I write this as the coronavirus hits our society, and the panic and misinformation out in the streets is causing more mayhem than the virus ever will. I am resigned to get the virus as a healthcare worker on the frontlines. We are ready for the outbreak, and we will make it through if society cooperates. However, if we have a run on the hospital, like the stores have seen a run on them, it’s not going to be a pretty picture.
This virus is definitely different. A virus is a peculiar organism. It needs a host to replicate; without a host, it’s nothing. The only way to stop the virus is to deprive it of a host. The one thing that is certain of COVID-19 is that it is extremely contagious. The virus spreads from person-to-person contact and droplet spread if within six feet. The other less common modes of spread are from surfaces that an infected person touches. Hence, the guidance to frequently wash your hands and not touch the face so as to avoid the virus from entering your body.
The virus can be spread before symptoms show, and mainly during maximum symptomatology. The good news is most people will be fine; the only responsibility we have is to prevent it from getting to vulnerable hosts. Like most crises, the most affected are the vulnerable, the elderly with multiple comorbidities.
What can you do to prevent yourself and others from getting the virus? The answer is simple―avoid exposure to the virus, and if you have the disease, avoid exposure to others. If you have symptoms, do not see your doctor without informing them in advance about your symptoms, so that you can prevent exposure to your healthcare personnel. Testing in the United States was initially done by the state department of health. Our hospital system has now begun testing, which involves a swab of the nose and mouth. The report will be available in six hours. The turnaround takes about 24-48 hours depending on how many samples we get for testing. There are rapid immunoassays that are being developed for screening, where a sample of blood can be tested for antibodies which should become available later this week, which could run thousands of tests. Again, the medical recommendation is self-treatment with measures you take for the flu. There is no vaccine currently available.
We have been proactive with our testing and resources. We are already looking to increase our ICU capacity, active infection control and community education, with the aim of preventing chaos. As far as who should come to the hospital is concerned, if you have difficulty breathing with high fever, you should come to the hospital for treatment. As the virus enters the lung, it can cause inflammation, and destruction of lung tissue, leading to a condition called ARDS (Acute respiratory distress syndrome). This causes a drop in oxygen levels that may be bad enough that you need a breathing tube and ventilator support.
As far as treatment goes, currently it’s supportive therapy. There is a drug Remdesivir that is being investigated against COVID-19 that has shown the most promise. This drug was previously found to be effective in animal models against MERS and SARS, both of which were coronaviruses similar to COVID-19. They are evaluating a 5- and 10-day treatment courses. There are trials in the USA and China ongoing. There have been a few case reports of anti-HIV drugs, but these are too premature to comment on right now.
Gilead pharmaceuticals that makes the drug is ramping up production and is working with agencies for compassionate use, in the emergency treatment on an individual basis, in the absence of approved options. They had previously stockpiled the drug during the Ebola crisis and are using the drug for the trials and compassionate use. The drug is not commercially available, so save yourself the call to the local chemist.
The bottom line is that it’s a virus, and viruses have been around us all our lives. Most times we fall ill, it’s a virus. We will survive this as a nation and a global community. The vulnerable will be at increased risk, if there is a run on the limited medical resources that are available. There are only so many ICU beds, ventilators, nurses and doctors. There is no need to panic. The world is closing down for business, but your medical system is open and ready for overtime. The white line of medical professionals is holding up so far.
Dr Arab is chairman, department of medicine, and director, division of cardiology, at Florida Hospital Memorial Medical Centre, United States
