Covid-19
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.
In this article:
- Diagnosis
- How long after exposure to test for covid?
- Coronavirus (COVID-19) Treatment
- Antiviral Medication
- Monoclonal Antibodies
- Convalescent Plasma
- Extracorporeal Membrane Oxygenation (ECMO)
- At-Home Coronavirus Treatment
- COVID-19 Vaccines
- COVID-19 mRNA Vaccines
- COVID-19 Adenovirus Vector Vaccine
- Immunocompromised and Vaccination
- References
IMPORTANT
COVID-19 is a viral rapidly spreading disease. Many people do not have symptoms, or have a very mild disease. Yet they can spread the virus to others
Test can determine if you are sick or infected with COVID-19. Most tests are fast and reliable. If you think you can have this infection or you came in contact with a person who tested positive – do not wait. Get tested, so you will know if you need to isolate
Vaccine is the best we can do right now to lower the chance of a severe disease, and reduce the spread around the globe.
Vaccine alone does not prevent the viral disease or the spread. It does not work for some variants, so masks and all infection measures must be still used.
Diagnosis
COVID-19 is a viral disease, so diagnosis is based on a positive test together with characteristic symptoms.
First, get tested. There are two types of testing available to most people, rapid testing and lab-based testing.
Rapid testing includes most home-based solutions. The benefit of this type of testing includes the speed at which results can be produced and convenience. Rapid testing, however, is considered to be less reliable than lab-based testing. A negative result on a rapid test has a higher possibility of being a false negative and the test should be repeated in 24 hours to increase the reliability of the negative result.
Types of rapid tests include antigen-based tests and some NAAT type tests. Rapid tests are the form available for purchase at local drug stores.
Lab-based testing is considered the most reliable form of SARS-CoV2 testing. This form of testing provides accurate results usually from a nasal or pharyngeal swab that is sent to a lab for testing. The downsides to lab-based testing is that it requires travel to a testing site, sometimes uncomfortable sampling methods, appointment availability, and time. In contrast to rapid testing, it may take days to receive your result, especially in times when a large volume of tests is being processed. The most common type of lab-based testing is RT-PCR.
Find a COVID-19 testing site near you using this tool from the US Department of Health and Human Services
How long after exposure to test for covid?
The CDC recommends testing for COVID immediately after you become aware of a known exposure to an infected individual. In the case that this test results in negative, consider retesting after 5-7 days if symptoms are present.
Coronavirus (COVID-19) Treatment
The range in types of symptoms experienced and the severity of those symptoms can vary greatly in COVID-19. Here we will discuss broadly the various treatment plans.
For people with mild to moderate symptoms of COVID-19 with risk factors (See “Risk Factors for Severe Disease”) that increase the likelihood of progression to serious disease and hospitalization, there are COVID-19 specific treatments available. These are not intended for asymptomatic patients or people without significant risk factors.
Antiviral Medication
Paxlovid (nirmatrelvir and ritonavir) is a drug produced by Pfizer recently approved by EUA for the outpatient treatment of mild to moderate COVID-19 in high risk patients. It contains a combination of two drugs, nirmaterlvir, an antiviral agent, and ritonavir, a cytochrome p450 inhibitor. This drug is available by prescription only, and is taken orally. Paxlovid should be started as soon as possible after diagnosis with COVID-19, within 5 days of symptom onset. Treatment consists of 3 pills, taken together twice a day, for five days. Nirmatrelvir is an antiviral drug that combats COVID-19 by interfering with the virus’ ability to reproduce. Ritonavir is taken in addition to nirmatrelvir for its ability to inhibit the cytochrome p450 system which prevents nirmatrelvir from being deactivated in the body.
Veklury (remdesivir) is an antiviral medication approved by the FDA for the treatment of hospitalized COVID-19 patients. This medication is administered through an IV and typically given for 5 days but may be extended patient dependant. Remdesivir is a RNA-dependent RNA polymerase inhibitor, which means the drug treats SARS-CoV-2 by interfering with the virus’ ability to duplicate its RNA genome. The most prominent side effects of remdesivir are nausea, skin rash, and allergic reaction.
Monoclonal Antibodies
Monoclonal antibody therapy is one of the most effective COVID-19 specific therapies available. Monoclonal antibodies, however, must be administered early in the course of infection to be effective which makes timing of diagnosis and availability of treatment an issue. Furthermore, monoclonal antibodies must be administered intravenously, and require a specialized setting to deliver the treatment. Monoclonal antibodies fight COVID-19 by binding to the spike protein on the outside of the virus. This aids your own immune system in the detection, identification, and destruction of the virus.
Each monoclonal antibody is highly specific to a site on the spike protein which allows it to be highly effective in treating the disease. This high specificity for the spike protein may also cause a problem when the virus forms new variants with mutations in the spike protein. If the spike protein changes too much, the monoclonal antibodies will no longer be able to identify the virus and help your immune system. There is some evidence that the Omicron variant has shown some resistance to certain formulations of monoclonal antibody therapy.
Convalescent Plasma
Convalescent plasma is a treatment for COVID-19 derived from other people who have previously had and mounted an immune response to SARS-CoV-2. These individuals, through mounting and immune response, have created COVID-19 specific antibodies which are thought to be the therapeutic value of convalescent plasma. Convalescent plasma, unlike other monoclonal antibody therapies discussed previously, will also contain other substances in the blood plasma which may include other immune system modulators. Treatment with convalescent plasma appears to be most beneficial if administered early in the course of treatment. Similar to other antibody-based treatments, convalescent plasma faces similar issues combating an evolving virus and may become less effective against variants.
Extracorporeal Membrane Oxygenation (ECMO)
ECMO is a technique for providing cardiopulmonary support to a patient. In a hospitalized patient with COVID-19, ECMO is an intensive treatment reserved for severe acute respiratory failure that fails to improve with standard treatments. Patients with severe acute respiratory failure that require ECMO are more likely to improve the earlier ECMO is started. Not all hospitals have access to ECMO and if a patient requires ECMO treatment they may have to be transferred to a facility that is capable. ECMO is a machine that helps patients to recover by doing the work of the heart and lungs, taking deoxygenated blood, reoxygenating it, and pumping it back through the body. This removes a tremendous amount of stress from the heart and lungs and allows them an opportunity to rest and heal.
At-Home Coronavirus Treatment
Most people who are otherwise in good health with mild to moderate symptoms of COVID-19 can recover at home. A few simple steps should be taken to ensure a healthy recovery. Make sure that you contact your primary care physician and let them know you are dealing with COVID-19 so that they are aware and ready to help if need be.
Also, pay attention to your symptoms and monitor how your symptoms change. Ideally, your symptoms should improve over time. If your symptoms are getting more severe after over a week, or you start experiencing troubling symptoms such as difficulty breathing, these are signs of worsening infection and you should be evaluated by a doctor. Treatment otherwise is supportive and tailored to your specific symptoms with OTC medications. Most will experience a fever that can be treated with Tylenol or ibuprofen.
Cough can be treated with antitussives such as dextromethorphan (Robitussin), but be careful as many cough suppressants can make it difficult to fall asleep. If you live in a household with other members in close contact, try to socially-distance yourself from them. Isolate yourself in a private room when possible. Wear a mask while occupying the same space as others and practice regular hand washing and sterilization of commonly used objects to reduce the risk of transmission to others.
COVID-19 Vaccines
In the United States, 3 vaccines have been granted emergency use authorization by the FDA for the prevention of COVID-19. At the time of writing, in the USA over 514 million doses of COVID-19 vaccine have been administered, with over 205 million Americans fully vaccinated, approximately 62.3%.
There are two classes of vaccine available in the USA, mRNA vaccines and adenovirus vector vaccines. Of these classes, the mRNA vaccines are preferred due to the combination of risk of adverse events and improved efficacy. However, if an mRNA vaccine is not available, you have an allergy to an ingredient in the mRNA vaccine, or another contraindication to receiving an mRNA vaccine, the adenovirus vector vaccine is recommended.
COVID-19 mRNA Vaccines
The development and widespread utilization of mRNA vaccines is a wondrous scientific achievement. Understanding how these mRNA vaccines work will give you an appreciation and excitement for the refinement and simplicity of the science behind these vaccines. mRNA is a way to store information. Viruses and humans both use the information in mRNA to understand how to build things.
Most proteins and structures in viruses and human cells alike require instructions in the form of mRNA to be made. The mRNA that viruses use contain all the same parts necessary to make proteins that human mRNA has. In order to make an effective vaccine, there must be an easy way for the immune system to identify the target. Scientists chose the spike protein which is all over the surface of the SARS-CoV-2 virus.
The instructions on how to make the spike protein were found in the virus, in other words, the mRNA for the spike protein was identified. When this mRNA is taken out of the virus and shown to the protein building structures in human cells, the information is translated from the mRNA into the same spike protein found on a COVID-19 virus! Since only the mRNA for the spike protein was isolated, the body is only able to produce the spike protein of the COVID-19 virus. It does not have the instructions on how to make the rest of the virus. After the cells in your body use the mRNA instructions to make the spike protein, it is shown to your immune system so your virus fighting immune cells can recognize the spike protein. That way, if your immune system sees the spike protein again, this time attached to a full COVID-19 virus, it will be able to recognize it and act more quickly to protect you.
The Pfizer-BioNTech BNT162b2 vaccine is an mRNA vaccine available to individuals 5 years and older. Pfizer is currently the only vaccine approved for pediatric patients.
Primary Series:
- (Age 5-11) two intramuscular injections 21 days apart at a reduced dose (0.1 ml) with a smaller needle
- (Age 12 or older) two (0.3 ml) intramuscular injections 21 days apart
Booster:
If you completed the Pfizer primary series.
Booster should be administered at least 5 months after completion of Pfizer primary series
- (Age 5-11) Booster not approved
- (Age 12-17) Pfizer booster only
- (Age 18 or older) Pfizer, Moderna, Janssen available, mRNA booster preferred
The Moderna mRNA-1273 vaccine is the second mRNA vaccine available. It is approved for patients 18 and older.
Primary Series:
- (Age 18 or older) Two (0.5 ml) intramuscular injections 28 days apart
Booster:
If you completed the Moderna primary series.
Booster should be administered at least 5 months after completion of Moderna primary series
- (Age 18 or older) Pfizer, Moderna, Janssen available, mRNA booster preferred
COVID-19 Adenovirus Vector Vaccine
The Janssen vaccine is unique to the other mRNA vaccines in that it is only a single dose which may prove more convenient to those with limited healthcare access or other special circumstances. Notably, while extremely rare, the Janssen vaccine has been associated with increased risk for thromboembolic events, thrombosis with thrombocytopenia, and Guillain Barre Syndrome.
As an adenovirus vaccine, the Janssen vaccine uses an attenuated adenovirus vaccine to help elicit an immune response. This weakened adenovirus has the COVID-19 spike protein on its surface. When injected, the body’s immune system will identify the attenuated adenovirus and attack it. During this process, the body’s immune system will be exposed to the spike protein on the surface of the attenuated adenovirus and remember it. When the body is later infected with COVID-19, the immune system will have memory of the time it saw the spike protein on the attenuated adenovirus and attack the COVID-19 virus more quickly.
The Janssen Ad26.COV2.S (Johnson &Johnson) COVIF-19 vaccine is the only adenovirus vector vaccine approved by the FDA for use in the United States.
Primary Series:
- One (0.5 ml) intramuscular injection
Booster:
If you received Janssen primary series
- (Age 18 or older) Pfizer, Moderna, Janssen available, mRNA booster preferred after at least 2 months
Vaccination if you have had COVID-19 in the Past
For people with prior COVID-19 infection, in most cases it is still advised to get vaccinated. It is not recommended to obtain COVID-19 antibody titers prior to vaccination to decide whether you have natural protection or not. Why? Because we just don’t know enough about how natural immunity forms for this virus. There is enough evidence now that some people can even carry the virus and get re-infected. Also, some research demonstrates that getting a vaccine can help remove the virus completely.
If you contracted COVID-19 between doses of a 2-dose series, it is still recommended to complete the series. Patients actively infected with COVID-19 should defer their COVID-19 vaccine until their symptoms resolve and are clear to end isolation.
For patients that received monoclonal antibody therapy or convalescent plasma for their COVID-19 infection, the CDC recommends waiting 90 days from your treatment to get vaccinated as these treatments may interfere with the efficacy of the vaccine.
For patients who had a severe infection with COVID-19 requiring hospitalization, the decision to get vaccinated should be discussed with your doctor as special considerations may need to be taken. In a majority of cases vaccination is still beneficial in these patients.
Immunocompromised and Vaccination
For people with an immunocompromising condition, vaccination against COVID-19 is highly recommended. Immunocompromised conditions tend to lead to a less robust immune response to the vaccine. The Advisory Committee on Immunization Practices (ACIP) recommends that those with certain immunocompromising conditions receive a mRNA vaccine primary course with a third dose added 28 days following the second dose.
The guidance on vaccine administration and boosters is rapidly changing as the scientists work overtime to understand this disease better. New vaccines are in works, as well as antiviral pills. We all are hopeful that this pandemic will be over soon.
References
- World Health Organization. Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003 (based on data as of the 31 December 2003). http://www.who.int/csr/sars/country/table2004_04_21/en/index.html
- Zhang, AR., Shi, WQ., Liu, K. et al. Epidemiology and evolution of Middle East respiratory syndrome coronavirus, 2012–2020. Infect Dis Poverty 10, 66 (2021). https://doi.org/10.1186/s40249-021-00853-0
- https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
- https://www.cdc.gov/media/releases/2021/s1227-isolation-quarantine-guidance.html
- https://www.ncbi.nlm.nih.gov/books/NBK436002/
- https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-first-oral-antiviral-treatment-covid-19
- https://www.ncbi.nlm.nih.gov/books/NBK563261/
- B.1.1.529 escapes the majority of SARS-CoV-2 neutralizing antibodies of diverse epitopes https://assets.researchsquare.com/files/rs-1148985/v1_covered.pdf?c=1638996264
- https://ourworldindata.org/covid-vaccinations?country=USA
- https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html
- https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html