Corona, COVID-19, SARS-CoV-2

What is Corona / COVID-19?

Corona-viruses are a family of viruses that range from the common cold to 'Middle East Respiratory Syndrome' (MERS). COVID-19 (COrona VIrus Disease) is the name given by WHO to the disease that is caused by a new (novel) coronavirus. This newly found coronavirus is now called ‘Severe Acute Respiratory Syndrome Coronavirus 2’ (SARS-CoV-2), 'CCP Virus' in other words.

How does SARS-CoV-2 Spread?

One can get infected by inhaling the novel coronavirus (SARS-CoV-2) if s/he comes near to someone who is suffering from COVID-19 or is a carrier of this virus.

This virus mainly transmits through droplets generated when an infected person sneezes, coughs, or even exhales. These droplets float in the air for some time (may be for hours) and then fall on floors, tabletops or surfaces. In spaces without proper ventilation (like lifts, entrances, corridors), infected aerosols (small droplets carrying the virus) can float in the air for hours.

An infected person may transfer viruses to objects (like knobs, utensils) and other surfaces s/he touches if his/her hand has traces of saliva, nasal discharge, etc. So one can also get infected by touching a contaminated object or surface (where the droplets containing viruses have landed) and then touching his/her eyes, nose or mouth. This virus can live on surfaces like plastic and metal for at least 2 days. Fomites are things, materials which may carry pathogens (viruses, bacteria, ...), such as paper (currency / bank notes), handles, knobs, switches, personal electronic devices, utensils, arm rests, clothes, etc. One can get enough new virulent SARS-CoV-2 viruses to cause COVID-19 by fomites. Clean or disinfect things / surfaces others (might) have touched. If you touch a surface which might have been touched by someone (who does not share living space with you), either wash your hands with soap or use a hand sanitizer. Avoid touching your face with your bare hand; when not in your home, use a handkerchief.

The infectious dose of SARS-CoV-2 causing COVID-19 is assumed to be low. It means that the amount of virus particles that can cause COVID-19 is less. Hence, SARS-CoV-2 transmits rapidly and is more contagious.

History >>

Symptoms

It generally takes more than 3 days after contracting an infective dose of SARS-CoV-2 for the symptoms to appear.

More than 80% of people develop mild flu-like illness and recover after taking care of themselves at home.

As per medical bodies, ‘common’ symptoms are:

• fever
• sore throat
• tiredness / fatigue
• cough / mucus / phlegm
• nasal congestion / runny nose
• shortness of breath (a serious symptom)
• aches and pains
• loss of appetite
• loss of taste or smell

‘Some other’ symptoms are:

• headache
• diarrhea
• conjunctivitis
• a rash on skin
• discolouration of fingers / toes
• nausea / vomiting

Various variants of SARS-CoV-2 result in slightly different symptoms.

Healthy people having ‘mild’ symptoms should manage their symptoms at home (with proper isolation from other family members) or in isolation centers.

Seek immediate medical attention if you have any of the following serious symptoms:

• difficulty breathing / shortness of breath
• chest pain or pressure
• loss of speech or movement
• sudden confusion

Testing

Pulse Oximeter

Use a pulse oximeter (cheap small ones are also available; called finger oximeter). A typical pulse oximeter shows both the pulse (heart rate) as well as the SpO₂(Saturation of Peripheral Oxygen). Simply, SpO₂ means oxygen saturation in the blood. Check SpO₂ every 3-4 hours even if the person / patient seems to have only mild symptoms.

Steps to Check SpO₂ and Pulse

Ask the person to relax (at least sit) before using a pulse oximeter. Most pulse oximeters clamp on our fingers. Place the person's middle finger of their right hand inside it. [We may use other fingers as well.] Record the reading that is shown on the display after about 4-5 seconds. If the reading varies by 3-4 points, wait again for 4-5 seconds before taking another reading. You can consider the mean reading after using the device for up to (say) five minutes.

The pulse rate is the number of heart beats per minute. A normal resting pulse is within 60–100 beats per minute.

What is the Breathing / Respiratory Rate?

Breathing rate is how many breaths you take per minute. The normal range is 12 to 20 breaths per minute (for a grown-up person at rest). If a patient who is resting for more than 10 minutes has a breathing rate less than 12 or above 25, it should be reported to a qualified medical staff.

Tell these readings to a health worker if -

1. the SpO₂ is below 95,
2. the temperature is above 99 Fahrenheit,
3. the breathing rate is above 20 breaths per minute or below 10 breaths per minute,
4. the pulse rate is either less than 60 or above 100.

One can also use a simple 6 minute walking test.

One should get either RAT, RT-PCR or any other Covid-19 test (specified by his district authority) done as soon as s/he develops any of those symptoms mentioned before. If the test is negative but the symptoms persist, then repeat the test after 2-4 days.

How is a sample taken for testing?

For testing, a nasopharyngeal swab or a nasal/throat swab is used. This special swab is about 6-inch long thin plastic stick with a cotton swab. It is inserted in the subject's one of the nostrils and moved around (or rotated) for more than 10 seconds. It is uncomfortable, but it doesn't hurt. The swab is then used immediately for a test called RAT or securely put in a special vial and sent to a lab for the RT-PCR test mentioned below.

There are three types of tests.

RAT (Rapid Antigen Test) - As the name suggests, it is a very quick way to find whether a person is suffering from COVID-19 or not. The swab mentioned above is used along with a kit to complete the test. A positive result of RAT indicates that the person is infected with SARS-CoV-2 viruses. Some times this test is not able to correctly detect the presence of this virus. So, a negative result does not always mean that the person is not infected with SARS-CoV-2. This test is more reliable when an individual is showing clear symptoms of the infection.

RT-PCR (Reverse Transcription Polymerase Chain Reaction) Test - This is a better but time-consuming test. It is ordered when RAT is showing a negative result but the patient is showing clear signs/symptoms of COVID-19. It can be done when a person does not have clear symptoms but has doubts about having infection.

Antibody Tests - These tests can detect whether a person has antibodies to the virus. A person has antibodies if s/he has contracted the virus in the past or is vaccinated. A blood sample is required for antibody testing. It does not indicate whether a person is COVID-19 positive or not.

HRCT (High Resolution CT scan)

Remember HRCT is not recommended if a person has mild symptoms. It exposes the person to 400 times more radiation than an XRay. It is not a diagnostic test to determine whether a person is COVID-19 positive or not. It is a suggestive procedure that helps in better prognosis. The RTPCR and RAT are diagnostic tools.

Vaccination

We need to take vaccines even if they are not 100% safe and 100% effective. Medical service providers not only need to interact with lots of people and some of them may be carrying SARS-CoV-2; so they need to take vaccine shots. If the vaccine is a two dose one, remember to take the second dose of the same vaccine.

If a person recovers from Covid, s/he may not need vaccination for at least 2-3 months. Talk to a primary health worker if the person has taken the first dose of a vaccine before getting Covid.

Don't rush for a vaccine, nor avoid one. If authorities or your physician think you should be vaccinated, let them vaccinate you.

Choose a remote vaccination center if it is less crowded than a nearby crowded center. (enjoy medical tourism if lock-down rules allows :-)

Side effects of vaccination include -

• local side effects at the site of the injection in the arm — pain, swelling, tenderness / sensitivity, redness, itch, warmth and swollen armpit glands.
• systemic side effects affecting the whole body — headache, fatigue, diarrhoea, chills and shiver, fever, pain in joint/s and / or muscle/s, nausea, ... These effects generally peaks within the first 24 hours after vaccination and lasts upto 2 days. For severe side effects seek medical attention.

Even after taking vaccine we need to follow COVID-19 protocols. Chances of vaccinated people getting infected is not low, but the severity of illness (COVID-19) will be lower. Lots of the vaccinated people may not become spreaders after getting infected.

To achieve what is called a herd immunity, governments need to vaccinate more and more people. Common sense always don't hold true, but it seems that if the vaccines governments are choosing has lower efficacy than not only the rate of vaccination should be high but most of the people need to be vaccinated.

Mutants / Variants, Strains

When genetic material (building block) of a virus (or any organism) changes during replication we get a new mutant / variant of that virus (or that organism). When after mutation/s, behavior of a virus changes we get a new strain of that virus.

Whether this novel Coronavirus is mutating faster than ordinary FLU viruses? Because of favorable conditions (mainly low temperature and lower humidity) generally we have more FLU cases in winter.

Delta variant is now proven to be more dangerous than the other variants. Omicron variant is the most contagious virus at present, but is not dangerous like delta.

Some viruses can jump (transmit) between species, there are chances of significant mutations from those jumps. Authorities of Denmark found some genetic changes in this virus in some minks. They said that this mutation might undermine the effectiveness of present vaccines.

COVID-19 survivors can again turn positive. Immunity may be specific to similar variants (a strain) only! We may not have a vaccine that will work against even the future mutations / strains of the SARS-CoV-2?

Future mutants / strains may require re-vaccination; So, Governments should not buy costly vaccines for mass vaccination. Governments should ensure cold chain distribution.

Medicines and Treatments

The most important thing for relative(s)/care-giver of a patient who is seeking home treatment is to find a qualified doctor (at least MBBS; who understand biochemistry, physiology, pharmacology, etc.) to guide them. They should be paying him / her for tele-consultations. They should get services of an experienced / qualified nurse / paramedic for ensuring proper medication regimen, setting-up oxygen, etc.

To avoid concurrent / secondary bacterial infections, antibiotics like Azithromycin are being used. A flu drug called Favipiravir was prescribed (off-lable) by some doctors.

It is not okay to take large doses of ivermectin. Ivermectin can interact with other medications, like blood-thinners. It is yet not proven to be effective!

Awake proning was/is being encouraged in patients needing oxygen-therapy.

An antiviral prodrug called Remdesivir was originally developed to treat Hepatitis C. It was also used to treat Ebola, etc. This drug is now used as a 'broad-spectrum antiviral medication'. Remdesivir is not very effective against COVID-19. As there isn't any feasible alternative, it is being used to 'treat' COVID-19.

For moderate to severe cases:

1. Sometimes a corticosteroid called Dexamethasone is used. It has side-effects, so it should be used by qualified professionals only.
2. Some mAbs (monoclonal antibodies) are being used in the western countries.
3. Plasma Therapy may not be effective!

Patients in ICUs should be given "warm" humid air to breath and a warmer to compensate for cooler temperature around them?

Hyperbaric oxygen therapy was also proposed for COVID-19.

There are some serious concerns regarding side-effects of Merk's antiviral drug (Molnupiravir) for COVID-19.

Complications

Patients after recovering from COVID-19 should take good care of themselves; other health complications may arise because of weakness and immuno-deficiency, like fungal infection mucormycosis.

COVID-19 mainly affects pulmonary system, but other systems / organs like heart, kidney and nervous system may get affected in some patients.

During this pandemic cases of -

• depression,
• anxiety and
• sleep disturbances

are rising among those who contracted COVID-19 as well as general (non-yet-infected) population.

The following brain-related symptoms may indicates some degree of involvement of nervous system.

• loss of smell
• headaches
• confusion

For most of the patients, simple 'smell training' could help overcome post-viral smell distortions.

The following symptoms indicates a clear of involvement of nervous system.

• delirium
• hallucinations

Yet the virus is not detected in the brain (frontal lobe and brainstem were checked in some studies).

Read:
1. Neuropathology of COVID-19 (neuro-COVID): clinicopathological update.
2. Why some COVID-19 infections may be free of symptoms but not free of harm.

Nutrients / Supplements

Taking following oral supplements occasionally may somewhat help you.

1. Vitamin C, specially if you haven't eaten enough citrus fruits (like oranges, lemon, ...), peppers, strawberries, or broccoli for weeks
2. Vitamin D3, specially if you have Vitamin D deficiency or get very limited exposure to sun-light
3. Omega 3 Fatty Acids if you haven't eaten fish for a long time. Good source of ω3-FAs is fish oil; take Flax seeds and Spirulina if you're allergic to fish!.
4. Zinc picolinate / Zinc citrate / Zinc gluconate
5. N-Acetylcysteine (NAC).
6. Pyridoxal-5-phosphate / Pyridoxine (forms of B6)
7. Methylfolate / Folic Acid (forms of B9), if you don't eat green vegetables may times a week
8. MethylCobalamin and / or Adenosylcobalamin (forms of B12), if you are a vegan/vegetarian
9. Calcium [Orotate], if you are a vegan/vegetarian or having a medical condition
10. Iodine, if you are not consuming iodine fortified salts/food-items.
11. Magnesium complex occassionaly if you are not using magnesium-containing laxatives or antacids. You may take Magnesium with Zinc.
12. Copper may also help in few cases.
    In the cases of copper overload, additional copper supplements may be harmful!

Supplements cannot cure or protect anybody from any infectious disease. Supplements can only slightly help you recover faster/better. These can also improve your immunity to a certain level. Do not avoid medical advice even if you are taking enough supplements.

Some of the lifestyle changes mentioned below (like wearing masks, social distancing and exercising) can help you to some extent in avoiding getting infected.

You may consider supplements like Quercetin, Astaxanthin, Spirulina, Neem-Giloy, Ashwagandha and Shilajit if you know what you are taking and have extra energy, time, etc.

Remember you should not keep on stuffing yourself with nutrients blindly. Some of the nutrients can interact with other nutrients / medications. If you take more than one nutrient pretty regularly, you should keep a record or diary of it.

Learn how various supplements works; how these can change your 'chemistry'! Don't think every thing natural is 'safe'; nature produces some of the best toxins, venoms.

Masks

Wear masks when you are not in your private place. If your private space is having possibility of aerosol containing the novel corona virus then you have to wear mask there also :-(. Also stop ventilation of your apartment if any of your neighbors or any person living above your apartment is having symptoms of COVID. If it is difficult to stop flow of aerosol/air from room/s of infected person/s to your room, then consider shifting temporarily to some other room.

Masks (particularly N95) are better than simple cloths like handkerchiefs, scarf etc. Because if side of the cloth gets reversed it will undo the purpose.

If you are using regular surgical masks (which are not N95), you may use a cloth over these masks for better protection. N95 (or FFP2, FFP3) certified masks are better if the chances of transmission is high in your area and if you are not vaccinated. If the chances of transmission is not high and you are vaccinated, use of 3 layered surgical masks with a nose clip is sufficient. Beards and facial hairs may interfere with the masks. If your mask breaths with you it has a perfect fit. Masks are also helpful in keeping our nose warm during winter and in air-conditioned environments. If you have recently been tested negative, you may use a respirator instead of a mask to avoid warm and moist air during summer and rainy days!

Wearing face-shield (or big goggles) and / or extra cloth over masks is necessary if the ventilation is not proper, particularly in the lifts and narrow entrances of multi-storied buildings. The exhaust of a typical lift/elevator is in the elevator-shaft only. If possible, keep the doors of the lift remain open for some time before entering!

As washing hands with soap does the purpose of removing the protective lipid layer of the virus (and killing them), we should put washable masks in water containing detergent after using and before washing it. Sunlight has rays like ultraviolet, which are harmful to viruses. It is better to dry masks and your cloths in sunlight.

Not only masks but covered (safety) spectacles should also be used while in crowded places. Apparently some pathogens can enter our body through eyes (nasolacrimal duct) also.

What to do?

We know that vaccines won't work on many of the mutations of this virus. One has to improve immunity. Immunity can be increased by doing exercises (how easy it is to preach) and occasionally taking health supplements some of which are mentioned above. Consult your doctor and get you blood tested for deficiencies etc. Sleeping for about 8 hours is good. It may help in maintaining positive thinking.

Keep in touch with near and dear ones by dialing them; its ok if they don't call you back, they may be getting their dose of socialisation by using other forms of communication like social media apps and sites. Avoid ego; don't criticize people around you. Maintain a few potted indoor plants.

Don't let your vitamin D level plunge.Soak some daylight, specially in winter. It also helps us keep warm. One study says serum zinc levels lower than 50 µg/dl is problematic. In most cases it is helpful to take a regular doze of zinc as soon as you feel like catching cold. Do not keep taking zinc regularly for months! If you are feeling healthy and fit, do some exercise!

Low Temperature helps viruses live longer on surfaces (outside hosts) and low humidity decreases our immune response against viruses. So do not sleep in temperature below 25 degree Celsius and do not use dehumidifying functions of Air Conditioners. If possible do not use ACs without some ventilation.

The SARS-CoV-2 virus does not transmit through water. So swimming alone is relatively safe; but swimming pool complexes may have aerosol containing the virus. The handles, knobs, switches of a public facility may have this virus or other pathogens.

If you have been inhaling steam in the past to fight the common cold, you may do that if you feel similar symptoms. If you have never inhaled steam it is better to take medical advice or start with inhaling vapors of warm water. As humidity helps so vapors of warm water may help some. The hot steam from boiling water may be harmful to airways and lungs in some cases! Also, it is not easy to handle boiling water. We have to be careful while using steam inhalers or vaporisers. Do not add oils or balms to boiling water. Very few people also used to inhale fumes of turmeric powder to get rid of symptoms of common-cold temporarily!

If you have been gargling for common-cold, sore throat, etc. you may do that for COVID-19 also. Gargling with lukewarm water (or solutions) may help some! Do not pressurize kids or elderly to gargle. You may like to use camphor.

If you have to go to work in the early morning, you may avoid taking bath before going out. It may be better to bathe after coming home than to bathe before going out. Do not bathe frequently as good bacteria help your skin.

If anything is delivered to your home, ask the person who brought it to put the item in a corner. If it is not urgent please do not touch or open it for a day or two. If it is urgent spray some diluted (0.5% to 1%) bleach (sodium hypochlorite), washing soda (sodium carbonate) or alcohol based sanitizer on to it before opening the packaging. Sanitize your hand after handling the item.

We all will personally (not just financially) get the brunt of this virus.

To console someone who has recently tested positive for COVID-19, we can say to him/her: "It is likely that most of us are going to get infected sooner or later like the common cold. So fight it out."

It's better to wash our newly bought food stock in salt water before cooking/using them. Use some cheap unbranded salt. Put lots of salt in a tub full of water, first wash those vegetables (like coriander leaves) and fruits (like grape) that are consumed without peeling. In the end wash roots which contains soil traces. Instead of ordinary salt some people use baking soda. Washing helps in getting rid of other contamination as chances of getting the virus through food items is rare.

How-to handle Cash?

If possible pay and receive money electronically. But some times we cannot avoid using cash.

If you are out shopping, take a pouch or small carry-bag with you. Ask the shopkeeper to put change s/he returns in that pouch. The next day you can use that change.

If you are running a shop keep two cash boxes, mark them as 'Even' and 'Odd'. Suppose you start this practice from an even date, put your all your cash in the box marked 'Odd'. Now on this day (with even date), ask your customers to put cash they give in the box marked 'Even', and give them the change from the box marked 'Odd'. Next day (odd date) when you open your counter, transfer the remaining cash from the box marked 'Odd' to the box marked 'Even'. Now accept the cash in the box 'Odd' and give change from the box 'Even'.

Miscellaneous

Recent studies indicate that Covid-19 hits men harder than women.

People with male pattern baldness may be a little more vulnerable! Androgens (male hormones) such as testosterone may be responsible in boosting the virus’ ability to get inside cells.

India & Covid >>

Which drugs are ineffective or less effective.

Now we know, the HIV drug combination ritonavir/lopinavir is ineffective in treating COVID-19. The Malaria drug HCQ (hydroxychloroquine) is not being used by doctors.

‘Virafin’ (Pegylated Interferon alpha-2b) received emergency use approval in India in treating moderate COVID-19 infection in adults. But as per WHO - interferon regimens appear to have little or no effect on 28-day mortality or the in-hospital course of COVID-19 among hospitalized patients.

Tocilizumab was used in some cases.

Roche / Regeneron's monoclonal antibody cocktail was used in some cases.

A molecule called 2-DG was approved for emergency use to treat COVID-19 patients in India. Health care professional should discuss with a cardiologist before administering this molecule to a patient with a history of cardiac problems.

Future!

If you haven't caught covid yet...

Whether we will have timely and effective vaccination and treatment from all the present as well as future mutants of SARS-CoV-2? Time will tell.

May be our heightened carefulness will result in the reduction in the number of cases of other contagious diseases.