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So what, exactly is all the panic about? We have a pandemic! – as declared by the World Health Organization (WHO) caused by a new strain of a coronavirus.
The WHOs website states that there has never been a pandemic caused by a coronavirus. This isn’t exactly true, since the “Common cold” affects the world pandemically every year, and it too is a coronavirus. If that is true, why is the entire world in an absolute melt down over this pandemic and what is the correct response?
Washing hands and staying home, away from large groups is a rational response. Avoiding public altogether and hording toilet paper IS NOT. Cancellation of large gatherings of people is a rational response. Hanging out with a bunch of people who’ve come from endemic areas is NOT. Having a cough and fever means coming to Urgent Care 24/7 and getting treatment, then go home. Stay home, avoiding public, especially elderly populations, is a rational response. If difficulty breathing becomes an issue, getting additional help is rational.
As this is a new virus, no one has natural immunity. So this may be akin to our visit from the legendary conquistador Desoto in the current day. We have no immunity for this virus. We catch it, we get flu-like symptoms and fever and maybe a cough. While this sounds simple, intensity of symptoms varies from person to person, can end in complications and recovery time can be much longer than your typical cold or flu.
WHO states in a report today that symptoms are non-specific and disease presentation can range from no symptoms to severe pneumonia and death. People with COVID-19 infection typically develop signs and symptoms on an average of 5-6 days with a range of 1-14 days. MOST PEOPLE HAVE MILD DISEASE AND RECOVER. Approximately 80% of people with laboratory confirmed disease, had mild to moderate symptoms. Only 13.8% have severe disease of which 6.1% are critical. Disease in children appears to be rare, with approximately 2.4% of the total reported cases under age 19. As of Feb 20, 2114 of 55,924 laboratory confirmed cases have dies (crude fatality ratio [CFR] of 3.8%). Initial infections in China were much higher in Wuhan in early stages of the outbreak with a CFR of 17.3%. This high rate understandably fed into some of the international fears that continue into today, albeit the rate has decreased to 3.8 world-wide. Mortality increases with age, with the highest mortality in people over 80 years of age with a CFR at 21.9%1.
With these statistics in mind, should we be concerned with infection? Absolutely. More importantly we should avoid the elderly and immune compromised population if we are not feeling well.
So what is this virus, and what does it mean to our community? In simple terms, it is a community spread virus that is appearing to be deadly to our elderly population. Unlike the influenza, it appears to be sparing younger children. While that is the case, children can still be carriers and spread the disease.
It is a virus that is spread by droplet contamination. It is not airborne2.
Several weeks ago, we at Urgent Care 24/7 saw what has happening in Wuhan and that it was spreading. We began stocking up on sensible items like Nebulizer kits and medicines so that we can treat people and help them recover. We offer a variety of testing including for COVID-19 and influenza. We have fluids infusion capabilities, breathing treatment and antivirals found to be effective in treatment of both diseases. We started working on obtaining another effective medication in COVID-19, Chloroquine Phosphate, a medication found to be effective the treatment of Malaria. More on that medication later in this discussion.
COVID-19s main feature appear to be pneumonia in some people. The pathophysiology in this virus has a coat (or a corona) of proteins that interact with an enzyme called Angiotensin-Converting Enzyme 2, or ACE2 in humans. When the virus inters specific cells containing ACE2, it injects its RNA and hijacks the cell, and uses the cell to create more viruses. These cells that contain ACE2 include the lung, the stomach, intestines, kidneys, the heart2. As these cells are hijacked and are turned away from their normal function by the viruses, they burst and die, causing a release in inflammatory markers. This cellular death causes the disease, and results in a inflammation reaction and in some additional disease. This explains, for a large part, for the problems in the lungs, especially in an elderly person whose immune response may not be adequate.
Urgent Care 24/7 has always been a leader in the community for lower cost care and ability to treat all times of the day. Treatment for this disease for mild to moderate symptoms can be symptomatic. We provide breathing treatments, fluids and antivirals/antibiotics as may be indicated. In severe disease, one may try the combination of medications that has been termed “the Thai cocktail”. That is essentially the use of anti-RNA antivirals.
Another combination used, is the combination of Tamiflu and Chloroquine Phosphate. This is one of the treatments we are working on making available if needed. Tamiflu is a common RNA antiviral, that is used in Influenza A and B. COVIS-19–like Influenza, HIV and other viral infections—is an RNA virus. As such, it has been found to respond to medications of other RNA viruses.
Another finding in the Corona virus is the Use of Zinc. Zinc decreases the infectiveness in the cell by inhibiting the cellular mechanisms that reproduce the viral material. The problem with Zinc is its’ 2+ charge that makes it very difficult to get into cells. Research also shows that by just increasing large amounts of zinc into a system does not get large increases in the cell where it is needed to fight the disease. This problem can be overcome if there is a mechanism to pull it through the cell wall, and this mechanism is called an Ionophore. Think of ionophore’s as a door that is very specific to what it lets through the door4.
The anti-malarial medication, Chloroquine Phosphate has been found to be that very ionophore that allows zinc into the cell5. So, the use of Zinc and Chloroquine can reduce the replication of the RNA in the cell along with the anti-RNA medication; the combo of which has seen success in treatment of this COVID-19 infection.
In summary, the preferred way to prevent infection and spread of COVID-19 is simple practices we should all have been doing in the first place. Washing hands, staying home when sick and avoiding those who are sick. Avoid touching face, eyes and mouth. Always cover one’s mouth when coughing, preferably into one’s sleeve. Frequently disinfecting commonly toughed surfaces like doorknobs will also decrease transmission.
Do not buy into the panic. Drink plenty of fluids and rest. Seek help if you’re not feeling well. We’d be happy to help. We are genuinely interesting in the health and welfare of our communities!
If you are experiencing any of the symptoms of COVID-19, please feel free to come to any one of our clinics at Urgent Care 24/7. We have locations in Atlanta, Athens, Savannah (2), Pooler, Whitemarsh Island and opening April 1, 2020 Orlando.
Stay up to date on Coronavirus by following World Health Organization (WHO) or the Center for Disease Control (CDC). If you want an in depth understanding of COVID-19 (Coronavirus), this is a good video: https://www.youtube.com/watch?v=U7F1cnWup9M&t=9s.
- WHO. “Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)”. 16-24 February 2020.
- WHO. “WHO Director-General’s opening remarks at the media briefing on COVID-19” – 3 March 2020.
- Bernard. “3 COVID-19 cases as Described by Doctors in Wuhan”. Medpage today. March 11, 2020.
- Velthuis, VanDenWorm, Sims, Baric, Snijder, Hemert. “Zn Inhibits Coronavirus and Arterivirus RNA Polymerase Activity In Vitro and Zinc Ionophores Block the Replication of These Viruses in Cell Culture TY PLoS pathogens. 6. e1001176. 10.1371/journal.ppat.1001176.
- Xue J, Moyer A, Peng B, Wu J, Hannafon BN, Ding W-Q (2014) Chloroquine Is a Zinc Ionophore. PLoS ONE 9(10): e109180. https://doi.org/10.1371/journal.pone.0109180