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COVID-19

Reference the Facts

The Skinny

What We Currently Know

  • It appears spread of this virus can occur often before an illness is evident.
  • As a result, people are presumed to be spreading the illness while asymptomatic or before they are confirmed to be positive.
  • Spread is believed to occur by person-to-person contact, or by contact with respiratory droplets on a pre-contaminated surface.
  • Aerosolized corona virus has been found to be viable for about 2 hours out side of the body; on cardboard for 5 hours; plastic and metal surfaces for over 3 days.
  • Illness can be mild in most people, but up to 16% develop severe respiratory compromise.
  • People over 40 years of age and adults with pre-existing health conditions [hypertension, kidney disease, diabetes, obesity] are at greatest risk of experiencing complications.
  • Since there is no conclusive treatment or vaccine, the mainstay of medical management is supportive in nature.

In late December 2019, a cluster of unexplained cases of viral pneumonia occurred in Wuhan, China. This illness was identified as coronavirus disease 2019 (COVID-19).  This Novel Coronavirus (SARS‐CoV‐2) and associated COVID‐19 disease can cause serious or even fatal respiratory tract infection without an directed means to combat the illness. This urgent situation is pressing the world to respond with the development of novel vaccine or a small molecule therapeutics for SARS‐CoV‐2.

Because this particular strand of virus has never been seen before, the medical community is learning to understanding the character of this virus’ mode of transmission, character of illness and clear determination of carrier status. Primary measures of management are aimed at prevention of transmission – which include frequent aggressive hand-washing, avoiding large crowds, and avoiding public places if you suspect you have been exposed.

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Coronavirus Lifecycle

Coronavirus is classified in subfamily Orthocoronavirinae, family Coronaviridae, as an enveloped positive single sense RNA virus.  The nomenclature provides clues to it’s function, alludes to it’s life-cycle and hints at it’s character, and possible weaknesses:  It is not known if the virus contents are extruded into the host cell or if the viral envelop merges with the  host cells membrane.  If there is fusion, there may remain a marker of the cell about the host cell’s status of infection. 

Entry into the Cell

The corona virus attaches to a cell receptor, the key like fit permits entry by activating the cell’s protease, allowing the virus to enter.  As it enters, the virus is ‘un-coated,’ releasing it’s RNA genome into the cell’s cytoplasm.  The viral genome migrates to the host cells ribosome, the structure which helps to translate the coding within a genome, producing from the viral genome a polyprotein.  This polyprotein will be involved with organizing and replicating the viral genome.

Reproduction within the host Cell

As copies of viral genome are produced, it helps itself to some of the other host cells machinery to assist in the reproduction of necessary proteins.  As it organizes, it depends on the host’s endoplasmic reliculum to translate it’s RNA rapidly, and the Golgi body apparatus to produce necessary proteins.  Once fully synthesized, several newly assembled viruses are released from the cell through exocytosis, each capable of completing the same cycle anew.

Exploring current Strategies

What You Can Do

A public information form prepared by the CDC advising measures the American public can do to limit transmission.

Managing Patients

Interview with Dr Eric Rubin and Dr. Lindsey Baden on making decisions about COVID-19 testing and treatment for your patients.

Approved Disinfectants

EPA approved disinfectants recommended to decrease transmission by disinfecting lingering surface virons. See updates below.

Community Strategies

CDC recommendations for community management to minimize disease transmission.

Three Steps to Success

1

Social Distancing

Maintain a distance of about 6 feet from all persons at all times.

2

Hand washing

CDC recommendations encourage 20-45 sec with soap and water.

3

Prioritize Your Health

.Optimizing sleep, activity and diet to minimize stress and exposure.

rest and isolation if you believe you have encountered someone sick masks use will not deter spread but can warn people around you
Social Precaution
Fingertip Pulse Oximeter Blood Oxygen Saturation Monitor for Pulse Rate with Lanyard Black
Pulse Oximetry
drink water to prevent dehydration e1587000907367
Hydration
acetominophen for fever discomfort 1
Fever & Muscle Aches
1000 mg vitamin c for immune system support
Immune Support
Puritans Pride Absorbable Calcium 600mg Plus Magnesium 300mg and Vitamin D 1000iu 60 Softgels for immune health
Fortified Immunity

Symptom Management

After contact with coronavirus, it may take 2-14 days for symptoms to begin.  After the asymptomatic period, initial symptoms of COVID-19 may be similar to the flu [fever,muscle aches, dry cough] but can include fatigue, headache and diarrhea.  Many are reporting the loss of smell and taste occurring suddenly during onset.  

Continue aggressive hand-washing and surface disinfection, avoid public places and minimize personal contact.  

Contact your healthcare providers to alert them to the onset of symptoms, many are encouraging patients to remain quarantined unless their symptoms progress.  For general muscle aches and fever, acetaminophen is usually recommended.  Patients typically sleep and have suppressed appetites, therefore, they are encouraged to drink water as most patients presenting to the hospital have been noted to be dehydrated.

Symptoms which would impose alarm include feeling light-headed and/or confused, difficulty breathing, pain in the chest, bluish lips.  All these symptoms demand prompt evaluation by a medical professional, contact your health provider immediately by phone.  

FAQ

Frequently Asked Questions & Updates

It is not known definitively.  The source of this recommendation was apparently the French Health Minister’s March 14th Tweet –  the basis for the judgement are unknown.  

I understand that dehydration has been observed to be an issue in people fighting COVID-19, as it often is in febrile illnesses, with or without diarrhea.  Although NSAIDS, are an effective choice for combating muscle aches and fever associated with the illness, they are limited by their well known side-effects [GI ulcers and kidney compromise, especially when already dehydrated].  Because dehydration is so common in patients with this virus, the first recommendation for these symptoms is acetaminophen [generic for Tylenol].

Maybe.  A preliminary study from Chinese data has suggested that Blood Group A was at higher risk of acquiring COVID-19, while Blood Group O has a lower risk of acquiring the infection.

If this is corroborated by future studies and statistics, the mechanism in Blood Group A individuals is that the humoral and innate immunity is compromised by the virus linking with a blood cell, creating a hybrid mimic.  Which is to say, that the virus would appear to the body like an antigen it is predisposed to react to – specifically an antigen readily found in people with blood type O and blood type B, but not found in people with blood type A.  Further, they purported that Anti-A antibodies [found in blood groups B and O] “specifically prevented the adhesion of SARs-CoV S-protein expressing cells to ACE2-expressing cell lines.”

It’s an interesting observation, but statistically, the observation is not quite as obvious.  It would suggest that further assessment is required to make such a claim – both of the character of the bonds the virus makes, and the statistical power of the groups evaluated to be definitely claimed.  What I failed to see was a clear correlation of the population of blood-type B [which should also have Anti-A Antibodies] with susceptibility similar to the Blood-type O.  It could be assumed other confounding factors predominated in these populations [like family households making up large portions of the study populations, living in close proximity with similar blood types].  Still an interesting study.

Hydrochloroquine is a medication most commonly used to prevent travelers to regions with endemic malaria from acquiring the disease and developing the illness; in addition, it has been used to stabilize rheumatic disease processes, such as lupus, by mitigating associated inflammatory processes.  

It’s pharmecodynamics as a weak base allow this medication to pass directly through our cell membranes, where upon encountering the cell’s lysosomes, it causes an abrupt change in the lysosome’s contents from acidic to basic.  The change leads to a decrease in intracellular processing, glycosylation and  secretion of proteins with many immunologic consequences.  

A small study conducted by researchers in China found that hydroxychloroquine accumulated sufficiently in the simulated patient target tissues to suggest it would be effective in slowing viral potency and minimizing our body’s cytokine storm  immune response that characterized sudden decline in patient stability evident to clinicians in hospitals.  The results were hopeful, but not definitive; especially as there are multiple serious dose dependent side effects with this medication, even when taken properly.  

A vaccination is a way of priming your immune system to have the necessary antibodies at hand so that it may effectively defend the body from an invading organism.  This is particularly advantageous because it can take the body 3-6 weeks from the time it is introduced to a challenging organism until it has produced the reserves necessary to successfully defend itself from a quickly multiplying organism.

A vaccine primes the system by introducing either a live organism, or crucial parts of a inviable organism.  Both are tricky.  By giving a live virus you may actually be introducing the COVID-19 infection to the individual, due to an incompetent immune system or dosage misjudgment.  To introduce a nonviable organism or introducing the body to fragments, you have to have a thorough understanding about how that organism interacts with the body and exactly which fragments would prime the body sufficiently.    

To date, there are at least 78 vaccine studies underway to assess both the safety of the vaccine on individuals and the effectiveness of the vaccine to prepare the body to defend itself from a full COVID-19 illness.  This can be particularly challenging for this type of virus, as RNA are known to mutate quickly, due to translation errors during replication.  Which is to say, the process of testing the vaccine requires multiple phases to ascertain both it’s safety and effectiveness, as well as a period of post vaccination evaluation to assure there are no long term side effects evident from the treatment.  Typically this process can require over two years.  I understand provision may be made to allow the investigational vaccines to be accessible to high risk individuals, possibly as early as July 2020, undoubtedly with a solid waiver signed prior to providing the treatment.

It is not known definitively.  The source of this recommendation was apparently the French Health Minister’s March 14th Tweet –  the basis for the judgement are unknown.  

I understand that dehydration has been observed to be an issue in people fighting COVID-19, as it often is in febrile illnesses, with or without diarrhea.  Although NSAIDS, are an effective choice for combating muscle aches and fever associated with the illness, they are limited by their well known side-effects [GI ulcers and kidney compromise, especially when already dehydrated].  Because dehydration is so common in patients with this virus, the first recommendation for these symptoms is acetaminophen [generic for Tylenol].

Updated EPA Product Search:  https://cfpub.epa.gov/giwiz/disinfectants/index.cfm

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