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COVID-19: WHAT YOU NEED TO KNOW NOW

April 7, 2020

SARS-CoV-2 (COVID-19/novel coronavirus) has permeated nearly all aspects of our lives. Along with the spread of this virus, angst and fear have additionally spread. Information about the SARS-CoV-2 virus and the resulting clinical infection COVID-19 changes rapidly and quickly becomes outdated. While there is still much that we are learning, the following information is accurate as of March 15th, 2020.

What is coronavirus?

Coronaviruses are a family virus named for the sugary proteins that stick out from the sphere giving the appearance of a crown. There are four very common, widely spread coronaviruses that typically cause the common cold. However, there have also been previous strains that have been more virulent including the original SARS, and MERS. These viruses are typically zoonotic (predominantly in mammals and avian species), but can be transmitted by humans. The virus is spread by droplet transmission, similar to influenza. This means that the virus travels in large droplets that are emitted by sneezing, coughing, or exhaling. Typically these droplets travel less than 6 feet. However, transmission can also occur by contact meaning if a person touches a contaminated surface and then touches their face, mouth, or eyes they can transmit the virus.

What are the Symptoms of COVID-19?

2-14 days after exposure (median of 4 days) the following symptoms may appear

  • Fever (can last over a week)
  • Cough (often a mild, dry cough)
  • Shortness of breath

A small percentage of patients report gastrointestinal symptoms. 

Early data suggests 80% of infections are mild or asymptomatic, 15% are severe and require oxygen and the remaining 5% are critical and require ventilation. 

Importantly, symptoms appear to worsen through the first week often peaking on day 7-8.

Who is at Higher Risk?

Early information out of China indicates increased risk of more severe illness associated with:

  • Older adults (age>65)
  • Those with chronic medical conditions such as
    • Heart disease
    • Lung disease
    • Diabetes

Smokers also appear to have more severe infections. Those with other significant medical problems or  taking medications that suppress the immune system (i.e. cancer, HIV/AIDS and autoimmune diseases such as lupus or multiple sclerosis) are at increased risk as well. Unlike influenza, children appear to have less severe illness than adults with low infection rates in the 0-19 age group. Preliminary data out of China also suggests children do not infect adults but vice versa.

How Dangerous Is it?

Current data indicates the mortality rate from COVID-19 is 3-4%. For comparison, 2003 SARS and MERS had mortality rates of 10% and 34% respectively.1 Seasonal influenza is generally reported to have a mortality rate around 0.15%. However, it is also important to remember that the mortality rate of COVID-19 could end up being much lower as many people infected have a very mild course or are asymptomatic and are never tested. Furthermore, limited availability of testing in multiple countries likely inflates the mortality rate.

How to Protect Yourself 

Basic precautionary measures include:

  • Wash your hands often with soap and water for at least 20 seconds. This is especially important after blowing your nose/coughing/sneezing or if you have been in a public place.
  • Use hand sanitizer with 60% alcohol if soap and water are not available, however soap and water should be your first choice.
  • Sanitize surfaces that may be contaminated. If you do not have cleaning products, you can use isopropyl alcohol 70%.
  • Avoid touching your eyes, nose, and mouth
  • Avoid close contact with those who are sick2

R-naught (R⌀)is a term used in epidemiology to describe the number of people infected by a single person with the disease. While this number can vary significantly based on population density, 2019-CoV-2 has an estimated value around 2.5 (The value was estimated at 15 on Diamond Princess Cruise ship). This is the reason that social distancing is effective in reducing the rate of transmission.

As a result, you should limit large social gatherings, unnecessary travel, crowded commutes, etc as increased population density increases the risk of transmission. While you may only have a mild infection if infected, your interaction with someone who is more susceptible could cause their hospitalization or death. Our healthcare system is soon to be overwhelmed. Protect your friends, neighbors and family by practicing social distancing. 

Telemedicine visits with your provider may be the best form of evaluation for medical care during this time. This avoids exposure to those who are potentially sick. If ill, your physician can determine if or when you need to go to the hospital for evaluation. Most mild cases can be treated at home. 

To boost immune function there are also several things you can do from a self care and integrative medicine perspective. 

  • Get 7-8h of sleep a night. Your body needs high quality sleep to recover and reset overnight.
  • Manage stress. This is a stressful time with lots of unknowns and time to implement stress coping mechanisms such as journaling, breathing exercises, meditation, walking in nature and physical exercise (preferably at home or solo outdoors at this time).
  • Optimize vitamin D level. Lowest vitamin D levels occur in winter and adequate vitamin D is needed for immune health. 
  • Eat a nutritious diet. Your gut plays a role in overall health. Feed it high quality foods such as organic vegetables, fruits, legumes and whole grains to optimize overall health and in turn boost your immune system. 
  • Supplement with herbs that support the immune system. These include elderberry, echinacea, vitamin C, astragalus. We presently have Black Elderberry Syrup and Viracid in stock. 
  • If unsure of current health, get in with your doctor for an assessment via virtual appointment. There are certain labs that should be checked at least annually to determine your health trajectory to keep you from having conditions that put you at risk of more severe response from infections.

If You are Ill

The priority is decreasing the rate of spread of COVID-19 and protecting those who are at higher risk. If you develop symptoms of fever, cough or have exposure to a person with COVID-19 the following is recommended:

  • Stay home to avoid exposing others. (Remember the virus is mild – think cough – for most)
  • Avoid being around others and animals in your home
  • Call your healthcare provider’s office or schedule a telemedicine visit and let them know your symptoms and that you are concerned about COVID-19 exposure. This will help the healthcare provider’s office prepare to avoid exposing and infecting others.
  • If you are mildly ill you can recover at home. Your provider can instruct you regarding how to self-isolate.
  • If you are sick and feel short of breath, you may need to go to the emergency department. If that is the case, wear a mask as soon as possible and identify yourself as a person with respiratory complaints and possible COVID-19 infection.
  • Wear a facemask if you are sick and coughing while around others. You do NOT need to wear a facemask if you are not sick unless you are caring for someone who is ill.
  • Disinfect high touch surfaces daily2

When looking for information, the CDC and WHO have the most up to date and reliable information. They also have a large amount of resources for nonmedical people as well as for employers. Please do not hesitate to reach out to us at Spruce MD if you have any questions during this challenging time at info@spruce.md or 864.979.2441. We are also offering acute care virtual visits at a discounted rate of $175 to help assist with care and triage of patients during the pandemic.

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