Coronavirus disease (COVID-19)

Corona viruses (CoV) belong to the family of virulent viruses which cause severe respiratory disease - from common cold to Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). A new type novel Coronavirus (nCoV) strain has been linked to the outbreak from 2019 which has not been identified in humans.

Epidemic Origin: It has been established from the available data that Coronavirus is zoonotic (transmitted between animals and humans) . There are 7 strains of Viruses which cause respiratory disease. The common cold causing Viruses belong to the 4 strains while 2 others (SARS-CoV and MERS-CoV) result in the deadly infections - SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome). The last strain in this group causes Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-CoV-2). The disease it causes is known as Covid-19, so named after the year it started to manifest.

The SARS-CoV transmuted from bats to Civet cats and then to humans in China, while the MERS-CoV mutated from dromedary camels (Arabian camels) to humans in middle east.
As of now, the source of the SARS-CoV-2 has not been identified except that it originated in Wuhan, China.

The SARS-CoV-2 Virus spreads through 3 possible ways:

• Direct Contact: Contact transmission results when a person touches any object that contains a live virus on it (fomite). Generally , 90 % of the virus is rendered inactive by the Ultraviolet (UV) rays present in sunlight.
  
• Droplets: Small particles of mucus, saliva emanating from a person when s/he speaks or coughs. Generally large droplets drop down and rarely travel more than a meter or so.
  
• Airborne transmission: Minute droplets, which come from an affected person when he sneezes, coughs or speaks, turn aerosol and can float suspended in the air for hours indoors under the right conditions. Humidity, other aerosolized contents, air movement and air density may play a role in the transmission of infection indoors. Increasing ventilation rate can lower the spread of this aerosol transmission.
  

Symptoms: it is not necessary for the patient to develop all symptoms immediately. Some may be ill for some time and then lapse into pneumonia. Or they may some symptoms initially and then become carriers themselves as they may not show debilitating symptoms further on.

Covid-19 symptoms as shown below, are typical and may indicate the progress of the infection. These symptoms have been collated from different authoritative research sources.

• 1. Fever typically high - 100 degree F or above
  
• 2. Cough
  
• 3. Breathing difficulties
  
• 4. Shortness of breath
  
• 5. body ache
  
• 6. Fatigue
  
• 7. Bowl abnormalities - Diarrhea leading to bowl ischemia or cholestasis - obstruction of bile flow resulting in obstructive jaundice.
  

The prognosis is grim for patients over 80 years of age. A study in China shows that the mortality rate for this group of patients is 14.8 % whereas for the overall population the mortality rate is 2.3 %. The lower respiratory tract infection may progress to pneumonia, acute respiratory syndrome, organ failure and death. There is some evidence that suggests that patients with type A blood group are 50 % more likely to require oxygen or ventilators as their genetic profile appears to make them susceptible to complications arising out of Covid-19 infection.

Normally our body immune system fights the pathogen as it enters our body. But during the process, the disease flares up in some cases and the same immune system tends to overact resulting in a condition called as cytokine storm which - if uncontrolled may lead to death. Some times this cytokine storm may be controlled with interleukin-6 (IL-6) inhibitor drugs.

Researchers found a mutated SARS-CoV-2 virus in China and Germany, called as D614G which appears more virulent than the earlier strain. It was thought that infection rate has increased rapidly due to mutation that changed the properties of the virus.

Treatment: As it is a viral infection, there is no direct medication targeted at this Virus. Other than normal care, there is very little option available to treat the disease. Antibiotics may be prescribed to treat secondary infection if any.

The ongoing research to control the Covid-19 infection has tentatively identified some drugs which may have some benefit. The following drugs may show some benefit:

• Ivermectin - A type of anthelmintics normally used to treat strongyloidiasis (threadworm, roundworm infestation) in animals or onchocerciasis (river blindness due to a type of roundworm infestation).
  
• Interleukin 7 (IL-7) drug that increases the number of T lymphocyte - (T cells) which is primarily responsible for killing the pathogen. Normal blood count of T cells is 2000-4000 per micro liter of blood. But in a serious case of this virus, the blood count of T cells drops to an abnormally low level of even 200 per micro liter.
  

ICAM Protocol :
A pharmacist, Ms.Carlette Norwood Williams has developed a treatment protocol with the acronym - ICAM. This proposed treatment option is not a new discovery. The individual line of medicine has been used all along. But the idea of synergy of using a combination of effective drugs has been suggested in this protocol.

• I - Immunosupport : primarily with the use of Vitamin C and Zinc
  
• C - Corticosteroid : To reduce inflammation of tissues with the use of Methylprednisolone
  
• A - Anticoagulant : To stop blood clotting with the use of blood thinners like Enoxaparin
  
• M - Macrolide : Antibiotic to fight against secondary lung infection from the Macrolide family such as Azithromycin and Clarithromycin which have higher level of lung penetration
  

It is better to prevent the infection in the first place.

Vaccines: Vaccines are our major tools in the fight against the virus by priming our body immune systems to defeat the pathogen. Though many vaccines have been approved for emergency use, their efficacies against the target virus vary. Messenger RNA vaccines (mRNA) contain specific instructions as a messenger to produce a spike protein. This technique of using instruction set instead of inactivated pathogen to create an immune response is better as you can modify the set of instructions in the future if the virus mutates. It also mitigates the risk associated with using inactivated virus.

Prevention: Primarily the Virus spreads through droplets and body fluids. Avoid any crowded area if possible. Avoid contact with anyone who shows symptoms of respiratory illness - cough, sneeze and running nose. Allow at least 3 feet of space between you and the infected person. Wash your hands with soap thoroughly. Remember the germicide in the soap takes at least 30 seconds to work. So wash your hands for at least 30-45 seconds and then rinse.

Use alcohol based hand sanitizer to disinfect your hands before you touch your face/eyes/nose/mouth. Cook your food including meat at high heat thoroughly. Wash your hands and tools/implements in the kitchen well. Always use different cutting board and knife for vegetables and meat. Do not use the same cutting board or knife which was used to cut raw meat to cut cooked food.

Your pets - dogs and cats are safe as long as they remain indoors or move in restricted area. It has not been established that normal pets pose any threat unless you are in a severely affected area. Use the standard precaution of washing your hands thoroughly after you come in contact with your pets.

Wheezing

Wheezing is a characteristic high pitched whistling sound made while breathing, a primary symptom of a chronic respiratory disease - Asthma. It is not uncommon in those with respiratory allergies, especially during the hay fever season. Sometimes, other respiratory infections could be accompanied by mild wheezing, especially when acute Bronchitis is experienced. It is also noticed in those with heart failure and Chronic Obstructive Pulmonary Disease COPD. While most commonly wheezing occurs during breathing out, it can sometimes also be related to breathing in.

Causes of Wheezing

Narrowing of airways results in breathing difficulty and wheezing. There could be several causes for narrowing of airways including inflammation from asthma, infection, allergic reaction or a physical obstruction such as tumor or foreign body inhalation. Among the possible causes of wheezing include allergies, insect bite or medication or pollen, pet dander, dust, foods, Bronchiolitis, bronchitis, childhood asthma, epiglottitis, GERD, heart failure, lung cancer, pneumonia, sleep apnea, smoking and vocal cord dysfunction.

Respiratory Syncytial Virus (RSV) Infection is also known as Bronchiolitis - inflammation of the bronchioles which in turn refer to the the narrow airways which branch from bronchi to the air sacs called as alveoli. This RSV infection largely affects infants and children.

To determine the cause of wheezing, your doctor will ask questions about any symptoms that triggers it. If you have no history of lung disease and develop wheezing after eating a certain food or in a certain season, respiratory allergy is suspected. The doctor checks the lungs with a stethoscope to find out where the wheezing is and how bad it is. During a first time evaluation, the doctor performs a spirometry - breathing test, and also a chest X ray.

Sometimes other blood tests and procedures become necessary depending upon the health condition. In case it is allergic wheezing, then a variety of tests to determine the allergies including dermatological examinations are done.

Wheezing problems

Wheezing is accompanied by difficult breathing, rapid breathing and briefly bluish skin color. Emergency care must be sought if wheezing begins suddenly after being stung by a bee, while taking medication, or eating an allergy-causing food or after choking on a small object or food.

Wheezing in infants

In case of a baby, wheezing could be due to cold or problematic asthma. But it is not always clear if the infant has asthma. It is essential to get a firm diagnosis and make sure that the child gets treated for any breathing problems. In some infants, Bronchiolitis could occur due to a viral infection. The airways swell making breathing difficult. As the airway of an infant is small, infants are easily affected. Wheezing could result due to Bronchiolitis, which may develop into asthma in later life. Otherwise a child could be born with a tendency to wheeze and therefore could be prone to bronchiolitis and asthma. Less common reasons for wheezing in infants include inhalation of a foreign object or piece of food into the lungs, premature birth, insufficiently developed airways and cystic fibrosis.

Treatment options

A variety of treatments are available to help alleviate wheezing. However, regular monitoring by a doctor is a must, especially if the patient has asthma, chronic allergies, severe bronchitis, emphysema or chronic obstructive pulmonary disease. In some, wheezing can be relieved by certain medications or by using an inhaler. Some might need insertion of a breathing tube into the throat. The doctor may recommend some or all of the following to reduce inflammation and open up the airways obstructing breathing to stop wheezing:

• A bronchodilator inhaler, which can act fast to dilate constricted airways.
  
• An inhaled Corticosteroid
  
• A long-acting bronchodilator and Corticosteroid combination
  
• A controller pill for asthma to reduce airway inflammation
  
• A non-sedating antihistamine pill or a prescription nasal spray for nasal allergies, which are available over the counter.

Self-care measures to ease wheezing

Moisturize the air by either using a humidifier or a steamy shower or just sit in the bathroom with the door closed while running a hot shower. This is simply because moist air can help relieve mild wheezing in some cases.

Drinking fluids can relax the airway and loosen up sticky mucus in the throat.

Active or passive smoking can worsen a cough and hence it is best to avoid tobacco.

Emergency

Normally, mild wheezing that accompanies bronchitis disappears when the infection subsides. But in case of breathing difficulty, she needs to rush to the doctor who can administer the following:

• A shot of epinephrine to open up the clogged respiratory passages.
  
• Oxygen
  
• Frequent nebulizer to ease breathing
  
• A mechanical ventilator to help you breathe

It is for the doctor to determine the cause of wheezing and then treat the patient for the specific cause.

Nosebleed

A nosebleed or epistaxis is usually not a serious condition. It can occur due to local or inherent body factors. Most nosebleeds are idiopathic. The nose is lined with tiny blood vessels that are liable to bleed if they are picked or inflamed or disturbed. Local factors that can lead to a nosebleed are trauma to the nose by a sharp object, foreign body inside the nose and intranasal tumor. Common systemic factors that can lead to a nosebleed include inflammatory reaction due to sinusitis, allergic rhinitis or environmental irritants, allergic rhinitis and respiratory disease. Placing an ice pack on the cheek might help reduce bleeding. Keep your head up without bending till the bleeding stops. Check with a medical person if the nosebleed does not stop after 30 minutes.