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Novel Coronavirus 2019

What it is, the symptoms, how to test, and what to do.

Novel Coronavirus 2019

What It Is

The name “Coronavirus” does not fit only one particular virus.  It’s actually a family of viruses and most people are calling the most recently famous member of this family “Coronavirus”.  The whole situation reminds me of the herpes family.  The herpes family includes Varicella (chicken pox), Epstein Barr (which causes Mono), Cytomegalovirus (risk in pregnancy and eye trouble) and many others, in fact a total of 130 others. But the most famous ones are the herpes simplex viruses that cause cold sores and the disease called herpes. Those viruses are what we usually mean when we talk about herpes viruses.

Similarly, the coronavirus that everyone is talking about is a new member of the Coronavirus family.  Epidemiologists are telling us they think that it came from an animal in China that infected humans which had not, to our knowledge, been infected before.

Humans have been dealing with other strains of coronaviruses for years.  In fact, Coronaviruses are viruses that cause the common cold.   But we’re used to those and not to the new ones.

Back in 2002 another Coronavirus caused Sever Acute Respiratory Syndrome (SARS). That Coronavirus was aptly called SARS coronavirus (SARS-CoV).  DNA analysis show that it was cave-dwelling horseshoe bats in China’s Yunnan province.  Overall 8,096 people got SARS, 7,082 of which were in Hong Kong or China.  So compared to new Coronova virus, COVID 19, a lot less people contracted it but it caused 774 deaths giving it a higher fatality rate of 9.6% than the new COVID 19 virus that we are talking about today.  Of course it’s too early now to calculate a definitive the mortality rate for COVID 19. There have been no new cases of SARS since 2004.

Another Corona virus from an animal came in 2012. This virus predominantly hit the Middle East and also caused bad respiratory symptoms.  This virus is not surprisingly called Middle East Respiratory Syndrome Coronavirus (MERS-CoV).  As of November 2019, there have been 2,494 cases of MERS and 858 deaths. This is also has a much higher fatality rate at 34% than the current COVID19 virus.  Cases spiked in 2014 and continue to be reported but not nearly as frequently since 2014.

If you call it the “Coronavirus” everyone knows what you mean, but officially the CDC is calling the virus the SARS-CoV-2. Whether this new disease that it causes is more contagious (as we suspect), people more mobile or testing is just more sensitive it is hard to tell. But there are a lot more cases of COVID 19 documented than of the other famous coronaviruses. The most famous tracker appears to be that of Johns Hopkins University which says of today (3/11/2020) that there have been 121,977 cases, 4,386 deaths and 66,702 documented recoveries.  If that’s all we knew we could calculate a 3.5% mortality rate but it’s difficult to do that in the middle of the storm.

If you look back at the China data, people with no underlying medical conditions had an overall case fatality rate (chance of dying) of 0.9%. However, if they already had cardiovascular disease it was 10.5%, if they were diabetic the fatality rate was 7% and if chronic respiratory disease was an issue the fatality rate was 6%.

Covid-19 Symptoms

Symptoms are nonspecific.  Generally it consists of flu like symptoms such as fever, cough and shortness of breath.  Amongst people admitted to the hospital with the virus, the most common symptoms include fever (77-98%), cough (46-82%), muscle aches,  fatigue (11-52%), and shortness of breath (3-31%).   It can lead to pneumonia and respiratory distress.

The incubation period from when someone is exposed to COVID-19 to the time when symptoms appear is about 4 days but based on other Coronaviruses epidemics officials are saying it could be anywhere from 2-14 days from exposure to onset of symptoms.

Testing

There are three places to think of regarding testing.

  • The CDC
  • The State Health Department
  • Anywhere else

Until February 27th, almost all testing in the United States of America was done at the CDC in Atlanta. Since then more and more states have been able to test with test kits shipped from the CDC.  There are no doctors’ offices or hospitals running the test.  Hospitals can collect the sample and send it to the State department of Health for testing.  At the time of this writing, March 11, 2020, there have been 43 people tested in Indiana.  Indiana is a state estimated to have 6,679,200 people.

Reasons to think you might have COVID-19 would be

  • typical flu like symptoms such as cough, fever, and/or shortness of breath

AND

  • one of the following
    • Recent Travel from a high risk place such as
      • China, Italy, Iran,  Japan or  South Korea
        • The above are the areas felt to have ongoing transmission but take note that there have been quite a few cases in Spain, Germany, France and cruise ships
  • Exposure to someone known to have the Corona Virus

Recent known exposure to someone having travelled from those places is concerning also but not part of the official CDC criteria for a definite reason to test.   Obviously the decision involves a discussion as this wouldn’t catch everyone as the first two Indiana cases got it at Biogen Company meeting in Boston.

The first person in Indiana to have COVID19 was commended for having called the hospital ahead of time to let them know he was coming. The hospital had him come through a separate entrance from the other patients, and examine him with full personal protective equipment in an isolation room and sent him home for self-quarantine.

While all that that is not mandated but the CDC it was the best option.  The test must be of the nose and mouth (nasopharyngeal and oropharyngeal) and of sputum if there is a productive cough.  As there have only been 43 tests done in Indiana, it is presently still best to do this at a hospital.

WHAT TO DO IF you are having respiratory symptoms:

  • Please call the office PRIOR to coming in if you are having respiratory symptoms.
    • You will be connected with a member of the clinical staff for triage and symptom evaluation.
  • Based on the conversation with the clinical staff you will be instructed to do one of 2 things:
    • Option 1:
      • Go to your local ER/hospital for COVID 19 testing to rule out infection
    • Option 2:
      • If you are instructed to come to the office for an office visit or treatment, call us at the front door on your cell phone to let us know upon which you will be given a mask before even entering the office.
      • A member of the staff will escort you to a private location to await evaluation/treatment through a different entrance than we usually use.

What to do when:
You don’t think you have corona virus (COVID-19) but you’re worried about it

  • Protect yourself from the environment
    • Wash your hands with soap and water throughout the day
    • You will touch you face form time to time but try to limit that and keep washing your hands.
    • When you sneeze, sneeze into your elbow
    • Wipe down the things you touch that are frequently touched by others.
  • Animal sources:
    • There have been no identified animal sources at this time in the US. However, the World Health Organization recommends that you avoid unnecessary animal contact and wash your hands after being with an animal.
  • Do everything you can to boost your immune system
    • The official word of the CDC of course is that there is not specific treatment for the virus but you can treat symptoms. We believe that for someone at risk it would be wise to do things that could boost the immune system. These things would include getting enough sleep, taking in at least 5000 IU of Vitamin D,   Zinc 25 mg, a good probiotic like GIH, an immune boosting multivitamin like Immupro and for certain people Thymosin Alpha 1 (an immune boosting peptide).

What to do when:
You have COVID-19

  • At the time of this writing this it would be rare, but if you were confirmed to have it you would still do all of the above to boost your immune system but you would either be self-quarantined for 14 days or remain in the hospital if required. After 14 days come see us for a follow appointment and evaluation.

What to do when:
You really think you may have it based on the criteria above

  • As noted we are still early in the life of this event here in Indiana. At this point we recommend you find a hospital to get tested at. And then be self-quarantined until the results come back.  If you are negative you can still do the things listed above to boost your immune system and protect yourself. If the results are positive then refer to the category above.

The plan here at HEALTH AND WELLNESS OF CARMEL

  • As recommended by the CDC we are posting reminders of contagion management steps at the front desk waiting rooms and patient rooms.
    https://www.cdc.gov/flu/pdf/protect/cdc_cough.pdf
  • We will be wiping down the rooms between patients including ones that serve as isolation rooms and the patient waiting rooms.
  • We will still ask you about respiratory symptoms at the front desk just to be safe.
  • In addition to wearing a mask, anyone with respiratory symptoms in the IV room will be spaced as far apart at possible.
  • If the patient is known to truly have or is suspected to have COVID-19 the provider will wear as much protective equipment as the clinic can acquire in this time of shortage to include masks, protective eye wear gloves, and gowns.
  • In addition to the patient rooms we will wipe down other areas likely to be touched by others like the entrances to the clinic.

There’s been a lot hype about all this and I know we all hope this becomes a thing of the past like SARS did, but until that happens we will be cautious and do everything we can to protect your health.

Bruce Thomas, MD