Covid-19

New information keeps appearing; this Diagnosis123 section was last updated 6/17/21.  Recommendations try to be consistent with CDC & WHO.

Covid-19, or simply “Covid,” stands for Coronavirus Disease 2019.  Itโ€™s caused by the germ โ€œSevere Acute Respiratory Syndrome Coronavirus 2,โ€ abbreviated SARS-CoV-2, which is a type of virus of the group Coronavirus (see Differences Among Germs).  Other coronaviruses cause a common cold.  In 2002 a very severe coronavirus then called SARS (now SARS CoV-1) killed 25% of people who got it, mainly in south China and Southeast Asia.  Another coronavirus Mid-East Respiratory Syndrome (MERS) evolved from camels in Saudi Arabia and killed 35% of people infected.  But even though SARS & MERS were spread person-to-person, they never spread far.  SARS CoV-1 has disappeared; MERS mainly occurs on the Arabian Peninsula.

SARS-CoV-2 began in bats & transformed itself to spread to people and cause Covid, which has spread throughout the world (a pandemic).  In the U.S., about 1-2% of people with Covid die (mostly of lung complications), but the problem is that itโ€™s very contagious, so that adds up to lots of deaths.  Among people over 65, 7%-10% may die; 5% among those who are obese, or have diabetes, chronic heart or lung diseases, kidney failure, late cancer.

Most people with Covid have mild symptoms.  Many have no symptoms at all, but can still spread it.  The younger the person, the less chance of severe disease, but some can still die.  Some people refer to it as โ€œjust a bad flu,โ€ but no recent โ€œfluโ€ ever killed over 500,000 people in the U.S. in a year.

There’s a theory that SARS-CoV-2 actually originated in a Chinese government laboratory, perhaps from a bat brought in for research, & then escaped. There’s no thought that it was created on purpose (aside from conspiracy theorists). In my mind, it doesn’t really matter. Of interest, smallpox virus has been eradicated from the earth since 1980, but is still kept in U.S. and Russian military labs for vaccine research (surely just in case the other side weaponizes it, since smallpox vaccine is no longer given anywhere).

Symptoms  —  The most common symptoms of Covid are fever, cough, body aches, and fatigue.  An unusual and somewhat common symptom is loss of sense of smell (one mom couldnโ€™t smell her babyโ€™s dirty diapers!).  There are many other possible symptoms like sore throat, diarrhea, and more, but they donโ€™t point as much to Covid as the other symptoms above.  The most severe symptom is shortness of breath; thatโ€™s who gets admitted to hospitals. See also Covid Symptoms.

Symptoms begin 2-14 days after becoming infected, usually within a week.  Mild cases last 1-2 weeks, but perhaps a third of people feel sick longer.  An important point to keep in mind is that severe Covid lung damage is usually delayed until after the first week of illness, & then keeps getting worse.  Everyone with Covid should have somebody to keep daily contact with them, in case they suddenly become much sicker.

There are several unusual manifestations of Covid.  Blood clots have been noted, in the lungs, or as a stroke (even in young people).  There have also been a variety of heart problems.  Toes turning red & painful is rare, but points strongly to Covid.  Also rare is generalized inflammation of many organs occurring in children (without lung involvement!).

There’s also phenomenon called “Long Covid,” or Covid “Long Haulers.” This refers to a variety of ongoing symptoms that persist after recovery; sometimes they start weeks after having gotten better, & rarely might they begin without having even felt sick with the original Covid infection. Long Covid includes fatigue, mental sluggishness, sleep difficulty, fevers, anxiety, depression, and more. Some reports say vaccination can “cure” Long Covid, but this hasn’t been studied systematically.

Diagnosis is made by a variety of Covid tests.

Treatment โ€“  If someone with Covid feels short of breath, they should go to an emergency room.  If they can breathe OK, they should stay at home.  Thereโ€™s no treatment to help them get better quicker.  Acetaminophen (Tylenol) or other over-the-counter medicines can help with fever and aches.  Nothing works very well to help the cough.  Drinking lots of fluids is important.

For patients sick enough to be hospitalized, the most important treatment is keeping their oxygen levels high enough until they get better on their own.  A variety of medications are used for patients in the hospital, and may help somewhat.  The main medication is a steroid (usually dexamethasone), but this can make mild cases worse, so nobody should ever take it on their own.

In terms of Isolation & Quarantine, the CDC recommends 10 days from when symptoms began, as long as fever has disappeared for at least 24 hours without taking medications for it. The same goes for people with a positive Covid test and no symptoms. However, this may change back to 14 days if mutated virus variants become more widespread (see Variants below).

Transmission โ€“  SARS-CoV-2 is essentially transmitted in the air.  The most risk is standing less than 6 feet from someone, although if the person is talking fast or loudly or singing, huffing & puffing, etc., the virus can spread farther.  Also, the virus can remain suspended in the air for 3-4 hours, so simply being in a crowded indoor location for a while can be risky.  Covid is probably not spread very often by objects, so deep cleaning is surely not worth the effort or expense, although hand hygiene is strongly recommended (washing for 20 seconds, or using alcohol-based gels).

Prevention โ€“ Staying at least 6 feet away from people & avoiding crowds, especially indoors, is probably the most important measure.  Wearing a mask may protect you a bit, but masks are most important for protecting others.  If a person has Covid but doesnโ€™t know it (30% to 40% of infected persons have no symptoms), the mask stops viruses from traveling far & getting up in the air.  The main mask for self-protection is the N95, worn by health workers dealing directly with Covid, which can now be purchased commercially. If you get one, only wear it indoors where people are around, which is when it’s most useful, so it doesnโ€™t get worn out. The KN95 mask is slightly inferior to the N95, but much superior to surgical and homemade masks, and is a little cheaper.

The CDC recently determined that vaccinated persons no longer need to wear masks, which has resulted in considerable confusion in public. Stores are dropping their mask mandates, although it’s impossible to know who is indeed really vaccinated (many of the people who refuse vaccines also tend to refuse masks). The main danger here exists for people with medical conditions which interfere with the vaccine, like those with active cancer, or taking medications which block the immune system.

Another danger is that the virus may someday mutate to evade the vaccine (see “Variants” below); then the CDC will revise its recommendation, with risk of widespread disappointment and anger. It’s very important for everyone to realize that Covid is new, nobody can predict the future, so we all need to face this threat maturely.

Vaccines  —  There are several available.  They have brief side effects; dangerous reactions are highly publicized but exceedingly rare.  Some vaccines are reported in the press as more effective than others, but thatโ€™s misleading, because they were tested in different populations of people, and none have been directly compared to each other.  All have been shown very effective in preventing severe disease, & especially death (which is the whole point!).  If you have an opportunity to be vaccinated, get one, whichever is available.

One big question is how long the vaccine protection will last.  We donโ€™t know if weโ€™ll need ongoing booster shots, or if so, how often.  At first, weโ€™ll certainly still need to take all preventive measures as described.  And unless most people get vaccinated, there will still be a lot of virus around us.

Recent news in the press involved strange blood clots in the brain within 2 weeks after receiving either of 2 vaccines: Johnson & Johnson, and Astra-Zeneca. Both employ the same technology, so there may be a relationship to the clots. The clots occur in around 1-2 people out of a million who’ve been vaccinated, although all were under 50-60 years-old, and almost all were women. It may make sense for this group of people to receive other Covid vaccines; the FDA and international regulatory agencies will come up with firm recommendations. Vaccination is recommended in pregnancy; there’s no evidence of any danger.

In our daily lives we do things that are much more dangerous, like ride in cars and cross city streets. The risk that a woman may die in pregnancy in the U.S. is about 1 in 7,000, which does not affect decisions to conceive. Then we can look at how many people died in a year from Covid-19 itself; for the unvaccinated, the risk is about 1 in 600. When dealing with life-threatening concerns like Covid, we should all try to think and act logically. In this case, getting vaccinated seems much more logical than not.

Virus Variantsย  —ย  All viruses constantly mutate rapidly, making minor changes in their genes.ย  Some mutations provide a virus with special advantages, like the ability to spread easier, or cause worse illness.ย  Right now there are 6 Covid “Variants of Concern”: “Alpha” aka B1.1.7 (UK Variant); “Beta” aka B.1.351 (So. Africa Variant); “Gamma” aka P1 (Brazil/Japan Variant); “Delta” aka B.1.167 (“double mutant” out of India); “Epsilon” aka B.1.429 (California); and Iota aka B.1.526 (New York). The Greek letters were applied late May 2021 by W.H.O., to avoid stigmatizing countries by using geographical names, though the numbers are still used in research. Concerns are as follows:

  • Easier to spread: Alpha (B.1.1.7), Beta (B.1.351), Delta (B.1.167); & Epsilon (B.1.429) [slightly easier]
  • Vaccines may not work as well, but still prevent serious disease & death: Beta (B.1.351), Delta (B.1.167) [one dose of Pfizer/Moderna not effective against Delta; 2 doses protect].
  • Some drugs used to treat hospitalized patients won’t work: Beta (B.1.351); Gamma (P.1); B.1.427; B.1.429
  • More severe disease: maybe Alpha (B.1.1.7); maybe Delta (B.1.167)
  • Lasts longer in body: Alpha (B.1.1.7). Maybe up to 2 weeks, so quarantine times may change

None of the variants so far seem to affect the Covid tests we do.  And none cause enough resistance to vaccine or prior infection so as to result in more hospitalizations or death. Recent data suggest that the mRNA vaccines (Pfizer & Moderna) fail in about 1 of 10,000 persons, and 1 in 500,000 of recipients have died of Covid.  The above information on variants is current as of 6/10/21.  The extent to which variants will evolve and spread will continue to change.

Can you get Covid a second time?  Yes.  There are some well-documented cases of reinfection, but not many.  The problem is, we donโ€™t know how long immunity from Covid will last, since the disease is so new.  Current studies suggest it’s likely protective at least 8 months. There’s some tought that persons who’ve had Covid may benefit from vaccine afterwards, or at least one dose, although data are still lacking (no downside to this, other than loss of a dose better given to an unvaccinated).

We hear about โ€œherd immunity,โ€ which is when so many people in a population are immune, that the disease no longer spreads. But with 20% to 40% of people unwilling to get the vaccine, or unsure, herd immunity may not be possible. This is especially true right now because vaccines are not yet approved for children, and we have no idea what role they may play in herd immunity for Covid.

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