What Doctors Know About COVID‑19

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Coronavirus Pathology

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Though I occasionally work with scientists, I am not one. My job is to help distill informa­tion into a lucid format. Findings within this article and adjoining references are from experts much smarter than me who analyze rapidly changing data.

The virus is labeled as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 is the disease caused by SARS-CoV-2. Coronaviruses derive their name from the cellular protru­sions, which resemble a corona flares from the sun.

On the way to 1 million cases, epidemiologists can explain how the disease spreads, but not yet how to package prevention into a vaccine. There are 20 drugs and the same number of vaccines under clinical trial, and it is too early to make recommendations about the efficacy of any for the treatment of the virus. COVID-19 is a rather weak pulmonary virus who’s membrane can be destroyed with detergents. It gains strength by attaching itself to other cells where it can proliferate.

Clear explanation (for physicians) of how COVID–19 replicates by Dr. Seheult of Med Cram.

When confined to the nasal cavities, COVID-19 may manifest common cold symptoms. If the virus advances to the lungs, it can fill areolae with fluid. This causes Acute Respiratory Disease Syndrome (ARDS), which interferes with oxygena­tion of blood cells, hindering thermoregulation. External mani­festa­tions are fever and cough. By mimicking healthy cells, COVID-19 evades natural defense by the immune system.

Some people misconstruing effects of zinc believe that oral mineral supplements ward off COVID-19. Zinc is beneficial at the cellular level. While taking oral zinc supplements may help recovery of some viruses, it is ineffective for COVID-19.

Oxygenation by means of a ventilator does little unless excessive lung fluid is displaced. I imagine something like the 50-year-old Bird Mark 7 Respirator could be a viable delivery system for pulmonary medica­tion. But there is not yet a drug guaranteed to work. So we must leave symp­toma­tic treat­ment to doctors.

How This Coronavirus Spreads

COVID-19 transmission is primarily via inhaled droplets from a cough or sneeze. It can also be transferred from a contaminated surface to the eyes, nose or mouth. One study suggests COVID-19 (SARS-CoV-2) is trans­mis­sible via feces. The toilet bowl, sink, and bathroom door handle of an isolation room housing a patient with the novel coronavirus tested positive for the virus, raising the possibility that viral shedding in the stool (anatomization during flushing with toilet seat up) could represent another route of transmission. To avoid feces contamination, the China CDC recommends washing your hands frequently, disinfecting surfaces, maintaining personal hygiene, avoiding the consump­tion of raw food, boiling water before drinking it and disinfecting hospital environments.

Novel coronavirus symptoms usually take 5 days to appear, according to a study released March 9, 2020 in the journal Annals of Internal Medicine. About 10–15% of mild-to-moderate patients progress to severe and of those, 15–20% progress to critical. The incubation for mild cases might differ somewhat. A 14-day quaran­tine is supported by evidence. However, an estimated 101 out of 10,000 cases could become symptoma­tic after the end of that 14-day monitoring period.

Patients who did not survive hospitalization for COVID-19 in Wuhan were more likely to be older, have comorbidities, and elevated D-dimer—according to the first study to examine risk factors associated with death among adults hospitalized with COVID-19. Age is a factor because the number of T Cells that fight unknown invaders reduces over time. Pre-existing conditions also play a significant role in mortality.

Lupus is a chronic health condition and many people living with the condition are likely to have a weakened immune system, most commonly as a result of immun­osup­pres­sive medica­tion they are required to take. This means that many people with a diagnosis of lupus would be considered as ‘high-risk’ if they contracted the virus.

What Exposed Physicians Should Do

Access to test kits for COVID-19 are becoming more widely available in the U.S. The CDC is shipping tests to laboratories designated as qualified, including U.S. state and local public health laboratories, Department of Defense laboratories and select international laboratories.

Five epidemiologic risk factors—listed from high to no identifiable risk:
  1. Present in the room: If a physician or other health professional is not wearing proper PPE and is present in the room or performed a procedure that generated higher concentrations of respirator secretions, they are at high-risk.
  2. Prolonged close contact: If a physician or other health care professional had prolonged close contact with a patient with COVID-19 where the patient was wearing a facemask, but the health care provider was not wearing a facemask or respirator, the health care provider should be actively monitored for COVID-19.
  3. Proper adherence to infection control: A physician wearing all recommended PPE including a facemask or respirator while having prolonged close contact with a patient who was also wearing a facemask is at low risk. It is important to note, though, that a respirator confers a higher level of protection than a facemask.
  4. Brief interactions with patient: Physicians and other health professionals who are not using all recommended PPE and have brief interactions with a patient, such as a quick conversation at a triage desk, are considered at low risk.
  5. Walked by, but no direct contact: If a physician or other health professional walks by a patient with COVID-19, has no direct contact with the patient or their secretions and excretions, and has no entry into the patient’s room, there is no identifiable risk.

What It Will Take To End This

Spending just $10 to treat each of 200,000 infected would cost $2 billion. Bill Gates, who is donating up to $100 million, realizes a cure will cost billions of dollars. He envisions a multi­national effort that inter­weaves commerce and diplomacy to develop, manufac­ture, and globally distribute a vaccine. The US government has declared a national emergency and loosened red tape associated with hospital compliance. This allows access to over $50 billion in the war against this coronavirus. Along with this announcement, a simplified government URL (redirect) was announced: coronavirus.gov

In an open letter to the Vice President of the United States, a consortium of Medical Professionals For a Better Response to COVID-19 outline, among other things, how a task force can mobilize. They suggest a national command with ethics committee that oversees state command centers. Each are staffed by teams of medical professionals and first responders. Their purpose is to advise hospitals and doctors while equalizing resources according to demographic needs. Proactive school closures offset by economic stimulus package that assist families is further recommended.

For the population in general, avoiding large gatherings, social distancing, and self-isolation when sick are most effective methods to ”flatten the curve.” The disease may circulate longer but the lower peak of cases to prevent outstripping available resources.

The WHO has consolidated guidance for countries into 4 categories:
  1. No cases
  2. Sporadic cases
  3. Clusters
  4. Community transmission

As the number of those contracting the virus continues to grow and many scientists investigate solutions, more data becomes available about demo­graphics and recom­mended care. The informa­tion presented here is based on current knowledge and recom­men­da­tions. See reference section below for Medscape detailed guide for hospitals. Doctors and health­care adminis­tra­tors should visit CDC website for evolving treatment guide­lines.

Interim prep guidelines for hospitals include:

Schedule appointments in advance of infected patient visit. Consider posting visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) with reminders to adhere to respira­tory hygiene and cough etiquette, hand hygiene, and triage proce­dures throughout the duration of the visit. Ensure that patients with symptoms of suspected COVID-19 or other respira­tory infec­tion (e.g., fever, cough) are not allowed to wait among other patients seeking care. Facilities should have policies and procedures describing a recom­mended sequence for safely donning and doffing PPE. —CDC

Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID–19 in Healthcare Settings.

Initial U.S. testing is limited to patients manifesting symptoms. There are tests that may identify whether a person has SARS-CoV-2 a few days prior to symptom onset post-exposure. This is more likely used for healthcare workers. Cleveland Clinic has developed an online virtual visit screening portal.

The PPE shortage is so severe that the CDC is warning hospitals to stretch out available supplies. Doctors are reusing masks between patients. Nurses are going to work, even if they have been exposed to the novel coronavirus. If their supplies run out, staff may replace face masks with bandanas or scarves.

References
  1. Who is getting sick, and how sick? A breakdown of coronavirus risk by demographic factors. statnews.com
  2. Nigeria records chloroquine poisoning after Trump endorses it for coronavirus treatment. cnn.com
  3. Risk Factors for Death From COVID–19 Identified in Wuhan Patients. medscape.com
  4. Coronavirus symptoms: What are the symptoms? Detailed study makes shocking find. express.co.uk
  5. There Is a ‘Tipping Point’ Before Coronavirus Kills. bloomberg.com
  6. Zinc will not ‘block’ coronavirus: The internet’s Covid-19 myths busted. expressandstar.com
  7. Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient. JAMA, jamanetwork.com
  8. New coronavirus may spread through poop. livescience.com
  9. Novel coronavirus symptoms usually take 5 days to appear, study says. cnn.com
  10. Some Patients Could Show COVID–19 Symptoms After Quarantine. medscape.com
  11. Coronavirus Disease 2019 (COVID-19). cdc.gov
  12. Coronavirus disease (COVID-19) outbreak. who.int
  13. What explains Covid-19’s lethality for the elderly? Scientists look to ‘twilight’ of the immune system. statnews.com
  14. Lupus & Coronavirus (COVID-19). lupusuk.org.uk
  15. Doctors: Here's what to do if you're exposed to COVID-19. ama-assn.org
  16. Responding to Covid-19—A Once-in-a-Century Pandemic? Bill Gates, NEJM
  17. Trump declared the coronavirus pandemic a national emergency. What does that mean? usatoday.com
  18. Open Letter to Vice President Mike Pence RE: US COVID–19 Response. medium.com
  19. Coronavirus Disease 2019. coronavirus.gov
  20. What Hospitalists Need to Know About COVID-19. medscape.com
  21. A serological assay to detect SARS-CoV-2 seroconversion in humans. medrxiv.org
  22. Find Out Your COVID–19 Risk. clevelandclinic.org
  23. Used facemasks and bandanas: How the CDC is warning hospitals to prepare for coronavirus shortages. cnn.com
Kevin Williams is a health advocate and writer of hundreds of articles for multiple web­sites, including: A Bit More Healthy, KevinMD (WebMD), and Sue’s Nutrition Buzz. He is a prior 15-year con­sul­tant for Neutrogena Research and Scientific Affairs.

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