Mexico coronavirus update: the epidemic is clearly still active
As of July 13, 2020, there are 304,435 confirmed cases, 28,843 active cases, and 76,824 suspected cases of coronavirus in Mexico. There have been 358,663 negative cases, 35,491 confirmed deaths, and 189,063 recovered persons. Nationally, 55 % of general hospitalization beds are available and 45 % are occupied. In beds with ventilators, 61% are available and 39% occupied.
The coronavirus in Mexico is slowing down, said Dr. Hugo Lopez-Gatell. The Under Secretary for Prevention and Health Promotion said the epidemic is clearly still active and that the fact that the backlog of cases is increasing does not mean that transmission is accelerating.
The five entities with the highest number of accumulated cases distributed by entity of residence are Mexico City, State of Mexico, Tabasco, Puebla and Veracruz.
The scientist said that, as has happened in other countries, in Mexico there is also a risk that with the current process of deconfinement there could be a resurgence, but this is not yet the case. Dr. López-Gatell asked Mexican society to ignore the noise generated or manufactured from intentional distortions, this in reference to false news or lies that are transmitted through the media and social networks.Hugo López-Gatell has stated on several occasions that the clinical picture of covid-19 is very similar to that of Influenza-type Diseases and Severe Acute Respiratory Infections. The epidemiological surveillance system used by Mexico, the Sentinel, served during the first weeks of the outbreak to calibrate the actual volume.
The pace of the epidemic, as Lopez-Gatell has pointed out several times, is not identical throughout the country. With more than 120 million people in 32 states, the spread of the disease is now combined with a complex traffic light of the risk of contagion, political decisions, and urgency to revive local economies. This is why the authorities have spoken of epidemics, in the plural.
The detection of confirmed cases of covid-19 has not been particularly effective anywhere in the world, including Mexico. Because it is a new, fast-growing respiratory disease with a symptom picture similar to other infections, it is difficult to keep up with it through testing alone. It is necessary to complement these diagnoses with others that show deviations from previous years.
In this way, the real volume of the epidemic can be seen without exact numbers, but also without the need to rely exclusively on the testing system. In 2020, the number of consultations for diseases related to pneumonia and influenza is fifty times higher than the average of previous years.
The number of deaths has generated controversy, because patients who died without having the result of the coronavirus test take about seven days to be counted, while there is an unknown number of suspicious deaths that could not be tested and were not recorded.
Faced with the possibility of a new outbreak of influenza at the end of the year, he said the country is "prepared" thanks to the "hospital reconversion" that has taken place, in which intensive care beds have been increased from about 3,500 to 13,000.
The end of the healthy distance, imposed at the national level by the federal authorities, has led to greater management by the States. This has resulted in the growth of cases in several entities. The situation in Puebla, Tabasco, Nuevo León, or Guanajuato, regions spread all over the country, is striking. The volume of the epidemic in these states is lower than in the capital for now. But the rates are much faster, which points to a greater potential epidemic in the short term.
With the end of the day of healthy distance, President Andrés Manuel López Obrador resumed his tours. The decision was criticized, but it responded to the urgency of the Executive to reactivate the economy in several regions of the country, depressed after the monetary brake that the confinement meant. The president has decided to set an example and force a return to normality despite the fact that the health authorities continue to advise staying in the entire country, which is divided into two colors. Red warns of the maximum risk of contagion. And orange, a high risk of contagion.
Hugo López-Gatell reminded the population that although the epidemiological warning signals of the Mexican states change from red to orange, "the epidemic is not over, it is not going to be over soon".
"Still, in the state where you live, it is most likely that there is a high level of epidemic activity in all of them. Some will begin to emerge from that intense epidemic activity. You can always do something to protect your own health and the health of your family and loved ones and the community at large," the undersecretary said.
In his message, Mr. López-Gatell asked the entire population to wash their hands "as often as possible" with soap and water. If these resources are not available, he pointed out that alcohol gel can be used to disinfect hands.
When you go outside, do so only if you have to. If there is not a compelling reason to do so, stay home. It is still important to stay home.
He stressed the importance of maintaining a healthy distance from other people: to stop the spread of the COVID-19 virus, and the current pandemic, it is important that the airways (the nose and mouth) are not close to other people's faces.
Ricardo Cortés Alcalá, Director General of Health Promotion, has mentioned that the separation between people should be at least two meters (6.5 feet).
"Start talking if you need to, but the shorter the talk the better, and definitely two meters. If you are surprised by a sneeze and cannot contain it, do not cover it with your hands, cover it with your arm. Same with coughing. This should stay forever, not just now, forever," he said.
Why you should put on the face shield
Undersecretary of Health, Hugo Lopez Gatell, explained why the use of the mask is an auxiliary measure, despite the fact that some states will continue to restrict mobility in public spaces for a defined period of time, the mask has become an auxiliary element of prevention in closed spaces.
The use of this feature is recommended in places such as public transport, since it is impossible to maintain a healthy distance inside a minibus, bus or subway.
The use of the mask does not prevent a healthy person from catching Covid-19, but it does work so that an asymptomatic citizen or one who is infected and does not yet have symptoms can spread it to someone else. Previously, mouth coverings were not recommended because the emphasis was on keeping people at home, which led to a 75 percent reduction in expected cases.
Coronavirus in Mexico could last until March or April 2021
The arrival of the influenza season in the fall and a likely spike in coronavirus infections with the colder weather of that time could prolong the virus epidemic until March or April in Mexico, said Undersecretary of Health Hugo Lopez-Gatell
Health authorities have said that the epidemic will be long in the country, but have also failed to predict its behavior, delaying predictions of the peak or its end several times.
"In October, the influenza season begins and there are some reasonable assumptions that we could also have a spike in COVID-19 along with influenza throughout the fall-winter season," the assistant secretary of health told Radio Formula.
The official responded that he was "correct" to a question about whether there would be the talk of the epidemic lasting until March and noted that "until March-April of next year".
New coronavirus, the epidemic
In December 2019, Dr. Li Wenliang, of Wuhan City Central Hospital in Hubei Province, China, warned his colleagues on social networks about seven patients who had atypical pneumonia similar to severe acute respiratory syndrome (SARS). SARS killed nearly 800 people worldwide in 2003, in an epidemic outbreak that emerged in China. The police forced Dr. Wenliang to keep quiet, and we lost the opportunity to mow down the epidemic that now concerns us.
The situation soon worsened, and on December 12 the Wuhan City Municipal Health Commission reported 27 cases of rare viral pneumonia, seven of them from seriously ill patients. What caught the attention of the authorities was that most of the patients had been to the same Wuhan fish and seafood market, where you can also buy live all kinds of creatures that are an essential part of the various recipes of that region: insects, bats, hedgehogs, snakes, marmots, field rats and other animals that are poached and sold illegally.
At first, it was thought that the epidemic originated in this market, since many viral diseases arise from contact between animals and humans (zoonoses). However, since not all the infected patients had been there, it is possible that the epidemic originated elsewhere. It is now thought that an infected person most likely visited the market and infected several of the customers. However, the market was closed on January 1st.
Sensing that things would become more serious, the Chinese government reported the situation to the local office of the World Health Organization (WHO) on December 31. And it was right: by January 3 of this year, 17 new cases had already accumulated, two days later there were 59 sick people and by February 16 51,857 sick people and 1,669 deaths had been confirmed. Of these, only 683 cases and three deaths are not from China. It was soon discovered that the new virus is capable of human-to-human transmission, but it does so less readily than SARS and despite the huge number of people infected the disease is not as lethal. Although the figures are not yet clear, it is estimated that around 2% of those infected die. On 31 January, the WHO declared this epidemic an international emergency.
Given the seriousness of the situation, the Chinese researchers did everything in their power to identify the pathogen. In the first days of January, they were not only able to isolate, culture, and identify it, they also managed to decipher its genome. The evidence left no doubt that a new coronavirus was responsible for the epidemic; according to the WHO, coronaviruses are a large family of viruses that cause diseases ranging from the common cold to more serious illnesses such as SARS. They are zoonotic viruses, that is, they are transmitted between animals and humans. The new coronavirus is called 2019-nCoV and the disease it causes is called COVID-2019 (Coronavirus Disease and the year it emerged).
On January 5, researchers from the Shanghai Clinical Center for Public Health and the School of Public Health at Fudan University deposited the genomic sequences of the new pathogen in an international database, GenBank, so that scientists from other parts of the world can contribute to understanding and solving the problem. The analysis of these data determined that the pathogen was closely related to two other coronaviruses that have caused serious problems in the recent past: one of them, responsible for the SARS epidemic that emerged in China in 2002 and killed 10% of those infected, and the other, the cause of the Middle East Respiratory Syndrome (MERS) that emerged in the Arabian Peninsula in 2012 and killed 30% of those infected. Coronaviruses are so-called because when looked at under an electron microscope they look like little crowns seen from above. By the way, their "spikes" are crucial for the virus to start the infection.
At this moment there are already many genomic sequences of 2019- nCoV from different patients. With them, researchers have designed molecular diagnostic methods, based on the amplification of specific regions of the coronavirus genome. These methods are a key tool for controlling the epidemic.
What is a coronavirus?
Coronaviruses are a group of pathogenic viruses that usually affect birds, mammals, and other vertebrates. They usually produce infections in the respiratory tract, although they can affect the gastrointestinal tract and sometimes the nervous system as well. Coronaviruses belong to the subfamily of Coronavirinae, which includes four genera: alphacoronaviruses, betacoronaviruses, gamma coronaviruses, and deltacoronaviruses. Virus 2019-nCoV belongs, together with the viruses that produce SARS and MERS, to the betacoronaviruses. Many of the colds we suffer from each year are caused by some alphacoronaviruses, but the infections they induce are usually mild and quick to recover.
The genome of coronaviruses is made up of a single, large molecule of RNA. In fact, these viruses have one of the largest RNA genomes known. That the genome of these viruses is RNA is relevant because it makes them more likely to mutate and therefore to evolve rapidly. Coronaviruses have 4 important structural proteins, but the protein that forms the peaks (S-protein) determines which host and which organism it will be able to infect.
The origin of the epidemic
Coronaviruses usually infect a wide range of animals. In some, the infection occurs without causing any major harm, probably because they have evolved together over thousands of years and have managed to smooth out their roughness over time. These animals that allow limited reproduction of the virus without becoming sick are called reservoirs. In the case of the coronavirus responsible for SARS, the reservoir was the civets and in the case of the MERS coronavirus, the camels and dromedaries. With these data in mind, it is certain that the first victim of this new epidemic was infected by being in close contact with a wild animal and not necessarily within the Wuhan market. That is why the Chinese authorities have banned the trafficking and sale of wild animals.
For a virus from an animal to infect us, it has to go through a series of mutations that allow it to infect and replicate in human cells. Initially, these mutations allow the virus to "jump" from the animal to the human. However, infection is poor and human-to-human transmission is rare. For the pathogen to be transmitted smoothly from human to human, the virus needs to acquire new modifications in its genome. When this happens, an epidemic can emerge. Sometimes viruses acquire other mutations that further increase their ability to infect. The problem is that our immune system is not prepared to fight the new pathogen; that is, we do not have specific defenses against the disease it produces.
Analysis of the 2019-nCoV genome also suggests that this new virus is a "hybrid". On the one hand, it is clearly related to coronaviruses that live in bats, like the virus that causes SARS. On the other hand, it was found that a fraction of its genome arises from another coronavirus present in an animal species yet to be identified. The fraction involved is precisely the one that has to do with the elements that form the peaks of the virus and that plays a crucial role in the first steps of the infection.
A multidisciplinary group of Chinese researchers suggested that snakes could be that reservoir, but their conclusions were soon shown to be premature. Recently, Drs. Liu-Chen and Chen published an analysis of pangolin viruses in the journal Viruses and found coronaviruses very similar to 2019- nCoV, suggesting that the reservoir may be this small mammal illegally trafficked into China for use in that country's traditional medicine. Pangolins were not on the lists of animals sold at the Wuhan seafood market, perhaps because their trafficking is punishable by 10 years in prison.
How dangerous is the new coronavirus?
One of the problems with this new epidemic is not only that the symptoms of the disease vary greatly, but also that the time in which they occur changes: in some of those infected the symptoms occur after two days and in others up to 14 days. To make things difficult, at first patients have symptoms that can easily be mistaken for the flu: fever and cough, often accompanied by muscle pain, headache, and fatigue. Elderly patients or those with an underlying disease such as diabetes or hypertension may have difficulty breathing and even need mechanical help to do so. In the worst case, the infection is fatal.
There is not much to do in the face of a 2019-nCoV infection, as there are no specific antivirals or vaccines. It is up to doctors to mitigate the severity of symptoms and allow the immune system to fight off the invading pathogen. Still, some Chinese researchers are testing all sorts of antivirals to determine if any help is available, including those that work against the Ebola virus. The WHO and many researchers around the world are working against the clock to develop a vaccine, but it is estimated that it will take at least a year to be ready.
How it is transmitted
The main mode of transmission is from person to person, by inhalation of the droplets and aerosols that we expel when we cough and sneeze, but also when we speak and breathe.
In a recent investigation, laser lighting was used to count the droplets expelled by a person. Researchers counted 2,600 droplets per second when the person spoke and found that speaking louder increased the size and number of the droplets. They then calculated that one minute of speaking very loudly can produce at least 1,000 virus-carrying droplets.
According to another study, the largest droplets settle down by gravity after about four minutes, but smaller droplets can remain suspended for eight to 14 minutes, like cigarette smoke. Thus, it is much more dangerous to be with other people in an enclosed space than in the open air. A study in China found that out of 7,324 infections, only one occurred outdoors, and according to a Japanese study, the chances of getting infected indoors are almost 19 times higher.
Another Chinese study of a COVID-19 outbreak in a restaurant showed that an infected person (but still without symptoms) infected nine more people at other tables because the air conditioning system recirculated the viral load aerosols expelled by that person through talking and breathing. The distribution of those infected in the restaurant revealed that they were in the path of the air conditioning current. Surveillance cameras showed that those infected had no direct contact with patient zero. Neither the other 80 customers nor the eight waiters were infected despite the fact that the premises were small and had no windows.
In an outbreak in a 19-story building in busy downtown Seoul, the person who caused the outbreak was identified as working in a call-center on the 11th floor. More than 1,000 people lived in the building, sharing elevators and common areas. But the team that studied the outbreak found that of the 87 people who tested positive for COVID-19 throughout the building, 84 worked in the call-center. And of these, 79 spent their workday crowded together without ventilation in the telephone area. On the rest of the 11th floor, only five people were infected and on the other 18 floors only three.
These cases suggest that, in fact, the main form of transmission is not the surfaces one touches (elevator buttons, door handles), but the respiratory droplets that float in the air. This is why it is necessary to use mouth guards and to keep your distance both indoors and outdoors. Outdoors it is better to walk than to stand still in the same place as other people. Air currents help disperse the droplets and thus dilute the particle load with viruses.
Reactivate the society
The measures being recommended by health authorities generally tend to avoid overcrowding in enclosed places. Thus, to return to workplaces, for example, it will be necessary to recondition them by distancing the workplaces and separating them with screens, dividing employees into teleworking shifts (where possible), and installing ventilation systems that do not recirculate the air. It is recommended to use mouth guards and not to share materials. Meetings should be brief, infrequent, with few people, keeping a healthy distance and speaking quietly with mouth guards. People should not share food, drink, or eating utensils and should continue to wash their hands frequently.
Without vaccination, there will be no return to normal
Two types of preparations are being tested: the traditional ones, with virus fragments, attenuated viruses or deactivated viruses, and the genetic ones, with sections of SARS-CoV-2 genetic material. In both cases, the preparation will have to be tested first in cell cultures and in animals to see if it is not too toxic, and if it triggers a sufficient immune response. Then it will be tested on people, with several stages to establish that it has no harmful side effects and that the immunizing effect is robust, as well as to determine the correct dose. Finally, it will have to be approved by health authorities, mass-produced, and undergo quality control tests.
All of this will take time. It is estimated that there could be a vaccine by the summer of 2021. In the meantime, we have to integrate the protective measures we have become accustomed to in our lives. Lopez-Gatell compared it to what happened after the 1985 earthquakes: today we have internalized the "I don't run, I don't scream, I don't push", as well as the periodic simulations. They are now part of everyday life. So, also hygiene measures, distancing and the use of mouthguards have to be integrated into a new normal.
And what do I do?
The future of the epidemic does not only depend on government actions; our personal actions can dramatically determine the course of the epidemic and the recommendations of the WHO are simple: wash your hands frequently, do not touch your eyes, nose or mouth with dirty hands, when you cough or sneeze cover your mouth with a tissue or the inside angle of your elbow, do not come into contact with people you know are sick. If you get sick, you and your family should take the WHO guidelines very seriously.
Hospitals should redouble their procedures to prevent nosocomial transmission of the virus as many of the SARS and MERS infections occurred in these institutions and it appears that the new epidemic is no exception. In fact, Dr. Li Wenliang, who first raised the alarm about 2019-nCoV, died from the infection in early February. Last piece of advice: stay well informed and obey the instructions of the health authorities.
Take care of yourself!
By Mexicanist, Sources: daily and weekly updates from Hugo Lopez-Gatell, Mexican Undersecretary of Prevention and Health Promotion. And with information about the new coronavirus from Dr. Miguel Ángel Cevallos, a frequent collaborator of ¿Cómo ves? He is a doctor in basic biomedical research and a specialist in bacterial molecular genetics. He works at the Center of Genomic Sciences at UNAM. Also, Sergio de Régules who is the scientific coordinator of ¿Cómo ves? and winner of the National Award for the Dissemination of Science "Alejandra Jáidar" 2019.
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