COVID-19 Update, April 23, 2020

Since my original article on Covid-19 several weeks ago (basic knowledge), much more has been learned.

As a short recap of my original article, Covid-19 is just one type of coronavirus, which is a whole family of viruses.

  • It has no cure, and no vaccine has yet been developed to prevent it.
  • It is more contagious (droplet and contact spread) and is more deadly (causes respiratory failure) than the influenza virus.
  • The only effective way to slow its transmission is by social distancing, wearing face coverings, and frequent hand-washing.
  • 80% of Covid patients will get better on their own, but the elderly or those with multiple other diseases, especially affecting the lungs, are more likely to become critically ill and die.
  • Stay-at-home measures should be employed with those with the illness unless it becomes critical. But if unsure, seek medical attention.

What’s been learned since my initial article is the following:

  1. Covid-19 lasts on surfaces for up to 17 days.
  2. Just normal talking, let alone sneezing or coughing (droplet spread), sheds millions of virus particles into the air, even from an asymptomatic (well-appearing) but infected (colonized) individual.
  3. Loss of smell and taste, along with flu-like symptoms (fever, body aches, shakes) is indicative of Covid infection.
  4. It is possible to become infected with Covid and influenza at the same time.
  5. The CDC (Centers for Disease Control) now recommends that EVERONE who goes out in public should wear a facial covering of some sort, as covering the nose and mouth can reduce viral shedding in the air. Frequent hand-washing is still recommended to prevent contact transmission. Medical-grade PPE (e.g., Personal Protective Equiment such as N-95 masks, face shields, gowns, foot coverings, etc.) should be used by healthcare workers and not by the general public, because they are still in short supply.
  6. The average time spent on a ventilator for critically ill Covid-19 patients is about 20 days, whereas non-Covid patients are on a ventilator about 7 days.
  7. More people on ventilators due to Covid die than non-Covid patients.
  8. Covid does not appear to be as seasonally dependent as the influenza virus, meaning that warmer weather may not be as protective as compared to influenza virus, which virtually disappears with warmer weather.
  9. Covid has no cure. Hydroxychloroquine has shown to be ineffective and has caused greater morbidity (illness) due to toxic side effects. Some medical studies on hydroxychloroquine have had to be terminated prematurely due the severe toxicity caused by this drug.
  10. A vaccine may be developed if possible. It’s not a matter of when, it is a matter of if – meaning that not all viruses are preventable by a vaccine. If this were not the case, we would have developed a vaccine for the “common cold” by now, but attempts to do so have met with failure.
  11. If a successful vaccine is developed, it will take approximately a year to be available.
  12. We in the United States have inadequate testing, either by nasal swab, which detects the virus directly, or by serum (blood) testing.
  13. The prevalence of blood testing for antibodies, the proteins the body makes to neutralize or “kill” the virus, is also inadequate. Hence, we do not know if “herd immunity” (the herd being the majority of the population) is possible.
  14. The virus can be shed for days even after the symptoms of the illness have subsided.
  15. Although unlikely, it is possible to become reinfected in the same year, that is, get the same illness twice in one season. This is rare with the influenza virus.
  16. If herd immunity is prevalent, it might allow the people who have made antibodies to go out into public safely, thereby allowing a gradual reopening of businesses and the economy.
  17. If herd immunity is not prevalent, it might be advisable to take all the precautionary measures we’ve mentioned for a lot longer.
  18. Even in those who make antibodies to Covid-19, it is not known how long these antibodies confer immunity to the virus.
  19. Certain studies (e.g., one from Harvard) seem to indicate that some degree of social distancing may be necessary through the year 2022.
  20. If preventive measures (like stay-at-home orders and shelter-in-place) are lessened, there will in all likelihood be a “second wave” of illness the spreads across the US.
  21. If Covid-19 and influenza both increase in the fall, the effects on both health as well as on the economy could be devastating.
  22. Certain tests for Covid 19 are not very accurate or reliable (having low sensitivity and specificity). Unfortunately, the FDA has approved some of these tests prematurely, and some of these tests have had to be recalled due to being faulty.
  23. Covid is more common and more severe in certain ethnic and socioeconomic groups. For instances, African-Americans and people of Latin descent have a higher incidence of Covid infection. There are various theories for why this is, including the fact that these groups are in occupations deemed as “essential services” (delivery, food handling, etc).
  24. Like all viruses, the Covid-19 virus can and has mutated at least once, making a vaccination more difficult to develop.
  25. The use of NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen may prolong Covid infection. These medications are used for pain and for fever reduction. I advise that acetaminophen (Tylenol) be used instead of NSAIDs in patients with Covid.
  26. Telemedicine is now being heavily recommended to treat not only Covid, but other non-emergent illnesses. By avoiding having to wait in a crowded doctor’s office, there will be less transmission. The waiting area in most doctors offices has been shown to be a veritable petri-dish of microorganisms, promoting disease transmission.

There is still much more that we have yet to learn about the virus.

New information (and mis-information) is coming out almost every day, from various countries. The World Health Organization is organizing studies being done on Covid 19 across the globe, thus gathering data on large groups of patients world-wide. However, good science takes time, and so these studies will need to be ongoing for at least several weeks to months to yield any conclusions.

I will write/post an update every so often as we continue to fight Covid, as new knowledge becomes available.

Free video consultations are available

Hope this helps! I have extended free video-consultations through the end of April on Click Schedule an Appointment and follow the instructions. Since the demand is high, please forgive me in advance if the connection does not go through on the first try. Unfortunately, band-width is not infinite!

Dr. Guha

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