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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).

France's Health Minister has issued a warning that NSAIDS -- aspirin, ibuprofen, Motrin, Advil, etc. -- should not be taken to control fever, as they may increase the risk of respiratory distress (link). However, it has not been confirmed that this is a risk in the current outbreak.

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. 

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