Covid 19 vaccine, your questions answered about the pandemic.

Covid 19 vaccine

 


Covid 19 vaccine and your questions answered about the pandemic.

 

 

COVID-19 has caused disease in over 12 million people worldwide and has resulted in over 500,000 deaths. This virus has changed our planet and the way we live. Well, I am here for you and will give you the facts as I see it. The last 3 letters of my name are K, I, S and that means keep it simple. We will also discuss the Covid 19 vaccine.

 

 

Ok let’s take a deep dive into this topic and we’ll get to your questions in a moment as well.

 

 

The average time to develop symptoms is 5 days but almost  everyone infected will develop COVID-19 within 12 days.

 

The Coronavirus is contagious and may be spread by coughing and sneezing but simply talking can spread the disease. Thankfully, it’s not contagious like the measles but now I’m showing my age. Yes, this is truly a baby boomer rant. But follow along because knowledge is a precious commodity.

 

Laboratory tests have shown the disease can survive on surfaces for 3 to 4 days. But that’s under ideal conditions in a laboratory. Survival is likely less.

 

The most common symptoms are fever, cough and shortness of breath, but nearly every organ symptom can be affected. Even the sense of smell can be lost.

 

Mortality rate varies by age and is thankfully low in the young. It is .3% for patients ages 5 to 17 but is over 30% for patients 85 and older. Three quarters of patients admitted to hospitals are age 50 and older. Most deaths are related to pneumonia, respiratory failure and excessive clotting. This virus has a particular predilection to attack lung tissue.

 

Ok, enough of my rant. Let’s get to your important questions.

 

What do you mean by asymptomatic carriers?

 

Oh-oh, we goofed but here’s the story. Over 50% of the spread of the Coronavirus occurs in people who have no symptoms. A more accurate term is “presymptomatic” which occurs a few days before the disease activates in the body.

 

The average time to acquire this disease is approximately 5 days.  The virus starts to shed 2-3 days before symptoms occur so others can also catch it during this time frame.

 

Asymptomatic carriers are likely very rare and docs have been circulating the wrong information or what I call unintentional fake news. You see, most people exposed will eventually develop symptoms. This is why the term presymptomatic is a more appropriate description.

 

Any person can harbor the disease and spread the virus even though symptoms have not yet developed. So the take home message is that people are contagious as soon as the virus is shed in sputum and saliva. This happens for a few days before symptoms.

 

So you just can’t trust anybody unless you have a Star Trek Tricorder which diagnoses everything. Ok, I admit that I’m a Trekkie!

 

Who should be tested, and which test should be used?

 

 

Folks, this stuff causes so much confusion, therefore I’m going to try and organize this mess so stay with me.

 

If symptoms are mild, one could just quarantine for 14 days and not test, but most people want to know if they harbor the disease. Certainly more severe symptoms, especially shortness of breath, warrants immediate testing.

 

Here’s the scoop.The best test to detect the disease is the PCR test which measures the nucleic acid, or the RNA of the virus. False negatives may occur if symptoms just recently began or if  the patient is in the presymptomatic phase where just a little virus is shed.

 

The doctor must extend the swab fully up the nasal passage or the virus may not be detected. I know that’s disgusting but it’s like when the doc sticks that tongue blade in the back of your throat and she tells you to say “Ahh” I personally vomited on my pediatrician when he did that to me during a housecall when I was 6 years old. Just call me Dr. Yoda.

 

COVID-19 can even be detected up to 6 weeks after the onset of symptoms by this test. The doc needs to correlate the test results with the symptoms. The PCR test can take 24-48 hours for results and I know it can be frustrating to wait that long.

 

As the disease winds down, an affected person can stop isolation after 10 days if he has been fever-free for at least 3 days and other symptoms (cough, fever, shortness of breath) has improved.

 

Also available is the rapid antigen test. This test detects viral proteins. These tests are fast and inexpensive but miss 20% of patients who would ordinarily be positive with the PCR test.

 

So if you just gotta know right away if your fever and cough are indicative of the dreaded coronavirus, then this test can be done. Just realize it’s limitations.

 

Finally, there are a host of quick fingerstick tests that measure antibodies to the virus. This test is quite accurate, but it takes at least one week and sometimes up to 3 weeks for antibodies to form after contracting the disease.

 

Additionally, immunity is probably short lived. If a patient insists on  a test and doesn’t have symptoms, then I often employ the antibody test.

 

Here’s the problem. Coronaviruses in general also cause repeated colds so likely long-term immunity doesn’t develop after exposure.

 

Hopefully, the vaccine will build a robust immunity just like the flu shot does.

 

A listing for approved tests can be found at: https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/vitro-diagnostics-euas

 

Unfortunately, the FDA site and the CDC site is like looking at an eye chart. But if you scroll down enough, you’ll see the approved tests.

 

 

What are the risk factors for this disease?

 

The most common risk factors for hospitalized patients includes high blood pressure, heart and lung disease, diabetes, kidney disease and cancer. Advanced age is likely the largest risk factor. Heck, advanced age is a risk factor for almost any disease!

 

Are masks really that effective? 

 

Yes, they are. These awful little critters spread by microscopic droplets expelled from the mouth. Both surgical masks and ND95 masks are likely better than cloth masks but all masks prevent the  spread of disease.

 

Social distancing (at least 6 feet), washing hands thoroughly with soap and water and covering coughs and sneezes all help to decrease the spread. This virus can actually spread just by talking. An uncovered sneeze can project droplets more than 20 feet. So masks are a necessity to keep you safe and others as well. That’s  a win-win for us all.

 

If I get this disease, what should the doctor give me?

 

Most people just need to isolate and wait if symptoms are mild. That’s simple enough. If hospitalization is required, patients usually need supplemental oxygen.

 

Hydroxychloroquine, an antimalarial drug, remains controversial and even political. A recent randomized controlled trial in July showed no efficacy. But an observational trial this month revealed  that this drug reduced the death rate by 50%. More studies are clearly needed but the preponderance of evidence says that it is ineffective and may cause dangerous cardiac arrhythmias.

 

Antivirals are also being examined. Remdesivir shortens the time of recovery and may also reduce mortality, but this latter aspect requires more study.

 

Dexamethasone, a steroid, is probably best reserved for the seriously ill. Early on, a steroid may reduce the clearance of the virus, thus making matters worse.

 

In the late stages of the illness, the immune system is often over reactive. It is here where dexamethasone reduced mortality by 35% in ventilated patients. The study needs to be replicated but provides lots of hope and we can use a little hope, right?

 

In summary, if hospitalization is required, consider supportive care with oxygen early on as well as the antiviral Remdesivir. Hydroxychloroquine may still be considered early in the illness, but most trials so far are negative.

 

If the severity of the illness increases, dexamethasone can be considered.

 

Donated plasma antibodies to COVID-19 can turn the tide for some patients, but it remains controversial and monoclonal antibodies to reduce the immune response are being studied with preliminary results demonstrating some efficacy.

 

 

 

Will flu shots protect me? 

 

Flu shots will not prevent COVID-19 from occurring, but getting the shot early in August or September might help limit your exposure to the pandemic.

 

By preventing the flu there will be less usage of our medical system and less potential exposure to COVID-19. Both flu shots and pneumonia vaccines likely reduce the incidence of heart disease and stroke as well. So protect yourself and others by getting these important vaccines.

 

 

Can my kids go back to school?

 

This is a difficult decision for parents, but it is likely schools can open. Children often have mild symptoms and are less likely to get the disease. And, children are rarely hospitalized for COVID- 19. Amazingly, less than 10% of kids in a Chinese study actually spread the disease to others.

 

Studies in Australia show that children are unlikely to spread the disease to their friends even if they are sitting right next to one another. Each school system will have a different process, possibly involving masks and social distancing as well.

 

 

What about a Covid 19 vaccine, doctor?

 

The accelerated progress towards a Covid 19 vaccine is truly remarkable. Six years of progress has been compressed to 6 months. Safety and efficacy need to be balanced and an RNA vaccine has never been made until now. I am hopeful that a vaccine will be ready for mass production by December 2020 or early next year.

 

During the 1918 Spanish flu, a few people died in the spring, but the virus mutated and came back with a vengeance in the fall killing 100 million people or 5% of the population. After that, the typical yearly flu was born. It is my hope that the same scenario will not be repeated and that the exponential growth in vaccine technology will quell the aggressiveness of this disease.

 

Ok, I’m getting too formal again. Just take care yourselves and be safe and know that there’s lots of hope on the horizon for a Covid 19 vaccine.

 

Good Health,

Dr Lipkis

 


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