COVID-19

A sudden onset of fever and respiratory tract symptoms (such as dry cough and shortness of breath) is reason to suspect COVID-19. A severe lower respiratory tract illness that does not have any other clear cause is also a reason. Along with tiredness, these symptoms are present in the great majority of COVID-19 cases. Using a pulse oximeter, at home, is an important step in evaluating breathing difficulties; a reading below 95, taken from a warm digit (finger), is reason for an in-person medical evaluation.

Problems with the sense of smell (known as anosmia), which can also interrupt the sense of taste, have been reported as common symptoms in patients with COVID-19, based on small studies in Italy, Germany, and South Korea. The American Academy of Otolaryngology-Head and Neck Surgery reports that anecdotal evidence is “rapidly accumulating” that a smelling disorder is a significant symptom associated with COVID-19, although not as common as fever and lower respiratory tract symptoms and not on its own.

Certain presentations of COVID-19 do not fit the emerging symptom profile. For instance, gastrointestinal symptoms, such as nausea and diarrhea, or upper respiratory problems may be the presenting symptoms of COVID-19. Some patients do not present with fever. An additional potential symptom is emerging and is under investigation by researchers including the International Federation of Podiatrists: purple-colored lesions, such as those of chickenpox, measles, or chilblains, that appear around the toes.

The period of infectivity is thought to be 14 days, however, this timeframe is not certain. Key questions include the degree of infectiousness:

• During the period of onset with symptomatic COVID-19;
• After symptoms subside during recovery; and
• Of those with asymptomatic COVID-19.

Coronaviruses, based on a study by the National Institute of Allergy and Infectious Diseases, can remain in the air for several hours. It is uncertain whether these aerosols, which are smaller droplets that are emitted when people breathe and speak, are a meaningful mode of COVID-19 transmission, particularly once they evaporate. Further, airborne transmission is an atypical mode of transmission for coronaviruses.

With regard to food preparation, coronavirus strains could be present at low and freezing temperatures for a certain period, however, basic food hygiene and safety practices should prevent transmission of the virus through food.

There is some mild evidence that those individuals with blood group type A have a higher rate of COVID-19 infection than those with blood group type O.

A number of approaches are being investigated to treat COVID-19, however, there is currently no treatment for COVID-19.  Of note, the virus itself is well-defined, with the entire DNA sequence laid out for researchers. Over 1,300 clinical trials are underway worldwide and, whenever possible, should be considered; a registry of international clinical trials can be found at clinicaltrials.gov.

Among others, there are 4 primary treatment paths that are under active investigation, however, with limited valid data about efficacy, optimal use, side effects and toxicity.

• Remdesivir, an experimental antiviral, with strong promise;
• Convalescent blood plasma, subject to logistical limitations, approved by the FDA for emergency use and derived from those individuals that are recovered from COVID-19 that have antibodies that attack the COVID-19 virus;
• Chloroquine and, a new version, Hydroxychloroquine, a drug used to treat malaria, lupus and arthritis and also approved by the FDA for emergency use; and
• Interleukin-6 pathway inhibitors, an anti-inflammatory used for management of diseases like rheumatoid arthritis.

Current protocols reflect a very wide range of experience about how to best provide respiratory support for those individuals that are severely infected, ranging from breathing therapies (like ironing) to use of respirators. At least six academic medical institutions, specifically Brigham and Women’s Hospital, Massachusetts General Hospital, Michigan Medicine, Nebraska Medicine, Penn Medicine, and University of Washington Medicine, have developed publicly available COVID-19 management protocols based on field experience.

Use of acetaminophen is preferred for symptom management with COVID-19 if possible; NSAIDs have been theorized to cause harm in patients with COVID-19, however, these concerns were raised with anecdotal data and there is limited evidence this is so.

The median time between infection and symptom onset has been estimated as 5.1 days. Within another 7 days, mild infections resolve while more severe infections become worse, potentially requiring hospitalization. A serious infection can last a month or more; symptoms can ease and then return with even more vigor. This video further describes the wide range of potential scenarios for both individuals and the population as a whole.

The Coronavirus Explained by "In a Nutshell" and Our World in Data

https://www.youtube.com/embed/BtN-goy9VOY?feature=oembed

Whether someone who has been infected with COVID-19 and recovers can become infected again depends on an antibody analysis that is only now seriously underway. While antibodies to the virus are induced in those who have become infected, it is unclear if those antibodies are protective for all individuals and, if so, how long any protective effect will last.