A SUMMARY OF WHAT TO KNOW
“From the First Day Until President’s State of Emergency”
Coronaviruses are a family of viruses that typically affect the respiratory tracks of humans, birds and most other animals.
Doctors associate coronavirus with the common cold, bronchitis, pneumonia and rarely severe acute respiratory syndrome (SARS) and they can also cause gastrointestinal effects.
Coronaviruses typically are responsible for common colds more than serious diseases. Most Americans will be infected by the coronavirus sometime during their life and will experience typical cold like symptoms including cough, cold, runny nose and congestion. However, coronaviruses sometime change their structure (mutate) and can cause more serious infections such as SARS (Severe Acute Respiratory Syndrome) and MERS (Middle Eastern Respiratory Syndrome).
Typically the coronaviruses as a family are responsible for common colds.
Over the last 70 years scientist have found that coronaviruses can infect mice, rats, dogs, cats, turkey’s, pigs, cattle, bats and snakes. These animals are capable of transmitting coronavirus to humans.
In November, 2019, health care workers including Dr. Li in Wuhan China identified a new novel coronavirus outbreak that subsequently spread rapidly throughout China and has now reached and is infecting over 150 countries in the world. This new coronavirus is named coronavirus disease 2019 or COVID-19.
WHAT IS A CORONAVIRUS?
In 1937, researchers first identified coronavirus. Coronavirus was found to be responsible for the infectious bronchitis in birds that had the ability to destroy poultry farms.
In the 1960’s scientist found evidence of human coronaviruses (HCoV) in the noses of patients with common cold type symptoms. Specifically two human coronaviruses were found to be responsible for most common colds including OC43 and 229E.
The name “Coronavirus” was given to the virus due to the crown-like projections on their surface. “Corona” in Latin means “Halo” or “Crown”.
Among human patients coronavirus infections typically occur during the winter months and early spring. Patient regularly becomes ill with a cold due to a coronavirus and can actually have recurrent infections by the same or similar coronavirus 4-6 months later.
The reason patients may experience recurrent coronavirus infections is because coronavirus antibodies do not last in human blood stream for a long time. Also, antibodies for one strain of coronavirus may be ineffective against another strain of coronavirus.
COMMON SYMPTOMS OF CORONAVIRUS
Cold or flu-like symptoms usually occur from 2-4 days after a coronavirus infection has occurred. Usually the symptoms are mild. However, symptoms can very from person to person and some forms of the virus such as COVID-19 can be fatal.
Respiratory symptoms include:
Gastrointestinal symptoms include:
Scientist cannot easily cultivate human coronaviruses in the laboratory. Some viruses causing respiratory illnesses like the rhinovirus is easy to culture. The difficulty in culturing coronavirus and the lack of a rapid point of care test makes it difficult to evaluate the impact of coronavirus on national economies and public health in general.
Until recently there has been no cure. Recently a protocol has been developed that may very well form the basis for a medical cure. A potential vaccine has been identified and is in human test trials at this time. Treatments include self care and over the counter medications. Patients can take several steps including:
Your doctor can diagnose the virus responsible for your respiratory illness by taking a sample of respiratory fluids such as mucus from the nose or taking a blood sample and submitting specimen to health department. Currently drive-thru test sites are starting in neighborhoods near you. A rapid point of care test should be available soon in emergency departments, clinics, pharmacies and other healthcare treatment environments.
TYPES OF CORONAVIRUS
Coronaviruses belong to the sub-family coronavirinae and the family or coronaviridae.
Different types of human coronaviruses vary in how severe the resulting infection becomes.
Doctors current recognize several types of coronaviruses that can affect humans. Types include:
In 2019, a dangerous new strain called SARS-CoV-2 started circulating causing the disease COVID-19.
Limited research is available for how HCoV spreads from one person to the next.
Researchers believe that the virus colonizes (collects) on the face, nose, mouth, throat and eyes and spreads through the mouth, the eyes and nose to the lungs into fluids in the respiratory system such as mucus.
Coronavirus can spread in the following ways:
The National Institute of Health suggests that several groups of people have the highest risk of developing complications due to COVID-19. These groups include:
Coronaviruses will infect most people sometime during their lifetime. Coronaviruses can mutate effectively which makes them so contagious.
To prevent transmission people should stay home and rest while symptoms are active. They should avoid close contact with other people. They should wash hands frequently. Wash clothes and bedding with warm water and laundry detergent. Clean hard surfaces with soaps and water frequently.
Covering the mouth and nose with a tissue or hanker chief while coughing or sneezing can also help prevent transmission. It is important to dispose of any tissues after use and maintain hygiene around the home.
In December 2019, the Center for Disease Control and Prevention started monitoring the outbreak of this new virus SARS-COV-2 which causes the respiratory illness now known at COVID-19. Authorities first identified the virus in Wuhan China.
Likely, more than 100,000 people have contracted the virus in China. Health authorities have identified many other people with COVID-19 around the world including over 14,000 in the United States. At this time 254,177 infections worldwide with 10,563 deaths.
On January 31, 2020, the virus first was identified as passing from one person to another within the borders of the United States.
The World Health Organization (WHO) have declared a public health emergency relating to the spread of COVID-19 to over 90 nations in the world. Some nations like South Korea, Italy, and Iran have been especially devastated by the disease.
The CDC has advised US residents that the COVID-19 illness is likely to spread widely throughout the United States. The United States declared National State of Emergency 3/13/2020.
The first patients with COVID-19 are linked to an animal and seafood market in Wuhan China. This fact suggests that animals initially transmitted the virus to humans. However, many people infected with the new COVID-19 have no connection with or exposure to the market confirming that humans are passing the virus to each other.
On February 17, 2020, the Director – General of the WHO presented to a media briefing the following updates on how often the symptoms of COVID-19 are severe or fatal using data from 44,000 people with a confirmed diagnosis. The following stages have been identified:
Stage and Severity / Percentage of People with COVID-19
Mild disease from which person can recover / More than 80%
Severe disease causing breathlessness and Pneumonia / 14%
ritical illness including septic shock, respiratory failure and the failure of more than one organ / 5%
Fatal disease / 2%
The Director – General also noted that the risk of serious complications increases with risk and underlying medical conditions which are male sex, hypertension, heart disease, lung disease and diabetes. Also patients taking immuno-compromising medications for underlying conditions such as cancer, rheumatoid arthritis, and other connective tissue diseases.
Symptoms vary from person to person with COVID-19. It may produce few or no symptoms during the initial illness. However, despite this benign initial presentation it can lead to severe illness which can be fatal. Common symptoms which demonstrate that the viral infection is worsening include:
It may take 2-14 days for a patient to notice symptoms after becoming infected.
No vaccine is currently available to COVID-19. Scientist have now replicated the virus. It is believed that vaccination trials will start soon and that vaccine for this illness will be available in 12-15 months.
SARS was a contagious disease caused by coronavirus that developed after becoming infected by the specific strain, SARS-COV coronavirus typically it lead quickly to a life threatening form of pneumonia.
During November 2002, the virus started in the Guangong Providence of Southern China eventually reaching Hong Kong. From there it rapidly spread around the world causing infections in more than 24 nations.
SARS-COV was capable of infecting both upper and lower respiratory tracks. The symptoms of SARS developed over the course of a week and typically started with a high fever. The fever would be followed with flu-like symptoms such as:
Pneumonia, a severe lung infection, usually developed. At the most advanced stage SARS caused failure of the lungs, heart or liver resulting in death. According to the CDC authorities marked 8,098 as having contracted SARS. Of those, 774 infections were fatal. The mortality rate was 9.6%.
Complications were more likely in older adults in half of all people over 65 years of age who became ill did not survive. Authorities eventually controlled SARS in July 2003.
MERS spread due to the coronavirus known as MERS-COV. Scientist first diagnosed this severe respiratory illness in 2012 after it surfaced in Saudi Arabia.
The virus reached the United States with the largest outbreak outside of the Arab peninsula occurred in South Korea in 2015. Symptoms of MERS included:
The illness spread through close contact with people who already had an infection. However, all cases of MERS have links to individuals recently returning from travel to the Arab peninsula. A 2019 study on MERS found that the disease is fatal in 35.2% of the people who contract it.
What do you need to know?
Infection by coronavirus refers to an invasion of the body by harmful micro-organisms or parasites. Infections range from mild respiratory symptoms to fatal respiratory symptoms.
What to know about viruses?
Viruses are likely the most abundant organisms on earth. They exist in almost every environment and they can infect animals, plants, and fungi. Viruses are often regarded as nonliving. Viruses rely on the cells of other organisms and animals to survive and reproduce. Viruses cannot capture or store energy themselves. Viruses cannot survive outside a host organism. Outside a cell, a virus strand of RNA/DNA wraps itself into an independent particle called Virion. The Virion is capable of living in the environment for periods of time without being attached to a host. The Virion can “survive” for time until it comes into contact with a host. The Virion attaches to a suitable host and penetrates the cell i.e. in the case of coronavirus human lung cells.
Once inside the host cell the virus “hacks” the cell to produce more Virions. The Virions leave the cell usually destroying the host cell as they escape looking for new host cells to attach to and recreate the reproduction cycle.
WHAT ARE VIRUSES MADE OF?
At the core of the virus particle is the genome, the DNA or RNA that contains the genetic material for replicating the process once the host cell is penetrated and the reproduction system is hacked. Virus is wrapped in coating of protein or fat called a capsid which protects the strand of DNA or RNA. The coronavirus that causes COVID-19 is wrapped in a fatty envelope.
Viruses are like predators with a specific prey that they can recognize and attack. In the case of coronavirus, the virus particle specifically is looking for opportunities to attach to and invade human lung cells.
Viruses that do not recognize our cells are harmless. Other viruses can in fact attack us but have no consequences and cause no harm. There are many animal and plant viruses.
Bats host many types of coronavirus, one of which is believed to have caused the novel coronavirus resulting in COVID-19. Viruses can mutate and combine with one another. Sometimes such as the case of COVID-19 viruses can switch species.
WHY ARE SOME VIRUSES SO DEADLY?
The most important viruses to humanity are ones that infect humans. Some viruses like herpes can stay dormant in the body for long periods of time. Other viruses like HIV cause a continuous ongoing infection requiring active diagnosis and treatment.
HOW MUCH HARM CAN A VIRUS CAUSE?
Depends on ability to avoid body defenses; replicate itself and spread to other carriers. Replication plus harm to the host equals outcome. Rapid invasion plus rapid growth kills the host quickly and limits the spread. On the other hand, slow replication and little harm creates large spread.
CORONAVIRUS HEALTH ADVISE
If you have a runny nose and sputum you have a common cold.
Coronavirus is not heat resistant and will be killed by a temperature of just 26/27 degrees. Coronavirus hates the sun.
When someone sneezes with coronavirus the infected droplets take about 10 feet before they drop to the ground or onto a hard surface and is no longer airborne.
Coronavirus droplets on a metal surface will live for at least 12 hours. So, if you come into contact with any metal surface, wash your hands as soon as you can with soap and water. Antibacterial soaps can be used but are not necessary.
On fabric, coronavirus can survive for 6-12 hours. Normal laundry detergent will kill it.
Drinking warm water is effective for all viruses. Try not to drink liquids with ice.
Wash your hands frequently as the virus can live on your hands for only 5-10 minutes. However, a lot can happen during that 5-10 minutes such as rubbing your eyes, itching your nose, touching your face.
You should also gargle as prevention. A common solution of salt and warm water will suffice.
Make sure you are drinking plenty of water.
Usually the coronavirus will first infect the throat so that you will have a sore throat lasting 3-4 days.
The virus then moves by nasal fluid into the trachea and then the lungs causing pneumonia. Usually this process takes 5-6 days to move from the throat to the lungs.
With pneumonia comes high fever and difficulty breathing.
The nasal congestion is not like the normal kind. You feel like you are drowning. It is imperative at this time that you seek immediate medical attention. Up to this point many symptoms can be and should be treated at home. Remember that emergency departments are experiencing increasing delays of being seen which means you will be required to sit in the waiting room where an abundant supply of the coronavirus may exist in the patients waiting to be seen.
Current projections for its expansion in the United States are only probable due to insufficient worldwide data. However, it is most likely to be widespread in the United States by mid to late March and April. The precautions that you should take are as follows, these are the same precautions I am taking myself:
Supplies that you may require in preparation for the pandemic spread to the United States:
Many scientist believe that this pandemic can be reasonably contained. However, I personally do not think it will be. Humans have never seen this associated virus before and have no internal defense against it.
Tremendous worldwide efforts are being made to understand the molecular structure of this virus. Unbelievable knowledge about this virus has already been achieved. However there are no drugs or vaccinations available this year to protect us or to limit the infection within us. Only symptomatic support is available.
Finally it is important that all of us comply with government leader requests and the request of State and local health officials who will continue to advise us and lead us through this epidemic. Our healthcare leadership team is second to none in the world. Our CDC officials working with WHO officials and Universities throughout the country such as Johns Hopkins University in Baltimore, Maryland will be working with the nation as well move through this time of infectious crisis. If you become sick and feel that you need a doctor’s attention I recommend that you first call your primary care physician to put together a plan for seeing you. In our practice we are actually making house calls on a number of our patients to avoid the patients sitting in the office waiting room or more importantly sitting in urgent care and emergency department waiting rooms where not only is your risk of being exposed to coronavirus increased but also your risk of being exposed to seasonal influenza which this year is quite severe and has resulted in the deaths of thousands.
It is important to keep the coronavirus pandemic in perspective. Yesterday 168 patients died from seasonal influenza within the United States. Zero patients died yesterday from infection with coronavirus. Please remember that at this time of the year there are several viruses including rhinovirus, non covid-19 viruses, influenza viruses A & B all of which are actively creating infections within our communities across all 50 states at this time.
Please remain calm. There is no reason for frustration and agitation. This is a national crisis that we can and will work through.
Terrance L. Baker, MD, MS, FAAEP, FAAFM