March 23rd Update from Dr. von Elten

Covid-19 is a disease caused by the SARS CoV2 virus. Below is a brief summary of what we know. I have reviewed many different sources of information. This is the best summary we can provide this point of time. Much of this will be what you already know but I have tried to be compulsive and record all that I’ve read.

What We Know

Infectiousness

This virus is more infectious than influenza. That means it spreads more easily than the flu. For each patient infected with the influenza virus they will infect approximately 1.5 patients. The Coronavirus patient will infect approximately 2-2.5 patients.

The virus is spread mostly by droplets- that is particles greater than 5 microns. These have a tendency to settle out of the air being pulled down by gravity. Hence social distancing requires keeping a distance of 6 feet from others.

However, there is some concern about aerosolized particles being able to spread the virus and under ideal conditions may last up to 3 days. These particles can be generated by the use of nebulizers. So if you think you are possibly infected, avoid using your nebulizer. If you need to use your nebulizer for asthma, COPD, etc.- don’t worry. If you live with others, use your nebulizer in your bedroom, not out in the family room. Keep your door to your room shut and others out of your room.

Experts suggest the level of infectiousness is greater after the onset of symptoms. Therefore, if you are feeling ill- self-quarantine until you can be evaluated. We are worried about the possibility of transmission occurring before the onset of symptoms. Therefore, avoiding going out in public or to ANY social gathering at this point in time unless it is absolutely necessary.

Incubation Period

The incubation period is the time from exposure until an individual develops symptoms. The peak of developing symptoms is about 5 days from being exposed. If you know you have been exposed, self-quarantine for 14 days. If you develop respiratory symptoms, self-quarantine for 14 days or until you are without fever for 72 hours and your respiratory symptoms are resolving. If you are known to have Covid-19, self-isolate for 14 days. The Virginia Department of Health will become involved in your monitoring if you are positive. You will need two negative tests before you can return to normal activity.

Originally it was hoped the infectiousness would diminish as the temperature became warmer with summer approaching. We do not know if this is true at this point.

Symptoms

Symptoms can vary widely from none to severe respiratory distress. 80% of patients will develop mild disease, but 10-20% can have more severe disease requiring hospitalizations, ICU admission or ventilatory support. The younger you are, the less likely you are to have symptoms or severe disease. Some patients will have no symptoms but can carry the disease and still be contagious. Some patients will think they have just a common cold yet will be contagious. Some patients will develop a fever, perhaps a cough or shortness of breath. The symptoms may develop into viral pneumonia. Or the symptoms may develop to a severe complication of respiratory failure and Adult Respiratory Distress Syndrome. Children for the most part have mild disease. Pneumonia in children is typically mild.

As providers we want to evaluate patients who are ill, especially those with fever, cough and shortness of breath. If the oxygen saturation rate is less than 94% patients should be evaluated.

Risk of severity

Who is at the greatest risk? Risk increases with age, gender and underlining health issues. Those patients over 60 years old enter the greater risk category, especially those over 80 years.  But recently there was a report of a significant percentage of patients between 20 and 64 years who developed serious illness. The risk in this group seemed to be those older- more middle aged than in the younger end of the range. 

Co-morbidities: what is meant by that term? Co-morbidities can also mean underlying medical conditions or ailments such as respiratory disease: COPD (emphysema), asthma, bronchiectasis, cystic fibrosis, etc. Cardiovascular disease is also a co-morbidity as have well as hypertension. Diabetes seems to be a frequent disease process that makes patients susceptible. Immunosuppressive therapy certainly places patients at risk. Or any disease process that might weaken the immune system, along with increasing age.

Treatment

As of the moment we have no known effective proven therapy for this illness, Prevention is the best therapy. What therapies are being explored? Anti-viral drugs, especially anti-HIV drugs are being tested. Biotech companies are trying to develop monoclonal antibody therapy. These companies are attempting to get the blood from recovered patients, isolate the antibody, and then manufacture the antibody. This form of therapy would be most useful to decrease the severity of the disease.

Originally it was stated Acetaminophen (Tylenol) as safer to use than non-steroidal anti-inflammatories Ibuprofen (Advil) or Naproxen (Aleve). This is no longer felt to be true. Non-steroidal anti-inflammatories can be used as safely as acetaminophen according to recent reports.

Vaccination

Unfortunately, there are no vaccines at this time. Pharmaceutical companies and Biotech firms are madly trying to develop a vaccine, but that appears to be 1-2 years out by the time one is developed, tested for efficacy and safety.

Testing

The tests to diagnose the presence of the Coronavirus are in very short supply. At this time what available tests we have in the U.S.A. are for the most part being diverted to the hot spots. Commercial labs are increasing the availability of the tests in our area. We are hoping to see a ramping up of supplies here shortly, within a week or two.

 Presently we are following the Center of Disease Control Guidelines as instructed by the Virginia Department of Health: testing is being reserved for those who are symptomatic (fever, cough and shortness of breath) as well as having a history of exposure (close contact). Close contact is defined as being within 6 feet for a significant period of time. Testing of symptomatic patients at this time is problematic. A patient could be early in the course of the disease and the test could be negative giving that individual a false sense of security. The individual could then be very contagious shortly thereafter, perhaps in a day or two.

We are hoping to have an increase of testing supplies here shortly. This will allow us to expand testing to symptomatic patients that do not meet the stringent criteria of the CDC. That could possibly occur as early as this week.

Prevention and Mitigation Strategies

Prevention is key to staying well. We recommend stay at home as much as possible, avoid going out unless for necessities. When out, practice “social distancing” (staying more than 6 feet away from someone) but it is better to avoid going out at all. Avoid social gatherings. Limit visiting the elderly including your parents if they live alone. If you do need to see them to drop off supplies, etc. leave the children home. Wash your hands or use hand sanitizer before seeing them. Stay at least 6 feet away. Limit your visit to do what is absolutely necessary. No hugging, etc.

Don’t take your kids to the stores to get groceries. Don’t let your kids go out and socialize. This will be a difficult time for everyone, but the more we can stay in and stay healthy, the better off everyone will be. We not only want to stay healthy ourselves, but we will want to avoid spreading this to others.

Stay healthy: Eat well- nutritious foods especially fruits and vegetable. Get a good night’s sleep. Exercise. And DON’T SMOKE or allow anyone around you to smoke.

Wash your hands or use hand sanitizer when available. Soap works well as the outer coating of the virus is made of lipid (a fat). Twenty seconds of vigorous hand washing can kill the virus (but not scrubbing as that may damage the barrier protection of the skin).

Hand sanitizer may be made from ¾ parts of 90% isopropyl alcohol and ¼ part aloe vera gel.

Avoid touching you face, especially your eyes and your nose where the virus can find an entry into your body.

Bleach (10% Clorox solution) applied for 1 minute on surfaces or hydrogen peroxide for 30 seconds can kill the virus.

The virus can live on different surfaces for various amounts of time. It can survive on copper about 3 hours, other metal (stainless steel) and plastic surfaces perhaps up to 3 days. We think it can survive on cardboard up to 24 hours. The duration of the survivability of the virus greatly depends on the temperature and the humidity. However, we do not know how contagious viral particles on objects will prove to be. Certainly, exposure to droplets in the air from coughing of infected individuals will pose the greatest risk.

Use common sense, be extra cautious, follow these guidelines and stay healthy.

Steven von Elten, M.D.

Leave a Reply

Your email address will not be published. Required fields are marked *