Coronavirus: New virus adapts itself once it enters the human body, says top US health official
'The average time from onset of symptoms to hospitalization was five days, and from hospitalization to the ICU was seven days'
While scientists are trying to figure out the next move of the Coronavirus Disease (COVID-19), which is still challenging to predict, Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), US, said the new coronavirus adapts itself once it enters the human body.
As a result, even if a person has minimal symptoms on the first day, he or she can end up becoming very serious over the next few days. Fauci's observations are based on a recent study, where the average time between the onset of symptoms to hospitalization was five days, and from hospitalization to the intensive care unit (ICU) was seven days.
Dr Fauci referred to stories from the 1918 pandemic, where someone would wake up in the morning feeling pretty well, go to work, fall down in the street, and then be dead in about 24 hours. “That's the great frightening thing about the 1918 pandemic. Obviously, not everybody went through that, but that's something that keeps getting repeated in the historical type of discussions of that outbreak,” Dr Fauci said during an interview with JAMA Editor-in-Chief Howard Bauchner.
This is, however, not the case for those infected with COVID-19.
“The thing that was really interesting I thought in the paper, if you look at the duration of time from onset of symptoms to hospitalization, I believe it was five days. From the hospitalization to the ICU was seven days. And from onset of symptoms to intubation was eight days. What that's telling you is that this virus is really acting different. This virus, when it gets in you, adapts itself so that you can wind up days later getting a really serious disease,” he said.
Dr Fauci added, “I think that's a heads-up. If somebody comes in and has moderate to minimal symptoms, stay heads-up for some deterioration over the next few days.”
In response, Bauchner said, “So, I think... you know, you're just raising the point that just because you're well on day one or two, doesn't mean you'll be well on day 4, 5, or 6.”
According to Dr Fauci, it can be said that experts do not know everything about this virus, but it is evolving in a way that looks like it is adapting itself to infecting much better.
The latest figures released by the Chinese National Health Commission show 63,851 reports of confirmed cases and 1,380 deaths across China. On February 13, 31 provincial-level regions on the Chinese mainland as well as the Xinjiang Production and Construction Corps reported 5,090 new cases of confirmed infections, 2,450 new cases of suspected infections, 2,174 new serious cases, and 121 deaths.
In the study, published in JAMA, medical records of 138 patients were analyzed by the research team from the Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University. Of these patients, 102 (73.9%) were admitted to isolation wards, and 36 (26.1%) were admitted and transferred to the ICU because of the development of organ dysfunction. “Thirty-six patients (26.1%) were transferred to the ICU because of complications, including acute respiratory distress syndrome (22 [61.1%]), arrhythmia (16 [44.4%]), and shock (11 [30.6%])," says the study.
The analysis shows that the median time from the first symptom to dyspnea (difficult or labored breathing) was five days, to hospital admission was seven days, and to acute respiratory distress syndrome (ARDS) was eight days. The median time from the onset of symptoms to ICU admission was 10 days.
“The most common symptoms at onset of illness were fever (136 [98.6%]), fatigue (96 [69.6%]), dry cough (82 [59.4%]), myalgia (48 [34.8%]), and dyspnea (43 [31.2%]). Less common symptoms were headache, dizziness, abdominal pain, diarrhea, nausea, and vomiting,” says the study.
Compared with patients who did not receive ICU care, patients who required ICU care were significantly older (median age, 66 years versus 51 years), and were more likely to have underlying health conditions, including hypertension, diabetes, cardiovascular disease, and cerebrovascular disease. This suggests that age and comorbidity may be risk factors for poor outcome, said researchers.
The experts also said that compared with symptoms in non-ICU patients, symptoms were more common in critically ill patients, including dyspnea, abdominal pain, and anorexia. “The onset of symptoms may help physicians identify the patients with poor prognosis,” said the team.