COVID-19, commonly referred to as COVID or even corona, is Coronavirus Disease 19, an infectious respiratory illness caused by the novel (new) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a virus discovered in 2019.[1][2][3][4]
COVID-19 was first identified in Wuhan, China, in December 2019,[1] and can infect babies, children, and adults of any age.[5] It spread globally, resulting in the 2019-2020 coronavirus pandemic.[6][7] There is some evidence that COVID-19 may be a disease of the blood vessels, as well as a respiratory disease.[8][9]
Symptoms are usually mild and begin gradually, although around 1 in 6 people with COVID-19 need medical help.[1] Some people become infected but don't develop any symptoms and don't feel unwell.[10] These symptoms may appear 1-14 days after exposure; most commonly around five days.[10][11]
Mild COVID-19
The phrases mild symptoms and mild or moderate cases have commonly been used to decribe any patients not in need of urgent hospitalisation during the pandemic,[12][13] yet considerable numbers of patients with COVID-19 who were considered mild or moderate cases were extremely ill or developed long-term symptoms which prevented any return to work or normal life.[14][15][16]
The American Academy of Otolaryngology on Sunday posted information on its website[22] 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.[21]
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.[21]
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.[23]
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.[24][25][26] Some asymptomatic carriers have abnormal chest CT scans, and some do not. False negative tests have also been reported.[24][25]
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.[18]
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.[19] 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.[27] Another study found group of 5 recovered patients were found to have reactivated COVID-19.[28]
COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020
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;[29] Dr Nigel Speight, Dr William Weir and Dr Charles Shepherd have said they do not think there is an increased risk.[30][31][32] Dr Lucinda Bateman has said this is unknown.[33]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.[29][30][31][32][33]
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. [29][34][35] A study in 2013 assessed immune system responses to the flu vaccine in people with ME/CFS, and found them similar to the immune responses of healthy controls, which indicated that vaccine effectiveness was similar in ME/CFS patients, although the study did not include a long-term follow-up to assess duration of vaccine effectiveness or overall effect on ME/CFS symptoms.[36] This means most ME/CFS patients would not be considered to be at very high risk of COVID-19 illness.[29]
The unproven autoimmune hypothesis states that a subtype of ME involves autoimmunity, which is an overactive immune system rather than a weakened immune response.[37] 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.[32][38][39] 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.[40][41]
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.[42] 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.[43]
Other corticosteroids (steroids) if they could suppress the immune system.[44]
Any other immunosuppressant drugs or therapies, including chemotherapy treatments and certain targeted cancer treatments[44][45]
Advice from the UK's ME Association
I have now reached the conclusion that people with pre-existing health conditions that make them more vulnerable to lung complications (which may or may not be the case with ME/CFS – at this stage we just don’t know), or have a condition like ME/CFS where an infection such as this will almost certainly cause a relapse, or significant exacerbation of symptoms, need to be doing far more to protect themselves, and to socially distance themselves from other people, than official NHS guidance indicates.
In particular, for those who are not housebound, this applies to social mobility and what you can do (and cannot do) if you decide to leave your home.[32]
Risk of death or serious complications in ME/CFS patients
25% ME Group for Severe ME
Although ME is a "chronic condition" my gut feeling is that they are not actually at greater risk of dying from the virus itself than healthy people. The conditions which put people at extra risk would be things like severe asthma or COPD, or immunosuppressed people eg those on chemotherapy for cancer.
The biggest worry therefore for ME sufferers is that catching the virus will make their ME much worse, and of course people in the 25% group do not have much leeway.
It might even be that worsening of their already severe ME could be a bigger threat to life than the virus itself.[31]
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.[48][49] The European ME Alliance is suggesting that non-Dutch speakers use an online translation tool to complete it.[48]
Prevention
Image author: CDC
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.[50][51]
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)[52]
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[52][53]
Coronavirus transmission from surfaces
The new coronavirus can survive on different surfaces for hours or days:
This means direct contact with an infected person is not needed to contact the illness.[54] Surgical face masks have not been effective against aerosols in previous influenza outbreaks like swine flu, but N95 respirators have been effective.[55]
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[52][53][57]
Take additional steps covering soft surfaces, food, laundry, and trash as described:
Severe Acute Respiratory Infection (SARI) is a type of pneumonia caused by COVID-19 which develops in severely ill COVID-19 patients.[58] A clinical trial is in progress to determine if intravenous vitamin C is an effective treatment for SARI.[58]
Acute Respiratory Distress Syndrome
ARDS is another complication of severe COVID-19, and may develop after 5-8 days of illness, along with pneumonitis and shortness of breath.[59] 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.[60]
Long COVID
Long COVID is the name used for long lasting illness after COVID-19 infection, generally described as symptoms lasting many weeks or months. People with long COVID have reported symptoms easing and then returning, new symptoms occurring and in some cases persistent symptoms that are worse than their original COVID-19 symptoms.
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.[61][62] 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.[63][64]
↑American Academy of Otolaryngology (March 15, 2020). "Coronavirus Disease 2019: Resources". American Academy of Otolaryngology-Head and Neck Surgery. Retrieved March 24, 2020.
