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Omicron 5, the fastest SARS-CoV-2 variant ever, has behaved and is behaving like a true “Formula 1” Ferrari.

It has acquired the ability to spread and infect as I had never seen in more than 40 years of medical experience in so many parts of the world and with infectious diseases, the most diverse and aggressive. In little more than a month the latest variant, from a few sporadic cases, 2/3 % of the total cases, entered almost every household and exceeded 70 % of the attendance. It has debunked all telegenic experts and radio amateurs and also accomplice to the “free everyone” given by the government and health ministry decrees issued in June following the example of many European countries, it has taken hold especially of younger individuals who, devoted to close encounters post-school and examinations, with rhythms of increasingly wild dances (as in our good old days) and choruses of live songs, have fostered with their scattered air droplets and droplet spread like fog, between a blaring song and a wild dance, all clinging together, one with the other tightly, the passage of the virus from person to person.

When I think of the last Santa Cecilia concert where we subscribers, a bit canine, were inside the “Santa Cecilia” hall, masked and alternating seats, a bit gasping. And in the Cavea thousands of young people, with their flames, hugging each other singing and shouting. The same kids who after two or three days had a family lunch with grandparents, parents, and aunts and uncles. How many of the prudent season ticket holders found themselves infected by the rowdy kids (good for them!!). A nice early summer lunch or dinner. All absolutely without a mask. As we all did.

The imposition of wearing this cilice, which fell with a series of government decrees, to the delight of many politicians and undersecretaries, has fostered the spread of the most prevalent virus that exists in the world at this time. Every family today has a few cases. And the Omicron 5 epidemic is spreading like wildfire. SARS-CoV-2 (initial) has mutated thousands of times, perfected in its ability to enter human cells and infect them, after the species jump from animals to humans.

Today’s Palio di Siena returned the city to its former glory. Tens of thousands of people crowded in and without masks. And from today the contrade festivities day and night. And tourists who will move everywhere from Siena. And the epidemic runs rampant. But someone had to think that on these occasions masks can be useful. Or can they?

Very aggressive, too aggressive initially not to arouse an immediate reaction of all humanity, and continually attacked by viral weapons of mass destruction (drugs, hyperimmune serums, vaccines), the virus in order to survive had to mutate by becoming less and less aggressive and more and more widespread. It would evade the human body’s defenses without doing too much harm to the host. Only in this way did it retain the ability to use humans as a reproductive cradle. And from variant to variant we have arrived at near perfection. A perfection that is also capable of decreasing the defensive capacity of the immune system, acting mainly on lymphocyte cells, and lowering defenses. But this virus does so much other damage, including promoting increased sugar levels and the onset of diabetes. A cunning little animal that masqueraded as Little Red Riding Hood, but remains a wolf underneath.

A “virus – microscopic animal” that spreads with just a few droplets. A virus-laden, imperceptible aerosol of saliva that spreads as we sing, squeal, call out for other friends. A kiss, a caress, and the virus reaches the first mucous membranes of the mouth and nose and begins its work of entry and reproduction. It multiplies, in those who have not killed or neutralized it earlier, beginning to inflame the nose, pharynx (the throat), larynx (hoarse, deep voice) and then tends to descend to the trachea and bronchi, especially favoring bacterial co-infections, which are the ones that can do harm and greatly worsen the clinical picture. Young people quickly outgrow the disease, and don’t think about chronicity, but they quickly pass it on to older people. And this is where problems can arise.

And this is where we clinicians have to intervene by reasoning when it is time for the different therapeutic actions to be taken. From the use of an essential anti-inflammatory, and pain reliever, to the essential antibiotic protection on secondary infections, When necessary, reasoned but sacrosanct, with antibiotics that have the greatest coverage and the greatest spectrum of action. If we follow the evolution, from nasal fontanelle, a true unstoppable flow of fluid from the nose, to a fricking throat, which then becomes pain, with lowering of the voice, and to some people the onset of fever, to others not. Headaches, burning meninges, quite frequently. And then great fatigue and confusion. Viruses and bacteria arm in arm come down and if we don’t stop them at the beginning, knowing the evolution, they get to the bronchi and then to the lungs. And when the disease advances and worsens, we should not fear the use of cortisone.

Treatment cannot be dictated by guidelines that are equally valid for everyone, written for those who know very little about clinical practice, but that must be tailored to the individual person, age, symptoms presented, and so on. As all the colleagues who read me and will have the pleasure of giving their opinion know, we have to adapt therapies to the person.

So this perfect machine, Omicron 5, runs on the track and is unstoppable. Those who know they have the virus should know that putting on the (fixed) mask avoids infecting others, and also spreading the virus in the environment. So those who are positive, use the mask and avoid walking around amplifying an infection that continues to make 70 to 100 deaths a day. If possible use your own bathroom or disinfect every time you use it. Eat in disposable plates and cups and then … orange and lemon juices, with ginger (strong antiseptic and immunostimulant), along with our best fruit. Olive leaf extracts, and a healthy diet based on plenty of fruits and vegetables. Control sugar at the end of illness, and even after a certain age a cardiological checkup.

And above all, those who have Omicron 5 do not follow the advice of some politician looking for easy votes, but think about your health and take care of those 4/5 days to get well again, without future consequences. And let us not abandon the use of the mask under certain conditions. We Italians in this we set an example to most foreign tourists who really behave recklessly.

But what are these variants of the COVID-19 virus. by ISS

dr.Paolo Meo tropicalist, infectious disease specialist

 

Cutaneous larva migrans (CLM) is a parasitic skin infection occured from the contamination of animal helminths.¹ The hookworm larvae penetrate the skin causing intensified itching and characteristic lesions. CLM is usually diagnosed on the basis of clinical presentation.²

Zanzibar, an island in the Indian Ocean which politically belongs to the Republic of Tanzania, is one of favourite destinations for European travellers. Even the COVID-19 pandemic and travel-related restrictions have not dramatically reduced the number of international tourist arrivals (the testing requirement in Tanzania was not introduced until 4 May 2021).

Polish tourists make up a large percentage of visitors to Zanzibar. Hundreds of Poles arrive there on direct charter flights; one of the top tourist locations is the Jambiani beach which stretches along the southeast coast of the island. In February and March 2021, several Polish travellers who had recently returned from Zanzibar (2–4 weeks before) were admitted to the University Centre of Maritime and Tropical Medicine (UCMTM) in Gdynia, Poland for the diagnosis and treatment of characteristic skin lesions localized on the feet (Figure 1). Four patients, aged 9–40 years old, of both sexes, had all been staying in different beach hostels in the vicinity of the Jambiani village. Each of the hostels consisted of between several and a dozen bungalows and offered accommodation for a maximum of several dozen guests coming from various European countries, mainly from Russia and Poland. The hostels were located directly on the beach, and therefore, some tourists were often walking barefoot when staying around their bungalows. Some hostels accepted guests with their pets at no extra charge, and for this reason, the presence of dogs on the beach did not come as a surprise either to the staff or to the vacationing tourists. Consequently, it was impossible to ensure that stray dogs do not enter the Jambiani beach.

Physical examination of the patients admitted to the UCMTM revealed erythematous, serpiginous or linear, pruritic lesions localized on the dorsal surface or soles of the feet. Each of the examined patients was diagnosed with hookworm-related CLM (hrCLM) and was prescribed oral albendazole 400 mg once daily for 3 days and additionally referred for liquid nitrogen cryotherapy applied once daily for 30–40 s near the head of the track (freezing of the larva; cryotherapy is discouraged as a treatment option for hrCLM by some experts who consider this method obsolete/the tissue damage can be worse than the effect on the larvae if applied for an effective time). Pruritus resolved within 2–3 days after initiation of treatment, while the skin lesions disappeared after 1–2 weeks of treatment.

Skin exposure to soil or sand contaminated with faeces of stray dogs or cats (while walking barefoot on the beach) was the potential source of infection. In the same period, multiple hrCLM cases were reported among 70 Danish students who had recently returned home after completing a 4-month internship at a school in Zanzibar that was located very near the beach with stray dogs.³

The larvae of hookworms which are present in the faeces of infected animals (mainly Ancylostoma spp.) can actively penetrate the human skin, but because humans are incidental hosts, the penetration is only limited to the skin and the parasites are unable to complete their full life cycle.¹ The diagnosis of hrCLM is based on the presence of characteristic skin lesions localized on the feet and manifesting with pruritus as well as a medical interview and travel history with direct exposure of the skin to beach sand.

Although the illness is self-limited, pharmacotherapy in the form of a single dose of ivermectin (200 μg/kg orally) or albendazole (400–800 mg/d orally for 3 days) aimed to kill the larvae migrating under the skin, helps to alleviate pruritus and heal skin lesions within 1–2 weeks of treatment initiation (the mean incubation period for hrCLM is generally 5–15 days).¹

There are, however, cases with long incubation period lasting up to 5 months.⁴ In such cases, pruritic lesions appear many weeks after a person had returned from a journey and are not necessarily associated with exposure to CLM.⁵ This is why a medical interview and a travel history are so important to establish an accurate diagnosis and prescribe the right treatment.

To date, the best way to prevent hrCLM is to avoid direct skin exposure to contaminated soil and sand; for this reason, travellers to destinations where hrCLM is endemic are strongly recommended to wear soft protective footwear so as not to come into direct contact with the dog or cat faeces which are considered to be the primary source of infection with CLM in humans.⁶

Taking care of the environment along the south-east coast of Zanzibar and ensuring that stray animals, whose excrement contaminate the soil, do not enter the beaches frequented by tourists are the recommended preventive measures against hrCLM transmission. Regrettably, they seem to be neglected by both local sanitary authorities and hotel staff.

articolo redatto da:
Krzysztof Korzeniewski, MD Journal of Travel Medicine, Volume 29, Issue 1, January 2022, taab136,