This type of post is not my usual thing, but I asked a nurse friend of mine to write a post about COVID-19 or coronavirus to give a perspective from the front line. Her name is Katrina San Juan RN, MSN, CSRN, PCCN, CCRN. Katrina is an expert in her field, and I trust her work. Please read it carefully so that you can get an idea of what we are up against! I truth the author of this post, but at the same time it is important to continue to educate yourself.
“Grab a Corona, Lets Talk about COVID-19”
Corona virus strains (and yes, there are numerous strains of them other than our now famous Wuhan Strain) are a group of viruses which, prior to 2003, was thought to normally cause similar symptoms to the flu, ranging from a cough, sore throat, fever and runny nose. Four specific strains have become notorious for the cause of the common cold in humans.
Corona viruses were first isolated and studied over 50 years ago, with one of the first reports in 1949, but it was not given its Latin royal name until the virus was observed under an electron microscope where its morphology resembled a “crown-like” appearance. They infect numerous species, responsible for a sweeping avian bronchitis and were the cause of an endemic gastrointestinal infection to swine’s, causing a largescale death of baby pigs in the 1970s-1980s.
In November of 2002, Severe Acute Respiratory Syndrome, commonly known as SARS, fueled the emergence of an epidemic virus in China, causing an estimated infection of 8100 between November to July of 2003. It killed an estimated 800 people, having spread globally to Europe, North and South America and Asia.
This write up would also hardly be accurate without mentioning Middle East Respiratory Syndrome (MERS) which was first reported in Saudi Arabia in 2012, likely originating from an animal source (they were thinking via camel) totaling 2519 infections and 866 deaths; two of which were confirmed cases in the United States.
Fast forward 17 years later from the severity of SARS -a brand new respiratory infection has emerged, as the entire world now faces the pandemic results of the Corona Virus Wuhan Strain, AKA COVID-19. It is a new strain of corona virus which was not previously observed in humans, its origins thought to come from wild animal consumption of bats and possibly pangolins (armadillo-like mammals). It was first reported in November of 2019 as doctors in Wuhan discovered a pneumonia-causing viral infection which was not responding to treatment.
Not Feeling Well?
It has now been about 4 months since the outbreak of COVID-19 in Wuhan, and now that China has finally entered a phase of decreased new cases, life is finally beginning to return to semi-normal life for its people. Needless to say, Chinese scientists have accrued vital new information. Though it may take quite a while to fully comprehend the entirety of COVID-19.
Let’s start with the basics: symptoms. Data published from the Chinese Center for Disease Control and Prevention show that 80% of people experienced mild symptoms (about 1 in 5 people), which appear anywhere from 2 to 14 days and range from (or combination of) fever, fatigue, sore throat, dry cough, body aches, runny nose, and in small cases, diarrhea. In severe symptoms, patients exhibited dyspnea, or difficulty breathing, chest pain, altered mental status and cynanosis (bluish discoloration of the skin due to diminished oxygenation). Thus, these patients require careful monitoring in an Intensive Care Unit, many of which will be intubated, their life supported by an artificial ventilation tube. These are known as severe cases, resulting in about 14% of COVID-19 occurrences and about 5% being critical cases.
Who Is Most Effected?
Chinese researchers have now found that both men and women carried an equal chance of contracting the virus, but the impact on men were much higher. Men had an estimated 64% chance of facing fatality to the virus, versus 36% of women, thus concluding that men were effected much worse. The same research found that 90% of pediatric patients were asymptomatic, with one case of a 14-year old boy dying and 6% were severe/critical cases. It is unknown why children were not as ill as adults.
However, as I mentioned earlier and repeat again, the virus has no regards to borders or age limit. As more and more cases in the United States are coming into light, the Centers for Disease Control has reported that about 20% of 508 patients that were admitted for COVID-19 symptoms and requiring hospitalization were within the age of 20 to 45 years. From a count of about 121 patients transferred into the intensive care unit, 12% were also within that age group.
This graph shows severe cases and ICU admissions from US cases reported between February 12 to March 16, illustrating that no age group is immune from the virus.
This Does Not Sound Desirous…What Can I Do Against the Virus?
Case trials are underway to help develop a vaccine, but this could take months, possibly even years. Therefore, the best fight against COVID-19 is preventing exposure to the virus. Most up to date studies as of March 23rd show that the virus can linger in the air for up to 3 hours, remain on copper surfaces for 4 hours, cardboard up to 24 hours, and plastic and stainless steel for 72 hours. Be mindful of cleansing metallic surfaces carefully as Chinese studies have found COVID-19 can remain viable on these surfaces for up to 9 days. So be vigilant about toughing handrails and door handles. Cleanse these regularly in your household with a disinfectant. Please visit https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html for an extensive list and guidelines for disinfection.
Most important points to consider…WASH YOUR HANDS. And often. With good’ ol” soap and water for at least 20 seconds, exercising friction between the soles of your fingers and thumbs. If soap and water are not currently available, utilize a hand sanitizer that contains at least 60% of alcohol, again rubbing this in carefully between your fingertips until the surface of your hands are dry.
DO NOT touch your face with unwashed hands, and cover or blow your cough or sneeze. Keep away from those that are sick or appear sick, and stay home if you are sick. COVID-19 is spreading in all communities. Studies have also shown that the virus can actually travel up to 15 feet, however it is being encouraged to remain at least 6 feet apart during the current “social distancing” phase with those that are not of your household. Remain up to date with expert advice, travel bans and restrictions and your state’s/country’s current activity restrictions. One of the best ways of prevention is practicing prevention outside of the household. These precautions are to protect us ALL.
If you are sick, wear a facemask or if you are taking care of those that are sick. If you are not sick, please consider those who truly do require these, such as your health care providers. There is a worldwide shortage on facemasks, please consider use of these rationally.
Once Someone Is Infected with COVID-19, Can They Get It Again?
Unfortunately, it is too soon to know whether people who have recovered from COVID-19 will become immune to reinfection. Scientists are aware from experience that reinfection is a concern in regards to the common coronaviruses seen during the winter seasons, causing illness time and time again despite a person having been exposed to the same viral strain since childhood. And despite the body’s production of immunity the antibodies eventually decline allowing vulnerability once again.
Patients infected with SARS were studied and found to have developed antibodies and these were still detected in blood samples despite having been infected way back in 2002-2003. However, the SARS epidemic was resolved within 8 months so further studies of reinfection are thankfully limited. As far as MERS, there were 2500 cases within an 8 year time span, so the case of reinfection also remains unknown. Although immunity was found for up to two years after initial infection.
Spring Is Around the Corner…Will COVID-19 Go Back To Its Corner?
It’s another question that has yet to have a definite answer. All scientists can gather is the same information they have collected from previous virus strains. Take the influenza strains for example. Its peak is in the winter, induced by the decrease in humidity levels not actual temperature. There are suggestions that perhaps COVID-19 may have temperature or humidity sensitivities, limiting its spread in warmer and much more humid climates. Take for example Singapore, Taiwan and Vietnam. There are certainly cases of COVID-19 but the spread has not gone out of control, but also keep in mind they were very much proactive in successfully containing the virus. But many tropical countries may not have as adequate access to testing kits so the reporting is inaccurate. But keep in mind, during the winter people tend to stay indoors, causing potential spread to be less detrimental. There is a current study being completed by physicists at the University of Utah who have received a grant to study the outershell of the virus and its responses to heat and humidity.
We hope for answers soon. Just as we hope for a resolution to this pandemic to end very soon.