What is Novel CoronaVirus and the associated disease?
The Virus: It is an enveloped single-stranded RNA virus, the initial cases originated from Wuhan China. It causes respiratory illness in humans and other animals
Disease: It causes acute respiratory illness
How does this spread? (Transmission)
Spread from person to person, through respiratory droplets - coughing or sneezing. Hence, maintain at least 2 meters or 6 feet distance between people.
Direct contact with an infected person and their mucous membranes.
Touching infected surfaces and then touching face, eyes, mouth or nose.
How long does the virus last in various places?
It can last in the air, through aerosols for at least 3 hours
On plastic, metal and other smooth surfaces, this virus is viable for at least 72 hours. (3 days)
On cardboard, it can last for about 24 hours.
What are the symptoms?
Symptoms generally start 3-5 days after the infection.
1. Fever in 99 % of patients, the most common symptom.generally more than >100 F
2. Fatigue in 70 %,
3. Dry cough in 59 %
4. Anorexia in 40 %, loss of appetite
5. Myalgias in 35 %, muscle ache
6. Dyspnea in 31 %, difficulty breathing
7. Sputum production in 27 %
8. Anosmia in 40%, Loss of sense of smell and taste has also been reported
Source: Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;e201585. doi:10.1001/jama.2020.1585
What is the incubation period?
The incubation period for COVID-19 is thought to be within 14 days following exposure, with most cases occurring approximately four to five days after exposure
Most cases occurring approximately five days after exposure
In a family, the cluster of infections, the onset of fever and respiratory symptoms occurred approximately three to six days after presumptive exposure
How severe is the illness?
The spectrum of symptomatic infection ranges from mild to critical; most infections are not severe.
1. Mild infection was seen in 81% of cases.
2. Severe disease (eg, with dyspnea (difficulty in breathing), hypoxia, or >50 percent lung involvement on imaging within 24 to 48 hours) was seen in 14 % cases.
3. Critical disease (eg, needing a ventilator) was seen in 5 %.
The overall case-fatality rate was 2.3 percent; no deaths were reported among noncritical cases.
Source: Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. Published online February 24, 2020. doi:10.1001/jama.2020.2648
What are the clinical findings?
1. Bilateral Lung infiltrates, on radiography of chest in 81% cases.
2. Lymphopenia in 44%
3. Elevated AST and ALT in 41% cases
Complications of the illness:
• RNAemia in 97% of cases
• Acute respiratory distress syndrome in 33% of cases.
• Acute cardiac injury in 13% of cases
• Acute kidney injury in 8% of cases
• Shock in 6% of cases
• Secondary infection in 5.6% of cases.
Source: Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis [published online ahead of print, 2020 Mar 13]. Travel Med Infect Dis. 2020;101623. doi:10.1016/j.tmaid.2020.101623
Long term consequence of the illness:
Yet to be determined.
Who all are at risk? (Risk of getting critical illness)
1. Older people
2. People with an existing medical condition: Heart disease, Hypertensives, Lung disease: Asthma, COPD, Chronic Smokers, Diabetes
3. Immunocompromised people: HIV-AIDS patients, Cancer patients of immunosuppressant drugs.
4. Pregnant women. The risk of mother to child transmission has not been documented.
Can you be infected and not show symptoms? Can you spread in this stage?
Yes, close to 30% of patients positive for the virus can be asymptomatic. They may spread the disease.
Can my pets be infected?
No, there haven’t been any reported cases of pets being infected with the coronavirus. However take basic hand wash precaution while handling unknown animals, as they can spread other diseases.
Can it be spread through mosquitoes?
NO, CoronaVirus is not spread through mosquitoes. But take basic precautions against mosquitoes as it can spread other diseases like dengue and malaria.
Can certain blood groups be affected more?
Some observations have been reported, but no concrete link has been found.However it had not been peer reviewed.
Source:Relationship between the ABO Blood Group and the COVID-19 Susceptibility
Jiao Zhao, Yan Yang, Han-Ping Huang, Dong Li, Dong-Feng Gu, Xiang-Feng Lu, Zheng Zhang, Lei Liu, Ting Liu, Yu-Kun Liu, Yun-Jiao He, Bin Sun, Mei-Lan Wei, Guang-Yu Yang, Xinghuan Wang, Li Zhang, Xiao-Yang Zhou, Ming-Zhao Xing, Peng George Wang
medRxiv 2020.03.11.20031096; doi:10.1101/2020.03.11.20031096
If you are sick or have suspicious history the self quarantine. (Guidelines)
1. Wash hands thoroughly with soap and water for at least 20 seconds, to be done frequently. Clean fingernails, between fingers, thumbs and wrist. There is no limit for washing hands, wash it every time after you touch surfaces that might be touched by others.
2. Hand sanitizer (with at least 60% alcohol/isopropyl alcohol), must be done after every use.
Only used if water and soap are not available. Make sure your hands are not soiled, sweaty or watery.
3. Try to stay away from people who have any symptoms of the infection.
4. Covering the mouth and nose while coughing or sneezing.
5. Avoid touching the face (in particular eyes, nose, and mouth).
6. Avoiding crowds (particularly in poorly ventilated spaces) if possible and avoiding close contact with ill individuals.
7. Cleaning and disinfecting objects and surfaces that are frequently touched (like doorknobs, taps, water fountains, handles on public transport).
Does drinking alcohol help? NO, don't be a #covidiot
Are masks required for healthy individuals?
• Can be used: reusable, non-surgical masks will work, especially in public or crowded areas. Experts recommend not wear a face mask if you are not sick
• Surgical and N95 masks are only for Healthcare professionals or people who are sick and/or are caring for the sick.
• Only wear a surgical mask or N95 if you are ill with COVID-19 symptoms (especially coughing) or looking after someone who may have COVID-19.
• Disposable face masks can only be used once. If you are not ill or looking after someone who is ill then you are wasting a mask. There is a world-wide shortage of masks.
Is there a self-test?
NO, there is no such available test
Is the test affordable/ free of cost?
It is being done in Government run centers, it is free of cost as such.
When will the test be accessible to all public?
Yes, it is. It will only be administered after assessment of the concerned health officials, kindly do not go and demand to be tested out of hysteria.
What is the testing procedure?
Contact your family physician first, then he will direct you to the respective center. or visit the nearest District health center.
Is there any vaccination?
No, there is no available vaccine. It is under development, so might be ready by 2021.
How long do the test results take?
It takes about 1-3 days.
Can I take Azithromycin or Hydroxychloroquine? or any other medication
No, don't take any medication unless advised by your licensed medical doctor.
Side effects of the above mentioned drugs include Retinopathy, Hepatotoxicity, Cardiovascular events.
How can I boost my immune system?
Eat healthy home cooked food with a balanced diet. Green leafy vegetables, cleared fruits etc.
Avoid eating unhygienic outside as much as possible.
Exercise or meditate. Pick up a hobby and chill out during the quarantine
Are inhalers a wise option to use when experiencing shortness of breath?
If you are a asthmatic, medical condition or have been prescribed by your doctor, then use it.
Otherwise do not self medicate.
Who needs to be tested? (as of 20th March 2020)
This will be directed by the physician, don't walk in and be demanding to be tested.
1. All asymptomatic individuals who have undertaken international travel in the last 14 days, they should stay in home quarantine for 14 days.
2. All symptomatic contacts of laboratory confirmed cases
3. All symptomatic health care workers.
4. All hospitalized patients with Severe Acute respiratory Illness (fever and cough and/or shortness of breath)
5. Asymptomatic direct and high-risk contacts of confirmed cases should be tested once between day 5 and day 14 of coming in his/her contact.
Direct and high-risk contact including those who live in the same household with a confirmed case and healthcare workers who examined a confirmed case without adequate protection as per WHO recommendations.
Is it advisable to visit the hospitals at this time?
Visit only if you are sick or it is an emergency. Visit a local clinic first, then hospital. Hospital is not a tourist place.
Are phones allowed to be used during quarantine?
Mobile phones are not banned, but kindly clean them with specialized kit or if not available (use microfiber cloth and alcohol wipes)
Who is most likely affected?
1. People with a recent history of travel from a region with confirmed COVID-19 cases.
2. A person living in the same household as a COVID-19 case;
3. A person having had direct physical contact with a COVID-19 case or his/her infectious secretions without recommended personal protective equipment (PPE) or with a possible breach of PPE
4. A person who was in a closed environment or had face to face contact with a COVID-19 case at a distance of within 1 metre including air travel
Strange times we live in. A virus known mainly for causing common cold comes out of nowhere and shows us how vulnerable the mighty human race is. I've been discussing with my peers and colleagues about this situation since early 2020 and started understanding about what this is all about. As a doctor the new information is difficult to process, then I see the people becoming Infectious disease expert with one Tweet!!🤦♂️
People were getting a grip of whats happening. Hungry people flocking to NGO kitchens, Entitled people complaining about lack of access to weird things. Looking at the inefficiencies of the bureaucracy and the reluctance to change, a global pandemic had to come for them to think about adapting. Then had to take care of my grandfather, which caused more disdain for the Indian medical practice. Under-therapeutic doses, pushing non-standard managements, disregard of protocol and general lack of sympathy. The weird heard mentality, tribalism and inability to understand and verify things. The horrors of abject poverty again made fresh, internship was not a great time. Managed to get some financial education and started taking responsibility like an adult. Realized never to blame anyone for things that are happening to me, there is always a way. Nothing in life is for free, from the free dinner you had somewhere to your girlfriend, everything and everyone has a price. I was missing my bed, lack of quality sleep is detrimental.
Is the Lockdown necessary vs extend the lockdown?
In a country where its easier to find diamonds on the street than common sense, lockdown was necessary. To stop the spread?, no to buy time to figure out how to deal with it, ramp up testing and tracing, increase production and establishing supply chains. You understand the importance of Community medicine curriculum. Then shouldn't the lockdown extend till this pandemic? NO, its just going to wipe out all sort of wealth in the country and take us back to the dark ages. The government can't keep feeding people indefinitely. The lockdown relaxation should have started by now, but the absolute power that the authorities went into the heads and that isn't a good thing. So let the government increase the taxes and make up the lost revenue there!!. Tax what income, what wealth, the low percentage of middle class is already taxed to the death. Increase the tax base not increasing the tax bracket. Increase the domestic demand of good and not the supply of goods, increase entrepreneurial spirit. The country has lived on what the government says for long enough. Give competition and innovations not handouts.
First cases appear in Kerala, India, some returning students from Wuhan. Kerala keeps dealing with such outbreaks quite often, so no harm I guess. Then Delhi, Mumbai and the first case in Bengaluru that to from a guy returning USA!. I still didn't worry as they government was contact tracing and testing them but with considerable delay, with only one lab in Pune. Then a circular that states that all inbound and outbound international flights from 22nd March will be stopped, sounds like the Pandemic just hit India. PM Modi announces "Janatha Curfew" and me thinking this sounds like a teaser to something else and bam! The Lockdown. And here I'm stuck in a strange place. With time on my hands I start pondering the internet for things to make sense, OpenWHO, Coursera and Osmosis.org were of great help. I register to volunteer in some Telegram group thinking might kill some time. Had a great time speaking to long lost friends and helping them make sense of this along with me as everyone had a unique story of their own. Certain questions was always prevalent "What next?", "Till when?", "What about my work", "Will I get infected". What next was simple, live with it!. Till when, I guess till a year or two, if you want to go back to normal like 2019, I would say 2022. What about my work, idk but all the government around the world are going to blame this for the looming recession that was due, might as well turn out to be a depression, who knows I'm not an economist. Will I get infected, hell NO, the chances of you getting TB or going into depression is much higher.What do I do, like in the old days when they kept a bucket of water outside the house, just do that and add a bar of soap and you are golden. Back home I was starting to get a grip of how stupid the 4th pillar of democracy was. I start consolidating all my online ventures into a newly bought website domain, rekindling my love for coding in the process and questioning my life choices, again. The boredom was killing me. Started gathering data about all the things regarding COVID-19, to see if the so famed community transmission has started in India, as everyone on Twitter was mentioning. ICMR was the doing random SARI surveillance in various Districts and the Health Department was doing some great work, but every other department looked like they were clueless. Speaking to people in different districts sounded like some fudging of number was on, but I had trust in the system as healthcare was not a compromise, at least where I live.
Seeing some weird illness going around in China, while I'm sitting in a club looking at the Chinese build hospitals in 10 days. Discussion about the self-medication with Azithromycin and Hydroxychloroquine. Booking flight tickets hoping the coronavirus doesn't affect me, that aged well.