Coronavirus: the known and the unknown | Guest column

  • Wed Mar 25th, 2020 1:30am
  • Life

Submitted by Gavin Guard

As a future healthcare professional, I believe it is my responsibility to translate clinical research and science into digestible information for patients and the general public. The unprecedented coronavirus outbreak is something that we have not witnessed in our lifetime. The spread of the coronavirus (COVID-19) is now at a pandemic level. Understandably, many are worried about what this may mean for the future of the country and the world as a whole. There lies a lot of uncertainty about this new pandemic- partly due to misinformation on Facebook and the media. My goal here is to highlight what we DO know about the virus so you can stay informed and take actionable steps to mitigate the spread.

How it started

The COVID-19 virus began in Wuhan, China. Scientists have identified that this strain of the coronavirus is very similar to other coronaviruses that cause SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) that have historically had high mortality rates compared to other respiratory illnesses. It looks like COVID-19 is a zoonotic virus, meaning that it came from an animal reservoir. Specifically, the virus originated from bats that soon started to infect humans. As of March 15, there are now 157,309 confirmed cases of COVID-19 worldwide affecting 118 out of 195 countries. However, there are many more people infected with COVID-19 that have yet to be confirmed.

How it spreads

SARS-CoV-2 is the virus that causes the COVID-19 disease. It is transmitted through respiratory droplets when an infected person coughs, talks loudly, or sneezes. It can also be spread through close contact through mucous membranes such as the mouth, nose and eyes. It is thought to be very contagious with a much greater death rate than the seasonal flu.

The Institute of Disease Modeling predicts that the COVID-19 will act much like the 1918 Spanish flu where 675,000 Americans died. Up to 96 million Americans (~1/3 of the population) can be infected with 480,000 deaths — and this is a conservative estimate. To put this into perspective, anywhere from 20,000 to 50,000 die of the season influenza virus every year. The graphic below depicts both the high transmissibility and clinical severity of the COVID-19 virus.

While many thought this outbreak was over-hyped by the media, new revelations about the virus show that this disease is to be taken very seriously. While we have an easy time understanding linear growth, most of us find it hard to comprehend exponential growth. To put it in an analogy, think about a lawn that develops one weed. Every day, the weed multiplies into two. After one day, there will be two weeds and after two days, there will be four weeds. After one week, there will be 128 weeds. Let me propose a question- at what day will the whole lawn be covered by weeds? It will be the day when only half the lawn is covered by weeds. This model shows us how fast a highly contagious virus can spread.

Who it’s affecting

In the United States, there are 2,866 confirmed cases with 58 deaths. In Washington alone, there are 642 confirmed cases with 40 deaths. It’s important to note that there are much more infected that have yet to be confirmed, making these numbers much higher. Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, suggests there is a 2-3% fatality rate. However, it is probably lower than this projection because this calculation is not counting asymptomatic infected individuals (those without symptoms yet).

The most susceptible to the virus are the elderly, especially those with comorbidities such as cardiovascular disease, diabetes, asthma and other lung diseases. This makes it even more important for social distancing to those at high risk in order to not transmit the virus.

As of yet, there have been no known pediatric deaths due to the virus. Nonetheless, infants with immature immune systems and younger kids with conditions such as asthma are still more at risk for contracting the virus. There is also a concern about how the virus affects pregnant women. In a small study of women in their third trimester, there was no transmission to the baby. However, this study was done in women who all had C-sections so a lot remains to be determined. In addition, there is also concern that low oxygen levels in the blood due to the virus can affect fetal brains either before or during delivery.

Symptoms

The incubation phase (the time from infection to the onset of symptoms) is anywhere from 2 to 14 days, with the majority from 3-7 days. For most healthy individuals, the virus is limited to cold-like symptoms such as cough, congestion, runny nose, fatigue. Fever is the most common symptom, with cough the second most common symptom. Infected individuals can also develop diarrhea, headache, fast breathing, and low oxygen levels in the blood.

Testing centers are now popping up across the country. Through reverse transcriptase-polymerase chain reaction (RT-PCR) testing, we can now quickly and efficiently identify those infected. This is a very specific test, meaning that a positive result means that you have the virus. However, you can still have a negative test early on in the infection.

What to do

So, what do you do about this new pandemic? There is a plethora of misinformed suggestions floating the internet. Most of the following information is from the CDC or peer-reviewed journals.

The best thing you can do is to avoid exposure altogether. It is probably best to avoid gyms, theatres, and other large gatherings. If you go out to eat, take it to go. When you go out in public, make sure to bring some hand sanitizer (with alcohol content at least 60%). Wash your hands (at least 20 seconds) frequently, especially after being in public. Try not to touch your eyes, mouth, or face. It goes without saying that you should stay home when you are sick or when you’ve been exposed to someone with respiratory symptoms. Try to limit non-essential travel, especially those requiring tight spaces such as trains, buses and airplanes.

Evidence suggests that the virus can live on surfaces for 24-72 hours. It is unknown how long it can live on clothes, but it probably can live on hard surfaces longer than rough surfaces like clothes. To be proactive, you can wipe down hard surfaces in your house with a bleach solution.

Contact your healthcare provider to get access to several weeks of medication. If you develop symptoms, you should call your primary care provider to inquire about testing.

Clinicians are trying their best to develop an effective treatment for the virus. The mainstay of treatment is supportive in nature — quarantining infected individuals and treating symptoms appropriately. There has been use of both oral and inhaled antiviral drugs with success. Some hospitals are also utilizing a tool called ECMO where blood is taken from the individual and “purified” through a processing machine. However, experts remain undecided if this should be used in the clinical setting.

Vaccines are certainly in the works. However, it takes several months just to go through phase 1 trials. This means that we will not see vaccines in use for up to 12-18 months according to Dr. Fauci. The first tenant of medical providers is to “do no harm,” so vaccine development needs to be ethical and effective before it is offered to the public.

The best thing you can do for your immune system are practices that are also recommended for general health. This includes good sleep, moderate exercise (not in a gym), and a diet that includes plenty of vegetables, fruit and protein.

While healthcare providers and public health officials believe that social distancing and self-quarantine are the first steps in mitigating disease spread, it’s also important to stay connected with your family and community. This is a time to take advantage of technology. Many should plan to “Netflix and chill” while the country comes to a halt in an attempt to slow the community spread of the virus.

I hope we can take time to avoid public discussions with political incentives. This is a time to come together as a country and community. Take time to slow down, spend time with your family, and reflect on the things in life you are grateful for. Together, we can get through this.

Sources cited

https://www.cdc.gov/coronavirus/2019-ncov/prepare/index.html

Chen ZM, Fu JF, Shu Q, et al. Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus [published online ahead of print, 2020 Feb 5]. World J Pediatr. 2020;10.1007/s12519-020-00345-5. doi:10.1007/s12519-020-00345-5

JAMA interview with Dr. Anthony Fauci, https://edhub.ama-assn.org/jn-learning/audio-player/18297087

Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak [published online ahead of print, 2020 Feb 26]. J Autoimmun. 2020;102433. doi:10.1016/j.jaut.2020.102433

Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak [published online ahead of print, 2020 Feb 26]. J Autoimmun. 2020;102433. doi:10.1016/j.jaut.2020.102433

https://institutefordiseasemodeling.github.io/nCoV-public/analyses/first_adjusted_mortality_estimates_and_risk_assessment/2019-nCoV-preliminary_age_and_time_adjusted_mortality_rates_and_pandemic_risk_assessment.html

Gavin will soon be graduating from the University of Colorado as a PA. He is the medical director at Roots Health Community which focuses on managing and reversing chronic illnesses through a functional medicine approach. Roots’ mission is to dramatically transform the health of the island community and create a world-class patient experience.