The Medico-Chirurgical Society of The District of Columbia, INC
"The Uninvited Visitor That refuses to Leave!!"
Dr. Juanita A. Archer, M.D
Six months ago, we were introduced to an unwelcomed, uninvited guest that changed our way of life. Now it has settled in to stay until we get a vaccine. We realized how deadly this visitor, Covid -19 (Sars Coronavirus 19) was when, in a few months, it killed some 130+ thousand of our family, friends and acquaintances of all ages and sexes in the USA. It’s specialized in stealing the lives of our precious elderly Black and Brown family members who were the backbones of many of our families as they carried our history in their memories. Subsequent to the racial disparities in the USA, Black, Hispanic and indigenous people died at a higher rate than White people. However, we now know that Covid-19 can cause morbidity and mortality in all age groups and in all racial groups. People of any age, any sex with a preexisting health problem including obesity were and are susceptible to this disease. As it made itself a deadly pandemic, more was learned about this virus and our response to it continues to change.
Recent studies of this monster reveal that unlike Sars (Severe Acute Respiratory Syndrome of 2002 & 2003) and Mers (Middle East Respiratory Syndrome of 2012), Covid -19 can be passed from one human to another even before symptoms appear thus, one can get Covid-19 from someone who has no symptoms!
This virus, described initially in China, has mutated to become more efficient at infecting humans faster than the original virus. Now there are two versions of this virus circulating. The original virus described by the Chinese, and the mutated form of the virus that infects humans faster than the original virus are both spreading in the USA, We do not know if being infected with one form of this deadly monster will leave antibodies that protect an individual from the other form.
What was thought to be a respiratory virus is now known to infect the walls of small blood vessels and cause clots plus a generalized immune response that also damages tissue all over the body. Since the lungs have so many small blood vessels, the multiple small clots prevent the blood from picking up the oxygen needed to breathe plus the immune response markedly impairs the lungs thus, one of the outstanding manifestations of its generalized infection is in the lungs.
As this virus destroys blood vessels all over the body, the symptoms may include tiredness, seasonal allergy-like symptoms, fatigue, shortness of breath, diarrhea, body aches, joint aches and/ or the severe generalized clotting of small vessels in children and young adults that occurs with an autoimmune inflammatory reaction called the Kawasaki-like disease. One of the clearest signs of a Covid -19 infection may be the loss of smell and taste.
There are two types of tests available to determine if Covid -19 is present. One is the Antigen test that measures pieces of protein that make up the Covid-19 virus.
As this virus destroys blood vessels all over the body, the symptoms may include tiredness, seasonal allergy-like symptoms, fatigue, shortness of breath, diarrhea, body aches, joint aches and/ or the severe generalized clotting of small vessels in children and young adults that occurs with an autoimmune inflammatory reaction called the Kawasaki-like disease. One of the clearest signs of a Covid -19 infection may be the loss of smell and taste.
There are two types of tests available to determine if Covid -19 is present. One is the Antigen test that measures pieces of protein that make up the Covid-19 virus.
This is the test commonly done today. It may take from 24hrs to 1 week for the results to be returned. The other type to determine if the virus is present is the PCR test. This is a very rapid test for measuring pieces of the virus. It is more specific for the presence of Covid -19 than the Antigen test and should be done if there is a question about the Antigen test.
To determine if an individual had Covid-19 in the past and recovered, a test called the Antibody test should be done. If this test is positive, the individual had Covid-19 in the past and is no longer infected. This test has suggested that the fatality rate may be as low as 0.6% of the population infected in some areas. The upper limit of the fatality rate is still unclear because of the limitations on testing. Increased Antigen testing by PCR is still the best test for active infections.
Prevention is the best treatment. It has been proven that fabric masks curb the transmission of the virus. The most common mode of transmission appears to be through person-to-person contact through respiratory droplets or aerosols and direct handling of contagious secretions. How far droplets may travel is unclear and also it is unclear how long infected aerosols can last. However today, there is good evidence that both of these can be limited by people wearing masks.
Washing hands frequently for at least 20 seconds (the length of time to sing the “Happy Birthday Song”) is still a primary means of preventing self-contamination.
Physical distancing and staying home has proven to be effective in many countries. Medical treatment has evolved. Remdesivir, a broad-spectrum antiviral agent, speeded up recovery in some sick patients. Dexamethasone, an anti-inflammatory steroid, may reduce the risk of death that is associated with the inflammatory autoimmune response.
Vaccines are in development and 20 vaccines are currently in clinical trials.
Assessment of the current status of Covid -19 in the USA, strongly suggests to this author that maintaining physical distancing, wearing masks, washing hands frequently, avoiding contact with any known source of Covid -19 are still strongly indicated in the USA for several months to come as the best way of preventing the deadly monster, Covid -19, from continuing to kill Americans. How long do we need to continue these life-saving measures? Probably until a vaccine is available!!
References:
1.Cevik, M.. Bamford, C.G.G., Ho, A., Covid -19 pandemic- a focused review for clinicians, Clin. Microbiol. Infect.: 2020 Jul: 26(7):842-847 (published online Apr, 2020)
2.Erin Garcia de Jesus, Here’s what we’ve learned in six months of Covid 19 – and what we still don’t know, Science News.org, June 30, 2020
3.Hagen, A., Covid-19 Serology Testing Explained, American Society for Microbiology, asm. org/articles/2020/May/COVID-19-Serology-Testing-Explained. May 19, 2020
4. Jayaweera, M., Perera, H., et al. Transmission of Covid-19 by droplets and aerosols; A critical review, Environ. Res. 2020 Sep; 188: 109819
To determine if an individual had Covid-19 in the past and recovered, a test called the Antibody test should be done. If this test is positive, the individual had Covid-19 in the past and is no longer infected. This test has suggested that the fatality rate may be as low as 0.6% of the population infected in some areas. The upper limit of the fatality rate is still unclear because of the limitations on testing. Increased Antigen testing by PCR is still the best test for active infections.
Prevention is the best treatment. It has been proven that fabric masks curb the transmission of the virus. The most common mode of transmission appears to be through person-to-person contact through respiratory droplets or aerosols and direct handling of contagious secretions. How far droplets may travel is unclear and also it is unclear how long infected aerosols can last. However today, there is good evidence that both of these can be limited by people wearing masks.
Washing hands frequently for at least 20 seconds (the length of time to sing the “Happy Birthday Song”) is still a primary means of preventing self-contamination.
Physical distancing and staying home has proven to be effective in many countries. Medical treatment has evolved. Remdesivir, a broad-spectrum antiviral agent, speeded up recovery in some sick patients. Dexamethasone, an anti-inflammatory steroid, may reduce the risk of death that is associated with the inflammatory autoimmune response.
Vaccines are in development and 20 vaccines are currently in clinical trials.
Assessment of the current status of Covid -19 in the USA, strongly suggests to this author that maintaining physical distancing, wearing masks, washing hands frequently, avoiding contact with any known source of Covid -19 are still strongly indicated in the USA for several months to come as the best way of preventing the deadly monster, Covid -19, from continuing to kill Americans. How long do we need to continue these life-saving measures? Probably until a vaccine is available!!
References:
1.Cevik, M.. Bamford, C.G.G., Ho, A., Covid -19 pandemic- a focused review for clinicians, Clin. Microbiol. Infect.: 2020 Jul: 26(7):842-847 (published online Apr, 2020)
2.Erin Garcia de Jesus, Here’s what we’ve learned in six months of Covid 19 – and what we still don’t know, Science News.org, June 30, 2020
3.Hagen, A., Covid-19 Serology Testing Explained, American Society for Microbiology, asm. org/articles/2020/May/COVID-19-Serology-Testing-Explained. May 19, 2020
4. Jayaweera, M., Perera, H., et al. Transmission of Covid-19 by droplets and aerosols; A critical review, Environ. Res. 2020 Sep; 188: 109819