What We know of COVID-19 as of 3/29/2020

Pouya Shafipour, MD Blog What We know of COVID-19 as of 3/29/2020

I've been attending a lot of calls and online meetings with scientists and medical doctors in New York, Boston, and China regarding our current Pandemic and thought of sharing some of the info to hopefully increase our general understanding of this disease and reduce the spread of it and delay the peak. Feel free to share the info with who you think might be interested and benefit from it. As you are aware, this information can change any minute as we are learning more about this infection and I literally see new information coming out and new research papers being published on a daily basis, a lot from China since they are a few months ahead of us as well as Italy and there is great collaboration between the scientists all over the world. This information is up-to-date as of today, March 29. 2020.

 
SARS CoV 2 a.k.a COVID 19
 
  • is from a family of known viruses, coronaviruses that are the most common cause of common cold as well as SARS 1 (from bats), MERS (Middle eastern respiratory syndrome from Camels) and now COVID 19 (from bats).
  • It originated in Wuhan China, most likely not bioengineered in a secret lab there since expert geneticists like Dr. David Sinclair in Harvard and MIT said there is no genetic footprint on the virus to suggest this was developed by humans  but as a natural mutation due to unhealthy food practices of eating live, wild animals which was also the case for the other two Coronavirus outbreaks, SARS 1 and MERS. As deforestation continues, more wild animals get displaced and come in contact with humans and other domesticated animals, as well as unhealthy farming practices, this can happen more and more. China as well as everyone else was aware of this type of SARS virus since its structure and function and infectivity is very similar to SARS 1 which caused a global epidemic in 2003 but never reached the US.
  • viruses are NOT living organisms but true parasites that need a host to replicate and function.
  • it can survive and be viable in the air (aerosol spread) for up to 3 hours, copper 4 hours, cardboard 24, stainless steel 48, and plastic for 48 hours. So hence when touching something outside, hand washing or sanitizing is very important and can significantly reduce the transmission of the disease.
  • Wearing a mask does not prevent getting the virus via air or transmitting it unless a fresh N95 mask is worn (a rarity now) and should be only limited to healthcare providers who are at risk but a basic mask or anything to cover your mouth will help prevent touching your face/mouth and stop the spread of the virus. So wearing a mouth cover or any type of mask is recommended in public places. This is something that has been practiced in Asia for many many years where sick patients always wear a mask in public.
  • These viruses are not going anywhere and will come back every few years. this one so far being the worst of them and very similar to the original SARS CoV 1 virus in structure and function but with stronger spikes on the surface which causes it to stick to surfaces and cells better.
  • It is a very fragile virus, sensitive to heat, especially above 38 C, detergents, soap, alcohol and other solvents as well as UV light.
  • you could have the virus and be infected up to 4 days before becoming symptomatic and can be spreading it. this is different from SARS CoV 1 which showed symptoms earlier.
  • based on a new study, CDC expects at between 40-70 percent of Americans to get the virus. However, not all might show symptoms similar to common cold of influenza. majority of the cases might have mild cough, congestion and fatigue and loss of sense of smell. At this point, best to completely self isolate. The reason to go to an Emergency Room is Persistent Fever (Temperature above 38 C or 100.4, shortness of breath and dry cough. The cases I personally have had that required hospitalization both included persistent fever above 101.2 and cough and extreme shortness of breath. The other positive cases which were managed at home were like a regular seasonal cold with mild fever/chills, congestion, and fatigue which resolved after 7-10 days. If you are having fever, it is recommended to completely isolate from everyone for at least 3 days after the fever subsides. 
  • We expect a peak in a few weeks, maybe mid April but the more strict we are with social distancing, we might be able to delay the peak so healthcare industry can prepare more and ideally result in less casualty.
  • It is general consensus from local doctors that China and Iran have significantly under-reported their mortality rates. However, China is sharing their test kits, scientific date and opening all of their research to western scientific and collaborating with the west.
  • It is possible that the virus reaches a peak and then slows down in the summertime and returns in the winter if we go back to our old habits.
  • the majority of cases in the US are between 18-65 years-old but the most mortality rates are still the elderly and people with comorbid conditions. cases under the age of 18 are rare and very mild. However I personally have a 30 year-old patient who is admitted and on oxygen who had mild symptoms for 2 weeks before becoming hospitalized and was very healthy prior to this.
  • After getting the disease, there is a likelihood of immunity to it, more than the common cold and influenza but the SARS CoV2 has also been mutating some and there are a few different strains of it, first likely from China, second likely from Europe, especially Italy and also a strain from Iran which is now spreading in Asia.
  • we are months away from a vaccine against it. There are research about convalescent blood as well as other modalities to treat this.
  • More rapid testing (5-15 mins) will be available in the next few days since Abbot got approval and will be shipping the test kits, about 50000 daily. Initially this will probably be limited to ERs and Urgent cares and gradually to everyone. the high success rate of Korea and Singapore relied not only on social isolation but on rapidly testing people and quarantining the ones infected since it takes up to 4 days for carriers to show signs of infection.
  • If you are on a blood pressure medication angiotensin receptor blocker aka ARB (e.g. Losartan or any other medication ending with SARTAN) or ACE Inhibitor (e.g. Lisinopril or any other medication ending with PRIL), do not stop taking it. the date are mixed. since SARS attaches to the Angiotensin converting enzyme 2(ACE 2) receptor to get into the cell, ARB medications might have a protective effect since they block this port of entry. There were some data from France recently which advised people to stop taking these medications but that is currently not recommended).
  • It is general consensus that if COVID-19 is suspected, for fever and pain, it is best to use Tylenol (acetaminophen) rather than Ibuprofen and Naproxen (Avdil, Motrin and Aleve). also corticosteroids are advised against use unless absolutely indicated to treat another condition (e.g. asthma, cancer, connective tissue disease, etc.)
  • there are a few drugs which have shown promise in treating and preventing COVID19 such as chloroquine, hydroxychloroquin (plaquinel) commonly used to treat Malaria, lupus and rheumatoid arthritis. Currently we think this is through inhibiting glycosylation of viral ACE-2 or inhibition of quinone reeducate 2, reducing synthesis of viral silica acid. these also have shown to reduce the inflammatory response of the body to the virus (cytokine storm) which damages the lungs. there are multiple clinical trials all over the country along with Azithromycin (aka Z-pack) and Zinc. There are also data about using these drugs prophylactically to avoid getting COVID-19. however, due to drug shortages and side-effects of these drugs, they should only be prescribed to sick patients who are hospitalized with respiratory distress/pneumonia or at very high risk healthcare workers prophylactically. DO NOT ask your physician to prescribe these drugs to you. Fortunately there is strong limitations as of last week in prescribing them and pharmacies are not allowed to dispense it without strong indication from the prescribing doctor (a pharmacist told me this yesterday)
  • there are also clinical trial on the HIV drug Kaletra (Ritonavir/Liponavir) (reverse transcriptase inhibitors) which has been more effective if patients are not very sick but not as promising as hydroxychloroquine.
  • People ask me about how to boost immune system, habits and vitamins/supplements to take to improve their immune system in these times. There are no firm, clinically proven vitamins or supplements which have shown to provide 100% protection but here's what I'm personally taking which has shown to improve immune system and help the body fight infections: Vitamin D3, NAC (N-acetyl Cysteine), Resveratrol, fresh crushed garlic, Zinc, Astragalus, Selenium, and NAC and try to eat as healthy as we can in these times. Out of all of these, Vitamin D3 and Zinc are the ones which are the talks of some recent scientific papers about showing some promise to help fight this virus. The other habits to boost immune system include: 7+ hours of restful sleep, daily meditation, daily exercise and practice of gratitude. 
  • If you have any symptoms of sore throat, low grade fever, fatigue or dry cough, DO NOT Panic. rest, hydrate, eat healthy, Isolate and take Acetaminophen (Tylenol) for fever and pain control and reach out to your doctor. Majority of people who get this will recover in 7-10 days.
  • After this is over, life as we know it will most likely change. Similar to how life changed after 9/11 and the 2008 financial meltdown but as humanity, hopefully we will come out of it stronger and more environmentally conscious and caring. Probably for a while more local traveling, more online learning and less busy gatherings and more hygiene practice.
  • The Positive is that in the history of Humanity, there has never been a time when all humanity including scientists have ever united as they have now to find a cure against a common enemy. We are very smart and when we put this knowledge all together, we can advance life and health significantly. As humans, we've never cared for each other so much globally as we do now. Hopefully this will continue after this ends...
 
To Health and a Passionate life...
 
 

--

Pouya Shafipour, MD

 

Author
Dr. Pouya Shapifour, MD Dr. Pouya Shafipour, MD Pouya Shafipour, MD, in Santa Monica, California, is a board-certified family medicine specialist with subspecialty training in a field of medicine known as bariatric or obesity medicine. He uses safe and effective medications in conjunction with dietary, nutritional, behavioral, and exercise counseling to manage obesity and medical conditions related to excessive weight gain or loss.

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