Covid-19 infection is a highly contagious virus transmitted via droplets from an infected person’s nasal or oral mucosa. These infected droplets contaminate air and surfaces when an infected person coughs, sneezes, yawns, sings or talks. Contact with the infected droplets whether directly (from person to person) or indirectly (from touching contaminated surfaces) enables viral transmission. Notably, infected droplets have been observed to survive for up to 72 hours on plastic and metal surfaces.
There are postulations that suggest the virus is airborne which means the droplets can be suspended in air and inhaled during inspiration. Arguably, the World Health Organization (WHO) does not support this postulation. They maintain that the droplet is too heavy to be suspended in air for long periods of time except for when a contact is within proximity of an infected person’s droplets.
Originally, Covid-19 infection is a zoonotic virus that found its way into humans. It was first documented in Wuhan China when recurrent cases of similar patterns of respiratory illness were encountered by health workers in December 2019. This strain of disease-causing infection was found to be a novel Corona virus named SARS-CoV-2 an acronym for Severe Acute Respiratory Syndrome Corona Virus-2. This name stems from the morphology of the virus as well as the characteristic respiratory difficulties it causes. The SARS-CoV-2 aka Covid-19 infection was seen to be similar to SARS-CoV (which causes the SARS infection) as well the MERS-CoV (which causes the Middle East Respiratory Symptom). These three are all Beta-Corona Viruses and primarily cause respiratory symptoms that are sometimes fatal.
The incubation phase of the virus varies from two to fourteen days. In essence, an infected person may present with symptoms of infection from as early as day two to as late as day fourteen. Some may not present with any symptoms while transmission of the virus can occur during the incubation phase as well as during the active phase.
There are five documented presentations of the infection namely: asymptomatic presentation, mild presentation of symptoms, moderate presentation of symptoms, severe presentation of symptoms and critical presentation of symptoms:
1. Asymptomatic presentation - one has tested positive to the virus but shows no sign of infection. This is why social distancing is highly advocated because an infected non-symptomatic individual is capable of unknowingly spreading the virus to people.
2. Mild symptoms – an infected person has symptoms that cause mild distress which resolves on its own. These symptoms include sore throat, fever, dry cough, sneezes, loss of taste or smell, shortness of breat, headache, nausea, vomiting, anorexia, diarrhea, dizziness, confusion, easy fatiguability and body ache. Note that the symptoms vary with individuals and some may have fewer or more of the symptoms mentioned. Usually, patients do not require hospital intervention and will do well on fluids and symptomatic treatment, including use of analgesics (preferably acetaminophens), hydration and rest. Patients are usually better by day ten of being symptomatic.
3. Moderate symptoms – this includes some or all of the symptoms mentioned above however, with greater intensity. At this stage, the cough and difficulty in breathing intensifies. Patients usually present with signs of pneumonia necessitating medical intervention and management. This set of people will begin to get better by the end of week two to the third week of infection. Their symptoms may also worsen and tip them into the more severe or critical phase.
4. Severe symptoms - when some or all of the symptoms mentioned prior cause a threat to life. This is particularly significant because of the severe difficulty in breathing which necessitates the use of oxygenation to keep all the cells and organs of the body perfused. This stage can easily worsen particularly, if the individual has underlying health conditions. Recovery at this stage varies from 3 to 6 weeks and in some cases, longer.
5. The critical stage is when a person’s condition significantly worsens and acute Respiratory Distress sets in necessitating mechanical ventilation and intensive care. This may then be followed by septic shock and multiple organ damage. Asides being intubated and placed on a ventilator, a routine of medications and tests are required to restore all that is going wrong with the organs and systems of the body. This care usually requires a much longer hospital stay if the patient survives.
Importantly, an infected person can remain asymptomatic for the entire course of infection or may progress to any of the other phases. Some research is also been done to determine the predictors of worsening symptoms, so as to facilitate better decision making in disease management. One research published by TechScience determined these three predictors of disease severity:
1. Mildly elevated levels of a liver enzyme - Alanine Amino Transferase (ALT)
2. Presence of body aches and
3. Elevated levels of haemoglobin.
While no universal treatment protocol has been efficaciously established; the use of Hydroxyl-chloroquine, Azithromycin, Ivermectin, some IL-6 blockers such as Actermra and Kevzara have been researched in some quarters with varying results. Nonetheless, none of these drugs are globally recommended as research is ongoing to ascertain their overall efficacy.
Findings show that the highest risk for severe symptoms and death include:
· Older age from 60 years and above*
· Underlying health conditions including diabetes, hypertension, cardiovascular disease, chronic respiratory diseases, obesity, cancer and immunocompromised states;
· The male gender (there is notably higher mortality in men than women).
*Bear in mind that all other age groups despite having no underlying disease have also died from Covid-19 infection. This is why recommended guidelines for prevention of Covid-19 infection is advocated for everyone by WHO alongside other health bodies. See the guidelines below:
· Maintain at least 6 feet (2 meter) from people around you – social distancing. This reduces your chance of contact with an infected person who is symptomatic or asymptomatic
· Wash your hands thoroughly with soap and water for at least 20 seconds on regular intervals. You will find an educative video on the proper hand washing technique here – https://www.instagram.com/p/B99agJ_Fy6y/
· If you do not have immediate access to soap and water, use a hand sanitizer that has at least 60% alcohol and rub your hands together until they are dry
· Avoid touching your face - particularly your eyes, nose and mouth to avoid transferring the virus into your mucous membrane suppose your hands have come in contact with the virus
· Cough or sneeze into your elbow or use a disposable tissue and trash into a lidded bin after use
· From time to time, wipe your household surfaces and common areas such as your doors, rails, table tops etc. with disinfectants
· Obey self-isolation or lockdown directives in your locality and avoid unnecessary travel, commute or gatherings.
· Contact your local designated health authorities if you have Covid-19 symptoms or upon exposure to the virus.
· Make use of a facemask if you have to go outdoors as suggested by CDC (this is debatable and WHO doesn’t recommend its use for non-care givers).
As with many viral infections, surviving covid-19 infection is believed to proffer immunity against immediate reinfection however, there is still more to learn here. Some patients who have recovered from Covid-19 infection have been observed to remain positive for the virus for up to 37 days thus necessitating the repeated testing until two consecutive negative results are obtained before discharge. A positive result means a person is still capable of shedding the virus and infecting others.
In conclusion, as you stay at home or go about your essential duties; ensure that you engage in activities that boost your immune system including eating healthy meals, resting adequately and engaging in physical activityso as to stay healthy and increase your chance of beating the infection should you become exposed to the virus. Do stay Safe!
Research Resources
https://www.nejm.org/doi/10.1056/NEJMc2004973https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html
Dr. Anne Olowu is a Public Health Physician and a Health Promotion Expert. She is founder of AnneAide Consulting and writes from Lagos, Nigeria