Coronavirus disease 19

From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history
Jump to: navigation, search

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.[1][2][3][4]

Computer-aided identification of lesions on the lungs of COVID-19 patients.
COVID-19 can cause lesions on lungs, and pneumonia.
Author: Shen et al. 2020. Journal of Pharmaceutical Analysis. Copyright: CC-BY-NC-ND-4.0

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]

Symptoms

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.[8] These symptoms may appear 1-14 days after exposure; most commonly around five days.[8][9]

Common Symptoms

Most patients only have one or two of the common symptoms.[8][11][12][13]

Other Symptoms

The World Health Organization that people call their doctor if they experience fever, cough or difficulty breathing.

Emergency Warning Signs*

*This list is not all inclusive. Consult your medical provider for any other symptoms that are severe or concerning.[9]

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.[14]
The American Academy of Otolaryngology on Sunday posted information on its website[15] 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.[14]
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.[14]

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.[16]

Neurological symptoms were:

Asymptomatic carriers

The SARS-CoV-2 virus causes COVID-19.
Author: CDC

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.[17][18][19] Some asymptomatic carriers have abnormal chest CT scans, and some do not. False negative tests have also been reported.[17][18]

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.[11]

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.[12] 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.[20] Another study found group of 5 recovered patients were found to have reactivated COVID-19.[21]

ME/CFS

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;[22] Dr Nigel Speight, Dr William Weir and Dr Charles Shepherd have said they do not think there is an increased risk.[23][24][25] Dr Lucinda Bateman has said this is unknown.[26]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.[22][23][24][25][26]

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. [22][27][28] This means most ME/CFS patients would not be considered to be at very high risk of COVID-19 illness.[22]

The unproven autoimmune hypothesis states that a subtype of ME involves autoimmunity, which is an overactive immune system rather than a weakened immune response.[29] 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.[25][30][31] 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.[32][33]
  • 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.[34] 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.[35]
  • Other corticosteroids (steroids) if they could suppress the immune system.[36]
  • Any other immunosuppressant drugs or therapies, including chemotherapy treatments and certain targeted cancer treatments[36][37]
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.[25]


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.[24]


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

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:

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.[40][41] The European ME Alliance is suggesting that non-Dutch speakers use an online translation tool to complete it.[40]

Prevention

image of Coronavirus Disease 2019 (COVID-19)
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.[42][43]

CDC advice

  • 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

High-touch surfaces: disinfect daily. Tables, doorknobs, light switches, countertops, handles, desks, phones  keyboards, remote controls, toilets, faucets, sinks, hard-backed chairs. Source: Coronavirus disease 19 Prevention - CDC, March 2020. Public domain image.

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[44][45]

To clean use:
  • Detergent or soap and water prior to disinfection. [44]
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)[44]
Check for updates:

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[44][45]

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[46][47]

This means direct contact with an infected person is not needed to contact the illness.[46] Surgical face masks have not been effective against aerosols in previous influenza outbreaks like swine flu, but N95 respirators have been effective.[47]

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"[48]


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[44][45][49]

World Health Organization (WHO) - "A specialized agency of the United Nations that is concerned with public health. It was established on 7 April 1948, and is headquartered in Geneva, Switzerland. The WHO is a member of the United Nations Development Group. Its predecessor, the Health Organization, was an agency of the League of Nations." The International Statistical Classification of Diseases and Related Health Problems (ICD) is maintained by WHO. (Learn more: en.wikipedia.org)

Centers for Disease Control and Prevention (CDC) - The Centers for Disease Control and Prevention is a U.S. government agency dedicated to epidemiology and public health. It operates under the auspices of the Department of Health and Human Services.

accuracy - The "closeness of an observation to the true clinical state". With respect to diagnostic tests, "accuracy" means how specific and sensitive the test is.

ME/CFS - An acronym that combines myalgic encephalomyelitis with chronic fatigue syndrome. Sometimes they are combined because people have trouble distinguishing one from the other. Sometimes they are combined because people see them as synonyms of each other.

immunologist - specialized medical doctor trained in managing problems related to the immune system, such as allergies and autoimmune diseases

myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

Centers for Disease Control and Prevention (CDC) - The Centers for Disease Control and Prevention is a U.S. government agency dedicated to epidemiology and public health. It operates under the auspices of the Department of Health and Human Services.

chronic fatigue syndrome (CFS) - A fatigue-based illness. The term CFS was invented invented by the U.S. Centers for Disease Control as an replacement for myalgic encephalomyelitis (ME). Some view CFS as a neurological disease, others use the term for any unexplained long-term fatigue. Sometimes used as a the term as a synonym of myalgic encephalomyelitis, despite the different diagnostic criteria.

BMJ - The BMJ (previously the British Medical Journal) is a weekly peer-reviewed medical journal.

renal - involving, related to or in the area of the kidneys

National Institutes of Health (NIH) - A set of biomedical research institutes operated by the U.S. government, under the auspices of the Department of Health and Human Services.

National Institutes of Health (NIH) - A set of biomedical research institutes operated by the U.S. government, under the auspices of the Department of Health and Human Services.

The information provided at this site is not intended to diagnose or treat any illness.
From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history.