Covid-19

In this article:

• What is coronavirus disease?
• Symptoms of COVID-19
• When to Seek Emergency Medical Attention
• Risk Factors for Severe Disease
• Serious Complications of COVID-19 infection
• When can COVID-19 symptoms begin to appear?
• What is the difference between Influenza (Flu) and COVID-19?
• What to do if you think you have it
• References

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IMPORTANT:

1. COVID-19 is a contagious rapidly spreading infection that is new to the humans
2. Coronaviruses, before appearance of COVID-19, were causing only a mild winter “cold” – a common upper respiratory infection affecting mostly children.
3. COVID-19 can cause rapid death due to respiratory collapse and cytokine storm. This happens in elderly, and in people who have chronic diseases (diabetes, obesity, hypertension etc.)
4. This is a respiratory virus, so its transmission is similar to flu and cold. This is why masks and hand-washing can help you to avoid getting sick.
5. Coronaviruses mutate fast, so it is anticipated that more variants that cause milder sickness will eventually dominate. We are all hopeful that such natural mutation will help us to end the epidemics and all super-measures that affect our lives.

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What is coronavirus disease?

Coronavirus disease is a general term describing symptoms caused by infection from a virus belonging to a large family of viruses called Coronaviridae. The viruses belonging to this family are identified by a corona-like microscopic view formed by the spike proteins on the surface of the virus. That is why it has the name “corona” derived from the Latin word for crown. 

Many viruses that belong to the coronavirus family are abandon in the community, and are a common cause of the common cold and upper respiratory infection. Other coronaviruses are not causing an infection in humans at all. These are frequently used in the medical labs for various experiments. 

The idea that COVID-19 is caused by a “runway” from laboratory experiments in China is supported by many scientists who are well-aware of a group that wanted to create an infectious virus from non-infectious by genetic manipulation (so called “gain of function”). Such experiments were discontinued in US due to ethical and medical concerns, but supposably continued in Wuhan laboratories. Others believe that this virus already existed in nature and “jumped” to humans.

Common symptoms include runny nose, nasal congestion, sinus pain, headache, and sore throat that typically resolve in a few days to weeks without need for intense treatment. However, a virus can mutate and change over time to become more infectious and more capable of causing severe symptoms. 

Changes to viruses can cause the virus to become much more dangerous than a simple upper respiratory infection and have the potential to escalate to pandemics! In 2003 the WHO identified a coronavirus causing severe, rapidly progressing respiratory illness with a high case-fatality rate of 9.6 percent with cases reported throughout China, Hong Kong, Vietnam, Singapore, and Canada. This virus came to be known as Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV). 

In 2012, a novel coronavirus was discovered in Saudi Arabia with a propensity to cause severe pneumonia and acute kidney injury and quickly spread to other countries in the Middle East, Northern Africa, Europe, Asia, and North America. The case-fatality rate of this novel coronavirus was found to be approximately 32.7% and came to be known as the Middle East Respiratory Syndrome Coronavirus (MERS-Cov).

In 2019 the world was forever changed when a new highly contagious coronavirus was found to be the cause of several cases of severe pneumonia in Wuhan, China. The novel coronavirus quickly spread throughout China to epidemic proportions, and not long after, a global pandemic. Due to the symptoms it causes, also known as Coronavirus Disease 2019 (COVID-19), this virus was named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2).

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Symptoms of COVID-19

The symptoms and severity of COVID-19 varies greatly from person to person. Some people may be asymptomatic and show no symptoms of infection at all, others may experience symptoms similar to the common cold or other upper respiratory infections, and some may experience severe infection progressing to pneumonia, ARDS, or sepsis. 

Here are some of the most common symptoms experienced with COVID-19:

• Fever
• Chills
• Fatigue
• Cough
• Sore throat
• Headache
• Muscle or joint pain
• Loss of smell or taste
• Nasal congestion
• Runny nose
• Nausea
• Diarrhea

When to Seek Emergency Medical Attention

1. Difficulty breathing
2. Excessive fatigue or sleepiness
3. Confusion
4. Blue coloring to lips or face
5. Excessive cough
6. Excessive sputum production
7. Chest pain
8. Palpitations

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Risk Factors for Severe Disease

• Unvaccinated status
• Age, especially >80
• Immunocompromised state
• Cancer
• Prior stroke
• Kidney disease
• Liver disease
• Heart disease
• Diabetes both type 1 and type 2
• HIV
• Down Syndrome
• Obesity
• Pregnancy
• Smoking
• Use of oral steroids

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Serious Complications of COVID-19 infection

Cardiac complications can be seen in severe cases of COVID-19. In approximately 15-30% of patients hospitalized with COVID-19 a lab value called troponins is elevated. Troponins are a marker of damage to the muscle cells of the heart. In COVID-19 patients with elevated troponins, damage to the heart may be caused by many factors including increased stress, cardiovascular demand, or even heart attack. Patients with increased troponins (proteins indicating heart muscle damage) require further evaluation. 

Other possible cardiac complications of COVID-19 infection include arrhythmias and heart failure. Patients with worsening heart failure in the context of COVID-19 indicate a worse prognosis. 

Increased risk for blood clots has been reported with COVID-19 infection. Unfortunately, some vaccines against COVID-19 also cause this severe condition that can lead to death.  It causes what is known as a hypercoagulable state in the body which increases the risk of formation of blood clots. This is not a usual clotting problem and was found not to respond to usual heparin treatment. This complication is most common in patients requiring care in the ICU. Blood clots can form in the veins where the blood flow is usually slow. 

If a blood clot forms in a vein, it is a serious condition and can cause pain, swelling, and redness in the area. Some of the most common areas for a DVT to form are the thighs, calves, and upper arms. A piece of the clot can break off and damage the lungs or brain. This is known as a pulmonary embolus or ischemic brain damage, and can be debilitating or even fatal. 

Signs of clot in the lungs include coughing up blood, rapid heart rate, difficulty breathing, and chest pain. In rare cases, a blood clot can form in the arteries. This can cause severe pain in the limb, and has the potential to cause a stroke if the clot forms in or travels to the brain.

Rashes have been reported with COVID-19 infection that take many forms. They can range in appearance from hives (urticaria), chicken pox-like (vesicular), lace-like (livedo), to measles-like (morbilliform). See your doctor if you have concerns about a new rash.

Acute respiratory distress syndrome (ARDS) and sepsis are possibly one of the most feared complications of COVID-19 and indicate severe disease and a poor prognosis. These conditions are closely related and caused by an overwhelming inflammatory response by the body to an infection. 

Unfortunately, there is no “cure” for these conditions. The treatment for ARDS and sepsis is generally to support the patient in recovery. Ventilators and prone positioning may be used to reduce the burden of breathing, fluids are administered to combat dehydration. In severe cases, extracorporeal membranous oxygenation ECMO is a machine used when the lungs are too damaged, filled with fluid, or otherwise unable to obtain oxygen. Once a person develops ARDS the mortality rate is approximately 40%.

There is another significant worry about covid impact on society in general. Psychiatric conditions were already on the rise before that pandemic. Now doctors find that the rates of anxiety and depressive symptoms are significantly increased: 14% (81/563) and 15% (84/563), respectively. 

Anxiety and depressive symptoms were then each separately associated with greater worry about contracting COVID-19 (relative risk (RR) 2.32, 95% CI 1.52 to 3.53; RR 1.67, 95% CI 1.10 to 2.54), greater stress (RR 4.93, 95% CI 3.20 to 7.59; RR 3.01, 95% CI 1.96 to 4.61) and loneliness (RR 3.82, 95% CI 2.21 to 6.60; RR 5.37, 95% CI 3.21 to 8.98), greater avoidance of the doctor (RR 1.62, 95% CI 1.06 to 2.49; RR 1.54, 95% CI 1.00 to 2.36) and difficulty managing health (least square means (LS Means) 6.09, 95% CI 5.25 to 6.92 vs 4.23, 95% CI 3.70 to 4.75; LS Means 5.85, 95% CI 5.04 to 6.65 vs 4.22, 95% CI 3.70 to 4.75) and medications (LS Means 3.71, 95% CI 2.98 to 4.43 vs 2.47, 95% CI 2.02 to 2.92) due to the pandemic.

When can COVID-19 symptoms begin to appear?

Anyone of any health status may experience mild or severe symptoms with SARS-CoV2 infection. As discussed previously, some people may show no symptoms at all. However, patients typically experience symptoms between 2-14 days after exposure, symptoms most commonly appearing within 4-5 days. That is why the timing of tests is getting shorter and shorter. The whole period when people can transmit the disease is also shorter than previously reported – roughly from day 2 after contact to day 5 of actual symptoms.

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What is the difference between Influenza (Flu) and COVID-19?

While different viruses, both the influenza virus and SARS-CoV2 are capable of causing remarkably similar symptoms. Therefore, if you are experiencing symptoms similar to the flu, you should also suspect the possibility of a COVID-19 infection. If you have known exposure to an individual diagnosed with COVID-19 and are now experiencing flu-like illness, you should have a high suspicion of COVID-19. 

As both viruses are very contagious, you should take the same protection and isolation measures to prevent transmission. Mild disease requires only symptomatic treatment and bed rest, while both severe flu and COVID-19 infection should be taken seriously and treated at the hospital.

What to do if you think you have it

COVID-19 can be difficult to distinguish from other upper respiratory infections. It is also possible to be infected with both COVID-19 and influenza or other viruses at the same time. If you are experiencing symptoms that make you suspicious of a COVID-19 here are some steps you can take to ensure the safety of you and your loved ones.

Isolate yourself as soon as possible. Those infected with SARS-CoV2 are most infectious to others early in the course of infection. A person is able to transmit COVID-19 about 1-2 days before they even begin to experience symptoms. Guidance from the CDC on how long to isolate is constantly changing, as we learn new evidence. 

Here are the current CDC COVID-19 isolation guidelines:

• Patients infected with COVID-19 can exit isolation after 5 days if the following criteria are met:

1. The person is asymptomatic or symptoms are resolving
2. No fever for the last 24 hours without the use of antipyretics (eg. Tylenol, Ibuprofen)

• If these conditions are met, the patient is free to exit quarantine but should wear a well-fitting mask around others for the next 5 days regardless of vaccination status or indoor/outdoor environment.

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References

Diagnosis of COVID-19 for controlling the pandemic: A review of the state-of-the-art.

Taleghani N, Taghipour F.Biosens Bioelectron. 2021 Feb 15;174:112830. doi: 10.1016/j.bios.2020.112830. Epub 2020 Nov 27.PMID: 33339696 Free PMC article. Review.

Coronavirus disease 2019 (COVID-19): An overview of the immunopathology, serological diagnosis and management. Anka AU, Tahir MI, Abubakar SD, Alsabbagh M, Zian Z, Hamedifar H, Sabzevari A, Azizi G.Scand J Immunol. 2021 Apr;93(4):e12998. doi: 10.1111/sji.12998. Epub 2020 Dec 3.PMID: 33190302 Free PMC article. Review.

Recurrence of SARS-CoV-2 viral RNA in recovered COVID-19 patients: a narrative review.

Dao TL, Hoang VT, Gautret P.Eur J Clin Microbiol Infect Dis. 2021 Jan;40(1):13-25. doi: 10.1007/s10096-020-04088-z. Epub 2020 Oct 28.PMID: 33113040 Free PMC article. Review.

COVID-19: Virology, biology and novel laboratory diagnosis.

Mohamadian M, Chiti H, Shoghli A, Biglari S, Parsamanesh N, Esmaeilzadeh A.J Gene Med. 2021 Feb;23(2):e3303. doi: 10.1002/jgm.3303. Epub 2021 Jan 6.PMID: 33305456 Free PMC article. Review.

COVID-19: A Multidisciplinary Review. Chams N, Chams S, Badran R, Shams A, Araji A, Raad M, Mukhopadhyay S, Stroberg E, Duval EJ, Barton LM, Hajj Hussein I.Front Public Health. 2020 Jul 29;8:383. doi: 10.3389/fpubh.2020.00383. eCollection 2020.PMID: 32850602 Free PMC article. Review.

Prevalence of anxiety and depressive symptoms and impact on self-management among adults with chronic conditions in Chicago, Illinois, USA, during the COVID-19 pandemic: a cross-sectional survey. Lovett RM, et al. BMJ Open. 2022. PMID: 34996790

Interrelationship between 2019-nCov receptor DPP4 and diabetes mellitus targets based on protein interaction network. Gao Q, Zhang W, Li T, Yang G, Zhu W, Chen N, Jin H.Sci Rep. 2022 Jan 7;12(1):188. doi: 10.1038/s41598-021-03912-6.