COVID-19
At Dr to You, we are committed to ensuring that our patients have the best possible understanding of their medical condition(s) and we believe that everyone should become a master of their own health.
Disclaimer:
The following is advice only and may not pertain to your specific clinical situation. It is therefore really important that you consult a doctor about your symptoms to get the most suitable advice for your symptoms.
INTRODUCTION
Covid-19 is caused by a virus called SARS- CoV-2, which belongs to a family of viruses known as coronavirus. The World Health Organization (WHO) became aware of the SARS- CoV-2 virus towards the end of 2019 after an outbreak of viral pneumonia in Wuhan City, China. Coronaviruses have been around for many, many years, typically causing respiratory illnesses such as flu-like illnesses. Viruses are much smaller than bacteria and without our cells’ machinery, they cannot replicate and divide, and therefore survive, in humans. Therefore, as devastating as Covid-19 has been, SARS- CoV-2 needs a helping hand from us to keep continuing to cause havoc.
Since WHO learned about the initial cases of viral pneumonia in Wuhan City, China, there have been widespread cases of Covid-19 around the world. As of November 2020, there have been over 54,300,000 confirmed cases of Covid-19 with over 1,300,000 deaths worldwide. In the United Kingdom alone, there have been over 1,300,000 cases, and over 50,000 confirmed deaths. Over 220 countries or areas have been affected. Covid-19 has had a widespread devastating impact on our lives including, but not limited to, socially, economically, and psychologically.
RISK FACTORS
The truth is everyone is potentially vulnerable to the SARS- CoV-2 virus. However, those most at risk of severe illness and complications requiring hospitalization and admission to intensive care units include patients over the age of 60 years old, patients of black and minority ethnic background, those with underlying chronic illnesses such as asthma, diabetes, chronic obstructive pulmonary disease (COPD), underlying heart disease, chronic kidney disease (CKD), obesity, immunosuppressed, solid organ transplant patients, patients with cancer receiving chemotherapy treatment. This is not an exhaustive list and if you have concerns about your risk status, you should speak to your doctor for further advice.
SYMPTOMS OF COVID-19
The signs and symptoms of Covid-19 can be quite vague. Many people do not develop any symptoms (asymptomatic patients), which can be difficult for both patients and clinicians. Asymptomatic patients are only diagnosed from the conduction of random tests. When symptoms do develop, this can take on average about five to six days from the time of being infected, although the range can vary from a few days up to 14 days. This is why self-isolation and quarantine guidelines are all-around ten to fourteen days.
The most common symptoms include a persistent, usually dry cough; persistent high temperature (fever); loss of smell, fatigue/malaise/general lethargy in association with these. Some patients might develop flu-like symptoms of muscle aches, sore throat, joints aches, or headaches. Symptoms indicative of a more severe case of Covid-19 include breathlessness, confusion, chest pain or chest heaviness, and persistent high temperature despite taking over-the-counter antipyretic medications such as paracetamol to lower your temperature.
If you suspect you may have covid-19, or that you may have been exposed to anyone with covid-19, it is important to seek medical advice.
WHAT TO DO IF YOU HAVE SYMPTOMS
If you have symptoms suggestive of Covid-19 such as a new persistent cough, loss of smell, fever, etc, you should arrange to have a coronavirus test. If you are not able to do a test, if the test is positive and you have mild symptoms, you will need to self-isolate for 14 days. Additionally, contact tracing of those you may have come into contact with within the preceding days should be effected, so that they too can either get tested or self-isolate.
WHAT TESTS ARE AVAILABLE?
There are broadly two types of diagnostic covid-19 tests available – the antigen and the PCR tests:
Antigen test – this test looks for a specific antigen of the SARS-CoV-2 virus. An antigen is a specific component of the virus that is identifiable as belonging solely to SARS-CoV-2. The test is done using throat and nasal swabs These tests are rapid and can usually be turned-around within half an hour to a few hours. They are however not as accurate as PCR tests and can return false positive or reassuring results.
PCR test – the Polymerase Chain Reaction (PCR) test is a lot more accurate. This test looks for specific SARS-Cov-2 RNA (Ribonucleic acid). RNA is a genetic material that is within the virus. The PCR test can detect the presence of a very small amount of this genetic material, through a clever process of RNA amplification. PCR is a highly specific test. It is, however, more expensive and can take days to turn-around
Antibody test – the antibody test does not detect whether you have Covid-19 presently. It only tells us whether you had a past infection of Covid-19. Antibodies are usually produced in response to active infection and the particular antibody that is tested for is called an IgG antibody. Typically, once produced, IgG antibodies remain present in the bloodstream for a long period of time, providing a reliable defense should you be exposed to the same pathogen in the future. In the case of covid-19, there is uncertainty about how long the specific SARS- CoV-2 IgG antibody persists following an infection. It is currently thought to possibly last in the region of six to nine months, and thus unlikely to provide long-term protection from future exposure to SARS- CoV-2 virus.
TREATMENT
It is really important to know that the vast majority of patients diagnosed with covid-19 develop only mild symptoms and do not need any specific treatment.
Prevention – there is currently no cure for covid-19. Thus a very important part of the treatment is prevention. It is therefore important to follow all public health advice including handwashing, social distancing, and self-isolation if you have symptoms, wearing a face mask in public places, etc. Vaccination also plays a significant role in preventing infection by SARS- CoV-2 virus in the first place, and if you are infected by it, in developing severe symptoms of covid-19.
Quarantining – quarantining people is for people who have been exposed or may have potentially been exposed to others with confirmed covid-19. The principle is similar to self-isolation and you are normally advised to quarantine yourself for ten to fourteen days.
Mild symptoms – If a patient has been confirmed to have the covid-19 disease, but has mild symptoms, self-isolation at home for up to fourteen-days is usually all that is required. During that time it is important to keep well hydrated, isolate yourself from others within your household, and be aware of symptoms of severe covid 19 so that you can seek prompt medical advice at an early stage should you deteriorate.
Severe symptoms – for patients who develop severe symptoms of covid-19 such as breathlessness, chest pain, chest heaviness, persistent uncontrollable fever, severe headache, significantly reduced frequency of urination, etc it is really important that they seek medical advice early. In the UK, medical advice can be sought via calling the NHS on 111, your GP, calling 999 for an ambulance, and if absolutely necessary going to your local accident and emergency department. Patients with these symptoms often need hospitalization for supportive management.
As there is no cure for covid-19, the aim is to support your vital organs and allow your body to fight the virus. Supportive treatment may be in the form of oxygen therapy, intravenous fluid to rehydrate you, ventilatory support in the intensive care unit for acute respiratory distress syndrome (ARDS). Additionally, you may be given dexamethasone, a very powerful steroid to reduce lung inflammation, blood-thinning medications to prevent or treat blood clots in the lungs (pulmonary embolism), antibiotics if you develop secondary bacterial pneumonia.
The research into the management of covid-19 is rapidly increasing all the time and some patients may be given an antiviral drug called Remdesivir, an immunosuppressant called Hydroxychloroquine, or novel immune-modulatory drugs collectively called biologics. Hydroxychloroquine, which received a lot of media attention in the early days of the fight against covid-19, is usually used to treat certain immune-mediated conditions such as lupus or SLE (Systemic Lupus Erythematosus). None of the aforementioned treatments should be bought over the counter or online to self-medicate on as they have serious side effects and should only be used under the supervision of a competent doctor.
PROGNOSIS
Firstly, it is essential to reiterate that approximately 80% of people recover without needing hospitalization, and only about 15% develop serious illness requiring hospital admission with 5% needing critical support including ventilatory support in intensive care when there is severe respiratory deterioration as a result of ARDS (Acute Respiratory Distress Syndrome).
Doctors and scientists are still learning about the long-term effects of covid-19. The majority of patients recover without any long-term consequences. Nonetheless, some patients are left with a myriad of symptoms collectively known as long covid syndrome. These include chronic lethargy and severe disproportionate fatigue, breathlessness, pins and needles, general weakness, brain fog, lack of concentration, etc. Several active research into long covid syndrome are underway to understand it better so that patients can be optimally supported. For some patients, the recovery of their smell or taste may take several months. Furthermore, there is also the additional long-term psychological impact of serious illness on any particular individual and on their loved ones.
HEALTH-MASTERY TIPS
Below are some key advice to help you be a master of your own health. These are self-help tools to reduce your likelihood of developing covid-19, and managing it appropriately if you do develop it:
- Do not be swayed by the many circulated unsubstantiated myths, which are not the focus of this article but include, 5G cause covid-19, questioning the speed at which vaccines have been developed, that vaccination is a means of inserting a chip into our body, that herbal remedies such as garlic or hot pepper are all you need, etc.
- It is important to follow the local public health and government advice of handwashing, social distancing, wearing a facemask in public places. If you have symptoms or have been confirmed to have covid-19 with mild symptoms, self-isolating.
- If you go on to develop any of the more serious symptoms such as breathlessness, chest pain, chest heaviness, you should seek medical advice early as you may need hospitalization and supportive management such as oxygen, intravenous fluid, or –ventilatory support in the intensive care unit.
- The earlier you seek medical advice the more, the better the outcome is likely to be.
DO YOU HAVE QUERIES?
If you would like to discuss your symptoms further with one of our experts, please contact us using one of the following means:
Website: www.drtoyou.co.uk
Email: info@drtoyou.co.uk
Contact Us Page: Drtoyou
Telephone: 02034359916
ABOUT THE AUTHOR: Dr Achmed Kamara
Dr. Achmed Kamara is a practicing NHS General Practitioner (GP) in the UK and Medical Director of Dr to You UK. He qualified as a doctor from the University of Cambridge in 2005 and has worked continuously in the NHS since then; amassing tremendous hospital clinical and academic medicine experience before qualifying as a GP in 2016. The articles written here (as well as the VLOGS on our youtube channel) are his way of sharing with you, useful tools about various medical topics, so that you can become a master of your own health.
