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Doctors review COVID-19 spread, symptoms, care

EDITOR’S NOTE: This is an article by local Centers for Disease Control Sentinel Physician Dr. Robert P. Blereau of Morgan City. This article is based on the publication “Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19) A Review” W. Joost Wiersinga, MD, PhD, et al, JAMA, 2020; 324(8):782-793, 8/25/2020.
The first coronavirus to cause severe disease was SARS\-CoV-2, (severe acute respiratory syndrome) which began in Foshaw, China in 2002.
The second was MERS (Middle East Respiratory Syndrome) which began on the Arabian Peninsula in 2012.
And now the latest coronavirus is COVID-19 that is said to have begun in Wuhan, China, in December 2019.
The most common form of spread of the virus are droplets from the mouth and nose during talking, coughing or sneezing.
Symptomatic persons within 6 feet for more than 15 minutes are at higher risk.
Contact surface spread is also a possibility which may last 3 to 4 days.
It is estimated 30 to 40% of coronavirus infected individuals are asymptomatic.
Since this is a respiratory virus infection the most common symptoms are that of a common cold including loss of taste and/or smell, fever, chills, cough, runny nose, headache, sore throat, shortness of breath, hoarseness and fatigue.
Sicker patients, due to viral inflammation of blood vessels of one or more organs in any part of the body, can develop pneumonia, liver injury, acute heart failure, heart attacks. arrhythmias, blood clots and strokes.
Other less common symptoms are nausea, vomiting, anorexia, diarrhea and abdominal pain.
The younger the patient without comorbidities, in general, the milder the disease.
Though comorbidities are present in 25% of infected individuals, they are present in 60 to 90% of hospitalized patients. Comorbidities include older age, hypertension, obesity, diabetes, heart disease, chronic lung, renal and liver disease, and cancer.
For unknown reasons COVID-19 infection in children have milder symptoms — usually just related to the upper respiratory tract.
A rare multisystem inflammatory disease in children occurs in 2 in 100,000 aged less than 21 years.
Diagnosis of COVID-19 is usually made on a nasal-throat swab for polymerase chain reaction at the usual site of entry of the virus.
Other testing sites, in decreasing order of highest positive rates, are lung fluid (98%), sputum (72%), nasal (63%) and throat swabs (32%), and feces, but not urine.
Blood antibody tests showing the body’s reaction to COVID-19 infection may be helpful but may take days to weeks to become positive.
It is unknown if the presence of COVID-19 antibody provides protection against COVID-19 infection, or for how long.
Chest X-ray and CT show a typical ground glass appearance and when present, can help establish a diagnosis.
An important part of COVID-19 infection care, when indicated depending on severity, is oxygen, either nasally or by endotracheal intubation, which helps the lungs recover and/or prevent further lung damage.
Antiviral drugs being evaluated or used for COVID-19 infection include convalescent plasma (antibodies), anti-inflammatory agents (dexamethasone, stat-ins), immunomodulation drugs, anticoagulants and antifibrotics.
Remdesivir given intravenously in hospital has decreased recovery time from 15 days to 11 days.
Dexamethasone has shown decrease in hospital deaths in the severely ill.
Most of the above drugs would be used in the hospital to inhibit the body’s deleterious response to the virus.
More than 200 trials of chloroquine/hydroxychloroquine with and without azithromycin are ongoing with few completed. Results are conflicting with no final recommendations for or against at this time.
Hydroxychloroquine and chloroquine have been used for over a half century and considered safe for prevention of malaria and treatment of rheumatoid arthritis. These drugs may cause QT prolongation on EKG, an electrical problem in the heart that can be associated with a rapid heart rate and death.
Use hydroxychloroquine and chloroquine with caution, if at all, in patients with cardiac disease until more studies are available.
Low income and minority groups are disproportionately affected by COVID-19 with respect to hospitalizations and deaths.
This may be a reflection of comorbidities, housing, transportation and economics.
Long term consequences of COVID-19 are unknown but may be significant for those with severe illness.
COVID-19 vaccines, both one or two shots and nasal, are being developed and should be considered by all without contraindications, to help end the COVID-19 pandemic as soon as possible.


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