The novel viral pneumonia (officially called COVID-19) started since December 2019 in Wuhan, Hubei province of China. Fever was the main clinical symptom. Some would also experience breathing difficulties with X-ray findings of infiltrative injury to both lungs. The cause of this novel pneumonia belongs to a class of virus called coronavirus. Other significant diseases such as SARS also belong to the coronavirus family.

Coronavirus (CoV) is an enveloped virus which gives its name from the crown-like spikes seen under electron microscopy.

Coronavirus infection among humans primarily involves the respiratory tract, including symptoms of general upper respiratory infection like nasal congestion, rhinorrhea, cough, and fever. However, infections caused by SARS-CoV, MERS-CoV, and COVID-19 (SARS-CoV-2) tend to be more severe than other strains of human coronavirus, with some cases developing severe pneumonia and even respiratory failure.

Apart from those transmissible to humans, other specific strains of coronaviruses are also known to infect animals such as bat, pig, cattle, turkey, cat, dog, and ferret. Case reports of animal-to-human transmission have also been reported.

When a pneumonia outbreak of unknown origin took place in Wuhan, China in December 2019, most cases could be traced back to Huanan Seafood Wholesale Market, a wet market selling seafood and wild animals. SARS-CoV-2 was detected in environmental specimens from this market; however, the exact source of infection remained elusive.
Besides, epidemiological studies of confirmed cases demonstrated infection among family members and healthcare personnel. As a result, it is highly probable that the risk of human-to-human transmission may be increased through respiratory droplets within close proximity, as well as direct or indirect contact with nasal or oral secretions and body fluids of infected individuals.
 

The main clinical manifestations of confirmed cases of COVID-19 are fever, general fatigue, respiratory symptoms, and dry cough, while some of them may even develop respiratory failure. In severe cases, the symptoms could progress to severe pneumonia, acute respiratory distress, or multiple organ failure, and shock. According to available epidemiological data reported so far, most patients eventually recover, but there are still some deaths. Most mortality cases had underlying diseases, such as diabetes mellitus, chronic liver disease, renal insufficiency, and cardiovascular disease, etc.

When travelling to epidemic regions or taking public transportation in those regions, wearing surgical face masks is recommended as a preventive measure, the same as preventing common respiratory tract infections.

If you have (1) traveled to or lived in epidemic regions during the past 14 days, or (2) been informed by health authorities that you were in contact with confirmed COVID-19 cases, and has developed a fever or respiratory symptoms during home quarantine, you should:

•  Put on surgical face mask immediately
• Contact the local health bureau, or dial the toll-free Taiwan CDC Infection Control Hotline 1922 for help, and seek medical service as advised as soon as possible.
• Be sure to inform the doctor of your travel history, occupational or other relevant exposure, and if anyone around you has developed similar symptoms.

After the SARS outbreak in 2003, Taiwan has been routinely screening for fever on all inbound international transportation at ports of entry and conducting quarantine assessments on the travel history of fever individuals. In response to the COVID-19 epidemic which first originated from Wuhan, China, the Taiwan Central Epidemics Command Center (CECC) has been constantly strengthening international epidemic surveillance as well as border control measures. To minimize the risk of any community outbreaks, passengers presenting with fever at international and Mini Three Links ports of entry are required to clarify any travel history to Wuhan and undergo comprehensive health assessment to evaluate the need of on-the-spot compulsory transfer to hospital (medical evacuation). For inbound travelers with upper respiratory symptoms who do not meet the criteria of compulsory transfer to hospital, they are required to complete the “Communicable Disease Survey Form” and receive “Notification of Compulsory Quarantine for Arriving Passengers with Suspicious Symptoms.” This is aimed at strengthening quarantine measures at ports of entry and to improve understanding of COVID-19 among the general public, while protecting domestic security at once.

According to the WHO and Chinese officials, the incubation period of the novel coronavirus between disease exposure to the onset of symptoms ranges from 2 to 12 days (7 days on average). However, 14 days of surveillance is required for those travelling to the regions of epidemic or in contact with infected patient(s) by the virus.

Apart from those transmissible to humans, other specific strains of coronavirus are also able to infect animals such as bats, pigs, cattle, turkeys, cats and dogs. There were also few cases of animal-to-human infection. Coronavirus can cause infection in humans and other vertebrates. Most types of coronaviruses transmit infection mainly via secretions and droplets. Some infected animals also suffer from having diarrhoea, and the virus present in the faeces can cause further disease transmission.

There is no vaccine as yet to prevent COVID-19. Prevention is the same as for other respiratory infections including washing hands frequently, wearing masks and cleaning up secretion from the mouth and nose appropriately. Other measures include avoiding crowded places such as markets or local hospitals, avoiding contact with animals and dead animals and avoiding eating raw meat or eggs. Additionally, you should wear masks and attend medical attention immediately when flu-like symptoms occur (such as body temperature ≧38℃, and coughing, etc)

Currently, there is no targeted treatment for COVID-19. Current treatment aims at supportive care. The anti-viral medications used for SARS have not been proven to help with the novel coronavirus infection. There is no vaccine as yet to prevent the novel (new) coronavirus. Please seek medical attention immediately if you are unwell.

Please wear a surgical mask immediately and call 1922 or local health bureau if you have been to or resided in the epidemic region affected by the novel coronavirus in the past 14 days, have been  identified as a contact of an infected person or have developed fever or respiratory symptoms. When you call for help, please seek medical attention as instructed and provide doctors with detailed travel history and occupational exposure.

For living environments such as furniture and kitchen, you can apply 1:100 diluted bleach (500 ppm). For bathroom or toilet surfaces, apply 1:10 diluted bleach (5000ppm) to disinfect. You should disinfect once a day with freshly diluted bleach and make sure there is good airflow to maintain good air quality.