COVID-19
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]
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] There is some evidence that COVID-19 may be a disease of the blood vessels, as well as a respiratory disease.[8][9]
Symptoms[edit | edit source]
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[edit | edit source]
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]
Common Symptoms[edit | edit source]
Most patients only have one or two of the common symptoms.[10][18][19][20]
Other Symptoms[edit | edit source]
- aches and pains
- shortness of breath
- nasal congestion
- sore throat
- very few people experience a runny nose, nausea or diarrhea[10][20]
The World Health Organization that people call their doctor if they experience fever, cough or difficulty breathing.
Emergency Warning Signs*[edit | edit source]
- difficulty breathing
- persistent pain or pressure in the chest
- new confusion or inability to arouse (unresponsive)
- bluish lips or face[11]
*This list is not all inclusive. Consult your medical provider for any other symptoms that are severe or concerning.[11]
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.[21]
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[edit | edit source]
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]
Neurological symptoms were:
- central nervous system symptoms:
- 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[edit | edit source]
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[edit | edit source]
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]
ME/CFS[edit | edit source]
Risk of COVID-19 in patients with ME/CFS[edit | edit source]
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.
[edit | edit source]
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]
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[edit | edit source]
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]
Risk of developing ME/CFS after COVID-19[edit | edit source]
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[edit | edit source]
- Mar 30, 2020, ME Association, ME Association full guidance: Coronavirus and ME/CFS by Dr Charles Shepherd[46]
- 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[47]
- Mar 16, 2020, ME Association, ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd[32]
- 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,[30]
- 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[31]
Research on ME/CFS and COVID-19[edit | edit source]
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.[48][49] The European ME Alliance is suggesting that non-Dutch speakers use an online translation tool to complete it.[48]
Prevention[edit | edit source]
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]
- 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[edit | edit source]
- 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[edit | edit source]
The CDC currently recommends people clean AND disinfect frequently touched surfaces daily:
- To clean use:
- Detergent or soap and water prior to disinfection. [52]
- 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)[52]
- 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[52][53]
[edit | edit source]
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[54][55]
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]
Disinfecting your home if someone is sick[edit | edit source]
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"[56]
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[52][53][57]
