COVID-19 : Advice from the Choose Health Medical Team

March 31, 2020
COVID-19

We have been receiving a lot of questions from the Choose Health community and wanted to give some expert advice and feedback to you all.

Our thoughts are with those families who have lost loved ones during this tragic time. As we pass the mark of 3,000 deaths in the US and 40,000 deaths globally, it is more important than ever to understand what we can all do to help protect ourselves, our families and our communities.

We are sending our support to all of the healthcare workers in the US and around the world who are working around the clock on the front lines during this pandemic. We are committed to providing donations to Americares, who are supporting communities with healthcare services across America and around the world in line with our COVID19 testing program. 

Firstly, How should I protect myself?

We are learning about COVID19 daily and it is important to listen to the existing medical advice and stay up to date on advice from the CDC

“The best way to prevent illness is to avoid being exposed to the disease.” - CDC


Here is a summary of the basic advice on how to reduce your risk:

Wash your hands often and thoroughly with soap and water for at least 20 seconds after going to the grocery store or leaving your house. 

Clean and disinfect frequently touched surfaces daily (e.g. tables, doorknobs, light switches, phones, faucets, sinks).

Hand sanitizer is an acceptable alternative to soap and water, but make sure it has at least 60% alcohol.

The virus travels in the air in respiratory droplets. It can survive on some surfaces for 1-3 days.

Avoid touching your eyes, nose, and mouth, especially with unwashed hands. The virus tends to enter the body through the nose and mouth.

Avoid close contact with people who are sick and stay home if you start experiencing symptoms. If you are concerned about your symptoms, especially if you are breathless, please contact your primary care provider.

Cover coughs and sneezes: use a tissue (and then dispose of it) or use the inside of your elbow. Then immediately wash your hands.

Avoid crowds and non-essential travel as much as possible. 

Stay more than 2m away from others, especially when indoors. (The virus travels through respiratory droplets and the chance of contracting the virus is higher in closed air environments).

It is important to stay safe at home, and stay positive.


What is Coronavirus and Where is it being spread?

COVID-19 is the medical condition caused by the novel coronavirus SARS-CoV-2 that was first identified in the Hubei province of mainland China in December 2019. Though we commonly refer to it as “the Coronavirus,” in fact this is a name given to an entire family of viruses that infect humans. The coronavirus family has been responsible for three relatively recent epidemics, including the current pandemic. In 2002-03 a coronavirus called SARS-CoV (severe acute respiratory syndrome-related coronavirus) was first identified in China and infected more than 8,000 people, leading to 774 deaths (9.6% death rate) in 17 countries. More recently, in 2012, MERS-CoV (Middle Eastern Respiratory Syndrome-related coronavirus) was another coronavirus identified in Saudi Arabia that led to an epidemic infecting 2494 people, including 858 deaths, according to the WHO.

The vast majority of patients (80%) display mild respiratory symptoms that can be managed at home. However, up to 20% can have more severe disease. There are some groups of people who may be more at risk of serious illness if they catch Coronavirus, such as the elderly, people with underlying chronic medical conditions such as high blood pressure, heart disease, diabetes, and obesity, as well as those with underlying respiratory conditions, like Asthma and COPD, and those who have compromised immune systems, for example patients receiving active cancer treatment.

COVID-19 has now caused well over 800,000 cases around the world. This number will certainly continue to grow, and updated global numbers are tracked in this map by the Johns Hopkins Center for Systems Science and Engineering.

Following the initial outbreak, efficient human-to-human spread has been observed, and it is the rate of such human-to-human spread that has public health officials alarmed. Current estimates hold that every COVID-19 infection will lead to 2-3 subsequent infections, which is a relatively high “reproduction rate” for respiratory viruses. In Italy, where over 11000 individuals have now died from this infection, the country has adopted rigorous containment measures including quarantine and travel restrictions in order to stem the outbreak. 

Between China and the US was the European experience, currently the epicentre of the pandemic, and European nations such as Spain, France and the UK have seen rising infection rates and deaths.

This article by Jason Scott Warner is particularly helpful to understand how the numbers of cases grow exponentially if we do not take the necessary precautions. 


How much of a threat is COVID19 in the U.S.?

Our lives and daily routines have been significantly disrupted by this unfolding pandemic. As it is a new virus, as a scientific and medical community, we are learning more and more each day about its behavior. Many of the world’s brightest and most well-regarded scientific minds are working tirelessly together to understand how to prevent it spreading and how to treat it, as well as to develop better testing methods and a vaccine.

We will do our best to keep the community updated on what we are learning.

On March 13, a National Emergency was declared in the U.S. surrounding the emergence and spread of the COVID-19 coronavirus in our country. On March 14, CDC recommended that all gatherings of greater than 50 persons be cancelled or postponed for a period of 8 weeks, and two days later the Federal government released new guidelines including avoiding gatherings of more than 10 people, closing schools, avoiding discretionary travel, restaurants and food courts. Comprehensive stay at home orders have been issued in many cities and states across the country.

In the U.S. the number of individuals diagnosed with COVID-19 continues to rise, and we expect it to increase exponentially for a while as more people are tested.  Updated U.S. COVID-19 statistics from CDC can be found here

This is a link to a national and state by state forecast of the possible effects of the pandemic on the healthcare resources and population in each state by the University of Washington. The accompanying white paper can also be found here. However, these forecasts are only estimates (likely best-case scenarios) and until widespread testing is performed, we cannot be sure on timelines.

What we know for certain is that the threat posed by this coronavirus inside the U.S. will be a dynamic challenge, affected by numerous factors: 

  • The characteristics of the virus itself
  • How transmission is affected by changes in our domestic and social customs such as physical distancing and changes in workplace settings and travel
  • The ability to deploy rapid and accurate testing at scale (that initially was only available from CDC on a limited basis) 
  • Whether investigational medication and treatment options being rapidly studied will be proven effective


What are my testing options today?

The team at Choose Health are working diligently with medical and regulatory experts to be able to provide a COVID19 testing solution to those that currently need it the most and eventually anyone that needs one in the Choose Health community and beyond.

The FDA is working around the clock to provide testing for those that need it on the front lines of this pandemic. You can keep up to date on the most recent testing options approved by the FDA at this link

The two primary methods of testing that are being rolled out, or working through the FDA approval process, in the US today are reverse transcription-polymerase chain reaction (RT-PCR) testing and SARS-CoV-2 Antibody testing.


RT-PCR:

These tests typically involve sampling a swab of saliva deep inside the nasal cavity or throat. RNA is extracted from the sample and it is run through a process at the lab to detect the presence of any SARS-CoV-2 virus. The turnaround time for results has decreased from days to hours, or even less, with recent testing developments. This test needs to be conducted by a healthcare professional today but several entities are working with the FDA on approving the use of these tests at home.


IgM and IgG Antibody Testing:

When a person becomes infected with the SARS-CoV-2 virus, their immune system starts to fight the virus by producing blood-circulating molecules known as antibodies. IgM is a class of antibodies that appears early in an infection (as early as 3-5 days) and is usually the first antibody to be detected. IgG is another class of antibodies that appears later and gradually replaces the IgM antibodies. Usually, IgG antibodies appear in the blood circulation within 1-3 weeks after initial infection and are responsible for longer-term ‘immunity’. The presence of SARS-CoV-2-specific IgM and/or IgG antibodies in the blood of a patient is a strong indication that the patient has been infected with the SARS-CoV-2 virus. The two options for antibody testing are immunochromatography (at-home testing cards) and lab-based testing (using e.g. ELISA or immunofluorescence).

This is the CDC resource available to help determine if you are a good candidate to be tested. 


What type of COVID-19 detection test is Choose Health working on?

The team at Choose Health are currently working with our medical advisory team and several laboratory partners to provide an antibody testing solution that will detect the presence of antibodies developed in our bodies in response to the presence of a COVID virus. We will update the community further as things progress. We anticipate launching this solution on the 13th of April.


Am I at risk?

In a report from the ISS in Italy, a deeper analysis of 3,200 victims who died in the pandemic up to the 20th of March 2020 showed that the median age was 78.5 and that 70% were men. In an assessment of 481 of the deceased, 99% of them were suffering from one or more underlying medical conditions. Almost 50% of the deceased had three of more previous pathologies. 

If you are young and healthy, your risk of serious health effects from a COVID19 infection are very low. 80% of all patients develop mild symptoms only and recover in a few weeks. 14% will have more severe illness and 6% will become critically ill. This possibility of having only mild symptoms is one of the key reasons the virus has been able to spread exponentially, as people continue to go to work and school without knowing they’re infected. This also highlights how important it is for each of us to follow the guidelines to reduce transmission.

You are advised to consult local and state health departments for updates pertaining to your geographic area because public health requires knowledge and vigilance at the local level!


How would I detect if I am infected or if I have had the virus?

Symptoms include; 

  • Fever with a temperature in excess of 100 degrees Fahrenheit, 
  • Dry or chesty cough and shortness of breath. 
  • GI or chest pain

You can run through a full questionnaire at this link from the Emory School of Medicine.

These are the same symptoms you might experience from influenza or other common respiratory illnesses. The ongoing availability of the testing options mentioned above will help to detect those who currently have and have previously had the virus.


Is it safe to work or travel in groups?

At the moment, recommendations are evolving and are very much dependent on the situation where you live. In most cities, schools have shut down and people are being advised to work from home if their jobs allow. Much international travel is being limited, and you should check the CDC website as you plan international travel. Most local health departments and city councils are recommending postponing non-essential large-scale public events. Many non-essential businesses and other entities are already working remotely and evolving to coordinate virtual events and conferences.

The timing on going back to normal working, school, and travel schedules largely depends on how we can control the pandemic. This means we all have a part to play. An important aspect is understanding how many people have already had the virus and developed antibodies to protect themselves. The proliferation of testing options to gauge this is essential. As the number of people who have recovered and are now immune grows, the curve will begin to flatten and normal life will resume. 

The University of Washington forecast of national and state by state cycles can be helpful to understand these timelines as well as the pressure on the health system. However, these forecasts are only estimates (likely best-case scenarios) and until widespread testing is performed, we cannot be sure on timelines.


How do I stay up to date?

As a part of our community, Choose Health is committed to bringing you updates on major issues that could affect your health, safety, and wellbeing. Other sources of information include your state and local health departments and the CDC, which maintains a coronavirus page here. Another authoritative source of information is the John Hopkins Center for Health Security.

 

This blog pro­vides infor­ma­tion about telemed­i­cine, health and related sub­jects. The blog content and any linked materials herein are not intended to be, and should not be con­strued as a substitute for, med­ical or healthcare advice, diagnosis or treatment. Any reader or per­son with a med­ical con­cern should con­sult with an appropriately-licensed physi­cian or other healthcare providers. This blog is provided purely for informational purposes. The views expressed herein are not sponsored by and do not represent the opinions of Choose Health™.

Dr. Alan Farrell

Dr. Alan Farrell is a board-certified Sports and Exercise Medicine and Family Physician and is the Choose Health Medical Director.

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