The New Year with New Pandemic
As of 26 March 2020, 171 countries have been affected by the coronavirus disease 2019 or known as COVID-19 pandemic with 467,866 infected patients and 20,845 deaths, representing a 4.5% mortality rate (1). While, at the time of writing, China is the most affected country, the rate of infection in China has slowed down significantly; however, this is not the case in Italy or the United States, which are the second and third most affected countries, respectively. Association of Southeast Asian Nations (ASEAN) countries, including Malaysia, have not been spared from COVID-19, although there have been fluctuations in the rate of infection demonstrated in the number of new cases and deaths reported in March 2020 (Table 1) (2). Barely three months after the first reported case, many countries have ordered lockdowns, including Malaysia. The Malaysian government announced an initial movement restriction order on 16 March 2020 and an extension to mid-April. These measure have been enacted for good reason. The trend in new cases does not appear to have peaked yet for Malaysia or other ASEAN countries (Figure 1) (3), although there have been fluctuations in the death rates (Figure 2) (1) perhaps due to different critical care capacities and resources in these countries.
COVID-19 is likely a zoonotic infection, which was transmitted from an unknown animal or environmental source to humans. It is now spreading via human-to-human transmission with an average basic reproductive rate (R0) of 2.2. In other words, for each patient, 2.2 other individuals become infected (4). For comparison, the R0 for severe acute respiratory syndrome (SARS) was estimated at 3.0 and Middle East respiratory syndrome (MERS) was less than 1.0. Based on the epidemiological data from Wuhan, there are several notable differences between COVID-19 and SARS and MERS: i) case fatality rates are lower; ii) asymptomatic spread can occur and iii) fever is more frequently absent (5). Gastrointestinal complaints are uncommon among COVID-19 patients but loss of smell and loss of taste have been increasingly reported as early signs of infection. Severe acute respiratory illness (SARI) is a severe complication, and typical computed tomography (CT) features include ground-glass and consolidative opacities in the periphery (6). However, it must be borne in mind that SARI can also be a manifestation of respiratory illnesses with other infectious or non-infectious causes, which need to be ruled out before attributing the presence of SARI to COVID-19.