COVID-19 - Medical Information
Both the new virus and SARS are from the coronavirus family, which also includes those that cause the common cold. Coronaviruses are a large family of viruses, some causing illness in people and others that circulate among animals, including camels, cats and bats. Coronaviruses are zoonotic, meaning they are transmitted between animals and people. The recently emerged COVID-19 is not the same as the coronavirus that causes Middle East Respiratory Syndrome (MERS) or the coronavirus that causes Severe Acute Respiratory Syndrome (SARS) in 2003. Detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans.
Bradykinin (BK) has multiple pathophysiologic functions such as induction of vascular permeability. The discovery of the kinin system is not recent, but its study in clinical field has been done only in the last years. Kinins are peptide hormones that have been implicated in the regulation of blood pressure, pain sensation and cell growth. The activation of this system is particularly important in blood pressure regulation and in inflammatory reactions, through bradykinin (BK) ability to elevate vascular permeability and to cause vasodilatation of arteries and veins.
Joseph A. Roche and Renuka Roche wrote 02 May 2020 to " ... propose a testable hypothesis that, a vicious positive feedback loop of des-Arg(9)-bradykinin- and bradykinin-mediated inflammation ? injury ? inflammation, likely precipitates life threatening respiratory complications in COVID-19. Through our hypothesis, we make the prediction that the FDA-approved molecule, icatibant, might be able to interrupt this feedback loop and, thereby, improve the clinical outcomes."
Thomas Smith wrote a chemical called bradykinin: "... normally helps to regulate blood pressure... the virus ... causes the body’s mechanisms for regulating bradykinin to go haywire. Bradykinin receptors are resensitized, and the body also stops effectively breaking down bradykinin.... The bradykinin hypothesis provides a model that “contributes to a better understanding of Covid-19” and “adds novelty to the existing literature,” according to scientists Frank van de Veerdonk, Jos WM van der Meer, and Roger Little, who peer-reviewed the team’s paper. It predicts nearly all the disease’s symptoms, even ones (like bruises on the toes) that at first appear random, and further suggests new treatments for the disease.... Physicians have struggled to understand the disease and come up with a unified theory for how it works. Though as of yet unproven, the bradykinin hypothesis provides such a theory. And like all good hypotheses, it also provides specific, testable predictions..."
Reported on 03 December 2020, World Health Organization expert groups recommended mortality trials of four repurposed antiviral drugs — remdesivir, hydroxychloroquine, lopinavir, and interferon beta-1a — in patients hospitalized with coronavirus disease 2019 (Covid-19). These remdesivir, hydroxychloroquine, lopinavir, and interferon regimens had little or no effect on hospitalized patients with Covid-19, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay.
Early evidence suggests the variant of coronavirus that emerged in the UK may be more deadly as well as being more contagious, British officials warned on 22 January 2021. "There is some evidence that the new variant (...) may be associated with a higher degree of mortality," Prime Minister Boris Johnson said at a Downing Street news conference. Patrick Vallance, the UK's Chief Scientific Adviser, said the new variant could be around 30 percent more deadly, although he stressed that only sparse data was available. "There is evidence that there's an increased risk for those who have the new variant, compared to the old virus," Vallance said. Among men aged 60, around 10 in 1,000 would be expected to die after catching the original strain, he said, whereas the number rises to "13 or 14" for the new strain.
For vaccine development, considering that SARS-CoV-2 is an RNA virus, its intrinsic high mutation rate will make it a challenging candidate for vaccine development. Severe Acute Respiratory Syndrome (SARS), Ebola, Influenza and HIV all RNA viruses. A May 2020 study from researchers at University College London examining samples from more than 7,500 people with COVID-19 has uncovered 198 mutations of the virus SARS-Cov-2 - and possibly keys to finding vaccines and treatments to best target the disease. What UCL researchers found is that mutations are not evenly distributed across the genome of the virus, meaning some parts vary more than others. This suggests that vaccines focused on those areas that do not change much from mutation to mutation could be most effective. Vaccine and drug design efforts should preferentially target the conserved regions which are harder for the virus to evade.
One of the mysteries of Covid-19 was why the virus strikes down older people while seeming to leave children untouched. The breakthrough could pave the way for new treatments to combat the pandemic. Researchers at Vanderbilt University Medical Center figured out that children have lower levels of a receptor protein that SARS-CoV-2 – the virus that causes Covid-19 – needs to invade the lungs. “Our study provides a biologic rationale for why particularly infants and very young children seem to be less likely to either get infected or to have severe disease symptoms,” explained Jennifer Sucre, an assistant professor of pediatrics who led the research. When a virus particle is inhaled into the lungs, protein ‘spikes’ latch on to the ACE2 receptor, which lies on the surfaces of certain lung cells. A cellular enzyme produced in mammals called TMPRSS2 then chops up the spike protein, allowing the virus to “break into” the cell by fusing with the cell membrane. After completing the infiltration, the virus then hijacks the cell's genetic machinery and uses it to replicate itself. The enzyme that lets the virus break into the cell increases significantly with age.
Jose-Luis Jimenez wrote August 25, 2020 that " When it comes to COVID-19, the evidence overwhelmingly supports aerosol transmission, and there are no strong arguments against it. .... aerosols smaller than about 50 microns can float in the air long enough to be inhaled. SARS-CoV-2 is only 0.1 microns in diameter, so there is room for plenty of viruses in aerosols.... Given this deeply held disbelief of aerosol transmission, just a few diseases, including measles and chickenpox, have been accepted as being transmitted through aerosols... observations are easily explained by aerosols, and are very difficult or impossible to explain by droplets or fomites.... COVID-19 is not very contagious under most situations, unlike, for example, measles: the CDC says that 15 minutes of close proximity to a COVID-19 infected person often leads to contagion... "
An August 2020 study identified a distinct order of symptoms among nearly 55,000 COVID-19 patients. Most symptomatic patients started out with a fever, followed by a cough. After that, they experienced a sore throat or muscle aches, which transformed into nausea or vomiting, then, finally, diarrhea. COVID-19 also differs from general influenza, where coughs come before a fever. With MERS and SARS, patients started off with a fever, but tended to develop diarrhea before vomiting.
In Europe, the observed case fatality ratio (CFR, or the percentage of deaths among confirmed coronavirus patients) has been high, with France reporting a rate of 15.2 percent, the United Kingdom 14.4 percent, Italy 14 percent and Spain 11.9 percent, according to JHU data. In the United States, the CFR is 6 percent, the data showed. By contrast, in South Asian countries, those rates have been far lower. India has a CFR of 3.3 percent, Pakistan 2.2 percent, Bangladesh 1.5 percent and Sri Lanka 1 percent.
A study by Safiya Richardson et al published 22 April 2020 that included 5700 patients hospitalized with COVID-19 in the New York City area, outcomes were assessed for 2634 patients who were discharged or had died at the study end point. As of April 4, 2020, for patients requiring mechanical ventilation (n=1151, 20.2%), 38 (3.3%) were discharged alive, 282 (24.5%) died, and 831 (72.2%) remained in hospital. " Mortality rates for those who received mechanical ventilation in the 18-to-65 and older-than-65 age groups were 76.4% and 97.2%, respectively. ... The findings of high mortality rates among ventilated patients are similar to smaller case series reports of critically ill patients in the US.... We expect that as these patients complete their hospital course, reported mortality rates will decline."
The World Health Organization warned 24 April 2020 that people who have had COVID-19 do not have antibodies that protect them from being infected with the virus. Most studies showed that people who have recovered from infection have antibodies to the virus. However, some of these people had very low levels of neutralizing antibodies in their blood. As of 24 April 2020, no study had evaluated whether the presence of antibodies to SARS-CoV-2 confers immunity to subsequent infection by this virus in humans. Tests need to accurately distinguish between past infections from SARS-CoV-2 and those caused by the known set of six human coronaviruses.
There are six distinct types of the novel coronavirus, each with a particular cluster of symptoms, concluded UK-based scientists in a new study on COVID-19 published 17 July 2020. Researchers analyzed data collected by the COVID Symptom Study, a voluntary app used by 4 million people in the UK that allows people to log their symptoms of coronavirus. The data revealed people infected with COVID-19 reported additional symptoms on top of the previously recognized cough, fever, and loss of smell.
These symptoms can be grouped into six distinct clusters, according to a statement published by the COVID Symptom Study after researchers on the project from technology company Zoe Global Limited and King’s College London analyzed the results.
- Flu-like with no fever - Additional symptoms: Headache, muscle pains, loss of smell, sore throat, cough, chest pain, no fever.
- Flu-like with fever - Headache, loss of smell, sore throat, cough, hoarseness, loss of appetite, fever.
- Gastrointestinal - Headache, loss of smell, loss of appetite, sore throat, chest pain, no cough, diarrhea.
- Severe level one, fatigue - Headache, loss of smell, cough, chest pain, fever, hoarseness, fatigue.
- Severe level two, confusion - Headache, loss of smell, loss of appetite, cough, sore throat, chest pain, fever, hoarseness, fatigue, muscle pain, confusion.
- Severe level three, abdominal and respiratory - Headache, loss of smell, loss of appetite, cough, sore throat, chest pain, fever, hoarseness, fatigue, muscle pain, confusion, diarrhea, shortness of breath, abdominal pain.
The researchers found that some of the ‘types’ of COVID-19 were more prevalent than others, and that certain types more strongly correlated with hospitalization of the patient. Broadly, COVID-19 patients whose symptoms were mainly flu-like or gastrointestinal were less likely to require hospitalization than those with muscle pain, confusion, fatigue and other symptoms.
People reporting clusters 1, 2 and 3 were found to be much less likely to require breathing support, with only 1.5, 4.4 and 3.3 percent of each cluster respectively requiring help, the study said. However, people in clusters 4, 5 and 6 were significantly more likely to require breathing support. Almost 20 percent of cluster 6 patients required breathing support, as did 8.6 and 9.9 percent of clusters 4 and 5 respectively. Patients in cluster 6 were the most at risk, with nearly half ending up in hospital, compared to just 16 percent in cluster 1.
Old people experience more severe symptoms. The study also reported differences in symptoms based on age and pre-existing conditions. People in clusters 4, 5 and 6 were also older, frailer and likely had pre-existing conditions such as diabetes, lung disease or were overweight, compared to clusters 1, 2 and 3, the study showed.
“If you can predict who these people are at day five, you have time to give them support and early interventions such as monitoring blood oxygen and sugar levels, and ensuring they are properly hydrated - simple care that could be given at home, preventing hospitalizations and saving lives,” Steves added. Using the cluster approach could allow for hospitals to better predict which patients are likely to require support sooner, and lead to greater health outcomes, the researchers said. The COVID Symptom Study is run by Zoe Global Limited and King’s College London in collaboration with Guy’s and St Thomas’ Hospitals.
Scientists studying the COVID-19 coronavirus said that it did not appear to be mutating quickly, which meant that a vaccine developed for the disease would offer long-term protection. Some viruses undergo multiple mutations as they replicate inside host cells. However, according to Peter Thielen, a molecular geneticist at the Johns Hopkins University Applied Physics Laboratory, there appear to be only four to 10 genetic differences between various strains of SARS-CoV-2, the virus that causes COVID-19. “That’s a relatively small number of mutations for having passed through a large number of people,” Thielen told the Washington Post 25 March 2020. “At this point, the mutation rate of the virus would suggest that the vaccine developed for SARS-CoV-2 would be a single vaccine, rather than a new vaccine every year like the flu vaccine.” A coronavirus vaccine would thus likely be similar to those for measles or chickenpox, single vaccines that don’t need to change.
A study carried out by researchers at Zhejiang University in Hangzhou, China, found that COVID-19 has mutated into at least 30 different variations, and that the ability of the novel coronavirus to mutate had been underestimated. The study, led by Professor Li Lanjuan and published on the website medRxiv.org on 19 April 2020, analyzed the strains of the coronavirus that had infected 11 patients from Hangzhou, where there are at least 1,264 reported cases of the illness. Researchers found that there were many more mutations within the small sample pool than had previously been reported. Within the sample, officials detected more than 30 mutations, around 60% of which were new.
Some of the changes were so rare that “scientists had never considered they might occur,” according to the South China Morning Post. Laboratory tests also found that certain mutations resulted in deadlier strains of the coronavirus. “Sars-CoV-2 has acquired mutations capable of substantially changing its pathogenicity,” the researchers wrote in the paper.
The study also determined that the deadliest mutations in the sample group were also found in the coronavirus strain most frequently identified across Europe. The milder strains were predominantly found in parts of the United States, such as Washington state. A previous study indicated that the predominant strains in New York, the US state hit hardest by the virus, were imported from Europe. However, the Chinese researchers also found that mutations which weakened the virus did not mean lower risk of severe illness for all people.
The SARS-CoV-2 coronavirus resulted in more severe illnesses than pneumonia, researchers from the University Hospital Zurich wrote in a study published 20 April 2020. COVID-19, the disease responsible for the ongoing coronavirus pandemic, can cause multiple organ failure after attacking the lining of blood vessels in the body, it was revealed in a Lancet study. The findings show that smokers and those with pre-existing conditions, namely obesity and cardiovascular disorders such as hypertension, were affected most when catching the virus. The study cited three cases, which revealed that viral elements remained in endothelial cells in the lining of blood vessels, in addition to inflammatory cells in patients suffering from the disease. Autopsies conducted on further coronavirus victims found that blood vessels were "full of virus", impairing blood vessel functions in all organs, according to one chief researcher. Contributing author, Frank Ruschitzka of the University Hospital Zurich, said that the virus not only attacked the lungs, but "vessels everywhere".
Citing preliminary information, WHO said the amount of time the virus survives on surfaces appeared to be a few hours. "Simple disinfectants can kill the virus making it no longer possible to infect people," according to the agency.
Both MERS and SARS have been known to cause severe illness in people. Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death. The complete clinical picture with regard to COVID-19 is still not fully clear. Reported illnesses have ranged from infected people with little to no symptoms to people being severely ill and dying.
Common coronavirus symptoms can include:
- Dry cough
- Shortness of breath
- Aching muscles
Less typical coronavirus symptoms:
- Phlegm buildup
- Hemoptysis [ie, coughing up blood]
Symptoms atypical for coronavirus:
- Runny nose
- Sore throat
US Federal Health officials expanded their list of known coronavirus symptoms on 26 april 2020. They say chills, repeated shaking with chills, muscle pain, headache, sore throat and the loss of the sense of smell or taste could be signs of a coronavirus infection. The U.S. Centers for Disease Control and Prevention had previously cited fever, shortness of breath and a cough as possible symptoms of COVID-19. .
Resarchers found that viable virus could be detected up to three hours later in the air, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel. Similar results were obtained from tests they did on the virus that caused the 2003 SARS outbreak, so differences in durability of the virus do not account for how much more widely the new one has spread, researchers said. The tests were done by scientists from the National Institutes of Health, Princeton University and the University of California, Los Angeles, with funding from the U.S. government and the National Science Foundation.
The COVID-19 coronavirus could last up to two years at below freezing temperatures if it is similar to coronaviruses from the same family, according to a medical expert from the Cleveland Clinic Abu Dhabi. “Research into similar coronavirus strains has shown that, in general, coronaviruses are stable in freezing temperatures and have been shown to survive for up to two years at -20 degrees Celsius,” explained Dr. Mohamad Mooty, Department Chair, Infectious Diseases, Medical Subspecialty Institute, at Cleveland Clinic Abu Dhabi. Given that studies on SARS-CoV and MERS-CoV, two recent coronavirus outbreaks, showed that viruses could survive for up to 72 hours at the average temperature of a fridge (4 degrees Celsius), Dr. Mooty said, “It is safe for us to assume that the virus responsible for COVID-19 might be similarly persistent.”
Based on 55924 laboratory confirmed cases, typical signs and symptoms include: fever (87.9%), dry cough (67.7%), fatigue (38.1%), sputum production (33.4%), shortness of breath (18.6%), sore throat (13.9%), headache (13.6%), myalgia or arthralgia (14.8%), chills (11.4%), nausea or vomiting (5.0%), nasal congestion (4.8%), diarrhea (3.7%), and hemoptysis (0.9%), and conjunctival congestion (0.8%).
People with COVID-19 generally develop signs and symptoms, including mild respiratory symptoms and fever, on an average of 5-6 days after infection (mean incubation period 5-6 days, range 1-14 days). Most people infected with COVID-19 virus have mild disease and recover. Approximately 80% of laboratory confirmed patients have had mild to moderate disease, which includes non-pneumonia and pneumonia cases.
The incubation period for viruses that cause the ordinary flu is about two days. But the novel coronavirus can stay hidden in the body for up to fourteen days. And while both the flu and the coronavirus have similar symptoms including a fever, headache, cough and muscle pain, those symptoms usually occur all at once with the flu, whereas patients with the coronavirus experience various symptoms over a longer period. In many cases of the coronavirus, the early symptoms are less severe than the flu.
According to British medical journal The Lancet, 82 percent of a study of 99 patients in Wuhan had fever. The second most common symptom was a cough. And 31 patients experienced shortage of breath. Only five patients had sore throat and four had a runny nose. There are also fewer patients with a stomachache and diarrhoea than during the outbreaks of the Middle East respiratory syndrome, MERS, and the severe acute respiratory syndrome, SARS.
A runny nose and a sore throat are typical signs of upper respiratory infection. Therefore, those who have bouts of sneezing or get the sniffles likely have the flu or a common cold. It seems initial symptoms are mild - it could present as a seasonal allergy or a regular cough. Based on a study of 41 early-detected cases, patients did not present with runny noses, sneezing or sore throats. Some of the new virus' symptoms resemble those of SARS, but there are some important differences. The new virus did not cause stomach problems such as diarrhea, which hit 20-25 percent of SARS patients.
With a cold, most people get a scratchy throat, then a runny nose and eventually develop a cough. Those symptoms, as well as fever and headache, can plague a person for days, making them feel listless. A common cold typically passes within a few days and most symptoms go away after about a week. A flu is more tedious, keeping a person bedridden for at least a week, in some cases requiring several weeks before a person truly feels healthy again.
By comparison, the flu hits all at once: A flu patient's head and limbs ache, a dry cough begins, one's voice becomes hoarse, painful throat aches occur and a high fever (up to 41°C / 105°F), often accompanied by chills, can knock you out in short order. One just wants to stay in bed, feels exhausted, has no appetite and can sleep for hours on end.
Although patients without symptoms can spread the virus, those with severe symptoms spread the virus much more. Those people without symptoms or with just mild symptoms are not the ones that spread the virus much. The contagiousness depends on the amount of virus that a patient gives out, so patients with mild symptoms shouldn't be a priority for quarantine.
Usually active people are much more likely to be infected because they could be exposed to the environment with virus. But elderly people or infants who are infected are more likely to get worse or die. Self-containment refers to literally quarantining someone suspected of a virus infection at home, and preventing them from going outside. There are many things to keep in mind, when a person and their family share the same space.
- First, it's highly recommended that they use a single room. Meaning, if you have your own room, you should be the only one using that space. If that's not the case, use a separate bed, or at least stay one meter away from the other person sharing the room.
- Shared spaces such as bathrooms and kitchens should have the windows open as often as possible to release any contaminated air. Instead of towels that family members share after washing their hands, it's recommended that disposable paper towels are used instead.
- While carrying a handkerchief is good, it's advised that you dispose of it after a day's use. If you don't want to throw it out, it's recommended that it's washed using laundry detergent and machine washing it at 60 to 90 degrees Celsius.
- You must always wash your hands after discarding your face mask, and disinfect areas you touched with your hands. In particular, things like doorknobs and office supplies are highly likely to spread the virus. It's important to wipe those surfaces with disinfectants one or twice a day.
- It's important to wear a medically-approved face mask, that fits.
It's important that anyone who shows symptoms to stay at home until the health agency confirms the symptoms have gone.
As of 24 February 2020 the total number of "recovered" outcomes was 24,286, while the number of "slipped this mortal coil" outcomes was 2,697, which is a raw Case Fatality Rate [CFR] of 11%. There is a tendency to misunderestimate CFR by comparing "total cases" to "gone to their reward" - but this disease takes roughly a month to produce an "outcome" and with rapidly increasing number of new cases, the denominator is always too big.
In round numbers, the United States might see 100,000,000 COVID cases, with 20,000,000 probable "severe" cases requiring hospitalization, with about 1,000,000 total existing hospital beds. Surely they won't all be sick all at once, but probably the total number of cases is greater than 100M.
The "outcome" CFR of more than 10%, implies even a low case incidence rate of 100M, projects 10 Megadeaths.
Upper tier white people who can telecommute and stockpile several months of supplies to shelter in place might not do so badly. Lower tier manual laborers who by definition cannot telecommute and who probably cannot afford stockpiling to shelter in place will probably not do so good - probably these people are disproportionately non-white - so when it is all over, who will do the work??? Probably the rural MAGA cohort will not do too badly, as they are already isolated, and prepping is not so hard to do in the boonies. Both those large MAGA rallies seem designed for mass infections.
The tendency to hope this all away by saying the statistics are flaky [which is true, particularly with statistics with Chinese characteristics] ignore the extent to which historical statistics have similar problems.
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