COVID-19 Information

Transmission | Prevention | Symptoms | Treatments | Vaccination | Virology

(Last update: Thu, Mar 26, 2020, 14:53 EDT)

COVID-19 is the disease caused by the SARS-CoV-2 virus (also known as 2019-nCoV). Symptoms appear 2 to 14 days after infection[i]. While more and more people are getting infected with COVID-19, most patients do recover[ii]. Here is what we know so far (with continued updates).

Transmission

• Respiratory transmission (primary)
  • Infected people who cough or sneeze expel respiratory droplets that contain the virus
  • The virus briefly becomes airborne
  • Transmission can occur within six feet (beyond that, the virus drops to the ground due to gravity)

• Contact transmission (less common)
  • The virus can stay alive up to[iii]
    • 3 hours in aerosols
    • 4 hours on copper
    • 24 hours on cardboard
    • 2-3 days on plastic
    • 2-3 days on stainless steel
  • Touching a contaminated surface or object can transfer the virus to a person
  • Not washing hands after touching a contaminated surface can lead to infection, especially if touching one’s face (mouth, nose, or eyes) after touching a contaminated surface

• Increased risk of contracting the disease because of contact with infected people exists for
  • Health care workers
  • Tourism industry
  • Household members of infected people

• Animals and pets
  • There is no evidence that dogs or cats get the virus
  • Wash your hands after contact with pets to avoid contact transmission to self

Prevent getting sick

• Social distancing[iv]
  • Keep a minimum distance of six feet from other people
  • Avoid crowds and public events

• Hand hygiene
  • Frequent and prolonged handwashing (https://youtu.be/3PmVJQUCm4E)
  • Apply hand-sanitizer with at least 60% alcohol

• Respiratory hygiene
  • Avoid contact with an infected person
  • Cough or sneeze in your elbow or tissue (discard tissue immediately)
  • Wear a mask (it’s not completely useless and it might protect those around you)

• Live a healthy lifestyle that promotes T-cell count
  • Don’t smoke
  • Exercise
  • Eat healthily (add fermented foods to support gut health)
  • Avoid alcohol
  • Take vitamin D (if low), selenium (might also lower mortality rate from sepsis), fish oil (take krill oil if allergic to fish oil)

Preventing the spread of the virus

• After travel
  • Keep your distance to others and
  • Self-isolate for up to two weeks
  • Check temperature daily

• If sick
  • Do not travel
  • Avoid close contact with others
  • Stay home and self-isolate or self-quarantine if possible
  • Wear a protective mask to minimize respiratory droplets in the air
  • Clean and disinfect surfaces

• About masks
  • Surgical masks will not keep the virus out but they can curb your respiratory output
  • N-95 masks are fairly effective for keeping microparticles, including viruses, out
  • Homemade and/or washable masks are a good idea if nothing else is available, as they communicate respect for others and set a good example. As with surgical masks, their preventive capacity is low but they might protect others from your respiratory output

Symptoms

• Viral syndromes:
  • Fever
  • Tiredness
  • Coughing
  • Less common:
    • Body aches
    • Runny nose
    • Sore throat

• Gastrointestinal symptoms (experienced by ~50% of people):
  • Lack of Appetite
  • Diarrhea
  • Vomiting (rare)

• Other symptoms:
  • Eye Infection (similar to pink-eye in 1%-3% of people)

• Possible respiratory issues:
  • Shortness of breath
  • Rales (rattling sounds when breathing)
  • Abnormal chest X-rays

• Potential complications:
  • Pneumonia
  • Need for intubation
  • Need for mechanical ventilator

• Extreme reactions (worst case scenario):
  • Respiratory failure
  • Organ failure
  • Respiratory shock
  • Cardio genetic shock (cardiac arrest)

Treatment

• Medical care:
  • Observation
  • Fluids (if needed)
  • Ventilator use (if unable to breathe on one’s own)
  • Artificial nutrition (through temporary feeding tubes)

• Therapeutic care:
  • No specific FDA-approved therapeutics at this point (but in the works)
  • Remdesivir[v] is being tested in the U.S. and in China

Hospitalizations by age group

Available data is still limited but here is a preliminary view of outcomes for  COVID-19 patients in the United States (by age group) between February 12– March 16, 2020.

* Hospitalization status missing or unknown for 1,514 cases.  ^† ICU status missing or unknown for 2,253 cases.  ^§ Illness outcome or death missing or unknown for 2,001 cases.  Source: https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm?s_cid=mm6912e2_w

Can I get COVID-19 more than once?

We don’t know.

According to Peter Openshaw (Imperial College London) “Some other viruses in the coronavirus family, such as those that cause common colds, tend to induce immunity that is relatively short-lived, at around three months.”

Vaccine development

A number of companies are working on a vaccine that targets COVID-19. Several human trials are already underway, as well.

Once the new vaccine has been approved, production has to be scaled up to make it available to millions of people.

Generally, it takes years, sometimes decades, to develop new anti-viral drugs. We can expect this process to happen much faster than usual for COVID-19 but it may still take a year or more from development to mass market.

Virology

“Coronaviruses are a large family of viruses, including some that cause ‘the common cold’ in healthy humans. In fact, these viruses are found throughout the world and account for up to 30 percent of upper respiratory tract infections in adults.” (NIH, 2020)

COVID-19, SARS (severe acute respiratory syndrome), and MERS (Middle East respiratory syndrome) are all coronaviruses. SARS emerged in 2002-2004, MERS emerged in 2012 and persists in some regions. COVID-19 emerged in 2019, most likely in Wuhan, China, and is closely related to SARS.

To infect a (human) host, the virus needs to gain entry into a cell. The green, spiky part of the virus protein is where and how the virus binds to human cells (via a receptor). Then another part of the spike fuses the virus and human cell membranes and the virus enters the human cell.

Once inside, the virus utilizes the cell’s mechanism to replicate itself.

Questions?  Please post any questions or concerns and I will try to find an answer or a source to consult.

[This blog post is developing and will continue to be edited as new updates become available.]

References

Lei P., et al. (2020, March). Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. https://journals.lww.com/ajg/Documents/COVID_Digestive_Symptoms_AJG_Preproof.pdf

MMWR (2020, March). Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020. Morb Mortal Wkly Rep. http://dx.doi.org/10.15585/mmwr.mm6912e2

National Institutes of Health. (2020, February). NIH clinical trial of remdesivir to treat COVID-19 begins. https://www.nih.gov/news-events/news-releases/nih-clinical-trial-remdesivir-treat-covid-19-begins

National Institutes of Health. (2020, March). Structural Biology Points Way to Coronavirus Vaccine. https://directorsblog.nih.gov/2020/03/03/structural-biology-points-way-to-coronavirus-vaccine/

National Public Radio. (2020). Interview with James Towne (medical director of the medical intensive care unit at Harborview Medical Center, Seattle). https://www.npr.org/2020/03/15/816042230/what-is-the-treatment-for-covid-19-patients-a-doctor-explains

Wrapp, D., et al. (2020). Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science, 367(6483), 1260-1263. https://doi.org/10.1126/science.abb2507

Wu, F., et al. (2020) A new coronavirus associated with human respiratory disease in China. Nature, 579(7798), 265-269. https://doi.org/10.1038/s41586-020-2008-3

Links

To Beat COVID-19, Social Distancing is a Must

https://www.nih.gov/health-information/coronavirus

https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces

https://www.npr.org/2020/03/15/816042230/what-is-the-treatment-for-covid-19-patients-a-doctor-explains

https://www.newscientist.com/article/mg24532754-600-can-you-catch-the-coronavirus-twice-we-dont-know-yet/#ixzz6Hp3pQmz0

Fact Sheets

https://www.who.int/docs/default-source/inaugural-who-partners-forum/coronavirus-poster-english-srilanka.pdf?sfvrsn=289dedc3_0

[i] https://annals.org/aim/fullarticle/2762808/incubation-period-coronavirus-disease-2019-covid-19-from-publicly-reported

[ii] Source: CDC, NIH

[iii] Source: NIH, vanDoremalen et al.

[iv] https://directorsblog.nih.gov/2020/03/19/to-beat-covid-19-social-distancing-is-a-must

[v] Remdesivir, is an investigational broad-spectrum antiviral treatment, that was previously tested for Ebola treatment in humans, as well as for MERS and SARS in animals.

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