More about Covid-19: its recognition, prevention and treatment

A risk with any pandemic is that the initial spread is so quick that it overwhelms the health services. A key aim for any country should be to avoid that, and social distancing will help.

Also read: Covid-19 FAQ – NICD answers your questions

The Covid-19 pandemic has led to many groups of scientists and specialists across the globe working together to try to eradicate and treat the disease as quickly as possible. A group of pulmonologists from all over the world have banded together to produce a consensus on the recognition, prevention and treatment of Covid-19 as it attacks both upper and lower respiratory systems at the same time.

 

We all now know that the initial transmission was zoonotic (from animals).  As the disease progresses, person-to-person transmission through droplets of infected particles occurs when an infected person coughs, sneezes or talks. Infection also occurs by touching an infected surface and then the eyes, nose or mouth. Droplets typically do not travel more than six feet (about two metres) and do not linger in the air. Some spread might be possible before symptoms appear, but this is not thought to be a common occurrence.

Also read: World Health Organisation: The world needs solidarity
to fight Covid-19

The exact incubation period is not known. It is presumed to be between 2 and 14 days after exposure, with most cases occurring within 5 days after exposure.

Covid-19 tends to cause more severe illness in elderly populations or in patients with underlying medical problems. Most of those afflicted showed mild illness (81%) to severe (14%), where lung involvement was listed as more than 50%.

Critical disease (respiratory failure, shock, multi-organ dysfunction syndrome) was reported in 5% and the overall case fatality rate was between 2.3% and 5%. Children appear to be only mildly affected.

In 1099 patients with Covid-19 pneumonia in Wuhan, the most common clinical features at the onset of illness were:

• Fever in 88%
• Fatigue in 38%
• Dry cough in 67%
• Myalgias (muscle pain) in 14.9%
• Dyspnea (breathing difficulty)in 18.7%

Pneumonia appears to be the most common and severe manifestation of infection. In this group of patients, breathing difficulty developed after a median of 5 days of illness. Acute respiratory distress syndrome developed in 3.4% of patients.

Also read: Covid-19: Bedfordview doctor urges reasonable isolation and debunks fake news (Audio)

Other symptoms

• Headache
• Sore throat
• Rhinorrhoea (excessive runny nose or post-nasal drip)
• Gastrointestinal symptoms (nausea, diarrhoea)

About 80% of confirmed Covid-19 cases suffer from only mild to moderate disease and nearly 13% have severe symptoms. Critical symptoms like respiratory failure, septic shock or organ failure occur in only 6% of cases.

Listen Covid-19: Bedfordview doctor encourages social distancing

Critical illness (respiratory failure, septic shock and/or multiple organ dysfunction/failure) is noted only in less than 6% of cases. Children usually display very mild symptoms.

Possible diagnoses

• A patient with sudden onset of at least one of the following: cough, fever, shortness of breath AND with no other medical reason for this AND with a history of travel or residence in a country/area reporting local or community transmission* during the 14 days prior to symptom onset;

OR

• A patient with any acute respiratory illness AND having been in close contact with a

confirmed or probable Covid-19 case in the last 14 days prior to onset of symptoms;

OR

• A patient with severe acute respiratory infection (fever and at least one sign/symptom of respiratory disease, e.g. cough, fever, shortness breath) AND requiring hospitalisation AND with no other aetiology that fully explains the clinical presentation.

Contacts

Close contact of a probable or confirmed case is defined as:

• A person living in the same household as a Covid-19 case;
• A person having had direct physical contact with a Covid-19 case (e.g. shaking hands);
• A person having unprotected direct contact with infectious secretions of a Covid-19 case (e.g. being coughed on, touching used paper tissues with a bare hand);
• A person having had face-to-face contact with a Covid-19 case within 2 metres and longer than 15 minutes
• A person who was in a closed environment (e.g. classroom, meeting room, hospital waiting room, etc.) with a Covid-19 case for 15 minutes or more and at a distance of less than 2 metres;
• A contact in an aircraft sitting within two seats (in any direction) of the Covid-19 case, travel companions or persons providing care, and crew members serving in the section of the aircraft where the index case was seated (if severity of symptoms or movement of the case indicate more extensive exposure, passengers seated in the entire section or all passengers on the aircraft may be considered close contacts)

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Disease progress

In mild cases this is the disease’s progress:

Early stage (0–4 days after the onset of the symptoms), in which ground glass opacities (GGO – a hazy look upon examination of substance, other than air) are frequent, with sub-pleural distribution and involving predominantly the lower lobes.

Progressive stage (5–8 days after the onset of the symptoms), the findings usually

evolved to rapidly involvement of the two lungs or multi-lobe distribution with GGO,

crazy-paving and consolidation of airspaces.

Peak stage (9–13 days after the onset of the symptoms), the consolidation becomes

denser and it was present in almost all of the cases.

Absorption stage (14 days or more after the onset of symptoms)

Isolation musts:

1. Any person properly diagnosed with SARS-CoV-2 infection.
2. Anyone who has symptoms of fever and respiratory illness, and has a history of close contact of a person who has either been diagnosed as Covid-19, or has a history of travel to a Covid-19-affected region within the last 14 days.
3. Any health-care worker with symptoms of fever and respiratory illness who has been involved directly in treating Covid-19 patients, or has close contact with persons involved in treating Covid- 19 patients during the last 14 days.

Those at greater risk

• Older age
• Male sex
• Medical comorbidities
• Chronic pulmonary diseases
• Cardiovascular disease
• Chronic kidney disease
• Diabetes

Inanimate surfaces

• Covid-19 virus can persist on inanimate surfaces like metal, glass or plastic for up to 9 days, but can be efficiently inactivated by surface disinfection procedure.
• Novel coronavirus are spread by people who have the virus coming in to contact with people who are not infected. The more you come in to contact with infected people, the more likely you are to catch the infection. Social distancing is infection control action that can be taken by public health officials to stop or slow down the spread of a highly contagious disease.
• In addition to social distancing measures taken by governments, we can ourselves choose to reduce physical exposure to potentially sick people, for example:

1. Exploring the option to work from home if your job allows for it.
2. Avoiding large public gatherings such as sporting events. Or situations where you may come into contact with crowds of people, for example in busy shopping malls.

3. Interacting with people over the phone/video calls, instead of in person.

These types of steps may be an impediment to normal life. However, the intention is that these will be a short-term measure.

Regular hand washing and moisturising

• The CDC recommends regular hand washing with soap and water for at least 20seconds.
• Prioritise washing prior to eating and after being out. Regular hand washing dries the hands, which, at an extreme, may make them vulnerable to infection. To mitigate this, regularly use a glycerine-based moisturiser with pump or squeeze mechanism.
• The CDC recommends that if soap and water are not available, use an alcohol-based hand sanitiser with at least 60% alcohol. Leave to air-dry.

 Sanitise your phone regularly

Given how often we use our phones, this seems like the next logical priority to be sanitised.

Using antibacterial wipes or alcohol swabs (typically 70% alcohol) to clean your phone and other items is a good option. If the antibacterial wipes claim to be able to kill the flu virus (H1N1), that’s a good sign they may be able to do similar for the coronavirus. Once finished wiping, leave to air-dry.

What else needs to be sanitised:

• Computer keyboard and mouse
• House and car keys
• Re-usable water bottles
• Car steering wheel
• Clothing pockets
• Door handle

Keep your immune system safe

• Sleep – Get adequate, high-quality sleep. For most people ‘adequate’ means 78 hours. It’s no coincidence that “burning the candle at both ends” increases risk of illness.
• Exercise – Exercise regularly, but don’t overdo it. To quote a 2007 study on exercise and the immune system: “Moderate exercise seems to exert a protective effect, whereas repeated bouts of strenuous exercise can result in immune dysfunction.”

Reference: INTERNATIONAL PULMONOLOGISTS CONSENSUS ON COVID-19, Chief Editors

Dr. Tinku Joseph (India), Dr. Mohammed Ashkan Moslehi (Iran)

Dear reader,

As your local news provider, we have the duty of keeping you factually informed on Covid-19 developments. As you may have noticed, mis- and disinformation (also known as “fake news”) is circulating online. Caxton Local Media is determined to filter through the masses of information doing the rounds and to separate truth from untruth in order to keep you adequately informed. Local newsrooms follow a strict pre-publication fact-checking protocol. A national task team has been established to assist in bringing you credible news reports on Covid-19.