Health Advisory: Coronavirus

 

Important Health Information:  Coronavirus 

 

COVID-19 Update:  July 2020

 “The Uninvited Visitor That Refuses to Leave!!”

 

Six months ago, we were introduced to an unwelcomed, uninvited guest that changed our way of life as it settled in to stay. We realized how deadly this visitor, COVID-19 (Sars Coronavirus 19} was when, in a few months, it killed some 130+ thousand of our family, friends and acquaintances of all ages and sexes in the USA.  It’s specialized in stealing the lives of our precious elderly Black and Brown family members who were the backbones of many of our families as they carried our history in their memories. Subsequent to the racial disparities in the USA, Black, Hispanic and indigenous people died at a higher rate than White people. However, we now know that COVID-19 can cause morbidity and mortality in all age groups and in all racial groups. People of any age, any sex with a preexisting health problem including obesity were and are susceptible to this disease. As it made itself a deadly pandemic, more was learned about this virus and our response to it continues to change. 

Recent studies of this monster reveal that unlike Sars (Severe Acute Respiratory Syndrome of 2002 & 2003) and Mers (Middle East Respiratory Syndrome of 2012), COVID-19 can be passed from one human to another even before symptoms appear thus, one can get COVID-19 from someone who has no symptoms!!

This virus, described initially in China has mutated to become more infective than the original virus. Now there are two versions of this virus circulating. The original virus described by the Chinese, and the virus that mutated in Italy to create a more rapid infection in humans and is now spreading rapidly in the USA.

What was thought was a respiratory virus is now known to infect the walls of small blood vessels and cause clots plus a generalized immune response that also damages tissue all over the body. Since the lungs have so many small blood vessels, the multiple small clots prevent the blood from picking up the oxygen needed to breathe plus the immune response markedly impair the lungs thus, one of the outstanding manifestations of its generalized infection is in the lungs. 

As this virus destroys blood vessels all over the body, the symptoms may include tiredness, seasonal allergy-like symptoms, fatigue, diarrhea, body aches, joint aches or the severe generalized clotting of small vessels in children and young adults that occurs with an autoimmune inflammatory reaction called the Kawasaki-like disease.  One of the clearest signs of a COVID-19 infection may be the loss of smell and taste.

There are two types of tests available to determine if COVID-19 is present. One is the Antigen test that measures pieces of protein that make up the COVID-19 virus. This is the test commonly done today. It may take from 24hrs to 1 week for the results to be returned. The other type to determine if the virus is present is the PCR test. This is a very rapid test for measuring pieces of the virus. It is more specific for the presence of COVID -19 than the Antigen test and should be done if there is a question about the Antigen test.

To determine if an individual had COVID-19 in the past and recovered, a test called the Antibody test should be done. If this test is positive, the individual had COVID-19 in the past and is no longer infected. This test has suggested that the fatality rate may be as low as 0.6% of the population infected in some areas. The upper limit of the fatality rate is still unclear because of the limitations on testing. Increased Antigen testing by PCR is still the best test for active infections.

Prevention is the best treatment. It has been proven that fabric masks curb the transmission of the virus. The most common mode of transmission appears to be through person-to-person contact through respiratory droplets or aerosols and direct handling of contagious secretions. How far droplets may travel is unclear and also it is unclear how long infected aerosols can last however today, there is good evidence that both of these these can be limited by people wearing masks. 

Washing hands frequently for at least 20 seconds (the length of time to sing the “Happy Birthday Song”) is still a primary means of preventing self-contamination.

Physical distancing and staying home has proven to be effective in many countries. Medical treatment has evolved. Remdesivir, a broad-spectrum antiviral agent, has proven to speed recovery in some sick patients. Dexamethasone, an anti-inflammatory steroid, may reduce the risk of death. 

Vaccines are in development and 20 vaccines are currently in clinical trials.

Assessment of the current status of COVID-19 in the USA, strongly suggests to this author that maintaining physical distancing, wearing masks, washing hands frequently, avoiding contact with any known source of COVID-19 are still strongly indicated in the USA for several months to come as the best way of preventing the deadly monster, COVID -19, from continuing to kill Americans.  How long do we need to continue these life-saving measures?  Probably until a vaccine is available!

 

References:

  1. Cevik, M. Bamford, C.G.G., Ho, A., COVID -19 pandemic- a focused review for clinicians, Clin. Microbiol. Infect.: 2020 Jul: 26(7):842-847 (published online Apr, 2020)
  2. Erin Garcia de Jesus, here’s what we’ve learned in six months of COVID-19 and what we still don’t know, Science News.org, June 30, 2020
  3. Hagen, A., COVID-19 Serology Testing Explained, American Society for Microbiology, asm. org/articles/2020/May/COVID-19-Serology-Testing-Explained. May 19, 2020
  4. Jayaweera, M. Perera, H., et al. Transmission of COVID-19 by droplets and     aerosols; A critical review, Environ. Res. 2020 Sep; 188: 109819

 

Juanita A. Archer, M.D.

 

 

CDC Recommendations 

The CDC recommends the following commonly known avoidance actions:

1. If you are sick, it is best to stay home from work, church, etc., to avoid spreading germs and infecting others.

2. Wash hands frequently for at least 20 seconds.

3. If unable to wash with soap and water, use fresh hand sanitizer that has 60% to 90% alcohol.  Note that alcohol evaporates rapidly.

4. Avoid touching your face, eyes and mouth.

5. Cover your nose and mouth with tissue if sneezing or coughing.

6. Clean surfaces often with antiviral, antibacterial disinfectant.

7. Until the weather gets warm, limit close contact to include hugging and kissing.  

8. Maintain good health habits to include sleeping 6 to 7 hours a night; healthy eating, drinking water and exercising appropriately and taking vitamins recommended by your physician.

 

What I Am Doing For the Upcoming COVID-19 Coronavirus Pandemic

The current projections for its expansion in the United Sates are only probable, due to continued insufficient worldwide data, but it is most likely to be widespread in the US by mid to late March and April.

Precautions:

- No handshaking!  Use a fist bump, slight elbow, elbow bump, etc.

- Use ONLY your knuckle to touch light switches, elevator buttons, etc.  Lift the gasoline dispenser with a paper towel or use a disposable glove.

- Open doors with your closed fist or hip; do not grasp the handle with your hand unless there is no other way to open the door.  Especially important on bathroom and post office/commercial doors.

- Use disinfectant wipes at the stores when they are available, including wiping the handle and child seat in grocery carts.

- Wash your hands with soap for 10 to 20 seconds and/or use a greater than 60% alcohol-based sanitizer whenever you return home from any activity that involves locations where other people have been.

- Keep a bottle of sanitizer available at each of your home's entrances and in your car for use after getting gas or touching other contaminated objects when you can't immediately wash your hands.

- If possible, cough or sneeze into a disposable tissue and discard.  Use your elbow only if you have to.  The clothing on your elbow will contain infectious virus that can be passed on for up to a week or more.

Recommended items to have in stock:

- Latex or nitrile latex disposable gloves for use when going shopping, using the gasoline pump and all other outside activity when you come in contact with contaminated areas.

NOTE:  This virus is spread in large droplets by coughing and sneezing.  This means that the air will not infect you, but all the surfaces where these droplets land are infectious for about a week on average - everything that is associated with infected people will be contaminated and potentially infectious.  The virus is on surfaces and you will not be infected unless your unprotected face is directly coughed or sneezed upon.  This virus only has cell receptors for lung cells (it only affects your lungs).  The only way for the virus to infect you is through your nose or mouth via your hands or an infected cough or sneeze onto or into your nose or mouth.

- Stock up on zinc lonzenges.  These lozenges have been proven to be effecting in blocking coronavirus (and most other viruses) from multiplying in your throat and nasopharnx.  Use as directed several times each day when you begin to feel any cold-like systems.  It is best to lie down and let the lozenge dissolve in the back of your throat and nasopharnx.  Cold-Eeze logenzes is one brand available, but there are other brands.

James Robb, MD