VERY IMPORTANT INFORMATION FOR GOVERNMENT, MDS AND CLINICAL STAFF

Latest findings of the German Robert Koch Institute in Germany concerning the corona crisis.
Free, independent, shortened and focused translation

by Dr. Walter Lipke, MD, Author & Scientist
Germany/Kenya 21st March 2020

With many thanks to the researchers and staff of the Robert Koch Institute Germany.

SARS-Cov-2 Checklist concerning Coronavirus disease -2019 also called COVID-19.

Status quo 20th March 2020

A) Short summary for the population:

Follow your government orders on shut down and quarantine strictly – it has proven to save very many lives!!!

  • The corona virus disease is most likely spread by droplet infection – therefore keep distance, use protection gear and seek quarantine please. It is the best practice from around the world to avoid infection.
  • Wash your hands frequently and avoid touching your face and eyes cause also this could transfer the virus from your hand to the face.
  • Stay away from infected people and areas with infection
  • The most group in danger is the 50+ and older!
  • ALL people with severe chronic diseases like diabetes or high blood pressure, respiratory diseases like asthma are also a high endangered group independent of their age!
  • Those that take immunosuppressive drugs of any kind are also a risk group to get the virus and face a severe disease and complications
  • Young children, pregnant women and newborn babies are obviously usually NOT in danger – if no severe other disease is present already
  • Even if the mother has the COVID-19 infection, the new born baby is usually not at risk and does not have to get it.
  • Stay calm and helpful to others, use prevention methods as communicated here and on other portals.
  • Infection rate, severe cases and suffering and even death toll in any country can be dramatically reduced by breaking the infection chain – please help to do so.


We want you all save – the crisis will go over and life will go on – but for now its better to be safe than later sorry!!!



B) Overview for professionals:

  • Transmission path – droplet infection!

    Droplet infection seems to be the mayor path of infection. In theory, smear infection and infection via the conjunctiva of the eyes are also possible. In practise, these only play a subordinate role, but medical staff should also take this possibility into consideration.

    Infection of the new born – from infected mother to newborn child:

    Till today there was no evidence of any infection of a positive coronar tested mother to a newborn baby during birth or after birth. So far no direct evidence could be made of such an infection. Such no conclusion can be made here.


  • Disease course and demographic influences


    Course of disease is varying very much, such unspecific and can vary from very mild or even courses with no symptoms at all to very severe courses and death. Such there is no “typical” course of disease.

    From more than 50.000 lab tested cases from China we find:

    Mostly fever and coughing is found and 80% of all disease courses are mild or moderate. In 14% there was shortness of breath and in only 6% the clinical symptoms became critical and life threatening.

    (See chart 1) The appearance of symptoms in COVID-19 in China (n= 55.924 study cases)

    source: Robert Koch Institute, Germany

    The median age is 51 years,, 78% of all cases are between 30 and 69 years of age, people in there 20th only show symptoms in 2,4% percent of this population age group.

    • Risk groups with severe cases :
      • aged people 50+ and 60+
      • Smokers
      • Patients with multiple severe diseases (Heart disease and high blood pressure, lung problems e.g asthma, chronical bronchitis, chronical liver disease)
      • patients with diabetis mellitus
      • patients with cancer disease
      • patient with weak immune system or such taking immune suppresive drugs because of other chronical diseases such as for example HIV
      • people taking immune system suppressing drugs ( some certain pain relivers, and corticosteroides)
    • Pregnant patients: No valid data available at the moment – so far no hint for more severe cases in pregnancy
    • Unborn babies: No valid studies at the moment, but in general high fever in the first trimenon (first 3 month) of pregnancy can lead to complications and miscarriage as we know from other diseases.
    • Children: Only few data on children and COVID-19 are available till date.

      All studies so far show: COVID-19 disease in children is generally mild and not aggressive.
  • Base reproduction number:

    NOTE: Different studies point out that ONE infected patient will infect 2 or 3 others.

    Therefore about ⅔ of all infections have to be avoided strictly to get the pandemia under control!
  • Incubation time and serial interval:

    The incubation time mostly is 5 to 6 days, in this time the patient shows no symptoms, than on day 5 to 6 the symptoms start and show the beginn of the clinical disease. In extreme it was found that this incubation period can last also between only 1 day and up to 14 days.For MDs: The serial interval in a study on 425 patients was found to be 7,5 days.
  • Duration of infectivity:

    In first studies these were the findings:
    • Throat : Up to 4 days from beginning of clinical symptoms in the patient
    • Saliva: Up to 8 days from beginning of clinical symptoms in the patient
    • Feces, urine, blood serum: No manifestion of COVID-19 measurable
  • Manifestation Index:

    Thats the figure showing how many of the infected will show clinical symptoms at all.

    Findings in different studies vary widely between 51%, 69% and 81% in evacuated groups of travellers.
  • Under Capture:

    Surveillance systems are bound to capture those infected.

    Those use different techniques and definitions to find infected among a group of citizen in a given population.

    In China surveillance systems were good to find 5% to 9,2%, meaning the number of infected people can be 11 or even 20 times higher than those recognized.
  • Lethality and deaths:

    This is the percentage of death in correlation to the number of those recognized as infected.

    Till today we have no significant numbers on lethality. Single studies in provinces of China or travellers on cruise ships show figures between

    At 27 Febr. 2020 3,5% or 2.747 people out of the recognized 78. 514 passed on in province Wuhan than raised to even 7,7% later.

    While in other Chinese provinces the percentage was significantly lower, meaning 0,8% death rates (103 out of 13.004 cases)
    • Lethality describes percentage of the deaths in correlation to to the infected number of patients. There are so far no significant data to that. If we imagine that we only diagnose a small percentage of the infected by our measures in a country or system that the real numbers of infection may be up to 10 or more times higher. Such the real lethality rate would drop significantly even below single digit numbers in reality.
  • Time from the onset of disease till patients developing pneumonia:

    In a chinese study (n=1.099) this was rated 4 days on an average (2-7 days in all cases). Of course not all patients develop a pneumonia. (See before).
  • Time from the onset of illness to hospitalisation: Different chineses studies show that from the onset of illness till beeing hospitalized people may take up to 7 days.

    Other studies showed: Even in light and in severe cases it takes up to 5 days till people are hospitalized.
  • Time from onset of illness till acute lung failure (ARDS):

    In severe cases where lung failure occurs chineses studies show it takes 8 to 9 days only.

  • Time from onset of illness till hospitalisation in intensive care units (ITS):

    Chineses studies:On an average it takes 10 days.
  • Time from hospitalisation till ITS:

    Chinese studies: On an average it takes 1 day
  • Set duration of hospital stay:

    In a chineses case study this time is mentioned to be on average only 10 days (7 to 14 days). WHO China – Joint Mission on Coronavirus Disease 2019 figures this in mild cases to be 2 weeks of hospitalisation and in more severe cases 3 to 6 weeks even.
  • Proportion of hospitalized among the sick:

    Normally this percentage is the figure of those patients having a severe cases of disease and have to be hospitalized in relation to those being diagnosed.

    Since every patient diagnosed was to go into quarantine is this disease, there is no way to find out this real proportion by now.
  • Proportion of those hospitalized with ventilation

    Different sources within China show 5-6% only, while China studies give us a number of 20 to 25%.
  • Proportion of those hospitalized who were treated on ITS (Intensive Care Units):

    No significant number available, inside China studies show 23 to 25%.
  • Proportion of invasively ventilated with extracorporeal membrane oxygenation (ECMO):

    There are no valid data on this so far. Studies available inside China vary from 6% to 24% to even 43% of all such treated patients.
  • Proportion of the deceased among ITS patients:

    No valid data yet available.
  • Asymptomatic and presymptomatic excretion and transmission:

    No significant evidence so far.
  • Tenacity activation of the corona virus on surfaces:

    Human pathogen viruses are known to be able to survive on surfaces like glas, metal or plastic for a certain time. Hereby the survival time is depending on other influences like temperature and humility.

    Since we have data on similar viruses to COVID-19 we can from there estimate that there is a similar behaviour, meaning the virus can be infectious up to 72 hours on such surfaces. It is therefore advisable to use surface disinfectants with proven limited virucidal activity. Those are suitable for inactivation of COROVID-19.
  • Vaccination:

    No vaccine is currently available. According to the WHO more than 40 substances are currently being developed. All are not yet finally tested, some are in preclinical trials and only ONE is in phase one of the clinical testing in the USA. Such it will take some more time to come up with a vaccine.

Sources:

(1): WHO. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). Report. World Health Organization (WHO); 2020 16-24.02.2020.

(2): RKI.de. SARS-CoV-2 Steckbrief zur Coronavirus-Krankheit-2019 (COVID-19). Robert Koch-Institute, 20th March 2020