COVID 19 Update
Did you know that COVID is still a thing? It is.
Earlier this summer, I attended an online CE (Continuing Education) lecture put on by the college I graduated from with my BSN. 2 physicians spoke about COVID19 and gave a detailed summary of all the information they had about the virus at the time. I took notes during this talk, coincidentally, and then I had the idea to write a Facebook post to share what I learned in the talk. I chose to focus on "non-clinical" information (not the statistics and medical jargon that isn't necessarily relevant to the general public) and I chose to summarize the information in lay terms (understandable language).
Well, that virus post went mildly viral. The original post was shared 477 times and was even used by FB pages for community or small local government organizations. A biology teacher even asked me if I would speak to one of his classes this school year. Crazy!! I am totally not qualified for that but I guess I gave that impression LOL. But, pretty cool. The link below is the original post, if you'd like to see it, and the rest of the content in this blog will be the update from the lecture yesterday. Please share this blog post if you like it and find it helpful and informative, and hey, while you're here - check out my other posts too!
The original Facebook post, and how much so many people appreciated it, is what sparked the idea for this blog - and it has been so cool and so therapeutic for me!
Do me a favor: Don't argue in the comments. Attending the lecture alone was 1 hour and 45 minutes long. Taking notes and then re-reading and re-typing them involves hours of work. But I care about sharing information in an unbiased, non-political (we don't need an OUNCE more of that right now), and non-condescending manner. This read is long - because there's a lot to say. But it's good stuff. OKAY! Let's geaux!
The title of the lecture hosted by UL Lafayette Continuing Nursing Education Department (mainly, Robbie Stefanski) was titled "COVID-19: Update on the Science, Transmission, and Emerging Evidence."
The 2 physician speakers were:
Tina Stefanski MD LDH / Office of Public Health Region 4 (Acadiana)
Chad Roy PhD, Tulane University School of Medicine, Researcher on respiratory health and the aerobiology of infectious diseases.
I do not take credit for any of the information shared here. I attended the lecture, took notes, and all that is typed below is credited to the above 2 physicians. This is simply a summary and translation. Please do not assume any statements are direct quotes, unless in quotes:
Dr Chad Roy went first:
Dr. Roy works at Tulane University, as a researcher, with students and monkeys. The goal of their work with this virus was to identify the "aerobiology of SARS-COV-2 and the plausibility of aerosol transmission." This means they studied the COVID virus in every way possible, including using single virus strands to see how it changes while it's in the air, in our bodies, on surfaces, how it changes and mutates in different environmental conditions, how long it's contagious, how it multiplies, how many monkeys (people) one sick host will infect, when it dies, and how it affected monkeys over time (going forward, "how it affected the monkeys" = "clinically"), and so on...
The virus was first tested only by itself, not using any monkey, rat or human subjects. This was in March of 2020, and at the time, this virus was brand new, and Dr. Roy and his colleagues knew nothing about it, including how dangerous it was (or was not).
Later, the 2 types of monkeys they used are Rhesus macaque (pronounced ree-sus ma-kak) monkey and the African Green monkey. These monkeys were used because according to Dr. Roy they are "so close to human beings." (genetically)
Dr. Roy and his colleagues were part of a network of research. The people at Tulane were collaborating with the US Army, the NIH (National Institutes of Health), and the University of Pittsburg Medical Center. The actual research work was carried out in a "Biosafety Level 3 Lab". He explained that there aren't very many labs like this in the US, and the one they used is unique and specialized for studying things like SARS-CoV-2. The researchers were very safe. They would generate aerosols (nebulizers - picture hairspray) into a chamber with live virus, propagated (they made more and more copies of the virus) from early clinical (actual patient) samples from Seattle, Washington. (2) (3)
They started by classifying the virus. As many of you may know, there are 26 coronaviruses, and only 7 of them (the alpha and beta types) can infect humans. The SARS epidemic in 2003 was caused by "SARS-CoV". (8)
2003 was the first time a corona virus infection in humans caused a world pandemic.
Dr. Roy stated that Coronaviruses cause 30% of common colds that we experience, and they've been circulating worldwide for a long time.
It still stands that the first diagnosed case of SARS-CoV-2 was in Wuhan province, China, and was shared with the world on 12/31/2019, when physicians reported an "unknown pneumonia" to the CDC. People were having strange pneumonias for which no cause could be identified.
That patient was not the first person to have SARS-CoV-2, just the first patient where a cause was finally identified.
Dr. Roy specifically stated that it is "improbable that SARS-CoV-2 emerged from lab manipulation" = meaning, he does not believe that scientists created this specific virus.
Sars-CoV-2 has an affinity for (it's drawn to, it gravitates toward, it plugs into) ACE2 receptors in the body. This is something unique to Sars-CoV-2 compared to all the other beta coronaviruses. This is one of 2 ways they are thought to "gain entry" into human body cells. Extra: ACE2 receptors are involved in our blood pressure regulation. Patients with COVID have even been treated with "ACE-inhibitor" medications that are used for treating high blood pressure (ever heard of Lisinopril?).
He did propose the 2 possible scenarios: 1. The virus "jumped" from an animal to a human. This process is called "Zoonotic Virus Transfer." The animals he suspects would be the Horseshoe Bat or the Chinese Anteater (Pangolin), both of which were present in the wet market in Wuhan. (4) (5) 2. The virus naturally selected humans after transfer from the animals (as opposed to other animals).
Nobody knows with certainty if zoonotic transfer occurred from one of these 2 animals, but it is possible. The 2003 SARS Corona pandemic did involve bats, and came from the Guangdong province, China.
MERS = Middle Eastern Respiratory Syndrome (the "other" pandemic) is still infecting people in the ME today, and is mainly spread from camels to humans.
Extra info not from Dr. Roy: The animal as the reservoir. In the chain of infection, the reservoir is the animal that has the disease inside of it but isn't necessarily sick from it, and transmits it to humans through the air, from handling the bats closely, invading their roosting areas, by bites, or many other ways. (6)
Back to Dr. Roy: SARS-CoV-2 is still found to have an incubation period of 2-14 days (normally 5-6 days). Meaning you are making more and more virus in your body, shedding that virus, and are without symptoms for potentially 2-14 days. Most people show symptoms by day 5 or 6. This was true in June and is still true now.
The virus can be transmitted from human to human by droplets (sneezes/coughs), direct contact (kissing, sharing utensils), airborne (someone sneezes, coughs, yells, talks, sings and you share the air with them or walk through their air shortly after), and indirectly through ... feces. (7) My words: WASH your hands with soap and water for no less than 30 seconds every single time you use the bathroom at home and in public. Wash your hands all the time, especially immediately before you touch your face, mouth or eyes, in general, not just for COVID. Earlier this summer we did not know exactly what ways the virus could be transmitted.
Viruses in aerosols (sneezes, coughs, our normal exhaled breath) are controlled by "terminal settling velocity". An exhaled or coughed or sneezed out COVID19 virus will fall out of the air just before 6feet of distance. This is the reason why the government is telling us to keep a distance of 6 feet from each other. That is where the "social distancing" measurement comes from, and Dr. Roy and his people studied this in the laboratory. For viruses that are smaller than 10 microns, social distancing doesn't matter, because they stay suspended in the air for longer.
Sars-CoV-2 is unique in a bad way. It stays suspended and is "replication competent" (it still has the ability to clone itself) for up to 16 hours in a laboratory setting. Dr. Roy made it very clear that a variety of factors in normal life make this replication competence time frame much, much shorter, but they needed a baseline measurement of these times to initiate decision making for public health measures. UV light is especially effective at killing Sars-CoV-2 almost immediately.
The virus is not present in or spread by blood.
Sars-CoV-2 is confirmed to be a "super spreader" because it is resilient and can be spread readily from asymptomatic people.
All of the treatments for people who are sick with SARS-CoV-2 are still "supportive". Meaning - doctors are still treating the symptoms and the consequences of this virus as they occur, with some things that are thought to be preventative. There is no cure.
MERS has a 1:1 infection rate. 1 sick human will only make 1 more human infected.
Stay with me, hang on during these next few paragraphs...
SARS-CoV-2 has a 1:6 infection rate. 1 sick human will infect 6 people. Hand to mouth activities are a major exposure pathway. Aerosolization (imagine hair spray, or cooking oil spray) is the other major pathway, with both small and large "respirable" (breathable) particles. Particles that are 1-2 microns (1,000 nanometers) are highly respirable, because they are the smallest.
SARS-CoV-2 is a big virus, compared to all other bugs. It measures 120 nanometers (0.12 microns) in diameter. (Extra: I spent way too much time trying to clarify what Dr. Roy said in his talk. I read way too many sources. Bottom line: the Sars-Cov-2 virus does not have a consistent size. 120 nanometers is accurate according to what I read, but what I found is that scientists used electron microscopes and measured that the Sars-Cov-2 virus has a range of sizes. "...the SARS‐CoV‐2 coronavirus itself ranges in size from 0.075–0.160 microns...."
The only point of saying that, is that it is well known that larger viruses and bacteria won't stay suspended in the air for long. They fall onto surfaces, and when we touch them, and then touch our noses and mouths, that's how we get sick. The example Dr. Roy used is that a particle that is 10-20 microns won't float. (9)
The spectrum (range) of clinical illness is from asymptomatic/mild to critical/death. The vast majority of monkeys experienced a mild, self limiting disease and spontaneous
recovery. A small fraction of them exhibited severe disease and 1 monkey died in their
first study. (10)
They did not know which animals would be susceptible to this corona virus at first. Mice are not susceptible. He said you could bathe a lab rat in a tub of Sars-CoV-2 and it would not "get" the virus.
The monkeys were given controlled "doses" of the virus in 2 different ways. And then the researchers took samples from the monkey's blood, urine, stool, airways, cheeks, spinal fluid, coughed up mucous, plus did chest XRays, PET/CT scans. The animals that were exposed to the virus and became very ill were humanely euthanized and full autopsys/post-mortem pathology studies were performed.
The 1 monkey that died early on was 16 years old, which is 90 in human years. She died on Day 8 after she was infected, by inhaling the larger dose of the virus.
There are consistent findings in the monkey's blood work (and humans for that matter) that they found in the sicker monkeys. They include but are not limited to: high potassium, high blood glucose, kidney failure, big/swollen red blood cells, body working over time to put out a lot of new and immature red and white cells (blood and immune cells).
There was a distinctive chest xray, that tended to occur on day 8 of illness. On day 7,
the monkeys had a normal/clear chest xray, and on day 8, they found nearly complete consolidation of typically the right lung. This means the right lung was "heavy and wet". Lungs are supposed to be filled with .... air.... not "wet". The term he used to describe the way the lung looked on the chest xray was a "snow storm" or a "white out". On an xray - a lung should be mostly black in color, because black = air. White colors on an xray are things like bone, or other solid or dense materials.
They measured how many copies of the virus were in different body tissue/fluid samples every single day after infecting the monkeys. There are "very high" levels of
Sars-CoV-2 on DAY 1 after infection from a nasal swab. So in less than 24 hours from exposure to the virus, you can have thousands and thousands of Sars-CoV-2 viruses in your nose, yet have no symptoms. This is what is meant by "asymptomatic spreader."
Just because you are infected does not mean you are symptomatic.
Titer count (the number of virus copies in your body)/Productive Infection does NOT coincide with occurrence or severity of disease. Just because you have a high viral count does not mean you will ever have symptoms. And just because you have a high viral count, it doesn't mean you will become severely ill.
Dr. Roy and colleagues identified the main comorbid conditions being: advanced age, elevated blood glucose, obesity and hypertension. They found that animals who were younger, lower body weight, without diabetes, and with normal blood pressure almost all had mild, transient disease.
Animals and humans: severity of illness is nearly 100% dependent on comorbidities. After testing dozens of monkeys and 3 different species plus clinical (people) studies. “ONLY see animals that are old and fat that are exhibiting severe phenotype disease." Having high blood pressure and diabetes can be predictive of clinical outcomes.
“Susceptibility to COVID and development of clinical signs are very correlative of comborbidity presence.”
They found evidence of productive infection particles from anal swab samples by day 6. He said "it's everywhere." The highest concentration of productive infection particles from exhaled breath was found on day 7 of illness.
Sars-CoV-2 is "tenacious". Normally viruses don’t like to be in the environment, this one does. The amount of time that Sars-CoV-2 stays alive and contagious on surfaces, depends on the surface. The time frames vary between copper, cardboard, plastic, stainless steel, etc. Sunlight dramatically decreases replication of this virus - it reduces aerosol half life from 16 hours to less than 1 minute.
NO NEED to wash amazon packages. He said this specifically LOL
Mutations: one predominant mutation that in April was in less than 1% of the viruses sampled ... now is in 100% of current clinical samples. Makes virus more transmissible and grow/replicate more effectivity but does not change pathogenicity (how sick it makes people). 100% of clinical samples worldwide show this. It’s spontaneous.
Contagious period: day 1 after exposure (asymptomatic) you are infectious, replication cycle is 6 hours. Generally infectious for 10-14 days in self limited cases. Severe phenotype of disease contagious period can be longer. So, 10-14 days for most of us. Extra: Everything I've read says that there is no infectious virus material that has been identified after day 8 of symptomatic infection. He did not specifically say this and I asked him this question. He stands by 10-14 days due to the fact that there can be viral RNA obtained from nasal swabs for that time period. Many other sources have been very clear that after day 8, the chance of being contagious is no longer thought to be a risk. Safest bet - 10-14 days.
She welcomed people to call or email directly with questions.
Tina.firstname.lastname@example.org and 337-262-5311
Might I suggest: If you are in a situation with an EMPLOYER or SCHOOL that is forcing you to get multiple tests done until you are negative before you are allowed to return to work or school - please e-mail Dr. Stefanski's office and get a statement from them that confirms this is NOT appropriate or necessary.
The decision to close bars down was based on contact tracing and the evidence that shows Sars-CoV-2 spread more readily in low ventilation, dark environments, that did not allow for social distancing.
Quarantining and contact tracing are "traditional" public health measures.
Dr. Stefanski called on NURSES specifically to reenergize the community to participate in mitigation (infection control) efforts as we are entering respiratory infection "season" and demands on hospital and healthcare systems are normally greater every year at this time, pandemic or not.
There is no change in quarantine and isolation recommendations: A + diagnosis quarantines 10 days from the onset of symptoms, up to 14 days. Day 1 is the day after symptoms develop. Close contacts are to quarantine for 14 days from the day they are exposed to the sick person with a + diagnosis, because you can develop symptoms up to 14 days after an exposure.
Case numbers do not include people with + antibody tests or those who died from an external cause such as a car accident. However, it DOES include patients who died from a condition that could be caused by COVID. The example she gave is a patient who dies of a Stroke. If the patient died of a stroke caused by a blood clot, and also tested + for COVID, this IS counted in COVID death statistics because COVID is known to cause a blood clotting disorder. The blood clotting disorder is a manifestation of COVID, and therefore it cannot be ruled out as the cause of the stroke, and therefore the death.
Number of infections is as low currently (mid October) as it was in May/begging of June ( very low and stable).
"Percent Positivity" = # of positive results divided by total tests done in 2 weeks. Goal was below 10% before schools opened. Now that schools reopened, goal was less than 5% percent positivity.
Acadiana has been under 5%, Lafayette specifically has been 3.7% recently.
It is safe to visit nursing home patients outside. Outdoor visits are not linked to spread or increase in % positivity, and recently nursing home visitation restriction has been lifted.
Regarding total cases, percent positivity since schools reopened: "Doing much better than any of us expected." All public and private schools have to report results to the Office of Public Health / Louisiana Department of Health. UL reports separately.
KIDS will be asked to go home from school and quarantine if they have 1 major or 2 minor symptoms.
Major signs/symptoms: a + COVID test, cough, shortness of breath, difficulty breathing, loss of taste/smell.
Minor signs/symptoms: fever, chills, rigor, muscle aches, headache, sore throat, nausea, vomiting, diarrhea, congestion, runny nose, fatigue.
If the child is sent home from school and instructed to see their doctor/provider - they SHOULD be tested for COVID, Flu, and Strep! They can go back to school when symptom and fever free for 24 hours without medications and negative testing.
Children in age range of 6 years to 19 years: stable number of infections since August 13th - no spike.
If the child is sick, older family members should NOT babysit.
Multisystem Inflammatory Syndrome (the Kawasaki-like disease) has occurred in 89 children in Louisiana, 4 have died. They experience multiple organ involvement, fever, diarrhea, skin rashes, blood clotting disorder and 75% of them become septic (infection is in their blood and they are in ICU). What happens is that the child may actually have COVID and either be asymptomatic or have mild illness and therefore, not be seen by their doctor/provider. 1 month after COVID infection, they will present to the ER were severe problems as written above.
Long-term heart and kidney problems are possible, we don't know yet.
Student-Athletes with symptomatic, moderate to severe disease: there are "Return To Play" documents from the American College of Cardiologists, Pediatric Cardiologists Perspective and more. Kids that survive this multisystem inflammatory syndrome or that have moderate COVID symptoms should have an EKG, MRI, cardiac blood work and inflammation marker labs done BEFORE they return to practice and sports. When a kid is sick with COVID - they should be RESTING - not running around outside, working out, or playing while home.
The molecular and antigen tests are still the main 2. One is rapid and one is not. Antibody testing is not helpful for diagnosing current infection.
The molecular test is the "PCR" test. This test is the most accurate. They detect the virus' genetic material. They are the "gold standard" test, but they do not distinguish between replicating (contagious) virus and remnants of viral RNA (pieces of virus). For THIS reason - these tests are NOT good for repeat testing! These tests can detect remnants of the virus for up to 12 weeks!
PCR: These samples have to go to a lab. They can be done just with a nasal swab or with throat + nose. Patients CAN do a self-swab while the healthcare professional watches them do it. If you don't do it good enough, we will reswab you LOL
Rapid Tests: there are 6 available, results in 10-15 minutes. They detect a certain protein on the surface of the Sars-Cov-2 virus. They perform best in the early stages of the virus, when the viral load is generally the highest - day 5, 6, 7 after onset of symptoms. After day 7, the viral load may drop below the limit of detection for that test. A PCR test could be positive where a rapid test would be negative in the same day in the same patient.
If you are highly suspicious that you have COVID and you get a negative result from a rapid test, confirm this with a PCR test. The only reason a PCR test should give a false negative would be the technique used to collect the sample (lazy swabbing) or handling of the sample after it's collected (delayed to the lab, left in the sun, wrong lab tubes, etc...).
If you are asymptomatic, and you get a + result on a rapid test, ask for a PCR test to confirm the + result before you quarantine yourself for 14 days!
Vaccine distribution in Louisiana is possible for January 2021. Vaccine will have priority groups, with priority group #1 including high risk workers in health care facilities, first responders, all aged general population with certain comorbid conditions.
If a child at school has a house member test positive, should they stay home? If someone in household tests positive, the whole household has to stay home and quarantine for 14 days. Wait for 5-7 days to be tested from day of symptoms/exposure. IF you have a negative test, you still have to complete 14 days. You can’t “test yourself out of quarantine”. Sick person has to isolate to 1-2 rooms. Identify ONE primary caregiver for the sick person, and that person caring for the child is quarantined for 24 total days. Why? The child or person with the illness may be sick for a few days, and the caregiver is exposed on all of those days. So, due to last day of exposure to the sick child while child is in quarantine, the caregiver has to add 10-14 days to that.
That's all folks....
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