Apr 23 2020
The entire world is taking various countermeasures to combat the novel coronavirus infectious disease (COVID-19), and Niigata University has decided to provide all classes in a non-face-to-face manner throughout the 2020 first semester as a measure to prevent the spread of COVID-19 infection.
Our decision is associated with the fact that the Japanese government has shifted the current containment measures against COVID-19 from "the border control measures" in the early stage; preventing the influx of infected people from abroad, to "the measures against cluster infections"; avoiding "Three Cs" (see below) and containing the spread of infection in clusters by follow-up investigations. Moreover, the government has now implemented "the restricting human mobility measures"; minimizing the movement of invisible infected people. As a result, the government declared the state of emergency for Tokyo and 6 prefectures on April 7, and it was also announced nationwide on April 16.
I have summarized the relevant basic knowledge here with the hope that you all will understand the background correctly regardless of whether you are in the liberal arts or sciences. There are several parts that overlap with my message on March 9 and April 6, but I have updated the contents and made them easy for new students to understand while they are being arranged to get to related materials and news articles for your advanced learning. I would suggest you just read the parts you are interested in.
?What is a virus and virus infection?
?What is the novel coronavirus infection?
?How do you get infected with COVID-19?
?What is a cluster infection?
?What are the symptoms of COVID-19?
?What is COVID-19 tested for?
?What is the treatment for COVID-19?
?What is a pandemic?
?What is overshoot?
?Why are preventive measures necessary?
?Washing hands and wearing masks
?Three Cs to avoid
?Social distancing
?Stay home and lockdown
?Daily precautions and emotional well being
?Prevention of prejudice and discrimination against COVID-19
Viruses are small particles consisting of a nucleic acid molecule (DNA or RNA) encased in proteins with a lipid envelope. Its size is about 100nm (1/10,000 of 1mm), which is too small to see with a light microscope.
Viruses cannot reproduce on their own, but can replicate by infecting (parasitizing) host cells, using host cell enzymes and cellular mechanism to replicate. Diseases which are induced from damage of the cells in our body by infected viruses are "virus infection".
There are many types of viruses, with different names. Influenza infection is caused by the influenza virus, norovirus infection is caused by the norovirus, coronavirus infection is caused by the coronavirus. Different viruses have different places (i.e., cells) in our body that they tend to infect and reproduce in. For example, norovirus tend to infect stomach and intestinal cells, causing acute gastroenteritis. Coronavirus tends to infect and reproduce in the throat, respiratory tract and lung cells, causing coughs, sore throat and pneumonia.
[Viral Infections / Discovery of the first coronavirus]
The novel coronavirus infection is a viral infection first recognized in Wuhan, Hubei Province, People's Republic of China in December 2019, and spread to other countries around the world within a short period of time. The World Health Organization (WHO) named the infection "COVID-19" and declared COVID-19 a pandemic on March 11. The Japanese government also declared the state of emergency for Tokyo and six prefectures on April 7 as the infection spread mainly in big cities, and the state of emergency was further announced nationwide on April 16.
Viral infection is specific to certain animal. Even among the same type of viruses, those infecting humans and other animals differ. Coronavirus is the same, and there were six known strains of coronavirus infecting humans, based on the genetic sequence. Of these, four comprise 10-15% of the cause of common cold, with only mild symptoms such as coughing and sore throat. The remaining two are the severe acute respiratory syndrome (SARS) which occurred in 2002, and Middle East respiratory syndrome (MERS) which occurred from 2012 mainly in the Middle East. COVID-19 is a new type of coronavirus that has a different genetic sequence from these six strains of viruses.
Generally, viruses that infect animals do not infect humans. However, in rare cases, viruses are transmitted from animals to humans (zoonosis). In such a case, the virus is normally not transmitted from an infected person to another person. However, a change in the viral genetic sequence may create a new variant virus that can be transmitted from human to humans. The origin of COVID-19 is yet to be known, however, it has been pointed out that the genetic sequence is similar to the bat coronavirus among the animal origin coronaviruses.
COVID-19 infection is a respiratory infection similar to the general coronavirus infection (so-called viral cold). Therefore, there are two possibilities: droplet infection and contact infection.
Although airborne infection is not considered to have occurred (infection caused by small aerosol particles), it has been pointed out that very small droplets (aerosols of about 5 μm or less in diameter) float in the air for a while.
Analysis of COVID-19 cases in Japan has identified cluster infection phenomenon. Cluster refers to a small group infection. It refers to a sharp increase in infection when a carrier is present in a crowded space with poor ventilation.
Therefore, COVID-19 causes infection of multiple persons if there is an infected person among a large number of people in a closed space with poor ventilation, where the group continue to speak in a close distance, even without coughing or sneezing. In addition to contact infection exhaled micro-droplets (aerosol) are known to cause infection in such an environment. This aerosol drifting in the air results in infection when inhaled through the nose or the mouth (i.e., aerosol or micro-droplet infection). This is how cluster infection occurs in the "Three Cs" (Closed spaces with poor ventilation, Crowded places with many people nearby, and Close-contact settings such as close-range conversations). This is also the reason we need to ask you to refrain from indoor student club activities, concerts, exercising in the gym, eating and drinking in groups, and so forth.
Many people infected with COVID-19 have an asymptomatic period of 3 to 14 days before showing signs of infections such as a fever (37.5 °C or higher) and common cold symptoms (coughing, breathlessness, dullness). Most people have their first symptoms within 3-5 days of contact with an infected person.
In general, many patients experience a fever and common cold symptoms for about a week, accompanied with extreme fatigue. It seems that symptoms are milder than influenza but continue longer. There are some people who experience diminished sense of smell and taste at an early stage, but this is not always a common symptom.
The symptoms differ by age, but overall, about 80% of patients have mild symptoms and recover in about a week. If this is the case, no special treatment is required, and resting at home should be sufficient. Resting at home while being careful not to infect family members and people around you is important to avoid transmission to other people.
On the other hand, if your fever continues for several days, breathing becomes difficult, or the coughs get worse, pneumonia is suspected. You should consult with the Consultation Center for CODIV-19 or other facilities by phone. For Niigata University students, please call the Niigata University Health Administration Center (Ikarashi campus: 025-262-6244; Asahimachi campus: 025-227-2040) on the phone for consultation.
Another feature of COVID-19 is that senior citizens and people with pre-existing diseases tend to suffer severe symptoms. According to the analytical data on occurrence in China, in contrast to the mortality rate for individuals aged 10 to 49 being only about 0.2%, it increases sharply to 1.3%, 3.6%, 8.0%, and 14.8%, for those in their 50s, 60s, 70s, and 80s, respectively.
A PCR (Polymerase Chain Reaction) test is conducted to determine whether a person is infected with COVID-19. This test has been used to detect the presence of bacteria, viruses, and other pathogens by rapid amplification of samples of their DNA and RNA. While antibody tests, rapid diagnostic test kits, and other methods are also being considered for faster detection, their development will take more time.
The PCR test for COVID-19 uses mucus obtained by taking a swab of deep inside the nose. Therefore, test results could be inaccurate if sample-taking is not done properly. Furthermore, this test looks for RNA specific to the novel coronavirus through rapid genetic amplification of the mucus sample with a special device. This process takes several hours and the results are not 100% accurate.
PCR tests are performed at public health centers in Japan only if deemed necessary by prefectural authorities, such as for people returning from overseas travel or those who have had contact with infected persons.
It has been pointed out that the number of PCR tests for COVID-19 performed in Japan has been extremely small. There sure are issues with the testing regime, but this is also due to Japan having taken a different prevention strategy from other countries during the initial stage of the outbreak.
There is still no specific remedy or medicine for COVID-19. At present, only symptomatic treatments are being administered.
As stated earlier, generally, around 80% of patients suffer only mild symptoms and recover in about a week. On the other hand, it must be noted that elderly people and those with pre-existing diseases tend to become severely ill.
In the mild cases, some patients are not even aware that they are infected and do not require any medical treatment. In cases where the patient experiences a fever and some coughing, medication is sometimes administered to help alleviate the symptoms (such as oral or intravenous antipyretic and cough medicines). The important thing is to take a lot of fluid and rest as treatment is basically similar to that for the common cold.
The problem is pneumonia, which causes the deterioration of pulmonary functions in severe cases, resulting in shortness of breath or even respiratory failure. Such cases require continuous oxygen administration and the use of ventilators to manage respiration. However, if the patient's condition deteriorates further and even a ventilator becomes ineffective, a life-support device called ECMO (extracorporeal membrane oxygenation) has to be used. This ECMO is a treatment employed for total pulmonary failure. It pumps blood from the patient's body, adding oxygen to it, and sends the blood back to the patient's body. Even young people may develop pneumonia, so they need to be careful.
While the development of various medicines and vaccines is currently being undertaken at a rapid pace, it should be expected to take a year before these products can actually be used.
Infectious disease outbreaks have three phases: endemics, epidemics, and pandemics.
Endemic: Group infection in a community or certain small geographic area. Spread of seasonal influenza falls into this category.
Epidemic (prevalence): Sudden increase in infections exceeding the expected level in a specific region or group is called an epidemic, and it may spread beyond region or country. In the past, the severe acute respiratory syndrome (SARS) infection fell into this category.
Pandemic: Simultaneous occurrence and spread of infections in multiple countries or continents. The largest pandemic was the Spanish flu between 1918 and 1919, and WHO declared a pandemic for H1NI Influenza in 2009. It seems that the WHO's decision on whether to declare a pandemic is based on an increasing risk of mortality as an index, taking the toxicity of the virus, the medical system of each country, the economic condition, etc. into consideration. Generally speaking, a pandemic causes disruption to global economy, and overwhelms the capacity of the current health care capacity. On March 11, 2020, the WHO declared COVID-19 a pandemic.
With the rapid spread of COVID-19 infection globally, there has been much talk about "overshoot" in Japan. While the terms "outbreak", "explosive rise" or "explosion" are used commonly in English speaking countries, this was the term used by the Expert Meeting on the Novel Coronavirus Disease Control in Japan to refer to an "explosive surge in the number of patients" with the spread of infection. The word "overshoot" can be interpreted as an abrupt change in the situation in an area experiencing only a slow spread of infection in the initial stage and a sudden exponential increase in the number of patients. As a result, this number rises at an uncontrolled rate on a daily basis, leading to an explosion of infections. As it is very important how to prevent this rapid change or overshoot for the infection prevention strategy at this point, the timing of lockdown or other measures has been a subject of much discussion in relation to the overshoot.
[How they flattened the curve during the 1918 Spanish Flu]
As COVID-19 infection spreads by the virus being carried from one person to another, the key is to eliminate the risks of infection. This disease is known to develop symptoms around 3 to 14 days after contact with infected people. It is also becoming known that COVID-19 carriers can pass on the virus to others even at the early stage of infection when distinct symptoms are absent. It is therefore assumed that in many cases, persons infect others without even knowing that they are infected themselves. This is one of the main causes of the rapid spread of this disease. It is essential that you all take it seriously and bear in mind the following points:
(i) Take care not to get infected yourself;
(ii) Always keep in mind that you might be infected yourself, and thus be careful not to infect others.
The following are tips to implement in daily life.
There is not much difference between the basic preventive measures against the new coronavirus and other infectious diseases. Therefore, it is important to prevent infection by following the general preventive measures. COVID-19 is transmitted by droplet infection and contact infection like the regular coronavirus, so the following points must be noted:
1) Hand washing: Thorough hand washing is essential, to avoid infection of mucous membrane of eyes and mouth from fingers contaminated with the virus. The virus attached to the handrails for stairwell, escalators, straps, doorknobs, tables and desks in public facilities is being reported to possibly remain alive for at least several hours and even for three days in some cases. In this regard, thorough hand washing after returning home is an effective preventative measure. I encourage you to follow "How to wash your hands properly" by the Ministry of Health, Labour and Welfare in Japan. You could watch to PPAP-2020-/PIKOTARO for your reference.
2) Wearing masks: The effects of wearing a face mask to prevent COVID-19 infection are the following two points.
(i) Avoid droplets of your saliva from spreading thinking that you might be infected;
(ii) Avoid direct contact with droplets of other people's saliva.
Therefore, if you take your mask off while having a conversation with others, it makes the whole thing about wearing a mask meaningless. Wearing a mask on your chin without covering your mouth and nose is also meaningless, and moreover unhygienic. Please make sure you wear your mask properly. A mask can be heavily contaminated if you or others surrounding you are infected. Once you wear a mask, never use it on the reverse side; be careful not to touch the mask's surface as the virus can attach to your hands and become a cause of contact transmission. It is ideal to replace your paper mask with a new one every day or use cloth masks with washing them every day.
There are various ideas on several websites, such as how to make a paper mask with kitchen paper, how to make a mask with a handkerchief, or how to make a cloth mask by sewing. It should be interesting if you try to make one in your own way.
Please remember to cough or sneeze into the bend of your elbow without covering your mouth with your hands in case you are not wearing a mask: cough etiquette.
According to the Expert Meeting on the Novel Coronavirus Disease Control in Japan, we are advised to avoid "Three Cs": Closed spaces with poor ventilation, Crowded places with many people nearby, and Close-contact settings such as close-range conversations. It is because these are the conditions that significantly raise the risk of infection, which may cause cluster infections mentioned earlier. Closed and crowded spaces where people intimately interact with each other create a hotbed for both contact and droplet infection. In consideration of this fact and actual cases of cluster infection that occurred in indoor sports facilities, student club activities and other extracurricular activities are suspended at the moment.
In light of the rapid spread of COVID-19 infection in urban areas, the government declared the state of emergency for Tokyo and other 6 prefectures on April 7 and nationwide on April 16 in accordance with the law. This has led to requests for closures of internet cafes, live-music venues, and karaoke for the same reason. In the Tokyo Metropolitan Area, some cases of infection have been confirmed at nightclubs and bars, so I urge you to refrain from not only parties but also part-time jobs. A case of contact infection through music game machines in Niigata City has been reported, so we are also asking to avoid going to video game arcades.
[Three Cs]
In addition to the basic infection prevention steps, what is needed at present is to keep a certain distance when in contact with other people. This is called social distance, which is the distance necessary to avoid droplet infection, and keeping this distance is called social distancing. This is set at 6 feet or 1.8 meters in the Western countries.
If we always keep the appropriate social distance, there is no way to find ourselves in the Three Cs and there will be no droplet infection. That leaves only contact infection.
While the appropriate distance is generally deemed to be 6 feet in other countries, Japan has a certain advantage because a majority of people wear face masks, but still, a distance of at least 1 meter has to be maintained when out and about.
Infection takes place through contact between people. Therefore, the most basic prevention method is to avoid contact. In that sense, social distancing is an effective measure.
However, it is not always possible to keep social distance when people engage in social activities. Depending on the nature of one's job, there is always the possibility of coming into contact with a number of people and being exposed to the risks of droplet or contact infection. The best way to prevent the spread of infection is to avoid all human contact. That is the reason for the appeal to "stay home."
At the local level, the best way not to spread the infection to other areas is for people in the contaminated areas not to go elsewhere. Restricting the movement of people in designated areas is called lockdown.
Lockdowns have been imposed in many cities in the Western countries in response to COVID-19 infection. All activities in these cities have been suspended and residents are prohibited from leaving their homes. For example, in France, people are only allowed to go out once a day for one hour within one kilometer from their homes and they are required to carry permits and identification when going out. Violators of this ban are fined 135 euro (approximately 16,000 yen).
Although Japan declared the state of emergency in Tokyo and six prefectures on April 7 and the state of emergency nationwide on April 16, the government cannot impose a stringent lockdown under the law. Therefore, the national and local governments have been issuing strong appeals for citizens to refrain from certain activities. However, the current state of the COVID-19 spread is extremely severe. We must seriously consider the fact that whether these voluntary restraints are observed and achieved will have a decisive impact on the infection situation in Japan from now on.
Below are the basic facts to consider on the alarming spread of the COVID-19 and its prevention:
Let me repeat that as the new semester begins, you should basically stay home. If you need to go out, please keep in mind the following:
(i) Avoid careless contact with other people. Refrain from shaking hands and doing high fives;
(ii) Maintain a safe distance (1-2 meters) from other people. Keep your distance from the person in front of and behind you when queuing;
(iii) Be sure to wash your hands after you touch objects, such as doorknobs, tables, desks, and other public surfaces. Do not touch your face before you wash your hands.
Always wash your hands after using the toilet. The novel coronavirus has been detected in the feces of infected persons. Therefore, rubbing the nose or mouth with virus-tainted hands exposes one to the risk of infection.
Your daily rhythm can be disturbed by refraining from going out. It is important to lead an ordered life by maintaining a well-balanced diet, getting moderate exercise and adequate sleep. We do advise that you avoid going out for unnecessary and non-urgent purposes, but needless to say, you can go out to get your groceries and basic necessities as long as you observe the preventive measures outlined above. It is fine if you want to take a walk in a sparse and quiet park or in the neighborhood on a sunny day.
Just be sure not to touch your face if you have touched something in a public space and wash your hands immediately when you return home. Those simple habits will protect yourself and lead you to enjoy life with peace of mind.
During the period of staying at home, there might be times when you feel lonely. However, never think that you are alone. Nowadays, you can contact your family and friends though e-mails, phone calls, or social media without seeing them in person. If you have something you are concerned about, please consult with people you can trust any time.
The Internet is inundated with an enormous amount of all sorts of news every day, including a fair share of fake news. We must be aware that lack of accurate knowledge and the proliferation of rumors and misinformation may give rise to prejudice and discrimination, such as:
?prejudice and discrimination against infected persons
?prejudice and discrimination against health care professionals working with COVID-19
In the former case, privacy may be violated completely, while in the latter case, for example children of health care professionals are being called "germs" in school. Parcel delivery service personnel may also face insensitive treatment.
Accurate knowledge is the most important for the prevention of prejudice and discrimination.
Infected persons are not criminals. Anyone could catch the novel coronavirus infection. Moreover, many patients suffer only mild symptoms, and this is a curable disease. In a sense, this is no different from the common cold or flu. Mutual respect is important and it is necessary to practice the basic prevention and response measures. As stated earlier, the basic prevention method is to avoid droplet and contact infection, and this is no different from the prevention of the common cold or flu. Therefore, there is no ground for prejudice or discrimination.
Please strive to obtain correct information and stay calm at all times. There is no need to be nervous unnecessarily or to instigate panic. We ask you not to be prejudiced when interacting with others.
[Article from American Psychological]
1. Q&A on coronaviruses (COVID-19) from the World Health Organization (WHO)
2. COVID-19 Map ? Johns Hopkins Coronavirus Resource Center
3. Coronavirus infection tracker -World Map- by Nikkei Asian Review
4. Coronavirus Business Update by Financial Times
5. A Paramedic Documents A Week Fighting The Pandemic in the United States
6. Coronavirus news, NHK World-Japan
USHIKI Tatsuo, MD, PhD
President
