessary at this time. If reopened on March 9 there are precautions schools should certainly take, such as disinfecting surfaces frequently touched by students on a daily basis. Any student who has recently been to a country with an epidemic may be asked to self-quarantine for 14 days, likewise students with cold symptoms should stay home until these resolve. But bear in mind the risk of infection in children is very low.

The important thing to remember is to remain calm and rational in face of COVID-19. While this virus has to be taken seriously, there is no need for widespread panic. Be careful with the information you come across online or through others. It easy for misinformation and rumors to spread as people allow their fears to cloud their judgement. The best advice would be to follow that given by your doctors or the health ministry and make sure to wash your hands frequently and thoroughly when interacting with others and public spaces.

This article was updated to reflect the decision of the Ministry of Education and Higher Education to close all schools and universities in Lebanon until March 8. The number of cases of coronavirus cited within the article are valid up to end February. This is an ongoing situation and numbers will rise.

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Khalil Diab

Dr Khalil Diab is a pulmonary and critical care specialist and associate professor of clinical medicine at the Gilbert and Marie Chagoury School of Medicine at the Lebanese American University.

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