The analysis below was written by Dr. David Anderson – President, COBA Atlanta Chapter, Inc.
April 04, 2020
To: Members of the Calabar Old Boys Association
2019-20 CORONAVIRUS PANDEMIC
The coronavirus disease 2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The disease was first reported in Wuhan, China in December 2019. Since then, it has spread to just about every country. The result of infection by this virus varies from no symptoms; mild to moderate symptoms, which is the majority of those infected; to severe illness that leads to recovery; and death.
What is the disease?
The virus has a liking for the lungs and those who get infected, some of them may develop pneumonia. Some of the patients who develop pneumonia will have an injury to the lungs and blood vessels, and they will have a problem getting enough oxygen going from their lungs to the blood and other organs. This is very serious and often results in them dying.
How do I get it?
The infection is spread from human to human. When someone with the infection coughs, sneezes, speaks or breathes, the virus is released into the air in very small droplets that are not visible to the naked eye. These droplets then float in the air for a while before falling to the ground, countertop, furniture, and other surfaces. While air-borne, the infected droplets may be inhaled by someone in close proximity to the infected person. The infection can also be passed on when the droplets that were on the furniture, countertop, doorknob, appliances, and other items are touched and become transferred by the hands to one’s mouth, nose, or eyes.
How long after being exposed to an infected person does it take to develop symptoms?
The time from exposure to the start of symptoms varies. Symptoms could start as early as 1 day after exposure or up to 14 days; however, the average is 5 days.
What are the symptoms?
Most people who are infected by the virus will have no symptoms or will experience only a mild flu-like illness that consists of the following:
FEVER – often a low-grade fever, less than 100 degrees Fahrenheit (normal is 98.6) but this could rise higher with time.
COUGH – may or may not have sputum associated with it.
FATIGUE – a feeling of generalized weakness, tiredness
SHORTNESS OF BREATH – cannot get enough air. This may present as breathing rapidly (more than 20 breaths per minute).
MUSCLE ACHE – ache and pains all over your body, especially in the thighs, legs, arms, and torso.
Other symptoms that have been reported in a minority of patients include DIARRHEA, LOSS OF SMELL, LOSS OF TASTE, LOSS OF APPETITE, SORE THROAT, HEADACHE, NAUSEA, VOMITING, AND ABDOMINAL PAIN
What are the emergency signs that I should be looking out for?
Difficulty breathing: The person is breathing rapidly (more than 20 times per minute) or just cannot seem to get enough air.
Persistent pain or pressure in the chest: The heart may not be receiving enough oxygen.
Confusion: Due to a lack of oxygen to the brain.
Lethargic: The patient appears sleepy and it is hard to stimulate them and keep them awake.
Blue lips and fingertips: Due to not having enough oxygen in the circulating blood.
How do I protect myself from becoming infected?
Avoid close contact with others unless you know that they do not have the virus.
i. Stay at least 6 feet away from anyone if you do not know if they are infected.
i. Wash your hands with soap and water frequently for at least 20 seconds. Wash them immediately when you get home, before eating, after touching any surface that you think may be contaminated by droplets of the virus, and after using the restroom.
ii. If you do not have access to soap and water, then you can use a hand sanitizer that is made from at least 60% alcohol. However, soap and water are preferred.
Avoid touching your eyes, mouth, or nose unless you have washed your hands.
Practice good hygiene.
i. Do not cough into your hands and then touch anything with them. Wash your hands with ii. Cough and sneeze into a tissue and throw it away in the garbage or flush it in the toilet, then wash hands.
Cover your nose and mouth with a mask or handkerchief when you have to go out of the home.
Clean and disinfect surfaces that are touched frequently, such as appliances, computer keyboards, doorknobs, faucets, countertops, cellphones, TV remote controls, etc.
i. Clean the surface first with soap and water where practical, then disinfect with diluted bleach.
What is the usual outcome for those who are infected?
Most people who are exposed to the virus will have no symptoms or will develop only a mild flu-like illness. However, some patients are more likely to develop a more severe illness that will require hospitalization and ICU care. These include the following group of people:
Adults 65 years and older
i. 8 out of every 10 COVID-19 deaths in the USA have been in adults over the age of 65
Chronic lung disease, such as moderate to severe asthma, chronic bronchitis, emphysema
Chronic kidney disease on hemodialysis
Chronic liver disease, such as cirrhosis, hepatitis
Cardiovascular disease, such as congestive heart failure, coronary artery disease
Diabetes mellitus, especially if it is uncontrolled
HIV/AIDS and other immune deficiency diseases
Obesity – morbidly obese people defined by a body mass index (BMI) of 40 and higher
Cancer patients being treated with chemotherapy drugs that weaken the immune system
What should be done if a household member is infected?
Physically isolate that person to a separate part of the house if possible. Have the person separate from the rest of the family for at least 14 days or until they are no longer having symptoms of the disease, whichever is longer.
Have the infected person wear a mask that covers the nose and mouth at all times.
If possible, have the infected person use a different bathroom. If this is not feasible, then clean up after them with diluted bleach. Be sure to clean toilet, faucets, basin, bathtub, countertop, and shower stall daily.
Provide separate utensils for the infected person to drink from and eat meals. Disposable utensils work well.
Household members should also wear a mask to lower the chances of inhaling droplets from the infected person.
Practice good respiratory hygiene.
Disinfect countertops, appliances, doorknobs, and other nonporous surfaces daily or as often as needed.
Is there treatment available for the COVID-19 disease?
Most patients infected by COVID-19 will not become symptomatic or have only mild symptoms. These people do not need to be treated and can be managed by observation and supportive care. If they have a fever, give them Tylenol (acetaminophen). If they have diarrhea, give them lots of fluid to drink, preferably with electrolytes such as sodium, potassium, and phosphorus. Sport drinks and Pedialyte work well for this. Lemonade is good, as well as ginger tea with lemon and honey.
Medications are available to treat COVID-19 disease; however, none are approved by the US Food and Drug Administration (FDA) to treat this condition. Hydroxychloroquine by itself, or in combination with Azithromycin, has shown some benefit in some patients. Clinical trials have started to study their effectiveness.
If I am infected with COVID-19 and have no symptoms, can I pass it on to others?
The simple answer is YES. So, keep a safe distance from others, practice good respiratory hygiene, and cover your nose and mouth with a handkerchief or mask when around others.
When should I contact my doctor or go to the emergency room?
If you develop any of the emergency signs or symptoms above, then you should contact your doctor or go to the emergency room for further evaluation and management.
Guys, I hope that you will find this information useful. Please take care of yourself.
David Anderson, M.D., FACP
President, COBA Atlanta Chapter, Inc.