The 2019 Novel Coronavirus COVID-19 is a new virus that causes respiratory illness in humans. The first identified outbreak occurred in 2019 in Wuhan, China with the majority of cases in China and has shifted to Europe and now the US. Since that time the virus has affected approximately 550,000 globally with approximately 86,000 documented cases in America with most persons fully recovering. The President of the United States declared a national emergency on March 13, 2020.
What is Coronavirus?
Coronaviruses are a family of viruses that typically cause mild respiratory infections like the common cold. There are at least two other strains of coronavirus known to cause serious disease or death in humans:
- Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
- Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)
- Novel COVID-19 (a double-stranded RNA virus) also known as SARS-CoV-2
Coronaviruses are very common among various animal species, including bats, cattle and camels. Animal coronaviruses, in rare instances, can be transmitted to humans. Such was the case with SARS-CoV and MERS-CoV. It was reported that the initial 2019-nCoV (now known as COVID-19) outbreak was initially linked to a seafood market in Wuhan, China, suggesting animal to person spread but this is not clear and now we do know there is clear community transmission hence the reason for self quarantining, social distancing, stopping discretionary travel and activity and pausing on elective activities and delaying all elective surgery for the next several weeks in order to free up hospital resources, beds and ventilators.
Who is most affected by COVID-19?
Several confirmed infected individuals had no contact with animals meaning despite early World Health Organization (WHO) reports it can indeed be person to person transmission. The virus appears to be very infectious and may be very serious in older, sicker individuals. Though the influenza virus in general causes many more total deaths every year, we believe the death rate is higher for COVID-19 and most people have not yet developed immunity.
Thus far, the deaths are primarily in older individuals with chronic disease while most young and healthy seem to recover fully although as with most all viral infections all can be adversely affected and reports of younger persons seriously ill and dying are increasingly reported. In addition, the young can asymptomatically infect their older relatives and community. The goal is to prevent rapid spread to everyone at the same time and thus everyone has to be involved. This has affected the entire country with certain hot spots being much more affected than other places.
Do not forget about “The Flu” and Pneumonia
It is important for all those who have not been vaccinated against influenza to get vaccinated, as the flu can cause morbidity and mortality. Every year young and old die from influenza. There are also anti-viral therapies that can treat influenza. People eligible for pneumonia vaccines should make sure they are up to date on all their immunizations. Those with chronic illness should have an adequate supply of chronic medications on hand.
In a high year, there were 80,000 Americans who died of influenza in the 2017-2018 flu season (from the flu and it's complications, according to the CDC.) That was an unusually high number as the usual American deaths from influenza are typically between 12,000-60,000 per year, with almost 13,000 American deaths from the H1N1 swine flu in 2009.
If you smoke or vape, NOW is a great time to stop. Protect your lungs.
How Coronavirus Spreads
Person to person transmission usually occurs
- Via close contact of about 6 feet or less
- After contact with respiratory droplets from coughing or sneezing
- During the time people are the most symptomatic or sick
- COVID-19 has been identified in feces, so wash your hands
It is important to practice good hand washing and droplet transmission like you would do with influenza. Most people who are exposed to the virus become infected and usually show symptoms within five days. Symptoms are a high fever and dry cough, which is different than a stuffy nose associated with common colds and spring allergies.
Confirmed COVID-19 Cases
As of March 27, 2020, there have been under 100,000 confirmed cases in the United States (with 1,300 deaths). The US government on Jan. 31, 2020 first suspended the entry of foreign nationals with a history of travel to China and then issued travel advisories to high risk areas including Italy, Japan, Iran and South Korea. By March 14, 2020 the US stopped travel from Europe to the US for at least a month. Other countries are following suit and many have closed their borders. As of March 18th, the US-Canada Northern border closed for all non-essential traffic, not including trade and on March 19th the US State dept. urged Americans NOT to travel abroad. By March 20th the US Southern border was closed.
We are at day 12 of the 15 day social distancing and shutdown by the President and Centers for Disease Control to reduce the impact of this we virus. Almost half of the US states have shelter in place orders which may be lifted in some places. Since more than half of the US cases are in New York anyone who has traveled from NY to other states have been advised to self quarantine for 14 days.
As of March 27, 2020 there have been approximately 550,000 cases reported globally. Of the confirmed cases, there have been approximately 25,000 deaths from the COVID-19. Most of the initial cases were in China, Italy, Iran, Iran and S. Korea although based on our large population size, the US has the most reported cases now that testing is more wide spread; however, the denominator based on our large population makes the percentage of infected cases less than other countries. Reported death rates are expected to rise and have been reported in many countries.
Two Strains of the Virus
The good news is most healthy people infected are expected to recover, and work is progressing quickly for a vaccine. There appears to be two strains of the virus: a weaker one and a stronger one (L and S strains) - as viruses are known to have antigenic drift. Good hand washing technique and avoiding touching nose, eyes and mouth prevents many viruses from infecting other people.
Most respiratory viruses will not be from COVID-19 but rather influenza and RSV and testing now involves co-testing in sequence. It is expected that most testing will be via drive-through testing stations and even self testing. There is some false negative testing, so even if you have a negative test and have reason to believe you had an exposure you still may want to self-quarantine after communicating with your treating physician. Anyone with acute respiratory illness should avoid contact with the elderly and those with chronic illnesses.
Nasal Swab Testing
Even though testing is available, nasal swabs may limit the total number of persons tested so the worried well and those with mild symptoms need to stay home! Those with chronic diseases, cancer, diabetes, lung disease, kidney failure, suppressed immune systems and those over age 60 and under age 3 will likely be prioritized. Self swabbing to screen for infection may become available.
Almost 200 Countries and Territories have reported COVID-19.
Coronavirus Symptoms and Complications
Symptoms of COVID-19 appear to include:
- High Fever
- Dry cough
- Difficulty breathing
- May have some gastrointestinal distress and myalgia/muscle pain
- Loss of smell and intense fatigue are other reported symptoms
Previous coronaviruses have been known to cause mild to serious illness. At this time, it is unclear the true mortality rate of COVID-19. With more data and more testing, we can more accurately calculate this. Many think it is 1% or less. It is believed that infection can present with mild respiratory symptoms that progress to pneumonia later and a “cytokine storm” about 5 days later. Individuals with a compromised immune system and the elderly are at a greater risk of serious illness if infected with COVID-19 but younger and middle-aged people have also required hospitalization and can die so everyone has to be “all hands on deck” all washed hands that is, to flatten the curve of infections to avoid overwhelming hospital resources in the counties and locales with the most cases. Our urban areas appear to be more affected that our rural areas.
Prevent the Spread of the Virus
- Frequently cleaning hands with soap and water for a minimum of 20 seconds. If soap and water are unavailable then clean hands using an alcohol-based hand sanitizer with a minimal alcohol content of 60%.
- Avoid close contact with those who are experiencing symptoms of a viral illness.
- Do NOT touch mucous membranes (eyes, mouth and nose) with unclean hands and before washing your hands for 20 seconds.
- Cough into sleeve (and wash clothing) or into a tissue which is disposed of.
- Ingest adequate vitamin D3 and vitamin C, eat a healthy diet rich in natural antioxidants and get enough sleep all of which helps your immune system. Do NOT overdose on mega doses of vitamins or take substances and drugs that are not recommended by your physician.
- Practice social distancing. The elderly and those with serious, chronic diseases should avoid crowded, congested spaces similar to what one would do during flu season and follow the advice of your local authorities which in many states has escalated to shelter in place. Most schools, events, church gatherings, national sporting events and local bars and restaurants have been closed, canceled and/or put on hold for several weeks. Grocery stores and carry-out food from restaurants remain available.
- The CDC and the President have advised no more than 10 person gatherings. Individual states are handling closures and orders to shelter in home individually.
- In times of emergency, it is important to not panic and seek information from reputable sources. Be ware of telephone and internet scams.
- It is always a good idea to have several weeks of chronic disease management medications on hand. Plan ahead. Food supplies and toiletries are NOT affected so people are encouraged not to hoard.
What To Do If you Feel Sick
- Cover your sneeze or cough with a tissue and avoid coughing or sneezing into your hands. Discard all tissues in the trash.
- Clean hands regularly and disinfect items and services that have frequently been touched.
- Avoid close contact with others and stay home from work/school and all elective activities.
- If you are coughing, wear a face mask if close contact with others cannot be avoided. However, regular face masks in general do not prevent the healthy from being infected and general face masks should be worn by those coughing and sneezing to protect others. Specifically fit medical face masks are for preventing highly infectious airborne infections like TB and measles to protect the healthy. Health care workers doing close medical procedures may need a specially fitted N95 mask as well as Personal Protective Equipment (PPE).
- If you or a loved one experience any of the COVID-19 symptoms listed above, seek medical attention and contact your health care physician, hospital or local public health department in advance to prepare for your arrival.
- If you have traveled to China, Italy or any high risk area or “hot spots” in the US or known positive contacts within the last several weeks or any other locales with reported outbreaks and you are experiencing symptoms of COVID-19, please contact your healthcare clinician via phone or electronically. It is getting much easier to get telephone/distance/virtual care. Now that community spread has been documented high fever, dry cough and flu like symptoms have to be initially considered as possible COVID-19, so isolate yourself and CONTACT your physician.
- Your health care clinician can instruct you on how to receive care perhaps virtually while going to a designated testing area and importantly minimizing risk and exposure to others.
This is an evolving situation and new evidence/recommendations may present daily and may be handled differently depending on the region of the country that you reside in as risks vary depending on your physical location.
Coronavirus Treatment Options
Treatment for COVID-19 is geared toward relieving symptoms, including controlling fever, cough and adequate fluid intake to avoid dehydration. There are no available current coronavirus vaccines but trials have started and several therapies including the anti-malarial chloroquine and hydroxychloroquine appear promising possibly with oral zinc and other anti-oxidant therapies. Melatonin, which declines after age 65 may have some anti-SARS2 viral activity.
Physicians are looking at IV therapies such as IV Remdesivir in hospitalized patients and additional clinical trials. Those with low oxygen levels may need prescription home O2. We are optimistic that anti-viral studies and other promising lines of research like using convalescent plasma of those persons who have recovered are underway that will provide critical evidenced based therapies.
It is important to remember the great strides we have made treating many viruses including HIV and hepatitis C.
Initially, it was anecdotally reported from France that ibuprofen use in persons with COVID-19 may have worse outcomes than with acetaminophen use for fever; however, this has NOT been confirmed by others.
Information changes rapidly. Please discuss any and all prescription AND non-prescription therapy with your physician and have your bottles with you when seeing your physician or advanced practice clinician virtually or in person. As far as chemo-prevention and treatment of COVID-19, we have anecdotal clinical reports. Importantly, large clinical trials are in progress and will provide needed information.
What you Can Do: Stay Up-To-Date About the State of the Novel Coronavirus COVID-19 and Please Stay Calm
- Novel Coronavirus (COVID-19) and You
- What to do if you are sick with COVID-19
- Travel Health Notices
- Health Alert Network: Update and Interim Guidance on Outbreak of 2019 Novel Coronavirus
Be Strong. Be Healthy. Be in Charge!
Oluwatosin Goje, MD and Taryn Smith, MD, NCMP
Walk-in Mammography at Cleveland Clinic is currently suspended as of March 11, 2020 until further notice. If you can obtain your medical care via telemedicine/distance care now is the time to get familiar with this emerging, convenient medical practice. Please read about distance medicine and virtual visits in the links below.
Oluwatosin Goje, who leads the Reproductive Infectious Diseases Program at Cleveland Clinic, is an Obstetrician Gynecologist fellowship-trained in Infectious Diseases at the Medical University of South Carolina, Charleston, SC. Dr. Taryn Smith is a Fellow in the Cleveland Clinic Specialized Women's Health Fellowship Program and will be joining the staff at Mayo Clinic Jacksonville in the fall 2020.
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