COVID-19 - What You Must Know

COVID-19

What You Must Know

––––––––

By

Dr. Kevin W. Wellington

Copyright © 2020

Introduction

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has produced the coronavirus disease 2019 (COVID-19) which has culminated in the continuing  2019–20 coronavirus pandemic. The outbreak originated in Wuhan, China, in December 2019 and was pronounced to be a Public Health Emergency of International Concern on 30 January 2020 by the World Health Organization. On the 11 March 2020 this outbreak was classified as a pandemic. Greater than 11 million cases of COVID-19 were reported in 185 countries and territories and caused more than 535,000 deaths. To date greater than 336,000 people have recovered but re-infection or relapse is a possibility.

In this book you will learn about SARS-CoV-2, and COVID-19, the disease that it causes. Some of the topics that will be touched on include the various symptoms that COVID-19 causes, transmission, complications, diagnostic tests, prevention strategies and current treatments (e.g. drugs) as well as treatments that are under investigation. In addition, self-isolation, how to care for someone with COVID-19, safety measures for entering the home as well as safety measures for when you are out in public, will also be covered.

DEDICATION

I dedicate this book to all the people who have lost their lives because of COVID-19, those who have been affected by the COVID-19 and also to the medical professionals who work selflessly around the clock to provide care to patients.

I also dedicate this book to my wife Annabel and my daughters, Sarah and Hannah, who supported me in writing this book.

TABLE OF CONTENTS

CHAPTER 1: THE CORONAVIRUS

1.1 Background

1.2 What is a Coronavirus?

1.2.1 Discovery

1.3 Coronavirus Infections in Humans

1.3.1 Background

1.3.2 Species and strains of coronaviruses

1.4 Coronavirus Disease Outbreaks in Humans

1.4.1 Coronavirus disease 2019 (COVID-19)

1.4.2 Middle East respiratory syndrome (MERS)

1.4.3 Severe acute respiratory syndrome (SARS)

1.5 Coronavirus Infections in Animals

1.5.1 Diseases caused by coronaviruses

1.6 The Origin of the Name Coronavirus

1.7 Structure

1.8 Symptoms  and Diseases of Coronavirus Infections

CHAPTER 2: COVID-19 SYMPTOMS AND TRANSMISSION

2.1 Background

2.2 Symptoms

2.2.1 Symptomatic patients

2.2.2 Asymptomatic patients

2.2.3 Complications from COVID-19

2.2.4 The organs affected by COVID-19

2.3 Transmission of COVID-19

2.3.1 Routes of transmission

2.3.2 The most infectious period

2.3.3 People most at risk

References

CHAPTER 3: DIAGNOSTIC TESTS FOR COVID-19

3.1 Background

3.2 Antibody testing

3.2.1 Protection against re-infection by COVID-19

3.2.2 Types of antibody tests

3.2.3 Commercially available antibody tests

3.3. Viral testing

3.3.1 Real-time reverse transcription polymerase chain reaction (rRT-PCR)

3.3.2 Isothermal nucleic amplification

3.4 Imaging

3.5 How to get tested

References

CHAPTER 4: PREVENTION OF CORONAVIRUS INFECTIONS

4.1 Background

4.2 Proper Nutrition

4.3 Hand Washing

4.4 Surface Cleaning

4.5 Face Masks

4.5.1 Who should wear a mask and when

4.5.2 When and how to wear medical masks

4.5.3 Non-Medical fabric masks

4.5.4 Technical guidance for making non-medical masks

4.6 Social Distancing

4.6.1 Background

4.6.2 Social and mass gatherings

4.6.3 Schools

4.6.4 Having sex

4.7 Self-Isolation

4.8 Disinfect groceries

4.8.1 Disinfecting your groceries at home

4.8.2  Safety measures to abide to when entering your home

4.8.3 Safety measures to abide to when in public

References

CHAPTER 5: TREATING COVID-19 INFECTIONS

5.1 Background

5.2 Drug treatments

5.2.1 Antiviral agents

5.2.2 Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers

5.3 Convalescent Plasma

5.4 Monoclinal Antibodies

5.5 Steroids

5.6 Anticoagulants

5.7 Vaccines

5.8 Antibiotics

5.9 Treatment of COVID-19 Symptoms

5.10 Distinguishing Between an Allergy, Common Cold, Flu and COVID-19

5.10.1 Background

5.10.2 COVID-19

5.10.3 Colds

5.10.4 Flu (influenza)

5.10.5 Allergies

5.10.6 Uncertainty about your symptoms

5.11 Clinical Trials

5.11.1 The SOLIDARITY trial

5.11.2 Other trials

5.12 Other Studies

5.12.1 Interferon-α2b

5.12.2 REGN-COV2

References

CHAPTER 6: MANAGEMENT OF COVID-19

6.1 Background

6.2 Lead  a Healthy Lifestyle

6.2.1 A healthy weight

6.2.2 Diet

6.2.3 Exercise

6.2.4 Stress

6.2.5 Smoking

6.2.6 Alcohol

6.3 Immunity and Age

6.4 Medications

6.5 Protective Equipment

6.5.1 Airborne Infection Isolation Rooms

6.5.2 Personal protective equipment (PPE)

6.6 Oxygen Support

6.6.1 Extracorporeal membrane oxygenation

6.6.2 Mechanical Ventilation

6.6.3 Mechanical Ventilation for COVID-19

6.7 Contact tracing

6.7.1 Technology

6.7.2 Ethical and legal issues

6.7.3 Steps in contact tracing

6.8 Psychological Support

6.9 Use of Technology

6.9.1 Information Technology

6.9.2 Other technologies

References

CHAPTER 7: WHAT TO DO WHEN YOU HAVE TO SELF-ISOLATE

7.1 Background

7.2 Self-isolation

7.2.1 Health care providers

7.2.2 Medications

7.3 Duration of Self-isolation

7.4 When to Get Medical Attention

7.5 Household Prevention Measures

7.5.1 Your room or designated sick area

7.5.2 Personal protective equipment

7.5.3 Utensils and other household items

7.5.4 Bathrooms

7.5.5 Laundry

7.5.6 Kitchen use

7.5.7 Waste disposal

7.6 Testing Other Household Members

References

CHAPTER 8: HOW TO CARE FOR SOMEONE WITH COVID-19

8.1 Background

8.2 Advice for Caregivers

8.2.1 The infected person

8.2.2 Household members

8.2.3 Caregivers

8.2.4 Items used by an infected person

8.2.5 Breastfeeding

8.3 Disinfecting the home

8.3.1 How to clean and disinfect

8.3.2 Hand hygiene and further preventive actions

8.3.3 Other factors

References

CHAPTER 9: A SUMMARY

9.1 BACKGROUND

9.2 TRANSMISSION OF COVID-19

9.3 SYMPTOMS OF COVID-19

9.4 COMPLICATIONS FROM COVID-19

9.5 PEOPLE MOST AT RISK

9.6 DIAGNOSTIC TESTS

9.7 INFECTION PREVENTION AND CONTROL

9.8 TREATMENT OF CONFIRMED COVID-19 INFECTIONS

9.9 HOW TO MANAGE COVID-19

9.10 SELF-ISOLATION

9.11 RESEARCH ON COVID-19

GLOSSARY

About The Author

CHAPTER 1: THE CORONAVIRUS

1.1 Background

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has produced the coronavirus disease 2019 (COVID-19) which has culminated in the 2019–20 coronavirus pandemic. The outbreak originated in Wuhan, China, in December 2019 (WHO) and was pronounced to be a Public Health Emergency of International Concern on 30 January 2020 by the World Health Organization (WHO). On the 11 March 2020 this outbreak was classified as a pandemic (WHO). Greater than 11 million cases of COVID-19 were reported in 185 countries and territories, and more than 545,000 deaths (ArcGIS). To date greater than 6.9 million people have recovered (ArcGIS; Statista) but re-infection or relapse may be a possibility (Feng, 2020; Politi, 2020).

The pandemic has had a catastrophic impact on the world resulting in one of the greatest global recessions in history with more than a third of the world’s population in lockdown (Kaplan et al. 2020). There has been an extensive lack of supplies which has been worsened by panic buying (Scipioni, 2020; CFR). The spread of misinformation about the virus has also occurred online (Clamp, 2020; Perper, 2020). In 197 countries about 99.9 per cent of the world's student population has been affected at universities, colleges and schools due to closure at either a local or national level (UNESCO). Furthermore, cultural, political, religious, and sporting events have either been  suspended or stopped (The New York Times).

1.2 What is a Coronavirus?

Orthocoronavirinae or Coronavirinae is the scientific name that has been assigned to the  coronavirus (Fan 2019; ICTV) that is a member of the family of Coronaviridae, order Nidovirales, and realm Riboviria (de Groot et al. 2011; ICTV). There are alphacoronaviruses and betacoronaviruses which infect mammals, and also  gammacoronaviruses and deltacoronaviruses which mainly infect birds (Decaro, 2011). The classifications of the coronavirus are listed in Table 1.

Coronaviruses, a sizable family of viruses, produce diseases in mammals and birds. In  animals like chickens’ coronaviruses cause an upper respiratory tract disease while in cows and pigs they cause diarrhea. Coronaviruses cause respiratory tract infections that can span from mild to lethal in humans. The common cold (which has other possible causes, predominantly rhinoviruses) are amongst the mild illnesses that are caused. The more lethal coronaviruses can cause  diseases such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). The new virus was given the name "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)" by the International Committee on Taxonomy of Viruses  on 11 February 2020. This virus causes the infectious coronavirus disease called COVID-19 (WHO). SARS, which caused the outbreak in 2003, is genetically related to SARS-CoV-2, but they do not cause the same diseases (WHO).

Table 1. Classifications of the different coronaviruses and the animals they infect.

1.2.1 Discovery

1.2.1.1 Animal Coronaviruses

The first coronaviruses were discovered in the 1930s when a new respiratory infection of chickens occurred in North Dakota. Domesticated chickens had an acute respiratory infection which was caused by an infectious bronchitis virus (IBV) (Estola, 1970). Gasping and listlessness were symptoms of the infection in new-born chicks that had a mortality (death) rate of 40–90% (Fabricant, 1998). The IBV which produced the disease was isolated in 1937 by Fred Beaudette and Charles Hudson (Decaro, 2011). The mouse hepatitis virus (MHV) and transmissible gastroenteritis virus (TGEV) were isolated In the 1940s (McIntosh,1974). The three diverse viruses were connected, but it was not known at that time (Gozlan, 2020).

1.2.1.2 Human coronaviruses

The first human coronaviruses were found in the 1960s (Kahn and McIntosh, 2005). These were human coronavirus 229E and human coronavirus OC43 which were the first to be studied and were from patients with the common cold virus  B814 (Geller et al. 2012). A Scottish virologist, June Almeida, at St. Thomas Hospital in London was the first to image these viruses  (Brocklehurst, 2020). Almeida, through electron microscopy, revealed that B814 and 229E were morphologically related by their distinctive club-like spikes and that these viruses were also morphologically related to the IBV (Almeida and Tyrrell, 1967).

Figure 1. Coronaviruses have a halo, or crown-like (corona) form when observed under an electron microscope. 

In the same year a research group at the National Institute of Health in the USA was able to separate another associate of this novel group of viruses employing organ culture and called the virus strain OC43 (OC for organ culture) (McIntosh et al. 1967). Like B814, 229E, and IBV the novel cold virus OC43 had distinctive club-like spikes when observed under the electron microscope (Brocklehurst, 2020; Hamre and  Procknow, 1966). Today it is unknown which present human coronavirus was the coronavirus strain B814 because it was lost (Monto et al. 2014). Since then other human coronaviruses have been found such as:

SARS-CoVin 2003

HCoV NL63in 2004

HKU1in 2005

MERS-CoVin 2012

SARS-CoV-2in 2019

The majority of these viruses produce severe respiratory tract infections (Su et al. 2016; Zhu et al. 2020).

1.3 Coronavirus Infections in Humans

1.3.1 Background

Coronaviruses can cause colds with severe symptoms like fever and a sore throat from swollen adenoids (Liu et al. 2017) as well as more severe infections such as bronchitis (either direct viral bronchitis or secondary bacterial bronchitis) and pneumonia (either direct viral pneumonia or secondary bacterial pneumonia) (Forgie and Marrie, 2009). SARS-CoV infects both the upper and lower respiratory tract and causes severe acute respiratory syndrome (SARS) (Forgie and Marrie, 2009). Coronaviruses differ considerably in risk factor because certain coronaviruses are fairly harmless like the common cold while others like MERS-CoV, have slain over 30% of infected people (Fehr and Perlman, 2015).

1.3.2 Species and strains of coronaviruses

There are six species of human coronaviruses and one species is subdivided into two different

strains which gives a total of seven strains (Table 2).

Table 2. The species of human coronaviruses.