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COVID-19, the disease caused by SARS-CoV-2 and which is often commonly referred to by the general term coronavirus, is a respiratory infection that appeared in late 2019, and has currently spread to most countries. This is intended to be a short, practical, and fact-checked reference for general use, but I am not a doctor.

Symptoms:

  • Fever, usually no higher than 103 f., 39.4 c.
  • Fatigue (tiredness)
  • Dry cough
  • Or, none at all.

Other symptoms may be present, but are not clearly indicative of COVID-19. These may include sore throat, aches and pains, nasal congestion, runny nose, or diarrhea, but the absence of these symptoms should not be taken as evidence of absence of COVID-19.

Spread:

Currently, it appears that COVID-19 can easily be spread through asymptomatic or lightly symptomatic people. This includes children, who do carry the disease but do not tend to have much of a problem with it. COVID-19 produces a high viral load in the nose, mouth, lungs, and feces, and can spread with no more coughing, sneezing, etc. than one experiences in a normal, healthy day.

You cannot reliably prevent spread, but you can reduce risk by washing your hands, using hand sanitizer when not able to wash hands, and sanitizing surfaces that are touched frequently (door handles, washroom fixings). Masks are potentially effective, but probably not worth doing unless you are willing to put some research into their proper use.

Danger:

Mostly this just sounds like the flu, and it may feel like the flu, but it has a higher mortality rate than the flu among those 30 and older, with the rate rising quickly with every decade of age. Among the infirm or elderly it can be especially fatal. If you are in an area at risk for COVID-19 (e.g., all of America and the UK), you should take extreme measures to avoid contact with elderly and medically at-risk people. This is sometimes termed social isolation or self-isolation.

Symptoms that indicate an escalation to pneumonia and multi-organ failure include:

  • Difficulty breathing or shortness of breath.
  • Persistent pain or pressure in the chest.
  • Confusion or inability to arouse.
  • Bluish lips or face.
  • CDC, March 15th, 2020

Any time you or a loved one has trouble breathing, contact a doctor immediately.

While it is good to protect children from disease, remember that kids are not the at-risk population here. Those most at risk are:

Useful Facts:

The average time from exposure to showing symptoms is 6 days (but may range from 2-14 days; link). You may be highly contagious during this time without knowing it. Once you show symptoms, you are probably safe to come out of self-isolation after 8-10 days (link).

COVID-19 (going forward, I refer to it as C19) was declared a pandemic by the WHO on March 11, 2020. As at that day, 326 people had died from the disease while as at today, the death toll is 464,483. Total cases today are 8,807,398, up from 6,315 on March 11, 2020. Large parts of the world shut down to curtail transmission. One criticism of the shutdown is that it is a reaction that is out of proportion to the danger. While C19 is contagious, it is not particularly lethal. Thus, shutting down society would lead to economic losses much greater than the value of the lives saved, so the argument went. Or goes. It is an argument that I find distasteful but which I agree with as explained here. I do not think being alive is good in itself. Nor do I think death is always bad.

Now, under normal circumstances, about 150,000 people die daily. If we divide total C19 deaths by the elapsed days starting from the first death on January 20, 2020 we get average daily deaths of 3,106. This is an increase of 2.01% on the normal death rate. While the dependents of the deceased would be negatively affected by the death, is it really that catastrophic to the rest of the world if the death rate is increased by 2%? Further, for the past 100 years, human population has been identified as the single biggest threat to humans and other life on the planet. Surely an impersonal culling by a disease should be a seen as an efficient way of beginning to solve the population problem.

I am actually rooting for the disease. I think it would be a net benefit for the world if human population was drastically reduced. If the reduction is in the developed countries, it would open up more spaces for migration from the 3rd world. If the reduction is in the 3rd world, there would be less pressure on the limited resources available to governments there. Whatever the case, there would be an improvement in living standards. If the reduction is drastic enough, it could solve a lot of the ongoing problems in the world because many of the conflicts are over land and other resources. Fewer people means less pressure on those resources, which would mean less conflict.

Covid-19 is an emerging infection that we are learning more about by the day. It's not something that is going to go away, and some things may permanently change because of it. 

I'm an ER nurse, so I've seen this first hand. It's a bizarre disease. It can affect the lungs, heart, kidneys,  digestive tract, brain, skin and other organs.  New presentations are popping up daily.

At this time, although most kids don't seem to be too badly affected (although quite a few have died), the main issue seems to be that 10 days to 2 weeks after they recover they are developing Kawasaki syndrome.

The most typical presentation is cough and fever, which can progress very quickly to shortness of breath.  Noninvasive measures such as Bipap aerosolize the virus and should only be done in negative pressure rooms,  which there are not many of.  Even nebulizer treatments broadcast the virus, so we have stopped using them on anyone and are giving up to 7 puffs of an albuterol inhaler using a spacer device. 

Interestingly enough, there is a second group which does not develop shortness of breath.  Never in my career have I ever had a calm conversation with someone whose oxygen saturation was 50% (normal is 98 to 100%). These people don't have a sensation of not getting enough air, they simply don't have enough oxygen in their bloodstream. This is very difficult to treat, because unlike with most severe respiratory infections the problem isn't getting enough oxygen into the lungs, it's that it's not being absorbed from the lungs. The term is "happy hypoxia". These people decompensate very quickly,  because they don't feel bad until their other organs are affected by the lack of oxygen.  They don't have high CO2 levels, which is usually what triggers the feeling of being short of breath. It's truly bizarre.

The most dangerous time seems to be 7 to 10 days after symptom onset; that's when cytokine storm can occur, which is an overreaction by your body's immune system that attacks organs.

We're seeing a lot of incidental findings of Covid-19 in people who are in the ER for completely unrelated reasons,  for example trauma patients who show the typical ground glass opacities in their lungs on CT. People with heart attacks whose xray shows they have it. People with abdominal pain whose CT shows they have it. We have begun to assume that everyone who walks in is infected with coronavirus.

People are also presenting with nausea,vomiting and/or diarrhea; they are presenting with stroke like symptoms, with confusion, with kidney failure, with pericarditis, with rashes; you name it, Covid-19 causes it. Many of them have no respiratory symptoms at all.

Furthermore, the percentage of deaths worldwide seems to be between 2 and 5%. Seasonal flu is 0.1%. But the bigger problem is that recovery takes months, and many people will have permanent damage to lungs, heart, or kidneys. Many young people are winding up not dying,  but becoming more or less permanently disabled. Relapses are also fairly common . 

Masks are mainly helpful when everyone wears them. They decrease the number of viral particles that are spread when an infected person speaks, coughs or even breathes. Masks (other than respirators) protect other people from you, since you are highly infectious before symptoms start and shed virus for an unknown amount of time after. I wear a mask to protect you,  you wear a mask to protect me.

So basically,  don't panic, but be careful.  Use your mask, social distance, wash or sanitize your hands,  stay home if you're sick, and see a doctor if you're really sick. 

I have had a tough couple weeks. I have had a tough year. It is hard to get perspective on anything. So, a story:

Last Wednesday, after a few days of feeling especially stressed, I was working on my computer, trying to schedule something. It was a complicated thing, but I was dealing with it. Until I wasn't. Within about a half hour, my brain seemed to fog over, I lied down, and started coughing, a persistent, hacking cough, hard enough to make me dizzy from lack of breath when I stood up. "Oh shit" I thought "is this it?". I had been pretty good about not going out, but about five days previously, I had ridden on a bus, where three people had foregone wearing masks. Was that it, I wondered? I had a hard time sleeping that night. The next day, I felt washed out, half-there. I don't really remember the sequence of events too well. The next day, I scheduled a Covid-19 test, under the belief (that I now realize is mistaken) that testing should be done as soon as possible. I went to the testing site, out at the fairgrounds, had a Q-Tip shoved up my left nostril (they asked which one I would prefer, and I thought "well, my right nostril is obviously the one I use more, lets do it to the left", and after a brief jab, I was done. And then, the waiting. And the sickness. The sickness was nowhere near the sickest I have felt, but it was, in a subjective sense, in its own category. I never developed a fever. I had a persistent, hacking cough, a fatigue and confusion that it is hard to explain, a total lack of appetite and diarrhea (or would have, if I had eaten anything), an altered sense of taste and smell, and some slight visual disturbances, as well as a weird sensation that my torso was being pushed on or pinched. After a few days, I made myself eat. I started to get some energy back. And six days after I took my test, I got the result back: negative. Which left me just as confused.

Eight days after my first coughing fit, I still feel fatigued and am coughing intermittently. There are two explanations for what is going on:

  • After a really, long, stressful year, one where I have been anticipating illness for months, I got some other type of minor infection and flipped out. I amplified the symptoms in my mind, and it sent me down the spiral of fear and anxiety until I couldn't eat or think. This could be a psychosomatic reaction to a very hard time.
  • As a young person who was otherwise healthy and had minimal symptoms, I was infected, but got a false negative on the test. Perhaps the viral load was not very heavy in my upper respiratory track. Maybe it was still building up at that point. Maybe the technician down at the fairgrounds dropped my Q-Tip on the ground and replaced it with another one. Who knows? Apparently, false negatives can be pretty high for these tests, especially if someone takes the test too soon after developing symptoms.

Which one of these is the case? I have no idea. I know that my own feelings of illness are mostly subjective. I can't say that just because I feel a certain way, that a scientific test is inaccurate. I am not the only case, but given my lack of classical symptoms, such as a fever and sore throat, I wouldn't blame someone for not believing me.

But here is where my personal anecdote can segue into an important point that seems to be objectively true:this disease is weird. It started in China, and first leapfrogged to Iran and Italy, before it had even reached some parts of China. In Vietnam, a densely populated country next to China, it has not caused a single fatality (as of this writing). In Chile, the disease was under control for a long time before exploding into one of the worst centers of the disease. In the United States, its center of infection has roved like a spotlight across the country, with major peaks in infections and deaths seeming to not tie precisely in with activities that could cause it. Florida "reopened its economy" seemingly without consequence...until it got hit with a sledgehammer, a month later. The current theory is the disease mostly spreads through small droplets of saliva, but it might also be left on surfaces, or remain airborne for longer periods. It perhaps spreads rapidly through "super spreader" events, but not so much through normal activities. It can be asymptomatic (and apparently, can be spread by asymptomatic people), it can cause something indistinguishable from a cold or (as Brazil's jackass of a President, Jair Bolsonaro would have it) "a little flu", or it can cause deadly pneumonia, or multiple organ failure. It seems to be most dangerous to the elderly and those with other conditions, but it also infects much younger people, and causes a rare inflammatory response in children, Kawasaki Disease. It is unclear whether the antibodies that people develop to it persist, or whether people can be reinfected. It is unclear how many strains of the virus exist, and whether some are more infectious or deadly than others. Some people have symptoms, even a syndrome, months after the infection should have been on its way. There is gathering evidence that some people (such as, perhaps, myself), get complicated symptoms, while avoiding the most obvious hallmarks of the disease. And right now, no one has sorted this out. The prognosis of the disease in the individual, and the epidemiological spread of the disease, are both scientifically poorly understood right now.

Oh, btw, for those of us in the United States (and also for anyone in Brazil), this disease landed at a time when the country lacked any type of leadership, and when societies ability to discuss things in any reasonable way, were absent.

Writing these things does not mean I am engaging in conspiracy theories. The fact that this disease had many question marks about it does not mean that it is a bioweapon or a 5th dimensional entity masquerading as a virus or a way for the Wayfairer company to infect our minds. Some of the basic science behind the disease, such as wearing masks and avoiding contact with other people, is really obvious.

I am mostly writing this, as a time capsule for myself, and for others: science might iron these things out with pedestrian explanations very shortly. In a year, most of this might be understood, and we might be putting this behind us. But right now? I, we, are at the bottom of a well, feeling the cold water run higher. Almost nothing that is going on makes sense to us, and it is scary.

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