What is a Virus and how does it work?
Viruses are little bundles of genetic code. They work by invading a cell and “hijacking” that cell’s equipment to make copies of that genetic code. Once a sufficient number of copies have been made, the cell explodes and all those little copies can now invade other cells.
There are two types of viruses: DNA and RNA. DNA viruses must translate their code from DNA to RNA before they can make copies of themselves. COVID-19 is an RNA virus which means it can invade the cell and immediately force the cell to make copies of itself.
What is a “NOVEL” virus?
A Novel virus is a virus that has never been seen by the human race before. Novel viruses existed in other species before being transmitted to humans. The species in which the virus lived before being transmitted to humans is called a reservoir. The most common reservoirs for novel viruses are pigs, bats, birds and sometimes cattle.
How do viruses spread?
Viruses spread through bodily fluids (blood, sweat, tears, respiratory secretions, saliva, urine). COVID-19 spreads primarily through respiratory secretions. As cells explode and die, viral particles float around in respiratory secretions. These viral particles spread as those secretions are released (through a cough or sneeze).
COVID-19 also spreads through “fomites”. Fomites are objects (such as a hand, doorknob or a pen) that viral particles can live on for a certain amount of time. When you touch a fomite, and then touch your face or mouth, the viral particles can infect you. Estimates suggest that the virus can survive on metal, plastic and fabric for several hours. The exact length of time the virus can survive on different fomites is not known.
There is possibility of fecal-oral transmission of COVID-19 as well but this is not well proven in the available literature.
How soon after being infected can someone spread COVID-19?
It takes at least 2 days for someone to begin spreading the virus after infection. The problem is that it takes at least 4 days (but sometimes up to 14 days) for someone to show symptoms. This means that there is a potentially very long period of time during which the virus can be spread by seemingly healthy people.
How infectious is COVID-19?
It is estimated that one person with COVID-19 will infect about 2.2 people. This number is called R0 (R-NOT) by epidemiologists. The higher the R0 the more infectious the disease. For comparison, the R0 for Measels is 12-18. The R0 for Influenza is about 1.4-1.8.
What are the symptoms of COVID-19?
Symptoms that are COMMONLY seen in COVID-19 are:
- Fever (83-98% of patients)
- Cough (46-82% of patients)
- Muscle Ache and Fatigue (11-44% of patients)
- Shortness of breath (31% of patients)
Symptoms that are SOMETIMES seen in COVID-19 are:
Symptoms that are RARELY seen in in COVID-19 are:
Is COVID-19 just like the common cold or flu?
COVID-19 is in the family of viruses called Coronavirus. This name is based on the characteristic “crown-like” structure of the virus when it is seen under a microscope. This family of viruses causes 10-30% of UPPER respiratory tract infections known as the common cold.
Although COVID-19 is structurally similar to the viruses that can cause the common cold, it is different in its behavior. COVID-19 is primarily a LOWER respiratory tract infection. COVID-19 kills by causing pneumonia and ARDS (Acute Respiratory Distress Syndrome) which is rarely seen in the common cold. It is more similar in its behavior to SARS and MERS which are also in the Coronavirus family.
Influenza is in a completely different family of viruses. It is not structurally related to COVID-19.
How severe is disease from COVID-19?
In at least 80% of cases, COVID-19 is a mild infection. When testing is more readily available, this number will increase because we will be able to find more people with asymptomatic infection. These are very encouraging numbers. However, in up to 15% of patients, the infection is severe which means it requires hospitalization. About 5% of cases will be “critical” requiring intensive care.
The overall death rate or “mortality” rate of COVID-19 is around 1-2% which seems low. However, this is MUCH higher than the death rate for Influenza which has a mortality of 0.1%. I have read statistics suggesting that the mortality rate for hospitalized patients is approximately 15%. That’s extremely concerning.
Who gets severe disease from COVID-19?
The overwhelming evidence suggests that severe disease is most likely to occur in patients who are older and/or have underlying health issues. However, many recent reports show severe disease in younger people and several infant and child deaths have been reported. Highest risk groups are:
- Patients age 60 and older
- Patients with Diabetes
- Patients with heart disease (Congestive Heart Failure, Coronary Artery Disease, Valve Problems)
- Patients with suppressed immune systems
Is there any treatment for COVID-19?
There are many experimental medications that are being investigated but currently there are no widely accepted treatments. In severe cases the combination of Plaquenil and Azithromycin have shown promise but these are only used in extremely ill patients. Antibiotics do not kill viruses. There are some experimental trials looking at “Anti-viral” medications but as yet no medication is widely recommended. One hospital in Houston is looking at giving donated plasma (a blood product containing antibodies) from patients who have recovered from COVID-19 to patients currently infected.
How can I protect myself?
The best defense we have against this virus is space. If the virus can’t get into a host, it can’t survive. So, stay away from other people especially if you are in a high-risk group. This includes family members, close friends, neighbors, etc. If you must be around other people, maintain at least 6 feet of distance between you and other people.
Remember that COVID-19 also spreads through fomites, so wash your hands OFTEN and try not to touch your face. Wipe down items with bleach or Lysol before bringing it into your home. Leave shoes outside. Wipe down door handles, handrails and other ‘high touch’ surfaces frequently. If you go grocery shopping, wipe down the cart handle before using it or better yet, try not to use a cart at all.
If you are healthy you to not need to wear a mask. It will not protect you. This will only shunt supplies away from healthcare workers on the “front lines” of this fight. Please do not hoard masks, gloves, gowns, face shields. If you have them, donate them to your local hospital.
What do I do if I have been exposed or I think I have COVID-19?
Call me. I will discuss your symptoms with you, and we will decide together if you need to be tested. If testing is indicated, we will discuss options for this. Please DO NOT go to the ER expecting testing. Due to the extreme shortage of available test kits, there are strict guidelines regarding who will be tested that must be followed. In the coming weeks as production of testing supplies increases, these guidelines may loosen.
Should I avoid NSAIDs (Ibuprofen, Naproxen Sodium, Aspirin)?
NO. At this time there is no overwhelming evidence that NSAIDs worsens disease or makes infection with COVID-19 more likely. This is currently under investigation.
Should I stop my ACE-I/ARB?
NO. ACE Inhibitors (medications that end in “PRIL”) and ARBs (medications that end in “SARTAN”) are blood pressure medications. There is no overwhelming evidence that being on these medications worsens disease or makes infection with COVID-19 more likely. Recommendation from the American College of Cardiology is to CONTINUE these medications. This is currently under investigation.