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Dr Wasim Ahmed

Cinque Terre

Mar 25, 2020 | Dr Wasim Ahmed

Battling coronavirus

Coronavirus disease 2019, or "COVID-19," is an infection caused by a specific virus called SARS-CoV-2. It’s a mutant variety of early SARS virus with more infectious and more lethal potential.

How is COVID-19 spread?

When a person carrying the virus (who may or may not have symptoms) coughs or sneezes near other people. If you touch a surface that has the virus on it and then touch your mouth, nose, or eyes.

What are the symptoms of COVID-19?

44 percent can have no symptoms initially but transmit the virus to others making them difficult to detect. 60-70 percent infected persons can have mild to moderate symptoms that does not need hospitalisation (fever, sore throat, runny nose, muscle aches, fatigue). But it’s important for them and their close contacts to have isolation for atleast 14 days.

Upto 20 percent can have severe symptoms ( breathing difficulty, effect on other organs like heart and kidneys) requiring hospitalisation many of which will need Intensive Care Death has been reported in 3-8% of infected population despite highest level of care.

Severe disease is more common in people who are older or have other health problems like heart disease, diabetes, lung disease, or cancer.

While children can get COVID-19, they seem less likely to have severe symptoms. However they are sources of infection to other members who can have serious manifestations.

How is COVID-19 treated?

No specific treatment for COVID-19. So far use of various drugs to slow down viral growth is only “Experimental” and for research purposes. They have NOT been shown to have any significant effect in management.

While mild and moderately affected patients can expect to get better in 1 or 2 weeks time, the severely affected ones invariably need hospitalisation, usually in Intensive Care.

Why Severely Ill COVID-19 patients are a challenge to treat?

Severe and Critically affected patients are a challenge to treat because:

  • Their oxygen and ventilatory care requires specialised “Negative Pressure Chambers” which are not usually present in most of the existing hospitals even in advanced countries
  • Existing hospital infrastructure is insufficient to provide critical care to such a large percentage of population even in the most advanced countries
  • They pose a risk to other patients admitted as well as Hospital staff
  • Their care causes disruption of health services to other sick patients

China had to build new hospitals with Negative Pressure Chambers to manage COVID-19 patients, but it’s not feasible for resource poor countries thereby posing a great risk to a large section of population.

What is “flattening the curve” of Corona epidemic?

Flattening the curve refers to using protective practices to slow the rate of COVID-19 infection so hospitals have room, supplies and doctors for all of the patients who need care.

On a graph, a sudden surge in patients over a short time could be represented as a tall, narrow curve. Too many people becoming severely ill with COVID-19 at roughly the same time could result in a shortage of hospital beds, equipment or doctors.

On the other hand, if that same large number of patients arrived at the hospital at a slower rate, for example, over the course of several weeks, the line of the graph would look like a longer, flatter curve.

In this situation, fewer patients would arrive at the hospital each day. There would be a better chance of the hospital being able to keep up with adequate supplies, beds and health care providers to care for them.

Limiting the Spread: Given the high infectivity of COVID-19, increased mortality and difficulty in its management, the only option in resource poor countries is to limit its spread.

Two most important measures include personal hygiene and social distancing.

Personal hygiene

  • Wash your hands with soap and water often – do this for at least 20 seconds
  • Use hand sanitiser gel if soap and water are not available
  • Cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
  • Put used tissues in the bin immediately and wash your hands afterwards
  • Stay 2 metres (3 steps) away from other people, if you need to go outside
  • Avoid touching your face with your hands, especially your mouth, nose, or eyes

If someone in your home has COVID-19, there are additional things you can do to protect yourself and others:

  • Keep the sick person away from others – The sick person should stay in a separate room and use a separate bathroom if possible. They should also eat in their own room
  • Use face masks – The sick person should wear a face mask when they are in the same room as other people. If you are caring for the sick person, you can also protect yourself by wearing a face mask when you are in the room. This is especially important if the sick person cannot wear a mask
  • Wash hands – Wash your hands with soap and water often (see above)

Clean often – Here are some specific things that can help:

  • Wear disposable gloves when you clean. It's also a good idea to wear gloves when you have to touch the sick person's laundry, dishes, utensils, or trash
  • Regularly clean things that are touched a lot. This includes counters, bedside tables, doorknobs, computers, phones, and bathroom surfaces

Clean things in your home with soap and water, but also use disinfectants on appropriate surfaces. Some cleaning products work well to kill bacteria, but not viruses, so it's important to check labels.

  1. Social distancing:

Because 44% of patients can initially have no symptoms but continue to infect others, Social Distancing has been advocated as an important measure to limit the spread.

There is a wrong notion that COVID-19 causes problems in only older and people with other underlying medical conditions. However we need to understand that every infected person, young or old, can transmit the virus to anyone and cause catastrophic problems to others that could include the elder members of their own families.

So, even if you are healthy, limiting contact with other people can help slow the spread of disease.

In general, the recommendation is to:

  • Cancel or postpone large gatherings such as weddings, social gatherings, sports events, concerts, festivals, parades, etc. But even smaller gatherings can be risky.
  • If you do need to be around other people, be sure to wash your hands often and avoid contact when you can. For example, you can avoid handshakes and encourage others to do the same.
  • Work from home or study online if possible.
  • Try to stay away from people who have any symptoms of the infection.
  • Avoid crowds. If you live in an area where there have been cases of COVID-19, try to stay home as much as you can.
  • Avoid Travel whenever possible.

What is self-quarantine?

Recommended for 14 days if risk of exposure:

  • Recently returned from traveling to a part of the country or the world where COVID-19 is spreading rapidly, or
  • If exposed to an infected person (within about 6 feets of travel)

Two weeks provides enough time for them to know whether or not they will become ill and be contagious to other people.

Self-quarantine involves:

  • Using standard hygiene and washing hands frequently
  • Not sharing things like towels and utensils
  • Staying at home
  • Not having visitors
  • Staying at least 6 feet away from other people in your household

Once your quarantine period has ended, if you do not have symptoms, follow your doctor’s instructions on how to return to your normal routine.

What is isolation?

For people who are confirmed to have COVID-19, isolation is appropriate.

Isolation is a health care term that means keeping people who are infected with a contagious illness away from those who are not infected. Isolation can take place at home or at a hospital or care facility. Special personal protective equipment will be used to care for these patients in health care settings.

 

Author is a Senior Clinical Fellow, Cardiology, Chelsea and West Minister NHS Trust, London, UK

 

Mar 25, 2020 | Dr Wasim Ahmed

Battling coronavirus

              

Coronavirus disease 2019, or "COVID-19," is an infection caused by a specific virus called SARS-CoV-2. It’s a mutant variety of early SARS virus with more infectious and more lethal potential.

How is COVID-19 spread?

When a person carrying the virus (who may or may not have symptoms) coughs or sneezes near other people. If you touch a surface that has the virus on it and then touch your mouth, nose, or eyes.

What are the symptoms of COVID-19?

44 percent can have no symptoms initially but transmit the virus to others making them difficult to detect. 60-70 percent infected persons can have mild to moderate symptoms that does not need hospitalisation (fever, sore throat, runny nose, muscle aches, fatigue). But it’s important for them and their close contacts to have isolation for atleast 14 days.

Upto 20 percent can have severe symptoms ( breathing difficulty, effect on other organs like heart and kidneys) requiring hospitalisation many of which will need Intensive Care Death has been reported in 3-8% of infected population despite highest level of care.

Severe disease is more common in people who are older or have other health problems like heart disease, diabetes, lung disease, or cancer.

While children can get COVID-19, they seem less likely to have severe symptoms. However they are sources of infection to other members who can have serious manifestations.

How is COVID-19 treated?

No specific treatment for COVID-19. So far use of various drugs to slow down viral growth is only “Experimental” and for research purposes. They have NOT been shown to have any significant effect in management.

While mild and moderately affected patients can expect to get better in 1 or 2 weeks time, the severely affected ones invariably need hospitalisation, usually in Intensive Care.

Why Severely Ill COVID-19 patients are a challenge to treat?

Severe and Critically affected patients are a challenge to treat because:

  • Their oxygen and ventilatory care requires specialised “Negative Pressure Chambers” which are not usually present in most of the existing hospitals even in advanced countries
  • Existing hospital infrastructure is insufficient to provide critical care to such a large percentage of population even in the most advanced countries
  • They pose a risk to other patients admitted as well as Hospital staff
  • Their care causes disruption of health services to other sick patients

China had to build new hospitals with Negative Pressure Chambers to manage COVID-19 patients, but it’s not feasible for resource poor countries thereby posing a great risk to a large section of population.

What is “flattening the curve” of Corona epidemic?

Flattening the curve refers to using protective practices to slow the rate of COVID-19 infection so hospitals have room, supplies and doctors for all of the patients who need care.

On a graph, a sudden surge in patients over a short time could be represented as a tall, narrow curve. Too many people becoming severely ill with COVID-19 at roughly the same time could result in a shortage of hospital beds, equipment or doctors.

On the other hand, if that same large number of patients arrived at the hospital at a slower rate, for example, over the course of several weeks, the line of the graph would look like a longer, flatter curve.

In this situation, fewer patients would arrive at the hospital each day. There would be a better chance of the hospital being able to keep up with adequate supplies, beds and health care providers to care for them.

Limiting the Spread: Given the high infectivity of COVID-19, increased mortality and difficulty in its management, the only option in resource poor countries is to limit its spread.

Two most important measures include personal hygiene and social distancing.

Personal hygiene

  • Wash your hands with soap and water often – do this for at least 20 seconds
  • Use hand sanitiser gel if soap and water are not available
  • Cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
  • Put used tissues in the bin immediately and wash your hands afterwards
  • Stay 2 metres (3 steps) away from other people, if you need to go outside
  • Avoid touching your face with your hands, especially your mouth, nose, or eyes

If someone in your home has COVID-19, there are additional things you can do to protect yourself and others:

  • Keep the sick person away from others – The sick person should stay in a separate room and use a separate bathroom if possible. They should also eat in their own room
  • Use face masks – The sick person should wear a face mask when they are in the same room as other people. If you are caring for the sick person, you can also protect yourself by wearing a face mask when you are in the room. This is especially important if the sick person cannot wear a mask
  • Wash hands – Wash your hands with soap and water often (see above)

Clean often – Here are some specific things that can help:

  • Wear disposable gloves when you clean. It's also a good idea to wear gloves when you have to touch the sick person's laundry, dishes, utensils, or trash
  • Regularly clean things that are touched a lot. This includes counters, bedside tables, doorknobs, computers, phones, and bathroom surfaces

Clean things in your home with soap and water, but also use disinfectants on appropriate surfaces. Some cleaning products work well to kill bacteria, but not viruses, so it's important to check labels.

  1. Social distancing:

Because 44% of patients can initially have no symptoms but continue to infect others, Social Distancing has been advocated as an important measure to limit the spread.

There is a wrong notion that COVID-19 causes problems in only older and people with other underlying medical conditions. However we need to understand that every infected person, young or old, can transmit the virus to anyone and cause catastrophic problems to others that could include the elder members of their own families.

So, even if you are healthy, limiting contact with other people can help slow the spread of disease.

In general, the recommendation is to:

  • Cancel or postpone large gatherings such as weddings, social gatherings, sports events, concerts, festivals, parades, etc. But even smaller gatherings can be risky.
  • If you do need to be around other people, be sure to wash your hands often and avoid contact when you can. For example, you can avoid handshakes and encourage others to do the same.
  • Work from home or study online if possible.
  • Try to stay away from people who have any symptoms of the infection.
  • Avoid crowds. If you live in an area where there have been cases of COVID-19, try to stay home as much as you can.
  • Avoid Travel whenever possible.

What is self-quarantine?

Recommended for 14 days if risk of exposure:

  • Recently returned from traveling to a part of the country or the world where COVID-19 is spreading rapidly, or
  • If exposed to an infected person (within about 6 feets of travel)

Two weeks provides enough time for them to know whether or not they will become ill and be contagious to other people.

Self-quarantine involves:

  • Using standard hygiene and washing hands frequently
  • Not sharing things like towels and utensils
  • Staying at home
  • Not having visitors
  • Staying at least 6 feet away from other people in your household

Once your quarantine period has ended, if you do not have symptoms, follow your doctor’s instructions on how to return to your normal routine.

What is isolation?

For people who are confirmed to have COVID-19, isolation is appropriate.

Isolation is a health care term that means keeping people who are infected with a contagious illness away from those who are not infected. Isolation can take place at home or at a hospital or care facility. Special personal protective equipment will be used to care for these patients in health care settings.

 

Author is a Senior Clinical Fellow, Cardiology, Chelsea and West Minister NHS Trust, London, UK

 

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