Coronavirus disease 19

Coronavirus disease 19, commonly known as COVID-19, is the infectious respiratory illness caused by the novel (new) Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), previously known as 2019-nCoV.

COVID-19 was first identified in Wuhan, China, in December 2019, and can infect babies, children, and adults of any age. It spread globally, resulting in the 2019-2020 coronavirus pandemic.

Symptoms
Symptoms are usually mild and begin gradually, although around 1 in 6 people with COVID-19 need medical help. Some people become infected but don't develop any symptoms and don't feel unwell. These symptoms may appear 1-14 days after exposure; most commonly around five days.

Common Symptoms
Most patients only have one or two of the common symptoms.
 * fever
 * tiredness
 * continuous cough, coughing episodes or a dry cough, or shortness of breath

Other Symptoms

 * aches and pains
 * nasal congestion
 * runny nose
 * sore throat
 * diarrhea

Emergency Warning Signs*
* This list is not all inclusive. Consult your medical provider for any other symptoms that are severe or concerning.
 * trouble breathing
 * persistent pain or pressure in the chest
 * new confusion or inability to arouse (unresponsive)
 * bluish lips or face

Additionally, there are reports that patients have lost or have a reduced sense of smell, or lost or distorted of taste, but are otherwise asymptomatic. "The American Academy of Otolaryngology on Sunday posted information on its website saying that mounting anecdotal evidence indicates that lost or reduced sense of smell and loss of sense of taste are significant symptoms associated with Covid-19, and that they have been seen in patients who ultimately tested positive with no other symptoms.""The symptoms, in the absence of allergies or sinusitis, should alert doctors to screen patients for the virus and “warrant serious consideration for self isolation and testing of these individuals,” the academy said."

Neurological symptoms
Mao et al. (2020) reported that 36% of a group of 214 COVID-19 patients admitted to hospitals in Wuhan, China, had "neurologic manifestations" of the disease.

Neurological symptoms were:
 * central nervous system symptoms:
 * dizziness
 * headache
 * impaired consciousness
 * acute cerebrovascular disease
 * ataxia
 * seizure
 * peripheral nervous symptoms:
 * altered or loss of sense of taste
 * altered or loss of sense of smell
 * impaired vision
 * nerve pain
 * skeletal muscular injury manifestations
 * impaired or change in consciousness:
 * somnolence
 * stupor
 * coma
 * confusion
 * delirium

Asymptomatic carriers
A number of studies have found that some people who test positive for COVID-19 do not have any symptoms of illness or a raised temperature, and have normal blood test results, but are able to infect others, some of whom developed severe COVID-19 pneumonia as a result of COVID-19. Some asymptomatic carriers have abnormal chest CT scans, and some do not. False negative tests have also been reported.

Estimates of the number of asymptomatic carriers vary wildly. Mizumoto et al. (2020) estimated that asymptomatic carriers accounted for 17.9% of the COVID-19 positive people on the Diamond Princess cruise ship, which was quarantined for 14 day after a previous passenger developed the illness.

Recovered patients testing positive
Lan et al (2020) identified a group of 4 recovered patients who continued to test positive for COVID-19 after recovery; suggesting that they may still be infectious. It is not known whether patients who have recovered may be reinfected later, or whether those who later needed treatment actually relapsed, or if recovered patients who later test positive do so because of issues with the diagnostic test's accuracy. Another study found group of 5 recovered patients were found to have reactivated COVID-19.

Risk of COVID-19 in patients with ME/CFS
There is a lack of evidence about ME/CFS patients developing COVID-19 illness; but a number of medical advisors have given their expert opinions on this. Immunologist and ME researcher Dr Nancy Klimas has said she believes people with ME/CFS are at a little higher risk of developing COVID-19 after exposure to the virus; Dr Nigel Speight, Dr William Weir and Dr Charles Shepherd have said they do not think there is an increased risk. Dr Lucinda Bateman has said this is unknown. Klimas, Speight, Weir, Shepherd and Bateman have all advised ME/CFS patients to take additional precautions, and highlighted that there is a risk of ME/CFS becoming significantly worse after viral infections or after COVID-19. ME/CFS includes immune symptoms including a sore throat, swollen lymph nodes, and flu-like symptoms, but patients are generally not considered to be severely immunocompromised, and immunosuppressant medications are unlikely to be used by most ME/CFS patients.  This means most ME/CFS patients would not be considered to be at very high risk of COVID-19 illness.

The unproven autoimmune hypothesis states that a subtype of ME involves autoimmunity, which is an overactive immune system rather than a weakened immune response. Evidence for this theory is limited.

Drug related risks
The following drugs may be used for some ME/CFS symptoms and are a possible concern
 *  Ibuprofen  - Ibuprofen drugs (Nurofen, Bruprofen, Advil, Midol, Motrin, Motrin) are anti-inflammatories commonly used for cold/flu symptoms and for ME/CFS. There have been some reports that ibuprofen taken for COVID-19 may prolong the illness and increase it's severity. Several countries including the UK and France now recommend that people with suspected or confirmed COVID-19 avoid ibuprofen and use paracetamol / acetaminophen (e.g., Tylenol) instead, although the evidence for this is relatively limited. There is no suggestion that ibuprofen affects the risk of catching COVID-19.
 * Rituximab - The MS Society has stated that taking rituximab, which has been used in clinical trials for ME/CFS, may affect the risk of catching COVID-19.
 * Ampligen - Ampligen or rintatolimod is sometimes used by ME/CFS patients, it is an antiviral immunostimulant rather than immunosuppressing drug, and is being tested for the treatment of COVID-19 illness in Japan. There is no information about whether it may help prevent COVID-19 in ME/CFS patients.
 * Fludrocortisone, a corticosteroid (steroid) - brand names include Florinef. This may be used by patients with POTS, which is common in ME/CFS patients.
 * Any other immunosuppressant drugs or therapies, including chemotherapy treatments and certain targeted cancer treatments 

Risk of developing ME/CFS after COVID-19
ME/CFS has been linked to many different viruses, but it is not known what the likelihood is of developing ME/CFS after COVID-19 illness.

ME/CFS charity medical advisors' COVID-19 statements

 * Mar 30, 2020, ME Association, ME Association full guidance: Coronavirus and ME/CFS by Dr Charles Shepherd
 * Mar 23 2020, Bateman Horne Center, COVID-19 resources
 * Mar 17, 2020, ME Association, Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS
 * Mar 16, 2020, ME Association, ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd
 * Mar 2020, 25% ME Group, re Coronavirus and members of the 25% ME Group, Severe ME charity | Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group | Update to the advice given on 29 February 2020,
 * Mar 2020, 25% ME Group, re Coronavirus and members of the 25% ME Group, Severe ME charity Types | Message from Dr Nigel Speight, Medical Advisor to 25% ME Group

Research on ME/CFS and COVID-19
COVID-19 is a new illness and research on the effects on ME/CFS patients has not been published yet. Patient surveys in progress include:
 * Corona ME/CFS study - ME/CVS-Stichting Nederland - in Dutch
 * A Dutch patient organization survey to assess if the risk of contracting COVID-19 is higher for those with ME/CFS, and if symptoms are more severe in ME/CFS patients. https://mecvs.nl/nieuws/persbericht-covid-19-onder-me-cvs-patienten/ The European ME Alliance is suggesting that non-Dutch speakers use an online translation tool to complete it.

Prevention
 The SARS-CoV-2 coronavirus is an enveloped virus, which means it is easier to kill outside the body than non-enveloped viruses like Coxsackievirus, or Poliovirus.
 * Get your Household Ready for COVID-19 - CDC
 * Novel Coronavirus (COVID-19)-Fighting Products - Center for Biocide Chemistries
 * Social distancing - Department of Health, Australia

CDC advice
 : Coronavirus disease 19 Prevention - CDC 
 * Know How it Spreads
 * Clean your hands often
 * Avoid close contact
 * Stay home if you're sick (may have the virus)
 * Cover coughs and sneezes
 * Wear a face mask if you are sick (may have the virus)
 * Clean and disinfect

High touch surfaces: disinfect daily
 The CDC currently recommends people clean AND disinfect frequently touched surfaces daily: 
 * tables
 * doorknobs
 * light switches
 * countertops
 * handles
 * desks
 * phones
 * keyboards
 * remote controls
 * toilets
 * faucets
 * sinks
 * hard-backed chairs
 * To clean use:


 * Detergent or soap and water prior to disinfection.
 * To disinfect use:


 * Disinfectants used against SARS-CoV-2 (list)
 * Most common EPA-registered household disinfectants will work, or
 * Diluted household bleach (mix: 5 tablespoons bleach per gallon of water, OR 4 teaspoons bleach per quart of water), or
 * Alcohol solutions with at least 70% alcohol
 * Follow manufacturer’s instructions for application and proper ventilation. Check the product is not past its expiration date. (Updated Mar 18, 2020)


 * Check for updates:


 * Coronavirus disease 19 Prevention - CDC

Suspected or confirmed COVID-19 cases: If possible the sick person should also clean:
 * soiled items and surfaces (as needed)
 * if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
 * provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants

Coronavirus transmission from surfaces
The new coronavirus can survive on different surfaces for hours or days:
 * small, airborne virus particles (aerosols) - 3 hours
 * copper - 4 hours
 * cardboard - 24 hours
 * stainless steel - 2 to 3 days
 * plastic - 2 to 3 days

This means direct contact with an infected person is not needed to contact the illness. Surgical face masks have not been effective against aerosols in previous influenza outbreaks like swine flu, but N95 respirators have been effective.

Disinfecting your home if someone is sick
The following is an abbreviated bullet-point list from the Centers for Disease Control and Prevention (CDC) article "Everyday Steps and Extra Steps When Someone Is Sick"

Suspected or confirmed COVID-19 cases:


 * Clean AND disinfect all high-touch areas daily.

If possible the sick person should also clean:
 * soiled items and surfaces (as needed)
 * if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
 * provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants

Take additional steps covering soft surfaces, food, laundry, and trash as described:
 * Disinfecting your home if someone is sick - CDC

COVID-19 pneumonia
Severe Acute Respiratory Infection (SARI) is a type of pneumonia caused by COVID-19 which develops in severely ill COVID-19 patients. A clinical trial is in progress to determine if intravenous vitamin C is an effective treatment for SARI.

Acute Respiratory Distress Syndrome
ARDS is another complication of severe COVID-19, and may develop after 5-8 data of illness, along with pneumonitis and shortness of breath. ARDS is a life-threatening condition that involves the patient's lungs becoming inflamed, and being unable to produce enough oxygen for the body's vital organs.

Myth, Hoaxes, Scams and Fake News
Many myths, hoaxes and fake news have been spreading, particularly on social media, some of which claim to be from doctors or health professionals. Scam include seeking fake cures or ineffective protective equipment like masks, scammers pretending to be from the World Health Organization asking for donations, or a stranger asking for money on behalf of a relative's medical bills.


 * Coronavirus disease (COVID-19) advice for the public: Myth busters - World Health Organization
 * Mar 3, 2020 - Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks - Buzzfeed News
 * Mar 2020 - Here's A Running List Of The Latest Hoaxes Spreading About The Coronavirus - Buzzfeed News
 * Cybersecurity - World Health Organization
 * Coronavirus scams - What the FTC os doing

Posters for those self-isolating to avoid infection

 * Unofficial posters stating where people should leave deliveries - Chronically Awesome

Mental health
Anxiety around COVID-19 illness may cause anxiety or affect mental health.
 * COVID-19 Guide - National Association of Mental Illness
 * Coping with stress during the nCov-2019 outbreak (poster) - World Health Organization

News articles and blogs

 * Feb 29, 2020 - They Recovered From the Coronavirus. Were They Infected Again? - NY Times
 * Mar 1, 2020, COVID-19 and ME - Invest in ME Research Newsletter
 * Mar 14, 2020, Former CDC director: Covid-19 is different from flu and we must respond differently, Dr. Tom Frieden - CNN
 * Apr 2, 2020, Will COVID-19 -19 leave an explosion of ME/CFS cases in its wake? - blog by Cort Johnson
 * Apr 8, 2020, Coronavirus: How Greece managed to flatten the curve - The Independent

Learn more
Government Health Organizations ME/CFS Organizations Johns Hopkins University Global Cases Map
 * Coronavirus disease 19 (COVID-19) - World Health Organization
 * Coronavirus disease 19 (COVID-19) - CDC
 * Coronavirus (COVID-19) - NHS
 * Guide to Local Production: WHO-recommended Handrub Formulations - only for when soap and water is not available
 * Protect yourself: Coronavirus disease 19 (COVID-19) - World Health Organization
 * Q&A on coronaviruses (COVID-19) - World Health Organization
 * Useful medical information when treating COVID-19 in patients with underlying myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and severe fibromyalgia (FM) - Dr Lucinda Bateman, Bateman Horne Center
 * COVID-19 Resources for People with ME - #MEAction
 * ME Association Guidance: Coronavirus (COVID-19) Update | 09 March 2020 - The ME Association
 * Desktop
 * Mobile