Coronavirus COVID-19 Disease Guide

​David D. Leonard, MD
March 16, 2020
 
Dear Patients,
I want you to stay healthy and, together, we will persevere through this Coronavirus pandemic (world-wide spread of a disease). Many of you have questions about the Coronavirus or (COVID-19) so I have prepared a guide to help navigate this situation. COVID-19 is the name of the disease. The name comes from Coronavirus Disease which was discovered in 2019. The actual name of the virus causing COVID-19 is severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). This virus is genetically similar to the coronavirus that caused the SARS outbreak in 2003. Coronavirus, named for the crown-like spikes on its surface, have seven types which can infect humans and cause symptoms.
 
The COVID-19 type is caused by a novel virus as its natural host is an animal but it evolved to be able to infect human beings and to be passed from person to person. That means it is new to our immune systems so we have no natural immunity which potentially causes more severe illness. COVID-19 disease appears to be more contagious and more lethal than influenza. People over age 60 and with underlying medical conditions are the most susceptible.  Some infected patients develop a serious viral pneumonia in both lungs requiring intensive care treatment and a ventilator. Younger people with  the infection may not have symptoms but they can pass the COVID-19 to their parents and grandparents.
 
The knowledge about this Coronavirus is rapidly evolving but I hope this guide will help keep you healthy and safe. The spread of the COVID-19 will start gradually and then will rapidly expand (think of popcorn popping). Hopefully the coming of warm weather will help extinguish the virus and give us time to come up with an effective vaccine or antiviral treatment if it returns in the fall.
 
Symptoms of COVID-19 infection:

1. High fever (greater than 101), non-productive/dry cough, and shortness of breath are the major symptoms. The symptoms can appear 2-14 days after exposure. Many patients may also have a runny nose and mild body aches.
2. The symptoms are somewhat similar to Influenza A and B (which are circulating in our community) but the influenza virus tends to cause more body aches, while patients with COVID-19 experience more shortness of breath. We can treat influenza with antiviral (Tamiflu) but there is no antidote yet for COVID-19.
3. As we are entering the spring many patients develop allergy symptoms (runny nose, itchy eyes, sneezing, scratchy throat) which can mimic a viral infection. The difference is that allergy symptoms are more of an inconvenience, do not cause a fever, and patients do not usually feel bad.

 
Transmission:

1. The virus spreads from person to person by close contact (within six feet). It most commonly spreads by respiratory droplets either by air or by surfaces contaminated with the Covid-19 virus. There is evidence the virus can live hours or days on surfaces.

 
Who is at risk?

1. Fortunately, most patients (about 80%) who acquire COVID-19 have mild or no symptoms. Those patients, although asymptomatic, can still infect others. The value of testing for the COVID-19 virus in patients lies in trying to prevent the spread of the virus to others. The young and healthy patients may have an asymptomatic infection but they may infect their loved ones.
2. Twenty percent of infected patients may have symptoms of fever, chills, cough and shortness of breath.
3. The most vulnerable patients are those over the age of 60 or those who have underlying medical conditions such as lung disease (emphysema), heart disease (congestive heart failure) or have compromised immunity (diabetes, cancer therapy). COVID-19 disease appears to be more lethal and more contagious than Influenza with a higher mortality.
4. If in a high-risk group, consider postponing routine follow-up doctor visits, annual physicals and elective procedures until COVID-19 has passed.

 
Prevention:

1. Stay home when sick except to get medical care. Postpone elective medical procedures/visits.
2. Cover you coughs and sneezes with tissue.
3. Wash hands for at least 20 seconds with soap and water (sing the “happy birthday” song twice).
4. Hand sanitizers with at least 60% alcohol can be effective. Let the alcohol completely dry on your hands.
5. Try to maintain six feet of isolation in public areas if possible.
6. Do not shake hands. Instead do the first bump, elbow bump or toe-touch instead.
7. Do not touch your eyes, nose, mouth before washing your hands. Patients infect themselves by touching a surface that contains the virus.

 
Effective cleansing and sanitizing agents for surfaces:

1. Routine cleaning with disinfectants of frequently touched surfaces (doorknobs, light switches, handles, faucets, desks, tables, cell phone surfaces, computer keyboards, etc.) will help prevent transmission
2. Disinfectants such as Clorox wipes, Lysol spray or other EPA-registered household disinfectants can be effective.
3. Alcohol solutions with at least 70% alcohol or diluted bleach solutions can be used (NEVER mix bleach with ammonia or any other cleaner). Prepare a bleach solution by mixing four teaspoons (20 ml) of bleach per quart (32 ounces) of water.

 
Management of patients with suspected or confirmed COVID-19:

1. Home isolation.
2. Wear a face mask to limit spread of the virus.
3. If practical, use a dedicated bathroom and bedroom.
4. Clean and disinfect high touch areas daily.
5. Avoid sharing personal household items (dishes, eating utensils, towels drinking cups, and even pets).
6. Wash hands often.
7. Monitor for symptom such as increasing shortness of breath. Before seeking medical care, call us ahead and alert us that you think you may have COVID-19 so we can give advice.
8. While in public, always wear a face mask.

 
Testing for COVID-19:

1. Testing areas for patients are under development. Plans are being made for drive through testing at designated centers. The value of testing is to know who is infected with COVID-19 so steps can be taken to limit their transmission to others. Currently, our office is not able test patients for COVID-19 and the emergency rooms are testing only those patients with more severe symptoms.
2. Suspected infected patients should self-isolate. If their symptoms of high fever, shortness of breath progress, they should call us for further advice of whether they should seek emergency room care. If their symptoms evolve rapidly, they should go straight to the emergency room.
3. Most patients infected with COVID-19 can be managed in their home environment. For most patients, avoiding the emergency room would be in their best interests so they are no inadvertently exposed to COVID-19.

 
Treatment:

1. At the present time, the treatment for the Corona virus is isolation and supportive care. There is no approved antiviral treatment for COVID-19.

 
Helping others:

1. For the most vulnerable of our community, please check on them periodically. Offer to do their grocery shopping, pick up their prescriptions and make sure they have adequate resources and care.
2. For businesses most affected (such as restaurants, beauty salons and other services), please consider buying gift cards which will help them stay in business and pay their employees).

 

The COVID-19 pandemic is probably going to get worse before it gets better. All of our lives have already been impacted but we are resilient and innovative. Working together, we will get through this.  Wash your hands frequently. Avoid touching your face. Minimize exposure to crowds. If sick, stay home. Check in on loved ones and friends and be sure to take good care of yourself to boost your immunity. The situation is changing rapidly and hopefully life will return back to normal sooner than later. Summer will be here soon
 
Take Care,
David D. Leonard, MD
([email protected])
 
FPFairfax.com
Ph: 703-352-7100
Resources: www.cdc.gov/coronavirus/2019