Original Publication Date: July 16, 2020:
"Today, I listened to a live continuing education seminar hosted by UL CNE, with speakers Drs. Tina Stefanski and Nicholas Sells. They encouraged us to share valid information with the public, and I've been wanting to write a post about Incubation/Contagion/Persistent PCR for weeks. Just never did. Here are only a very few highlights that I thought were good things to talk about (maybe repetitive or dumb to front-liners). I've been on the outside looking in on all this COVID stuff, so I wanted to inform myself and share. Leaving out nearly all of the clinical info and fa sho not arguing about anything :
**What was true 2 months ago, may not be today, and may or may not be tomorrow. This isn't a blame game. I wonder how things will change by the time this pops up in my FB memories next year...**
**I wish I knew how to do italics on FB, but I don't, so caps lock it is.**
- Sars-Cov-2/COVID 19 is an RNA virus that is temporary. While you are infected - it lives in your respiratory tract (nose, throat, chest) - this is the basis of "rapid" testing methods. You don't enter a carrier state.
-There are 2 main types of COVID so far - L type and S type: L type tends to be more severe, more contagious, and has mainly respiratory symptoms. S type has mainly GI symptoms and seems to be less contagious.
-There are TWO types of TESTS:
PCR/Molecular Tests and ANTIBODY tests.
NASAL, NASOPHARYNGEAL, PHARYNGEAL swab tests are PCR/Molecular tests. The detect viral particles in secretions from locations where the virus lives. AS OF NOW - laboratory evaluation of this virus shows that after EIGHT TO TEN DAYS of clinical illness - it is not possible to recover (enough or any) viable viral material that is capable of causing an infection in a new host. This is what the 10 day quarantine rule is based off of. Day 1 of your illness is the day you are infected, and "incubation period" starts on this day. You will not be symptomatic the day you are infected. In terms of being contagious, by day 8-10 since first having symptoms, you are no longer considered to be contagious - if you had symptoms and they resolved. The relevant term if you so choose to Google: Viral Limit, Persistent PCR.
ANTIBODY Tests: look for Sars-Cov-2 "IgM and IgG" - proteins that your body makes that perform immune functions. IgM = acute infection, current infection, a blood test that CAN have cross sensitivity (be positive if you have antibodies to other corona virus strands), and needs to be cross checked with a nasal swab test if you have symptoms and/or an exposure to a known + person. IgG shows a "gone" infection - you had it, it's in the past, you had an immune response.
-This is a NOVEL virus - it's new - it's different - it is CURRENTLY being studied, clinically (on real, live people - might I add with MUCH success - case fatality rates in people with no underlying conditions is 0.6-0.9%) and in laboratories (how does it act, how contagious is it, how does it replicate, when does it stop, etc). WE ARE ALL watching medical-science history in action. Have a little awe and wonder, would ya?
- GLOVES are included in PPE recommendations for health care providers who will come into direct contact with the patient and/or their bodily fluids and secretions (they always are, it's called universal precautions) - they are NOT recommended for the general public for activities of daily living! HAND WASHING is still a mainstay and is so important.
-Gym-Goers: If you exercise to a point of increasing your rate and force of breathing, especially if you are mouth breathing - it is recommended that you wear a mask. If you can keep a 6ft+ distance between yourself and other people, it's probably fine, but when you move around the gym to different stations, equipment, bathroom, to chat - mask on. Equipment should be cleaned and disinfected every single time a person uses it, before a new person touches it.
- The 2 primary ways the virus is SPREAD is through (1) large droplets (sneezes, coughs). EVEN if you are not wearing gloves and someone sneezes on a surface that you unknowingly touch - if you wash your hands BEFORE you touch your eyes, face, nose, mouth, open wound - you avoid transmission. (2) Aerosolization = if you or your child have ever used a nebulizer for bronchitis, pneumonia, RSV, etc - the smoke that the neb machine makes with the liquid medication is aerosolized. Hairspray, is aerosolized, also, if that is a better visual.
- Is there any way that doctors and hospitals in a better position to help you? YES! The real-time trial and error of drugs, intubation or not, types of oxygen, positioning, etc has resulted in better knowledge, regimens, and answers! There are NO FDA approved drugs for treating coronavirus specifically - all drugs being used are off label - this is COMMON in healthcare!
-The incubation period (the day/time the virus enters your system until the day/time you SHOW symptoms) is still 4 days, with a range of 2-7 days! The longest known asymptomatic incubation period is 14 days, this is what the quarantine-after-exposure-before-symptoms time period is based off of. If you are exposed to someone who has the virus, and you develop symptoms - you should quarantine for 10 days only as long as you improve in that time period! If you relapse, your time starts again.
-If you are exposed to someone (example: you saw your aunt on Tuesday and she starts to feel bad on Thursday, gets tested, and gets a positive result on Friday) you need to wait until day 4 or 5 from exposure to get tested to AVOID a FALSE NEGATIVE test!
-10% of patients have only GI symptoms at presentation. They may or may not develop respiratory symptoms.
- Predictors of advancing to severe disease states (cytokine storm, ARDS, MODS) are old age and underlying chronic conditions: Diabetes, Renal Disease, Immunocompromise.
-"Silent Hypoxia" (comparable to a silent heart attack, you didn't know you had it, until one day your heart isn't beating the way it should) : decreasing oxygen saturation (the % they measure when they place the light on your finger to check your oxygen level) with impending respiratory failure (inflammatory response in the alveoli causing damage/swelling to the cells that exchange oxygen and carbon dioxide) WITHOUT dyspnea (the sensation or visual presence of having difficulty breathing/being short of breath/struggling to breathe). Decreasing oxygen saturation and impending respiratory failure without dyspnea = Your check engine light is not coming on.
- There are 3 phases of illness, most people will stay in Phase I, some will advance to Phase II, patients in ICU are in Phase III. Remdesivir and Steroids (Dexamethasone) give the best outcomes when started in Phase I.
- Not everyone qualifies for Remdesivir, the exclusion criteria: multi organ failure, requirement for inotropic agents (medications that are making your heart pump stronger/better), creatinine clearance <30 (renal/dialysis patients), concomitant use of other experimental antiviral drugs.
-Dr. Sells did not mention Azithromycin as part of treatment regimen for outpatients verbally, and it was also not included in the treatment slide. Was unable to ask him about that as he had to end his time.
- You do not need and your employer should not (and soon won't be able to) REQUIRE you to have repeat tests done until you are negative - as above - you can have a "persistent positive PCR" without being contagious. This wastes testing supplies and time.
- If you becoming symptomatic, get tested, get a positive result, you stay isolated for 10 days from the day you first had symptoms.
- If you are exposed to someone, you find out later, you don't show symptoms, you get tested, and it is negative or positive, you should still quarantine for 14 days due to the possibility of later onset of illness or asymptomatic spread.
- You can test + for wayyyy longer than you are actually sick and/or contagious. Googling: Persistent Positivity, Persistent Positive PCR.
-Most people will have dyspnea by day 6.
-Most people get admitted to the hospital on day 8 of illness (if they ever get admitted at all).
-People who become severely ill, requiring ICU/intubation usually do so 10 days post exposure.
- Dr. Stefanski had no opinion on Advil when Covid+, Dr. Sells was no longer on the call when that question came up and she preferred that he answer. Stick with Tylenol for fever/pain.
Pearls:
- EXPOSURE does not equal INFECTION. Do you get every illness your child gets? Probably not. (If your answer is yes, you got some thinking to do and tweaks to make)
- You can throw a temper tantrum longer than a 2 year old, this virus can be spread when you are asymptomatic - just like the flu. Viral strands are shed from your nasal/oral passages naturally, and when you sneeze or breathe really hard while working out, or cough, you force them out all over the place. This isn't new. We've been infecting each other this way for lightyears. You technically don't have to wear a mask, but you can't claim ignorance about the way the viral particles are spread.
- You do not have a medical condition that prevents you from wearing a mask, with maybe few exceptions. A friend the other day mentioned claustrophobia. I would also say tactile aversion as with some developmental disorders and I would think having a tracheostomy. You ARE NOT retaining CO2 while you wear a mask LOL, it makes me giggle. You have ANXIETY while you are wearing a mask. And while your anxiety is valid, CO2 retention is not.
- 2 things can be true at once.
Love,
a lowly NP