Late last year, many workers from the seafood markets in the province of Wuhan and Hubei started reporting pneumonia like symptoms that progressively worsened. This illness spread at an alarming rate and quickly became an uncontrolled epidemic. The Chinese government was forced to notify the World Health Organization (WHO) regarding this new threat that was devastating its country. Before we know it, similar symptoms were reported by individuals throughout the world. Now we are facing a ferocious pandemic that has claimed the lives of thousands across the globe and has brought the global economy to a stand-still.
Although the origin of the pandemic was speculated to have originated in Wuhan, China, there is no solid evidence that proves this fact. On the contrary, a study that came out in January 25th, 2020 denotes that the first individual that became ill due to this illness was on December 1st, 2019 which had no connection to the seafood market in Wuhan nor Hubei in China (Lauren M. Sauer M.S, Hopkinsmedicine.org) Until today, thorough investigations are still being carried out to trace the origin of the new Global Killer
What is a Corona Virus
A crown or halo-like appearance brought about by the glycoprotein impregnated viral envelope classifies the coronavirus into the family Coronaviridae. To put it in simple terms, it is called coronavirus as it looks like a crown when studied under the electron microscope. Most human coronavirus fall into two categories which is 229E-like and OC43-like.
The Coronavirus is mostly found in avian and mammalian species and they are similar morphologically and chemically in animals, the Coronavirus has known to invade and attack various tissues causing mild to severe diseases, in humans, its usually known to cause mild upper respiratory tract infection. There are also documented cases in which the Coronavirus from the gastrointestinal system causes symptoms of diarrhea which is most commonly seen in children. There is no solid evidence that the human coronavirus can be transmitted by animals.
The Coronavirus invades the respiratory tract through the nose, invade respiratory epithelial cells, causing it to become vacuolated, damaging its cilia and forming syncytia. Inflammatory mediators will be produced which in turn produces nasal secretions and local inflammatory response. This will manifest as sneezing, flu, fever and in some cases breathing difficulty as airway obstruction takes place. The condition is usually self-limiting during which the virus is secreted in the nasal secretions. Hence the possible transmission as nasal secretion is transferred via airborne method when a patient sneezes or physical transfer as nasal secretion from one individual is transferred to the next individual by direct physical contact.
(David A.J. Tyrrell and Steven H. Myint, Medical Micribiology 4th Edition)
SARS, MERS-COV, and COVID-19
Back in 2003, the World Health Organization (WHO) announced that the disease Severe Acute Respiratory Syndrome (SARS) was caused by a strain of Coronavirus that was traced by to Asia in 2002. The novel coronavirus was identified as the causative agent and named SARS-Coronavirus or just SARS-CoV in short. It infected almost 8000 individual and caused a recorded death of 774 individual.
Another strain of Coronavirus was then identified in the middle eastern regions in late 2012. The WHO, learning from previous experiences during the SARS outbreak was quick to respond and issue global alerts to contain and prevent the condition from becoming a global pandemic. The virus, now called Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was traced as far as France, United States of America, South Korea and Tunisia as travellers who has visited middle eastern countries returned back to their nation. There was no proper data as to how many individuals were infected globally during this outbreak but it was estimated that around 477 individual died from MERS-CoV.
Since December 31st 2019, another Coronavirus outbreak was reported in Wuhan, China which has since been called Coronavirus 2019 (COVID-19) which is now a global pandemic which has caused caused a death toll of more than 35,000 individuals and counting daily.
(sourced from Wikipedia.com)
COVID-19 and indemnity insurance
As the number of global populations being diagnosed of having COVID-19 rises exponentially daily, medical practitioners and the general public has developed a stigma towards anyone and everyone that coughs or sneezes. Well, can u blame them with our current situation?
To differentiate the symptoms of seasonal flu a.k.a influenza from symptoms of COVID-19 based purely on clinical findings is almost impossible. As number of COVID-19 cases rises daily, it is safe to assume all patients that presents with flu like symptoms to be COVID-19 positive until proven otherwise. “it’s important to note that, because respiratory viruses cause similar symptoms, it can be difficult to distinguish different respiratory viruses based on symptoms alone” – WHO.
At present, there is no immediate testing apparatus that can aid in the detection of COVID-19 as there is for Influenza and Dengue. The only method will be a clinical laboratory testing using the Polymerase Chain Reaction method (PCR) that is not only costly but also time consuming and meticulous. Although there are positive results in the development of a rapid test kit for COVID-19, the availability is questionable for the time-being.
The usual symptoms to be expected when a patient presents with seasonal flu are fever, cough, runny-nose and headache, and the symptoms to have a high index of suspicion for a COVID-19 will be all those symptoms mentioned accompanied with shortness of breath. In the United States, 1% of individual with seasonal flu develops complications severe enough to be hospitalized ( Rachael Rattner, livescience.com 19th March 2020). Having said that, don’t you think a patient that started with a mild seasonal flu, which later developed into community acquired pneumonia (CAP) might also present with shortness of breath? What if the patient is an elderly patient with reduced effort tolerance? Can he be having a seasonal flu with an early Acute Coronary Syndrome (ACS) rather then COVID-19? Have you considered the fact that he might be on restriction of fluid which he may not be compliant or he might just be an inactive patient who took 2 flights of stairs to see you while having a flu. It’s a tough conclusion to come to but this is where experience, skills, knowledge and other factors comes in the picture.
What if the patient had no shortness of breath? Would you conclude that he does not have possibility of carrying the COVID-19 virus and discharge him? What if the patient is yet to experience his incubation period of 2 weeks but is COVID-19 positive? What if he is among those individuals that shows very little symptoms or no symptoms for COVID-19 but happens to be positive, which later passes on the virus to a co-worker that dies from it and your patient was traced to be the perpetrator? Can he hold the doctor responsible for not diagnosing him or telling him the possibility of him being a COVID-19 positive and that he can be the reason for another’s death? Can he take legal actions against the doctor in this case?
But having said that, many doctors out there fail to see the early symptoms of COVID19 and discharges the patient back home. Healthy asymptomatic patients that steers the diagnosis of the doctor away from COVID-19 despite them being the carrier for the virus. What happens if the patient returns home and then starts to develop symptoms and is found out to be positive for COVID-19 later on? Will it be the doctor’s fault not to be able to pick it up during the 1st visit? What if the patient succumbs to this unforgiving virus and dies? How would the doctor defend himself? A report published in the journal of Emerging Infectious Disease on March 13 explains the potential time delay between hospitalization and death among cases in China.
The death rate of seasonal flu ranges around 0.1% in the US (NewYork Times), and according to the study published on February 18th 2020 in the China CDC Weekly, it is stated that the death rate for COVID-19 is around 2.3% but many are forecasting a much higher number then the ones published.
With all these uncertainties lurking around, it is utmost important for a doctor to equip himself with indemnity insurance. With global economy crashing and mega firms going bankrupt, many individuals will lose their job and income. Desperate individuals will stop at nothing to take advantages of situations like this that will be rewarding for them if the by exploiting gray areas and loopholes that are present in the system. The best defense to all this will be to practice defensive medicine and undeniable to safeguard by having indemnity insurance.
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