Questions about Treatment for Coronavirus (Covid-19)
Patients with coronavirus have a number of coagulation (blot clots) abnormalities which can result in excessive tendency towards creating clots (thrombosis) and it is clear from the evidence that this may be a big risk factor for death in severely ill patients and needs to be carefully treated and studied further. The mechanisms are not currently well understood but involve:
- Endothelial injury
Clinical feature can include, often despite prophylactic-dose anticoagulation:
- Venous thromboembolism including extensive deep vein thrombosis
- Pulmonary embolism which is seen in up to one-third of patients in the ICU even when anticoagulation is given.
Autopsy studies also demonstrate that hypercoagulability is common in the most severely ill patients. In one study where a post-mortem was performed on 21 patients that died from coronavirus, a pulmonary embolism was found in four and in those who had the data available and it was found that almost 50% of the deceased had mircrothombi in alveolar capillaries.
In another study of 12 post-mortem examinations 7 of 12 had bilateral deep vein thrombosis (clots) in the legs with all cases having been both bilateral and interestingly unsuspected in all patients. Of those 12 - the cause of death in at least 4 was determined to be a pulmonary embolism - clots in the lungs.
Studies also demonstrate that widespread clothing and micro clots were significantly more prominent in the lungs of the patients who died of coronavirus compared with the lungs of controls who died of for example the flu.
Risk factors for hypercoagulability
Studies indicate - due to the fact that most patients have risks such as obese males, other medical conditions with heart disease, high blood pressure and diabetes being common.
Other clinical presentations
The data regarding how the tendency for thrombosis can present includes:
- Arterial events such as an increased incidence of strokes,
- acute limb ischemia,
- potentially heart attacks and
- microvascular clotting and even bleeding.
Dexamethasone - the first effective treatment
In a press release dated June 16th 2020 - researchers from the RECOVERY trial at Oxford, announced the results of a randomized control trial in which severely ill patients were given dexamethasone, an anti-inflammatory of the glucocorticoid family. The sickest of those patients who were on ventilators saw a decline in death of one third. In less such patients, those on oxygen therapy but not on ventilators mortality declined by 20%. Of note patients who were neither ventilated nor on oxygen showed no such decreases.
Richard Haynes from the University of Oxford, one of the leaders of the RECOVERY trial, wrote to the Scientist saying: "We tested it because we believed it could be effective, but I don't think anyone was expecting to see quite such large effects."
While there are those who say that it is too early to make a definitive conclusion many hospitals in US states are adding dexamethasone The benefits of the drug include the fact that it is a well known drug, cheap and widely available. Additionally the fact that it is generally safe, well-tolerated and has a long-half life - thus allowing once a day dosage - makes it a particularly good candidate. It also "makes sense" that it should work by decreasing the inflammatory and white blood cell response to the lungs.
In the UK, the chief medical officers of England, Wales, Scotland, and Northern Ireland wrote to all the doctors and hospitals to indicate that dexamethasone should become standard care for admitted patients with COVID-19 who require oxygen.
"It's a very safe, generally well-tolerated--at reasonable doses--steroid that works predominantly by its anti-inflammatory effects," said Dr. Matthew Cheng, a microbiologist and infectious disease expert at the McGill University Health Centre. "With regards to the press release, I was quite honestly elated. This is the first data that we have that suggests that a drug is able to improve the chances of survival in those that are critically ill, and so while I eagerly await the scientific publication I was absolutely thrilled to receive the news and to read about it yesterday," he added.
How does dexamethasone work?
Dexamethasone, a glucocorticoid and other similar drugs regulate the body's immune system and response by entering a cell's nucleus and suppressing expression of genes that encode inflammatory cytokines and increasing expression of other genes that have been shown to limit immune system overreactions.
ARDS is a syndrome with different causes, including pneumonia, sepsis, and inhalation injuries. Symptoms include shortness of breath, faster respiratory and heart rates, and dangerously low blood oxygen levels. According to Rochwerg, ARDS is inflammation-driven, so the problem is actually the intensity of the immune response, rather than the trigger itself. In ARDS, the body produces inflammatory cytokines, and white blood cells go into the alveoli of the lungs, potentially causing inflammation.
"COVID--in the extreme case--an cause ARDS, and that's why people die predominantly," Rochwerg says. People are sick for weeks upon weeks, by which time the virus might have cleared out of their systems, he explains, "but it's their own bodies' ramped-up inflammatory process that's now caused all the damage in the lungs. Based on that idea, it makes sense that steroids should work. They help dampen the host response. They help knock down those inflammatory cytokines and all those white blood cells going to the lungs."
While very promising in the sickest of patients the mortality rate still remained high and further trials and understanding is needed to improve outcome in both the sickest of patients as those who are less severely ill. More research is required with new drugs and strategies required to further decrease death and the severity of disease.
What should I do if I have symptoms?
If you have a fever, cough, trouble breathing, or a combination of other Covid 19 symptoms, call your doctor or nurse. They’ll ask you about your symptoms, and about any recent travel, and if you’ve been in contact with others who have been diagnosed or have developed symptoms and might be sick. They’ll also ask you about your history, to rule out if your symptoms may be related to allergies, the flu, or other health conditions, and may have you get a test for the flu to rule it out.
If your symptoms aren’t severe, it’s best to call before you go in.
Many people with only mild symptoms should stay home and avoid other people until they get better. If your symptoms are severe or you’re very sick, you should go to the hospital or clinic. You should call ahead if you can to see if they have special precautions you should take and to let them be prepared for your arrival. Of course, if this is a medical emergency, you should call 9 1 1 for an ambulance.
How Long do Symptoms Last?
For most people, symptoms fade within a few weeks. But in others, Covid 19 can lead to serious problems like pneumonia, not getting enough oxygen, heart problems, or even death. This is more common in older people or in those who have other health problems like heart disease, diabetes, lung disease, cancer, or obesity.
I've heard that bleach and disinfectant kill Covid 19. Can I use that for me if I get it?
No. Spraying your body with disinfectant will not be effective in curing or eliminating the virus in your body. In fact, it will only cause additional symptoms and can be harmful.
Also, do not use any disinfectants inside your body, either by drinking or injecting. This can be fatal.
Covid 19 is not killed in the body with disinfectants, alcohol, methanol, ethanol, bleach, or other such substances. Taking them internally will cause illness, organ damage, and could possibly kill you.
Are there drugs that are used to treat or prevent Covid 19?
While there is a great deal of research and testing going on, there isn't any drug or therapy that has shown to be effective in the treatment of Covid 19. There are studies currently being conducted with existing drugs, but there have been no conclusive outcomes for any, and there is a danger in taking them without the oversight of a doctor, because there are significant risks to those with pre-existing conditions, and in using improper dosages.
Do not take any prescription medications without the express advice of your doctor.
What's Being Done to Improve Treatment?
Because there’s no treatment for Covid 19 itself, only the symptoms, doctors are studying several different treatments to learn what might work for Covid 19 . There are a number of clinical trials, which are scientific studies to test treatments and medicines to see how well they work in patients with the disease. Depending on your symptoms and condition, your doctor may recommend you take part in one. It is important to only do this at the recommendation of your doctor. Do not try any new medicines or treatments without talking to a doctor.
How Do We Manage Severe Cases of Covid 19?
If you have more severe symptoms, especially those that include trouble breathing, you might need to stay in the hospital, possibly in the intensive care unit, or ICU. While there, you’ll probably be in a special isolation room where only medical staff will be allowed in the room, and they’ll have to wear special gowns, gloves, masks, and eye protection.
The doctors and nurses can monitor and support your breathing and other body functions and make you as comfortable as possible. You might need extra oxygen to help you breathe easily. If you’re having a very hard time breathing, you might need to be put on a ventilator, a machine that helps you breathe.
How Do We Manage Mild Cases of Covid 19?
Mild illness means you might have symptoms like fever and cough, but you don’t have trouble breathing. Most people with Covid 19 have mild symptoms and can rest at home until they get better. This usually takes about 2 weeks, but it's not the same for everyone.
If you’re recovering from Covid 19 , it's important to stay home and self-isolate until your doctor or nurse tells you it's safe to go back to your normal activities. This means staying apart from other people, even the people you live with. When you can stop self-isolation will depend on how long it has been since you had symptoms, and in some cases, whether you’ve had a negative test, which shows the virus is no longer in your body.
How is Covid-19 treated?
Right now there’s no specific treatment for Covid 19, and instead the only treatment is to treat the symptoms. People with mild cases may be able to stay home while they get better, but those with severe cases or other health problems might need to go to the hospital. Here is information on how mild and severe cases are treated.
What should I do if someone in my home has Covid 19?
If someone in your home has Covid 19 , there are certain steps you can take to protect yourself and others:
- Keep the sick person away from others. If possible, the sick person should stay in a separate room, and use a different bathroom. They should also eat in their own room. And to be extra safe, experts are recommending that the person stay away from the pets in the house until they’re better.
- Have them cover their face. The sick person should cover their nose and mouth with a cloth mask when they’re in the same room as other people. If they can't use a face cover, you can help protect yourself by covering your face when you’re in the room with them.
- Make sure everyone washes their hands with soap and water often, that includes both the sick person and everyone else in the house.
- Clean often. Here are some specific things that can help:
- Wear disposable gloves when you clean. It's also a good idea to wear gloves when you have to touch the sick person's laundry, dishes, utensils, or trash.
- Do the sick person’s laundry separately from everyone else’s in the house, and be careful to avoid contact. Wear gloves and cover your face when doing the laundry, and be sure to wash your hands before and after. Wash or wipe down the outside of the washing machine and dryer after putting in each load.
- Regularly clean things that are touched a lot. This includes counters, bedside tables, doorknobs, computers, phones, and bathroom surfaces.
- Use a disinfectant on surfaces. Soap and water are effective, but disinfectants on surfaces is best. Check your cleaning product labels to make sure they’re effective on viruses, since some products are only effective for bacteria. The EPA, the Environmental Protection Agency, has a list of products on their website that are effective disinfectants for covid 19.
What if someone I live with gets sick?
Most people who get Covid 19 can safely and fully recover at home. If someone in your home is sick, there things you can do to help them and to protect yourself from becoming infected. If a person is sick they should isolate from the rest of the house, but it’s also important to remember that they will need help, not only in staying isolated, but in meeting their basic needs. The symptoms of the disease can be rough, too, so remember, they’re sick, too. They’ll need your help.
- Help them with basic needs.
- Remind them to follow their doctors instructions
- Help them manage their symptoms with medications and care
- Get them the supplies they need (medicine, toiletries, laundry, food and drink, etcetera)
- Monitor their symptoms to track to see if they’re improving or worsening
- Keep them engaged in the household, they’ll be lonely and feel like they’re a burden.
- Take care of their pets
- Remind them to exercise
- Keep the doctor’s number handy, and call if symptoms worsen
- Seek emergency help if the person has:
- Trouble breathing
- Persistent pain or pressure in the chest
- New confusion
- Inability to wake or stay awake
- Bluish lips or face
- Protect yourself
- Stay at least 6 feet apart
- Wear a mask, preferably a medical mask if you’re in close contact with the person
- Wash your hands with soap and water for at least 20 seconds frequently, use hand sanitizer
- Use a separate bedroom and bathroom, if possible
- If you have to share a space maintain social distancing, wear a face mask, have them wear a face mask, and open a window to increase the air circulation
- Eat in separate rooms and don’t share utensils or dishes
- Wash the sick person’s dishes with soap in hot water, and wear gloves while washing them.
- Wash your hands again after removing the gloves
- Don’t share personal items with a person who is sick, including dishes, toiletries, brushes, sheets, blankets, towels, soap, shampoo
- Keeping it Clean
- Clean and disinfect “high-touch” surfaces and every day items, like tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks, and electronics.
- Use soap and water first, then follow up with a disinfectant cleaner.
- Be careful using cleaning products, many can cause further breathing problems if used in closed spaces or combined. Read the instructions.
- If you’re sharing a room with a sick person, don’t over clean. Only clean the person’s area if it’s dirty, to limit contact and possible infection.
- The sick person can clean if they’re feeling healthy enough, but be careful if they are having trouble breathing. Don’t have them use strong cleaners if they’re having any respirator symptoms.
- Make sure the sick person has their own cleaning supplies including tissues, paper towels, cleaners and sponges. Don’t share.
- If you’re sharing a bathroom the sick person should clean up after themselves after each use, including disinfecting. If this isn’t possible, wear a mask and wait as long as possible after the sick person has used the bathroom before cleaning it.
- Make sure to use liners or bags in all garbage cans.
- Do the sick person’s laundry separately.
- Don’t shake it out
- Wear disposable gloves
- Wear a face mask
- Wipe down the machines after putting the dirty laundry in
- Wash in hot water whenever possible
- Remove gloves and wash hands right away
- Dry on the hottest setting possible
- Wash hands after putting the clothes in the dryer
- Clean and disinfect the hampers before putting clean clothes back in
- Wash your hands afterwards
What does Self Isolating Mean?
Self-isolation or quarantine is when you have symptoms or you’ve been exposed to the virus and you are trying to avoid spreading it to others, including those in your household.
When you self-isolate you are minimizing any and all interaction with others, staying at least 6 feet (2 meters) away from others, and not touching surfaces or sharing items with them without cleaning and disinfecting them.
Here are some tips on how to self isolate (assuming you don’t need medical care)
- Have a large, well-ventilated area, ideally with a separate bathroom
- Don’t share a room with others. If that’s not possible, make sure the beds are at least 6 feet (2 meters) apart.
- Monitor your symptoms daily
- Remain in quarantine isolation for at least 14 days
- If you develop symptoms, especially any difficulty breathing, contact your doctor or medical professional immediately.
- Stay positive, stay connected via telephone or video chat as much as possible.
- Exercise, including breathing exercises.
- Talk during meal times, through doors or distance, to remain a part of the household.
- Use a mask whenever interacting with anyone else.
- Wash your hands frequently and don’t touch your face.
- Clean and disinfect your surroundings and all your dishes, utensils, after using them.
- Don’t panic, and don’t stress out about not being productive. By isolating you are doing something incredibly valuable and selfless.
What if I feel fine but think I was exposed?
If you think you were in close contact with someone with Covid 19 , but you don't have any symptoms, you should self-quarantine at home for at least 14 days. This means staying home as much as possible, and staying at least 6 feet, 2 meters, away from other people in your home. Self-quarantine is slightly different from self-isolation, which is when a person who is sick stays in a completely separate room from others.
You should also monitor and track any symptoms. If you do start to have symptoms, call your doctor or nurse right away.
How is Covid 19 treated in pregnant women?
Doctors are studying several different treatments to learn whether they might work to treat Covid 19. In certain cases, doctors might recommend these treatments or taking part in a clinical trial, a scientific study that tests new medicines to see how well they work. But some medicines aren’t safe to take during pregnancy, so you should talk to your doctor about all the risks involved.
Fever is a common symptom of Covid 19. If get a fever while pregnant, ask your doctor, nurse, or midwife what to do. Acetaminophen (for example, Tylenol) can be used to treat a fever and is generally safe to take during pregnancy.
How is Covid 19 in children treated?
There is no known specific treatment for Covid 19. Most healthy children who get infected can recover at home, and usually get better within a week or 2.
It's important to keep your child home, and away from other people, until your doctor or nurse says it's safe for them to go back to their normal activities. This decision will depend on how long it’s been since the child had symptoms, and in some cases, whether they’ve had a negative test (showing that the virus is no longer in their body).
Doctors are studying several different treatments to learn whether they might work to treat Covid 19. In certain cases, for children being treated in the hospital, doctors might recommend trying these treatments.
What should I do if my child has symptoms?
If your child has a fever, cough, or other symptoms of Covid 19, call their doctor or nurse. They can tell you what to do and whether your child needs to be seen in person.
If you’re taking care of your child at home, the doctor or nurse will tell you what symptoms to watch for. Some children with Covid 19 suddenly get worse after being sick for about a week. Stay in regular contact with your child’s doctor’s office to document and discuss the symptoms, and they’ll keep you up to date on any concerns, and when to call for emergency help. For example, you should call right away if your child:
- Has trouble breathing
- Has pain or pressure in their chest
- Has a rash
- Has blue lips or face
- Acts confused or not like themselves
If you have a baby that’s having trouble feeding normally, you should also call the doctor or nurse for advice.