Virus World

Authorities have confirmed the death  of 38 cats died in South Korea due to avian influenza. It is the first time in South Korea that cats have died from avian influenza, and it is the second time in the world. 40 cats were being protected at a private cat shelter in Seoul,. On the 24th of last month, the cats started dying due to high fever and loss of appetite. 38 cats died in one month. A research team led by Professor Song Dae-seop of the Department of Veterinary Medicine at Seoul National University investigated and confirmed that it was H5N1 avian influenza.

Of the 38 dead, 35 were incinerated and 3 were frozen. The World Health Organization warned of the dangers of avian influenza by announcing the first case of avian influenza in which 29 cats died in Poland on the 17th. The quarantine authorities said they are conducting an epidemiological investigation and are preparing quarantine measures with domestic and foreign experts.

Researchers in South Korea found that roughly 30 percent of those infected never develop symptoms yet probably spread the virus. Of all the coronavirus’s qualities, perhaps the most surprising has been that seemingly healthy people can spread it to others. This trait has made the virus difficult to contain, and continues to challenge efforts to identify and isolate infected people. Most of the evidence for asymptomatic spread has been based on observation (a person without symptoms nevertheless sickened others) or elimination (people became ill but could not be connected to anyone with symptoms). A new study in South Korea, published Thursday in JAMA Internal Medicine, offers more definitive proof that people without symptoms carry just as much virus in their nose, throat and lungs as those with symptoms, and for almost as long.  “It’s important data, that’s for sure,” said Benjamin Cowling, an epidemiologist at the University of Hong Kong who was not involved in the work. “And it does confirm what we’ve suspected for a long time — that asymptomatic cases can transmit infection.”

Daegu, the city at the epicentre of South Korea‘s coronavirus outbreak, has filed a civil damages suit against a church that has been linked to over 5,200 of the country’s cases. Widespread infections among members of the Shincheonji Church of Jesus in February and March made South Korea the first country to have a major outbreak outside China. The city now is seeking 100bn won (£66m) in damages from the church for allegedly ignoring the city’s quarantine measures and allowing the disease to spread among its members. The church has insisted it fully complied with government efforts. At least 5,213 of the South Korea's total 12,484 Covid-19 cases have been linked to the church, according to the Korea Centres for Disease Control and Prevention.

Authorities had previously filed a complaint against the church, accusing it of refusing to submit a full list of members and facilities and not cooperating with city health efforts. The church’s founder, Lee Man-hee, has advised members who recovered from the virus to donate their blood plasma for coronavirus research. Around 4,000 recovered Covid-19 patients from the religious group have reportedly agreed to donate their plasma as a way to express gratitude to the government and medical staff. South Korea health officials have said that, in the absence of other treatments or vaccines, plasma therapy may be a way to lower the death rate, especially in critical patients. At least 17 South Koreans have received the experimental therapy, which involves using plasma from recovered patients with antibodies to the virus, enabling the body to defend against the disease. South Korea has reported 281 deaths from Covid-19.

South Korea reported more virus cases Friday and declared a “special management zone” around Daegu after an outbreak linked to a church. South Korea reported 100 new virus cases Friday, bringing the country’s total to 204, many of them clustered around a southeastern city, and raising fears that the outbreak is getting out of control. In the capital, Seoul, officials banned major downtown rallies and shut down a big park to avoid mass public gatherings where the virus could spread. Workers in protective gear also sprayed disinfectant in the city’s subway. Most of the new cases have been reported since Wednesday. The spike, especially in and around Daegu city, has raised fears the outbreak is overwhelming the region’s medical system. Many of the cases have been linked to a church in the city.

And the first two cases were confirmed in South Korea’s 600,000-member military, a navy sailor and an army officer who had both reportedly visited Daegu recently. Prime Minister Chung Se-kyun said in a televised statement the central government will concentrate its support to the southeastern region to ease a shortage in sickbeds, medical personnel and equipment. “A month into the (COVID-19) outbreak, we have entered an emergency phase,” Chung said. “Our efforts until now had been focused on blocking the illness from entering the country. But we will now shift the focus on preventing the illness from spreading further in local communities.”

The surge of infections in Daegu and several cases in Seoul with unclear infection routes forced government officials to acknowledge Thursday for the first time that the virus was circulating in the local population. Initial cases of the illness in South Korea had been connected to China, where the virus has infected 75,000 people and caused more than 2,200 deaths. South Korea on Thursday reported its first virus-related death, one of 11 outside mainland China. Daegu Mayor Kwon Young-jin on Thursday urged the city’s 2.5 million people to stay home and wear masks even indoors if possible....

A new COVID-19 study reveals children with coronavirus, even those who are asymptomatic, can shed the virus for up to three weeks following infection. New research suggests that children can shed SARS-CoV-2, the virus that causes COVID-19, even if they never develop symptoms or for long after symptoms have cleared. But many questions remain about the significance of the pediatric population as vectors for this sometimes deadly disease, according to an invited commentary by Children’s National Hospital doctors that accompanies this new study published online Aug. 28, 2020 in JAMA Pediatrics. The commissioned editorial, written by Roberta L. DeBiasi, M.D., M.S., chief of the Division of Pediatric Diseases, and Meghan Delaney, D.O., M.P.H., chief of the Division of Pathology and Lab Medicine, provides important insight on the role children might play in the spread of COVID-19 as communities continue to develop public health strategies to reign in this disease.

The study that sparked this commentary focused on 91 pediatric patients followed at 22 hospitals throughout South Korea. “Unlike in the American health system, those who test positive for COVID-19 in South Korea stay at the hospital until they clear their infections even if they aren’t symptomatic,” explains Dr. DeBiasi. The patients here were identified for testing through contact tracing or developing symptoms. About 22% never developed symptoms, 20% were initially asymptomatic but developed symptoms later, and 58% were symptomatic at their initial test. Over the course of the study, the hospitals where these children stayed continued to test them every three days on average, providing a picture of how long viral shedding continues over time. The study’s findings show that the duration of symptoms varied widely, from three days to nearly three weeks. There was also a significant spread in how long children continued to shed virus and could be potentially infectious. While the virus was detectable for an average of about two-and-a-half weeks in the entire group, a significant portion of the children—about a fifth of the asymptomatic patients and about half of the symptomatic ones—were still shedding virus at the three week mark.  Drs. DeBiasi and Delaney write in their commentary that the study makes several important points that add to the knowledge base about COVID-19 in children. One of these is the large number of asymptomatic patients—about a fifth of the group followed in this study. Another is that children, a group widely thought to develop mostly mild disease that quickly passes, can retain symptoms for weeks. A third and important point, they say, is the duration of viral shedding. Even asymptomatic children continued to shed virus for a long time after initial testing, making them potential key vectors.

However, the commentary authors say, despite these important findings, the study raises several questions. One concerns the link between testing and transmission. A qualitative “positive” or “negative” on testing platforms may not necessarily reflect infectivity, with some positives reflecting bits of genetic material that may not be able to make someone sick or negatives reflecting low levels of virus that may still be infectious.  Testing reliability may be further limited by the testers themselves, with sampling along different portions of the respiratory tract or even by different staff members leading to different laboratory results. It’s also unknown whether asymptomatic individuals are shedding different quantities of virus than those with symptoms, a drawback of the qualitative testing performed by most labs. Further, testing only for active virus instead of antibodies ignores the vast number of individuals who may have had and cleared an asymptomatic or mild infection, an important factor for understanding herd immunity. Lastly, Drs. DeBiasi and Delaney point out, the study only tested for viral shedding from the respiratory tract even though multiple studies have detected the virus in other bodily fluids, including stool. It’s unknown what role these other sources might play in the spread of this disease...

Original study published in JAMA (August 21, 2020):

https://doi.org/10.1001/jamapediatrics.2020.3988 

See also editorial (August 28, 2020)

https://doi.org/10.1001/jamapediatrics.2020.3996

Mobile phone and credit card data helped to identify nearly 250 coronavirus infections linked to a fast-moving outbreak that began in a popular nightclub district in Seoul. Soon after South Korean nightclubs reopened 30 April, public-health officials noted a cluster of COVID-19 cases among people who had visited Seoul’s Itaewon club district. Jin Yong Lee at Seoul National University Boramae Medical Centre and his colleagues used mobile phone location data, credit card payment records and other information to identify more than 60,000 people who had spent time in or near Itaewon clubs (C. R. Kang et al. Emerg. Infect. Dis. http://doi.org/gg4fhj; 2020) in late April or early May. All were encouraged to undergo testing for SARS-CoV-2.

By late May, officials had tested more than 40,000 people. The effort turned up 246 infections — including several that were 3, 4 and even 5 steps along the transmission chain from club-goers.

Oroginal Report at Emerging Infectious Diseases: 

https://wwwnc.cdc.gov/eid/article/26/10/20-2573_article

South Koreans are tested for COVID-19 in “drive-thru” spots. Patients go through a pre-screening booth where their symptoms are recorded and body temperature taken, then a nasal swab is taken. Results are received by text in 24h. If you have COVID-19 symptoms, the test is covered by the Government and you pay only 20% of the cost, about US$ 30. If you have no symptoms and you still wish to get tested, then you pay the entire amount, about US$ 150.

All South Koreans enjoy a universal “Medicare-type” insurance system provided by their government. Citizens pay a monthly tax in their paycheck. The cost varies depending on the income of the person. Cost is heavily biased, so wealthier individuals pay significantly more. A significant fraction of the population pays nothing at all. On average, South Koreans pay about US$ 100 per month (yes ! no typo, one hundred dollars).

The Government-based care usually covers most needs at 80%, and some at 100%. Citizens have the freedom to choose the hospitals and health facilities they visit. South Koreans can also access to corporate-based medical insurance if they wish. The South Korean government, as the major provider of health care, plays a major role in taken care of the prevention, surveillance and administration of therapies to its population. The differences with the US system are clear. Few people in South Korea complain about their health care system, which runs in the top 10% of the world’s health systems.

Next time you have to vote, think about the next pandemic, the choices you’ll have, and what your candidate plans to do with the dysfunctional insurance-bases health care system we have in the U.S.