Disclaimer: This is a general overview of COVID 19. A lot of the information is evolving therefore kindly refer to the CDC or your country’s public health agency.
I am a practising physician, an Internist and hospitalist working in the USA and this is my small attempt to raise awareness about this virus.
What is COVID 19 or SARs COV 2?
COVID 19 or SARs COV 2 is the virus (severe acute respiratory syndrome coronavirus 2) which is responsible for the pandemic across the world. It originated from Wuhan, China. We first learned about it when a cluster of cases with severe pneumonia was reported around New Year’s Eve 2019.
Some facts: As of today:–
World over 12.9 million cases and over 571 thousand deaths.
Equally important! Over 7 million recoveries!
US: over 3.3 million cases; 137,000 deaths and over 980,000 recoveries. Curve going up again.
India: over 878,000 cases. Over 23000 deaths 553,000 recovered- cases still rising
UK: 290, 000 cases. Over 44800 deaths.
China 85,522 cases. Reported Deaths: below 5K
Italy: 243,000 cases Deaths: 34,954 and 1.9 million recovered. Less than 300 cases are being reported everyday now. Lockdown worked!
Spain: 254,000 cases. Deaths 28,403. 150K recoveries.
South Korea: 13,479 cases. 289 deaths. 12,204 recoveries. Over 90% recovery rate!
Japan: 21,500 cases.. Below 700 deaths.
Hongkong: 1522 cases. 8 deaths. 1217 recovered!
One death is too many. Yet it is important to know that most people who get the infection recover.
Overall death rate is probably less than 1% (as many cases are asymptomatic and undiagnosed). It’s also important to keep in mind that this rate is considerably higher in the at risk population.
The mortality (death) rate in India is much lower than other countries – (why?- unaccounted deaths (doubt), underlying resistance/immunity which ‘protects’ against severe illness?)
Besides the above the cost of the infection has been much higher- people have lost their livelihoods, their jobs and businesses have been shut down- some permanently. It has also had a huge mental health cost– such as isolation, lack of contact with your loved ones and dying alone from the disease.
As we all know people are getting frustrated and they want to know when it will end. Unfortunately that is anyone’s guess.
- What is the incubation period (How long to symptoms after exposure): upto 14 days, average 4-5 days.
- Asymptomatic (people who are infected but don’t show symptoms) transmission has been documented.
- Diagnosis of infection is by the molecular or antigen test. A single negative test in a patient with symptoms and or high risk exposure does not rule out infection. Repeat testing should be done.
- What is antibody testing? Antibody test is a blood test which can detect recent or past infection with COVID 19. It may take 21 days or longer for someone to turn positive (seroconvert). It is not recommended for diagnosis of infection.The antibody tests available so far are not 100% sensitive and there can be both false positive and false negative tests. No antibody test has been approved so far in the U.S.A.
- What can the antibody test be useful for?
-It can be used to see who is able to donate plasma.
-Assess the number of people who have been exposed in a community
-Assess degree of response to a vaccine.
-Important! having antibodies to SARs-Cov-2 doesn’t mean you are immune to it.
Therefore PLEASE continue to wear a mask and maintain social distancing even if you have had the infection or have detectable antibodies in your blood.
6. How is it transmitted: COVID 19 is a respiratory virus hence is transmitted by inhalation or touching contaminated surfaces and then touching face, nose or mouth.
Therefore wearing a mask and washing hands makes sense!
7. Is the virus airborne (does it spread over long distances)? Virus spreads through the breath. According to the latest news it is suspected that the virus could be airborne, i.e. it may spread over distances longer than 6 ft and it may hang around in the air for a prolonged period of time (several hours) even after the source (infected person) has been removed. Virus may travel more than 6 ft in poor ventilated versus in well ventilated areas. AVOID CROWDED INDOOR SETTINGS ESPECIALLY WHERE PEOPLE ARE NOT WEARING MASKS. Further investigation is underway.
Examples of infections with airborne transmission: tuberculosis, measles.
8. I have been exposed to COVID 19 can I take any drug to prevent getting sick?
No drug so far has been found to prevent the disease after exposure. (research is underway)
9. I am traveling to a high risk area. Can I take any drug to avoid getting COVID 19? No drug so far is approved for prophylaxis. (research is underway)
10. What kind of illness do people get?
Illness ranges from Asymptomatic and mild to severe pneumonia or acute respiratory distress syndrome with multiorgan failure and death.
11. What are the symptoms?
Most common: cough; fever or chills; difficulty breathing; diarrhea and nausea.
Other symptoms: Can also have sore throat, ‘cold’ symptoms, headache, dizziness, loss of taste and smell.
12. Types of illness:-
Asymptomatic or presymptomatic: those who test positive but don’t have symptoms. They should Self isolate at home for 14 days.
Mild: those with symptoms but no difficulty breathing or abnormal chest x ray. Recommendation is to Self isolate at home. Close monitoring for worsening. No specific tests or treatment.
Moderate: people who have evidence of lung disease by clinical symptoms or abnormal chest xray but have normal oxygen levels.
Severe: those with reduced oxygen levels, difficulty breathing, > 50% infiltrates on chest xray.
Critical: those with respiratory failure, shock, and or multiple organ failure.
One of the unusual manifestations of the COVID is neurological or neuropsychiatric illness– strokes and altered mental status- confusion, loss of cognition, and psychosis which can occur de novo or worsen pre existing illness.
In children severity of illness is judged based on oxygen levels. Though generally the disease is less severe there has been an association with a severe illness called Multisystem inflammatory syndrome in Children (MIS-C). https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/children/mis-c.html
Pregnant women maybe at higher risk for severe illness.
13. Who is most likely to get severe illness or die from COVID 19?
People who are 65 or older
Those with preexisting illness including but not limited to:- high blood pressure, diabetes, heart disease, lung disease, cancer, kidney disease, obesity.
14. What is the current treatment?
Recommendations are still evolving. As of date– no FDA (Food and Drug Administration) approved drugs for treatment of Covid 19 in the USA.
However there are recommendations based on clinical trials/research that have been completed or are ongoing:–
Please understand that the ultimate choice of whether to use a certain treatment or not is decided by the patient in consultation with his/her doctor.
1.Remdesivir is an antiviral agent approved by EUA (emergency use authorization) recommended for those hospitalized with severe infection– i.e. requiring oxygen or on mechanical ventilator or ECMO (extracorporeal membrane oxygenation)
Only hospitalized patients can receive remdesivir.
Costs $3.120 for five day treatment course.
2.Dexamethasone – a readily available inexpensive steroid with potent antiinflammatory effects is recommended for those with severe illness i.e. requiring oxygen or on mechanical ventilation.
3. Convalescent plasma – (plasma from those who have recovered from COVID 19). Is being used widely but does it really work. Data is insufficient so far. Is generally considered safe and is inexpensive.
There is insufficient data to recommend for or against use of Interleukin 1 and Interleukin 6 inhibitors. Trials underway.
Currently we are using the triple cocktail of convalescent plasma, remdesivir and dexamethasone in people with severe illness who are hospitalized with COVID 19.
Chloroquine and hydroxychloroquine is no longer recommended for treatment or prophylaxis.
15. Prevention is better than cure! As there is no magic bullet so far which cures this disease.
Because the virus is transmitted via respiratory droplets/aerosol and contaminated surfaces.
Wear masks covering your nose and mouth and maintain a physical distance of at least 6 feet. Wash hands with soap and water for at least 20 seconds regularly and several times a day.
Isolate: those who test positive or have symptoms and or have had high risk exposure (see close contact below)
Self isolate for at least 10 days from onset of symptoms and until you have no fever for at least 3 days (without need to use medicines) and improvement of cough and breathing.
Asymptomatic (positive antigen test, no symptoms): self isolate x 14 days
A Vaccine that works will be the best answer. Many are in phase 3 trials. It’s not yet known if these vaccines will lead to protective immunity and if so for how long.
16. What is contact tracing?
Identifying those people who have been in close contact with a known or potentially infected person– within 6 feet and for longer than 15 minutes.
17. Why contact tracing?
To identify potentially infected persons who have the ability to infect others.
18. Why lockdown?
COVID 19 is highly infectious. 1 person with COVID 19 can potentially transmit infection to 2.5 people (R0 or R naught). The infection can then spread exponentially. Since many among these people can have minimal or no symptoms they will continue to spread the infection.
Lockdown or forced quarantine is a way to prevent this uncontrolled spread of infection (reduce R0) so hospitals don’t get overwhelmed and people who need help are able to get it.
Precautions can potentially be removed once R0 has become less than 1 or 1 infected person is spreading the infection to less than 1 person.
19. What is the mortality or death rate from COVID 19?
It is probably less than 1% (since 100% of the population hasn’t been tested and there are many people with asymptomatic/mildly symptomatic disease.)
20. What do people from covid die from?
Most people who die due to COVID 19 die from severe lung disease called ARDS (acute respiratory distress syndrome) and multiorgan failure.
21. Is a person who recovers from COVID 19 still infectious?
CDC (centers for disease control) has established symptom based criteria for those people with covid to return to regular life–you have remained isolated for at least 10 days after your symptoms first appeared AND at least three days (72 hours) after recovery (absence of fever (without use of fever reducing medicines) and significant improvement or resolution of cough, shortness of breath etc.
22. Does a person who has recovered from covid become immune to getting infected again?
So far it is unknown how long antibodies last in the body and if they are protective or not.
23. What is the risk of reinfection? It is unknown. Therefore continue to use precautions.
24. I think I may have been exposed to COVID but haven’t been able to get tested. What should I do?
If you think you have been exposed and are asymptomatic please self isolate (quarantine) yourself for 14 days from the day of exposure and monitor for signs and symptoms.
25. I think I may have been exposed to COVID and have mild symptoms.
Isolate and monitor for worsening symptoms.
You can discontinue isolation if it has been 10 days after your symptoms first appeared AND at least three days (72 hours) after recovery (absence of fever (without use of fever reducing medicines) and significant improvement or resolution of cough, shortness of breath etc.
26. Can a person with covid 19 get infected with another virus or bacteria at the same time– Yes it is possible.
27. Who should be tested?
Anyone who thinks he or she has been possibly exposed should be tested even if they don’t have symptoms (asymptomatic infection). As this person can transmit infection to someone else.
28. Avoid dense and large gatherings such as pubs, bars, concerts,
Being outdoors is better than indoors- due to better air circulation.
Take home points–
COVID 19 is NOT A HOAX!
If you care about your health and that of your loved ones Please:–
WEAR a MASK in public spaces.
MAINTAIN Physical distancing- 6 ft from others.
WASH hands with soap and water for at least 20 seconds (hmm happy birthday song twice) and often.
AVOID large gatherings.
AVOID poorly ventilated areas. Outdoors is better than indoors.
Maintain healthy habits: Get enough sleep, eat more whole plant foods, limit added sugars, limit alcohol, get adequate exercise, manage stress (easier said than done).
PRAY FOR AN EFFECTIVE VACCINE.
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