COVID-19 (Coronavirus Disease 19) March Update- causes, symptoms, diagnosis, treatment, pathology

By Now you've probably heard of Covid-19 or corona virus disease discovered in 2019 which is responsible for a global pandemic Covid-19 is caused by SARS COV 2 or severely acute respiratory syndrome corona virus - because it's genetically similar to the Sarris corona virus which was responsible for the SARS outbreak in 2002 now corona viruses that circulate among humans are typically benign and they cause about 1/4 of all common cold illnesses in Covid-19 what happened is that there was a corona virus circulating among bats which are a natural animal reservoir and it mutated just enough to start infecting an intermediate host the Pangolin an animal that looks like a cross between an anteater and an armadillo in late 2019 the corona virus mutated again and started causing disease in humans the outbreak began in China but has since spread around the world as of March 9th 2020 or roughly three months into the outbreak there have been 109 thousand five hundred and seventy-eight confirmed cases of Covid-19 and three thousand eight hundred and nine deaths resulting in a fatality rate of 3.5%but that represents an average across different countries and time frames based on a large study in China digging deeper reveals that the fatality rate in China was actually 16% for cases between January 1st and January tenth but then it fell steadily over time until it was only 0.8% for patients with symptom onset after February 1st there are two main reasons for this first the hospitals and clinics were initially overwhelmed and couldn't manage the disease so both patients and health care providers were getting severely ill and dying but within a few weeks with better equipment testing and processes in place the healthcare system responded and brought down the fatality rate dramatically now as a point of comparison the flu typically causes fatality rate of 0.1 percent so even based on this data Covid-19 is still 8to 35 times more deadly than the fluid’s also worth pointing out that for Covid-19 the mortality rates differ by group so for example if you split things out by age you can see from this table that fatality rate is relatively low if you’re below 60 with no deaths seen in children 9 and younger but then it starts to really climb up for the elderly so they're really the ones at highest risk similarly the fatality rate is higher for folks with hypertension diabetes cardiovascular disease chronic respiratory disease and cancer relative to folks without any of these conditions and of course a lot of the elderly typically have one or more of these conditions so it's not surprising that they go hand in hand now although the Cova 19 pandemic is still ongoing the good news is that in China and also in South Korea the number of new cases per day has dropped off largely due to the aggressive public health measures like quarantine aggressive testing and ensuring hospitals have the right equipment and staffing based on the current data over 80% of the patients with Covid-19 have a mild infection and some people don't develop any symptoms at all for others they can develop symptoms that can range from pretty mild like fever cough and shortness of breath all the way to serious problems like pneumonia severe lung damage can cause acute respiratory distress syndrome or a RDS which occurs when the lung inflammations so severe that fluid builds up around and within the lungs the severe infection can cause septic shock which happens when the blood pressure Falls dramatically and the body's organs are starved for oxygen a RDS and shock are the main cause of death for people with the infection and again this is most likely to occur in those over the age of60 smokers and people with other medical conditions like heart disease in addition to causing disease coronaviruses can spread quickly usually the virus spreads when people cough or sneeze and tiny droplets containing the virus are released these droplets can land on another person's mouth nose or eyes and that allows the virus to enter a new person when a person with Cova Dean travels to a non affected area this is called an imported case if they start spreading the disease to household contacts and those around them it’s called local transmission since it’s usually isolated to a small area and can be easily traced back to the original person however when people begin to contract the disease without a clear source it's called community transmission to prevent or contain community transmission some schools and businesses have shut down and some conferences sporting events and other large gatherings have been postponed or canceled once a person is infected symptoms develop about five days later this is called the incubation period now there's debate about how much asymptomatic or pre-symptomatic people which is to say folks that are in the incubation period are spreading the disease and it may be much more than what we originally thought viruses are given a reproductive number or are not based on how quickly they spread and person-to-person transmission has been confirmed both in and outside of China and are not of one means that an infected person passes it on to one new person and are not of two means that one person spreads it to two new people and so forth if the Arnott is below one the infection Peters out if it's at one it stays steady and if it's above one then it continues to spread the current estimate for Covid-19 isn't our knot of 2.2 as a point of comparison the are not of the flu virus is about 1.3 soaked Ovid 19 spreads quite a bit more easily to confirm the diagnosis a reverse transcription polymerase chain reaction or RT PCR test can be done which can detect very small amounts of viral RNA it's worth mentioning however that early in the disease the rt-pcr can often miss the infection altogether meaning that it's not very sensitive so if severe pulmonary disease is suspected a chest CT should also be done to help detect the presence of viral pneumonia it’s also important to look for other causes of similar symptoms by doing things for example like a quick flu test or respiratory viral panel to look for alternative causes of the symptoms treatment is focused on supportive care such as providing fluids oxygen and ventilatory support for really ill people there's also early data showing that REM des avear an antiviral drug previously used against Ebola can be helpful and it’s being tested in large-scale clinical trials in the US and China unfortunately there's no vaccine currently available to protect against COVID-19 having said that there are some being researched including one that is in clinical trials and will likely be ready by 2021 so the main goal is to avoid person-to-person transmission in areas with community transmission anyone with mild symptoms regardless of whether they have been diagnosed as having COVID-19 or not should wear a mask and they should self quarantine within their home if those symptoms worsen they should  call their clinic or use telemedicine to talk to a clinician for people with symptoms that live with others or even with pets they should self quarantine in a separate room and use a separate bathroom if possible and they should avoid sharing house hold items like bedding or eating utensils in fact there has been a confirmed case of human to dog transmission where COVID-19 went from a person to their pet dog however the dog didn't get sick and there's no evidence that pets can spread this disease or become sick so it's not necessary to take measures against companion animals finally anyone with symptoms including children and younger adults should not attend school work or any other in-person gathering and should avoid travel now for individuals that don't have symptoms but are at higher risk like those over age 60 and people with a chronic disease the recommendation is that they also self quarantine to avoid the chance of getting sick self quarantine requires keeping a few weeks supply of your medications groceries and household items as well as having an emergency contact person coronaviruses don't usually spread overlong distances in the air but they can get flung from one person to another on tiny droplets of saliva when someone’s coughing or sneezing in addition some strains of coronavirus can survive on surfaces for over a day with that in mind if you're a healthy person living in a non outbreak area there commendation is to avoid travel to disease outbreak areas generally stay away from crowded places and stay at least six feet were two meters away from anyone with symptoms wearing a surgical mask is not recommended because they’re meant to catch droplets from a cough or sneeze going out rather than preventing you from breathing in the virus similarly wearing an n95 mask is not recommended because they're only meant to be worn by healthcare workers in addition cleaning and sterilizing frequently touched surfaces like toilet seats door handles phones and keyboards is also a good idea as always careful hand-washing is key and it should be done with soap or alcohol-based hand sanitizers and scrubbing for 20 seconds also avoid touching your eyes nose and mouth this is the area known as yourt-zone it's a common entry point for viruses into the body for healthcare workers who are around people with COVID-19 the recommendations to apply droplet and contact precautions that includes wearing personal protective equipment like a clean dry surgical mask gloves long-sleeved gowns and eye protections like goggles or a face shield when performing a procedure that generates aerosol like tracheal intubation bronchoscopy CPR or non-invasive ventilation it's important to wear ann95 respirator this prevents 95% of the small particles like respiratory droplets from passing through all right is a quick recap the SARS CoV- virus causes COVID-19 the virus travels in respiratory droplets and enters the body via the mouth nose or eyes it can cause symptoms like fever cough and shortness of breath and in some people it can progress to more dangerous complications like pneumonia a RDS and shock the highest risk is among the elderly and those with other serious health conditions treatments are focused on supportive care but medications like REM des a veer are in clinical trials and there’s a vaccine in clinical trials as well that will likely be ready by 2021in the meantime the best strategy is prevention this includes careful hand-washing avoiding traveling to disease outbreak areas and crowded places when possible avoiding touching your t-zone and if you're a healthcare worker using personal protective equipment you