Year of the Mask; COVID-19 Challenges for Orthopaedic Surgery

As a response to the viral pneumonias and severe illnesses that were emerging in patients, an ophthalmologist Dr Li Wenliang, working at Wuhan Central Hospital, voiced his concerns only to be severely admonished by the authorities. The accelerated spread of the Severe Acute Respiratory Syndrome (SARS) in Wuhan, and then globally, as a result of the novel coronavirus was acute and pronounced. China alerted the World Health Organisation to several pneumonia cases at the end of December 2019 and the first death was recorded in early January 2020. The respiratory physician Dr Nanshan Zhong, announced human-to-human spread and a few days later on the 23 January 2020, Wuhan was placed under quarantine. The virus spread outside China and the WHO declared the outbreak a global health emergency on 30 January 2020. Tragically Dr Li Wenliang died on 7 February 2020 as a result of exposure to the virus, leaving a five-year-old son and a pregnant wife. On 11 February 2020, WHO named the novel viral pneumonia as Coronavirus disease 2019 (COVID-19). The International Committee on Taxonomy of Viruses suggested the name ‘SARS-CoV-2’ as a result of their phylogenetic and taxonomic analysis of the virus. Coronaviruses belong to the family of Coronaviridae, and comprise of large, single, plus-stranded RNA with a 29,903 nucleotide genome. There are 4 genera (designated α, β, γ, δ) of coronavirus and β-CoV mainly infects the respiratory, gastrointestinal, and central nervous system of humans and mammals. 2019-nCOV is the 7th member of the family of coronaviruses. SARS-CoV and MERS-CoV also belong to β-CoV and the nucleotide sequence similarity between SARS-CoV and 2019-nCoV is about 79%. SARS-CoV-2 possesses the typical coronavirus structure with a spike (S) protein in the membrane envelope. This S protein can bind to the receptors of the host to facilitate viral entry into target cells and can also bind to the human angiotensin converting enzyme 2 (ACE2), but cannot bind to the human cells without ACE2. The high affinity between ACE2 and the S protein also suggests that the population with higher expression of ACE2 might be more susceptible to SARS-CoV-2. [1] It is highly likely that the virus originated in its natural host, the horseshoe bat (Rhinolophus affinis) and spilled out via some wild animals such as pangolins, and from a seafood and meat market into humans. The human to human transmission of the virus is via direct transmission (cough, sneeze, droplet dispersal and droplet inhalation) and contact transmission via oral, nasal and eye mucous