By Brian James Rose
As the incidence of the novel coronavirus disease 2019 (COVID-19) increases dramatically on a near-daily basis, public fear and anxiety have skyrocketed to unprecedented levels. Indeed, the latest figures on the 30th of April 2020 suggest that there are almost 3.2 million confirmed COVID-19 cases globally, 1 million of whom are from the United States of America (USA) alone. The mortality incurred from COVID-19 is equally staggering – the virus has claimed in excess of 220,000 lives worldwide. The Centers for Disease Control and Prevention (CDC) has disseminated timely and evidence-based reports which convey effective preventative strategies to mitigate the spread of COVID-19.
These preventative strategies include minimizing travel outside of one’s home, avoiding large community events and mass gatherings, as well as maintaining personal hygiene standards such as frequent hand-washing and not touching one’s face and eyes with one’s hands. The efforts to curtail the spread and impact of COVID-19 have been spearheaded internationally as well; the World Health Organisation (WHO) has promulgated live-webinars and online learning modules that detail infection prevention and control measures. Several schools and institutions of higher learning have implemented online learning, and employers have been encouraged to allow workers to function off-site and perform their duties remotely.
During these uncertain times, there are several questions and doubts relating to COVID-19. Some nefarious agents take advantage of this uncertainty by disseminating blatant falsehoods and vague claims. Profit-seeking individuals may embellish their product claims to prevent or even cure COVID-19 despite the lack of robust evidence. Verifiable and high-quality evidence is more important today than ever. In this article, we contend with some of the most frequently asked questions by the public as regards COVID-19 and support the information with evidence sourced from the latest scientific literature.
What is COVID-19?
COVID-19 is an RNA virus with a crown-like appearance that is capable of causing respiratory and gastrointestinal diseases. Members of the coronavirus family are found in several animal species, such as camels, bats, cats, and cattle. Human-transmissible coronaviruses have been identified since the 1960s. Common human coronaviruses cause self-limiting common colds, but some strains such as SARS, MERS-CoV, and COVID-19 cause epidemics which feature mainly respiratory manifestations and are characterized by much higher mortality rates (Li et al., 2020a).
Clinical Presentation of COVID-19
The clinical course of COVID-19 is generally mild for most individuals who contract the infection. A recent study that was published on 10th April 2020 revealed a collective analysis of 43 separate studies involving 3,600 patients who had contracted COVID-19. The data suggested that fever (83%), cough (60%), and fatigue (38%) are the most common symptoms of a COVID-19 infection (Fu et al., 2020). A minority of patients have phlegm (30%), shortness of breath (30%), and muscle aches (30%). An even smaller minority (about 6%) of patients exhibit no symptoms at all – these patients are termed to be asymptomatic.
Therapeutic Strategies for COVID-19
Considering that the vast majority of people do not manifest severe symptoms with COVID-19, it is important to bear in mind that the following therapeutic strategies are for patients who are at a high risk of complications from COVID-19. So far, the following risk factors have been validated to confer a higher risk of COVID-19 related mortality – chronic diabetes mellitus, heart failure, hypertension, chronic obstructive pulmonary disease, and obesity (Li et al., 2020b). These patients with severe COVID-19 disease are typically admitted into specialized wards for continuous monitoring. These specialized wards include the high-dependency unit (HDU) and intensive care unit (ICU) where sophisticated equipment is utilized to conduct this monitoring. Physiological parameters such as the patient’s blood pressure, heart rate, respiratory rate, lung function, and oxygenation status are monitored so that clinicians can adjust the supportive therapy to maintain the body’s vital organ functions. Supportive therapy includes the administration of fluids to keep patients hydrated when they are unable to eat, using a ventilator to help their lungs function when they are failing, and administering potent drugs to maintain their blood pressure within a healthy range.
Most people who are young (<55 years old) and healthy have competent immune systems which can clear the virus; the median time from the onset of symptoms to the first negative COVID-19 swab test is 9.5 (6.0 – 11.0) days (Ling et al., 2020). For people without any symptoms, the clearance rate is challenging to establish because there is no clearly defined start point (as they have no symptoms). However, it is unlikely to be longer than three weeks. Currently, a vaccine to prevent COVID-19 infection is being researched by several independent teams worldwide but is unlikely to be commercialized until mid-to-late 2021. Two anti-viral drugs – remdesivir and lopinavir-ritonavir are being trialed as potential therapeutic options in COVID-19 patients with severe disease, but preliminary data are not conclusive as regards their efficacy and safety (Al-Tawfiq et al., 2020, Cao et al., 2020). In view of the limited therapeutic options for severe disease, and an obese and aging population in the USA, the public is strongly recommended to exercise social distancing and self-isolating measures until this pandemic has tided over.
The COVID-19 pandemic is unlikely to recede in severity for the next few months; daily incidence reports suggest an increasing trend in detected cases worldwide, especially in densely populated cities. While most young and healthy people will not suffer complications from a COVID-19 infection, several adults are at risk of severe disease because of co-existing medical conditions. Treatment today is generally supportive, and no specific anti-viral drug has been validated to be safe and effective. Keep up to date with ever-changing COVID-19 statistics here.
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Li, H., Liu, S.-M., Yu, X.-H., Tang, S.-L. and Tang, C.-K. (2020a) ‘Coronavirus disease 2019 (COVID-19): current status and future perspectives’, International Journal of antimicrobial agents, pp. 105951-105951.
Li, X., Xu, S., Yu, M., Wang, K., Tao, Y., Zhou, Y., Shi, J., Zhou, M., Wu, B., Yang, Z., Zhang, C., Yue, J., Zhang, Z., Renz, H., Liu, X., Xie, J., Xie, M. and Zhao, J. (2020b) ‘Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan’, J Allergy Clin Immunol.
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