Coronavirus disease-2019
As of April 3rdGeneral information
Introduction:
Coronavirus disease-2019 (COVID-19) is a disease caused by severe-acute respiratory
syndrome coronavirus-2 (SARS-CoV-2). This disease was identified firstly in Wuhan, China as
pneumonia with unknown cause on December 2019. In mid-January 2020, researchers in
China successfully identified the new virus and provided the basic information of the SARSCoV-2 genome sequence. At the same time, due to the Lunar New year holiday, a lot of people
in China travelled around the world and the global transmission was started.
As of March 30th, more than 150 countries have reported SARS-CoV-2 infection with morethan 690,000 positive cases1. World Health Organization (WHO) declared COVID-19 as apandemic on March 11th. It means that the outbreak was occurred worldwide. Most of theaffected countries have difficulties to contain the outbreak due to the complexity of social
consequences.
Pathogen:
SARS-CoV-2 is an enveloped, positive sense single-stranded RNA virus belonging to familyCoronaviridae genus Betacoronavirus. Other human-pathogenic viruses identified areclustered in this genus, such as middle east respiratory syndrome coronavirus (MERS-CoV)and SARS-CoV-1 which causes MERS (from 2012) and SARS (in 2003), respectively. The viruses(HCoV-229E and HCoV-OC43) that cause common cold also belong to this genus.
As an enveloped virus, SARS-CoV-2 genome is packed inside the double layered lipidstructure along with transmembrane protein e.g. membrane glycoprotein, hemagglutininacetylesterase glycoprotein and spike glycoprotein. Coronavirus mainly characterized by thespikes that form a crown-like structure. This structure is responsible for viral infection into
human cells2.
Transmission:
SARS-CoV-2 is transmitted by direct contact with an infected person or contaminatedobjects via droplets (sneezing, cough, saliva). Under the experimental condition, SARS-CoV-2
can remain on the surface of plastic and stainless steel until 72 hours. Furthermore, spreadingof SARS-CoV-2 in hospital setting is of concern due to the virus ability to remain infectious inaerosols3.
Symptoms:
In the early phase, COVID-19 mainly causes fever, fatigue and shortness of breath. Thesymptoms may appear around 2-14 days after exposure4. In the late phase, pneumonia isobserved in the patients.
Diagnostic:
To date, the golden method to detect SARS-CoV-2 is quantitative real-time reversetranscriptase PCR (qRT-PCR) assay. This assay targets viral genome in the swab samples

collected from patients or suspected persons. Besides, many nationalities also using serologic
test that detect antibody (immunoglobulin M (IgM) and/or IgG) from blood sample.
Current situation:
1. Worldwide- Disease transmission
To date, the center of infection has shifted from China to Italy then to UnitedStates of America. Most of the positive cases were reported due to contact tracingwith the cases. The diseases transmission is not only depending on imported cases,
but the existence of local transmission. Identification of a new cluster (group ofpositive cases which emerge at the same time and place) as soon as possible being
one of the keys to control the local transmission.
-Lockdown, quarantine and isolation
Some countries have locked down their territories to prevent a massive spreadingof COVID-19 to improve the health facilities, and try to find the best anti-viral anddevelop a good vaccine. They quarantined the people from the infected area atleast for 14 days and isolate all the patients.

-For more information, you can access WHO situation reports on
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situationreports

2. Japan- First case of local transmission
The first COVID-19 case of local transmission in Japan was identified in Tokyo at
the end of January, from a bus driver which have contacted with a group of tourists
from China. From there, the government conducted contact-tracing for everyone
who had the history to close contact with the cases.
-Current situation
As of April 3rd, 2020, COVID-19 cases in Japan have been reported from 44 out of47 prefectures with the highest positive cases reported in Tokyo, followed byOsaka, Kanagawa, Chiba, Aichi, and Hokkaido.

-COVID-19 situation in Hokkaido
The first case of COVID-19 in Hokkaido was identified in late January from a tourist
from Wuhan, China. Since then, Hokkaido had a rapid increase of the positive cases.
From February 28th to March 19th, the governor of Hokkaido Prefecture declared
the emergency status for Hokkaido prefecture. During that time, most of thepeople were asked not to leave their home during weekend, refrained fromvisiting crowded places and did not make any after work parties.
For more information about COVID-19 in Hokkaido, please visit: Website: http://www2.hiecc.or.jp/soudan/emg/index.html?lang=en
 Facebook: @Whatsoninsapporo
 Twitter: @PrefHokkaido (in Japanese)References:
1. Who.int. 2020. [online] Available at: <https://www.who.int/docs/default-

source/coronaviruse/situation-reports/20200330-sitrep-70-covid-19.pdf?sfvrsn=7e0fe3f8_4>[Accessed 7 April 2020].

2. Holmes KV. 2003. SARS coronavirus: a new challenge for prevention and therapy. J
Clin Invest 111:1605-9.
3. van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN,
Tamin A, Harcourt JL, Thornburg NJ, Gerber SI, Lloyd-Smith JO, de Wit E, Munster VJ.
2020. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. NEngl J Med.
4. Centers for Disease Control and Prevention. 2020. Coronavirus Disease 2019 (COVID19) – Symptoms. [online] Available at: <https://www.cdc.gov/coronavirus/2019ncov/symptoms-testing/symptoms.html> [Accessed 7 April 2020].

What should I do if …
Importance and purpose*You might not show symptoms even if you are infected, but you may be spreading thevirus.
*Protect yourself from COVID-19 is important but it is also important to protect people
around you in case you are infected.
*Please avoid going to hospital due to just feeling anxiety but no symptoms.
What should I do if …….
1. If I am sick now. Government set the definition of COVID-19 cases. If you meet
any of the criteria below, please contact to call center. Tel: 001-272-7119
a. You have fever above 37.5oC and fever doesn’t go away for 4 days.
b. Feeling tired badly (Fatigue) or difficulty in breathing (Dyspnea).
c. You are old (65 years or older), have underlying disease (Diabetes, heartdisease, respiratory disease) or under chemotherapy with symptoms above(a or b) for 2 days.
If my family/housemate is sick and relevant to #1, please contact to the call center,and follow guideline from government. See detail→COVID-19 preventive measures
2.

If I may have/ had contact with a COVID-19 case. Have chatting without protection(like masks) and face to face within 2 meters for a while.

About call center
http://www.pref.hokkaido.lg.jp/ss/tkk/koronasoudantoiawase.html
Hokkaido Foreign resident Support Center
http://www.hiecc.or.jp/soudan/en/
General Information about Corona in English
http://www.clair.or.jp/tabunka/portal/info/contents/114517.php
Where should I call in Sapporo?
Emergency or you have symptoms now→ 011-272-7119
General question about COVID-19.
→ 0120-565653

COVID-19 preventive measures
Importance: aimed at limiting and delaying COVID-19 spread and tracing all contacts orhealthy carriers and spread of COVID-19
COVID-19 can be transmitted easily: (or high-risk occasions for COVID-19 transmission)- When droplets by close contact during talking, chatting or eating- By contaminated fomites (when handling infected tools or objects, shaking hands, …)- In close and unprotected contact with COVID-19 sick person or prolonged contact
with asymptomatic person
Warning: protect yourself and protect other persons
Classical health measure at individual or community level can protect everyone from COVID19
Individual hygiene measures- Hand hygiene practices to reduce risk of infection from direct contact withcontaminated fomites. Wash hands using water and soap, hydroalcoholic solution or
clean hands with alcohol based wet wipes.
- When coughing or sneezing, cover the mouth and nose with a tissue-paper tocontain droplets- Wear facemask if you have cold or cough to limit the risk of being infected or
shedding virus by droplets- Discard tissue-paper or used facemask in a trash cane
- Don’t greet by shaking hand, kissing or embracing- If you have fever or cold, call directly (toll free call)- If you have been in contact with somebody who is suspected or confirmed COVID-19
diseased, call a medical staff (toll free call)- Make attention to sharing items (computer, phone, ….)- Avoid touching your face, eye or nose with you hand
Community-based measures
Warning: People who do not show symptoms can spread COVID-19. Protect yourself orother people
Community containment: Isolation / quarantine and keep social distancing.
- Avoid close contact at the individual level and social meetings to limit virus spread- Movement limitation or self-isolation: Stay at home to avoid any contact with any
sick person or SARS-CoV-2 healthy carriers or when having respiratory symptoms- Social distancing, keep at least 1m distance each other persons (especially those withfever, cold or cough)- When you have fever, Cough or chill and respiratory symptom, stay at home andreport your situation to (toll free call) for early identification and isolation or wear
mask to go to hospital- Report any sick person and help to save lives and identify COVID-19 carriers- Avoid crowded placeReferences
Ng Y., Li Z., Chua Y. X., Chaw W. L., Zhao Z., Er B., Pung R., Chiew C. J., Lye D. C., Heng D. &Lee V. J. 2020. Evaluation of the Effectiveness of Surveillance and Containment
Measures for the First 100 Patients with COVID-19 in Singapore - January 2-February
29, 2020. MMWR Morb Mortal Wkly Rep 69: 11, 307-311.
Remuzzi A. & Remuzzi G. 2020. COVID-19 and Italy: what next? Lancet.
Wilder-Smith A. & Freedman D. O. 2020. Isolation, quarantine, social distancing andcommunity containment: pivotal role for old-style public health measures in the novel
coronavirus (2019-nCoV) outbreak. J Travel Med 27: 2.
Adhikari S. P., Meng S., Wu Y. J., Mao Y. P., Ye R. X., Wang Q. Z., Sun C., Sylvia S., Rozelle S.,
Raat H. & Zhou H. 2020. Epidemiology, causes, clinical manifestation and diagnosis,
prevention and control of coronavirus disease (COVID-19) during the early outbreakperiod: a scoping review. Infect Dis Poverty 9: 1, 29.

https://www.pig333.com/company_news/containment-measures-for-coronavirus-covid-19on-pig-farms_15954/
https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirusinfection/health-professionals/public-health-measures-mitigate-covid-19.html

Challenges
1.
Asymptomatic Cases
The main way to spread the virus is by droplet from an infected person. People withsymptoms shed high amount of virus and are the primary source of infection if not isolated
and treated1. However, some infected people develop no symptoms2. These infected people
without symptoms may pass on the virus to others accidentally or unknowingly. Some reports
point to this possibility. For example, in China some members of a family who had contact
with an infected person a day before they showed symptoms later tested positive to COVID193. A report from Singapore in which several people developed symptoms days after contact
with infected persons before they developed symptoms also raise the possibility of presymptomatic transmission4.
2.
Unknown information
There are reports of positive test to the virus after recovery5. It is unknown if these cases werereinfection or the viral particles detected where remnants of the previous infection. It isunclear if such cases can spread the virus. There is also limited information of virus
neutralizing capacity of antibodies in recovering patients. Such information can help in
determining the immunity of recovered patients and help in development of vaccines. Yet
still, treatment of COVID-19 is unknown. There is still no approved drug nor vaccine for use
against COVID-19 yet.
3.
Diagnostic methodsThe rapid transmission of COVID-19 requires a rapid and accurate diagnostic test. The
available qRT-PCR test used for confirmation of COVID-19 has shown varied ability to detect
positive cases of COVID-196,7. When combined with Chest X-ray, detection of patients withsymptoms is improved. Several new tests with improved detection ability in a short period
are being developed and evaluated.
Suggestions:
1. There should be increased collaboration between scientists and policy makers ingovernment to help better understand the COVID-19 disease and use such knowledgeto make effective control measures.
2. Improved case definition for diagnosis to include mild cases of COVID-19.
3. Intensified contact tracing to identify exposed persons. This should include contacts
during the asymptomatic phase of the disease as there is a possibility of transmission
before symptoms occur.
4. The government should improve information sharing system. For example, to theextent possible share the information used as a basis for a decision. This will help
public understand the rationale of the decision and avoid misunderstanding ormisinterpretation.
References
1.
Pan Y, Zhang D, Yang P, Poon LLM, Wang Q. Viral load of SARS-CoV-2 in clinicalsamples. Lancet Infect Dis. 2020;20(4):411-412. doi:10.1016/S1473-3099(20)30113-4
2.
Mizumoto K, Kagaya K, Zarebski A, Chowell G. Estimating the asymptomatic
proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond
Princess cruise ship, Yokohama, Japan, 2020. Eurosurveillance. 2020;25(10):1-5.
doi:10.2807/1560-7917.es.2020.25.10.2000180
3.
Guoqing Qian*1, Naibin Yang*1, Ada Hoi Yan Ma2, Liping Wang1, Guoxiang Li1,Xueqin Chen3 XC. A COVID-19 Transmission within a family cluster by4.
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presymptomatic infectors in China. J Chem Inf Model. 2013;53(9):1689-1699.
doi:10.1017/CBO9781107415324.004
Vol ER, Wei WE, Li Z, et al. Presymptomatic Transmission of SARS-CoV-2 —Singapore ,. Morb Mortal Wkly Rep. 2020;69:1-5.
OSUMI M. Questions raised over COVID-19 reinfection after Japanese woman
develops illness again. The Japan Times. February 2020.
Kim S, Kim D-M, Lee B. Insufficient Sensitivity of RNA Dependent RNA Polymerase
Gene of SARS-CoV-2 Viral Genome as Confirmatory Test using Korean COVID-19
Cases. Preprints. 2020;(February):1-4. doi:10.20944/PREPRINTS202002.0424.V1
Strunk JL, Temesgen H, Andersen H, Packalen P. Correlation of Chest CT and RT-PCR
Testing in Coronavirus Disease. 2014;80(2):1-8. doi:10.14358/PERS.80.2.000