Podcast #189 - Must Know Information on Coronavirus Disease 2019 (COVID-19)

Coronavirus Disease 2019 (COVID-19) has been a very popular topic over the last few months.  However, there has been a great deal of misinformation and new information that has changed what we previously thought about this disease.  While we discuss this topic, it is worth noting that this may continue to change further and that this post was last updated on 3/3/2020.

Coronaviruses are fairly common and usually cause mild to moderate upper respiratory infections (URIs), but we have seen deadly versions in the past including Middle East Respiratory Syndrome (MERS-CoV) that was first reported in Saudi Arabia in 2012 and Severe Acute Respiratory Syndrome (SARS-CoV-1) that was first reported in Asia in February 2003. 

COVID-19 is caused novel coronavirus first identified in Wuhan, Hubei Province, China in December 2019.  The virus itself is referred to as SARS-CoV-2.  Given how this can cause confusion, most sources are simply referring to both the virus and the disease by COVID-19 which is what we will also do here.  In this post there will be a number of citations to help support what is discussed and to help eliminate concerns for spreading any misinformation.

Essential Biology

• COVID-19 is a non-segmented, positive sense RNA virus.
• It binds via the angiotensin-converting enzyme 2 (ACE2) receptor located on type II alveolar cells and intestinal epithelia.
• As the viruscontinues to mutate, its virulence and transmission will also change.
  • A summary of the differences can be seen in the infographic below from the Daily Mail.
  • The worse of the two forms, the L strain, appears to be occurring less frequently which may be due to it "burning itself out" early on.
  • This can be attributed to more severe cases being diagnosed and isolated quickly limited the opportunity to spread.
• The primary pathophysiology for COVID-19 is acute respiratory distress syndrome (ARDS) which causes diffuse alveolar damage directly from the virus (versus the more common hyper-inflammatory injury seen with other illnesses).
• Another emerging concern is that a cytokine storm may occur.
  • As theInternet Book of Critical Care explains, this can have features of bacterial sepsis or hemophagocytic lymphohistiocytosis.
  • There may be elevations of C-reactive protein (CRP) and ferritin which track with disease severity and mortality.

Fast Facts on COVID-19

• The overall fatality rate is estimated to be between 2-4% depending on the resource.
  • However, some have suggested that the rate may be lower including possibly less than 1% based on some limited evidence and the assumption that there are a number of asymptomatic or minimally symptomatic cases.
  • This seems a likely possibility as Washington state believes that COVID-19 has been infecting scores of people weeks before the virus was first detected.
• Mortality rate increases with age.
  • In the above linked study, no deaths were reported in children less than 10 years of age.
  • Those between 70-79 years of age had a 8% chance of dying from COVID-19.
  • Patients 80 years and older had a 14.8% chance of dying.
  • 80% of fatal cases occurred in individuals 60 years of age and older.
• Also, the mortality rate increases with certain comorbidities.
  • Cardiovascular disease - 10.5%.
  • Diabetes - 7.3%.
  • Chronic respiratory disease - 6.3%.
  • Hypertension - 6%.
  • Any form of cancer - 5.6%.
• It is known to spread several ways.
  • Large droplet transmission (similar to viruses such as influenza) which can be prevented with a standard surgical mask and the risk is limited to within approximately 6 feet of the patient.
  • Airborne transmission remains controversial, but the Centers for Disease Control (CDC) in the United States recommends using airborne precautions.
  • Contact transmission ("fomite-to-face") is an often overlooked but important type given the possibility of transfer if surfaces are not properly cleaned (the virus can live on surfaces for up to a week), hand hygiene is not performed, and if people touch their face especially after a known exposure.
  • Asymptomatic transmission is also possible if the person infected lacks symptoms or if a patient who has recovered continues to shed the virus, but the latter will most likely have a low viral load and low risk of transmission.
• While the personal protective equipment (PPE) recommended may vary with time (such as whether N95 masks are necessary), the procedure to know how to apply (don) and remove (doff) is vital to avoid transmission.
  • The below video helps demonstrate the key points and includes the equipment recommended.
  • Gown, gloves, mask, and goggles or eye shield are recommended with COVID-19.

To help get an overall synopsis of COVID-19, there is an excellent infographic included below which is found on Propofology.com and includes a higher resolution html image.

Testing, treatment, and disposition depend on a variety of factors and difficult to cover at this time given the daily changes and updates that are being received.  However, the infographic above and the resources available with the CDC, World Health Organization (WHO), and certain reputable sources such as IBCC can help in the future as this continues to evolve.  We encourage you to follow local and national guidelines.

Let us know what you think by giving us feedback here in the comments section or contacting us on Twitter or Facebook.  Remember to look us up on Libsyn and on iTunes.  If you have any questions you can also comment below, email at [email protected], or send a message from the page.  We hope to talk to everyone again soon.  Until then, continue to provide total care everywhere.

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