Coronavirus (COVID-19): Burning questions discussed

At the moment Coronavirus pops up in most conversations at social events or during a consultation with patients. We are all naturally very concerned about the possibility of a pandemic and how to best protect our families.

Having said this I am sitting in front of my PC, trying to decide if this is a topic I feel I should be tackling. It is a strange place to find oneself in as a medical practitioner because the truth is that this is a very new virus, hence it being called “novel” and not too much is known about it. Being “novel” also means that those first infected by the virus had no natural immunity to the virus.

I have spent some time reading the literature and trying to sift through the information overload which has been presented to us since the first reported case on 31 December 2019.

What I do know is that Africa has very few confirmed cases and South Africa currently has one confirmed case to date and really reassuring, to me as a paediatrician, is that children seem to have milder symptoms than adults, are less vulnerable to the infection and to date no child under the age of nine years old has passed away as a result of COVID-19. The highest risk of death is in the elderly (over 80 years old). This means that, much like with the influenza virus, granny and grandpa or those with chronic conditions such as diabetes or heart conditions are more at risk of developing life-threatening complications from COVID-19. Thankfully children appear to be protected from this novel virus, which is certainly not the case with influenza.

Let’s try to answer some of the current, burning questions, bearing in mind that the answers may change as new information is gathered around this novel virus.

What exactly is Coronavirus?

What we are all currently concerned about is COVID-19. This is a new strain of the Coronavirus family.

Coronaviruses are spread from animals to people and may result in a common cold or a severe chest infection like pneumonia.

The world has experienced other Coronaviruses. In 2002 the SARS virus spread throughout the world but was originally transmitted from civet cats to humans. MERS was another of the Coronaviruses with its origin being camel to human transmission.

COVID-19 also arose from animals but like the other viruses, is now spread from human-to- human through respiratory droplets and close contact (around 2m). The latest information coming out of America is that the virus has also become a community virus. In other words, a person who gets the virus may not be aware of being in contact with an infected person. Instead, they may pick it up because the virus itself has been left behind on a surface like a keyboard, desks, clothing and so on. This makes control more difficult.

Watch this video of Prof Barry Schoub, World Expert Virologist

When is the most infectious time for the virus?

 

Since the virus has only been present in humans for a couple of months the information is based on the current statistics.

The incubation period for the COVID-19 virus is thought to be 2 to 14 days. Most patients are thought to be contagious while they have symptoms. The symptoms may last as long as 19 to 21 days.

Four healthcare workers still tested positive for the virus 5 to 13 days after their symptoms had cleared.  Scientist are unsure at this point if these people were still infectious after the symptoms cleared despite the positive tests.

The statistics, therefore, indicate that some people may be ill for as long as three weeks to four weeks.

What are the symptoms of COVID-19?

In the majority of cases most people suffering from COVID-19 will have mild cold-like symptoms. There are reported cases of people who had no symptoms at all but for the most the symptoms would include:

In mild cases

  • Fever
  • A dry cough
  • Headaches
  • Muscle pain
  • Sore throat
  • Difficulty breathing

 

In severe cases

  • Severe pneumonia
  • Acute Respiratory Distress Syndrome
  • Kidney failure
  • Sepsis
  • Death

 

 

What should I do if the symptoms do appear?

 

In most cases it is more likely to be a common cold or flu. If you or a family member have recently (in the last three to four weeks) traveled to areas where the COVID-19 virus is prevalent or if you have been in close contact with an individual from one of these countries and the symptoms described above develop then action should be taken. Phone ahead to your healthcare practitioner and describe the situation. Going and sitting in a waiting room full of other people is not a good idea as you may then spread the virus to other individuals. Your healthcare practitioner will be able to advise you on the correct steps to follow.

There are strict protocols in place to assist you.

What can we do about COVID-19?

 

At the moment, we can protect ourselves by not traveling to the places where the illness is prevalent. This would include China, South Korea and Italy. Countries that should be avoided if possible include Iran and Japan with Hong Kong, Singapore, Taiwan, Thailand and Vietnam being cautioned against. Within South Africa, avoid areas where you will come into contact with lots of people and follow our steps below.

There are precautions which need to be taken. These are pretty standard things which I would hope people with flu would follow in any case:

  • Wash hands often with soap and water for at least 30 seconds.
  • Keep your distance from sick people.
  • Cover your mouth with your elbow and turn away from people if you are going to cough or sneeze. Avoid using your hand to cover your mouth because you are likely to touch a surface and spread the virus.
  • Put dirty tissues into a sealed packet or flush them down the toilet. Wash your hands immediately after throwing your tissue away.
  • Stay at home when you are sick and get plenty of rest.
  • Stay well hydrated
  • Make sure you are eating properly and that your body is getting all the right nutrition to fight infection. Foods with good sources of vit C and zinc should be included in the diet. A zinc supplement may also be helpful because our food is often lacking in zinc.
  • Thoroughly cook meat and eggs
  • It has also been suggested that flushing your nose with a saline nasal spray containing xylitol will help control viral infections. This can be done throughout the day but can also be done at the end of the day when everyone is home. A normal saline solution will also do the trick.
  • Normal surgical masks only protect others from you. If you cough or sneeze while ill it would prevent your droplets being released into the air. Most masks won’t fit properly over the nose and mouth to prevent other people’s particles getting into your airways unless you have a properly fitted respiratory mask that forms a tight seal around your nose and mouth.

 

In cases where symptoms are severe the authorities will advise us. Patients will need to be tested and isolated from the general public if necessary. Treatment is supportive with bed-rest, fluids and oxygen if necessary. If organ failure sets in then medical care in an ICU setting would be necessary.

 

What now?

 

This is truly the million-dollar question. For now, don’t get into a mad panic. I assure you that our authorities have put measures in place to deal with the virus. Protocols have been circulated to medical practitioners to prepare for the virus crossing our borders. We have to be vigilant but not hysterical. We are moving towards winter when colds and flu are part and parcel of family life.

I would suggest the flu vaccine to protect your family against the strains we can do something about. Other than that, eat well, get out into the fresh air and away from crowds and do your best to keep stress levels low. Stress, lack of sleep and poor nutrition are known factors in lowering of the immune system. We certainly don’t want any of that until we have found a vaccine or anti-viral agent that can contain this new, unpredictable virus.

Scientists are working frantically on a treatment but this may take as long as a year to be produced. The measures put in place in China have meant that the rate of new infections has slowed down in China relative to the rest of the world. In my opinion, this is a good sign as we are able to learn from and model ourselves on action taken by other countries.

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