CORONAVIRUS COVID-19: A Critical Approach to the Pandemic

CORONAVIRUS COVID-19: A Critical Approach to the Pandemic

Coronavirus (COVID19) is an infectious disease that still has no cure. Then, what can we do against situation?

What is COVID-19

COVID-19 is the name of the infectious disease caused by the virus SARS-COV-2, also known as coronavirus. It first appeared in the city of Wuhan, capital of the province of Hubei, China.

The first number of cases started to appear in a food market where poor sanitation exists. Above all, coronavirus was identified as an acute respiratory syndrome of unknown origin.

Countries with coronavirus

Figure I. Graphic representation of countries infected by SARS-CoV-2.

On January 30th 2020, Dr. Tedros Adhanom Ghebreyesus, general director of the World Health Organization, stated that coronavirus is a public health emergency of international relevance.

Epidemiology of COVID-19

SARS-COV-2 is a pathogen from the coronavirus family. It is not the only member, in fact, there are up to 7 strains of human coronavirus.

Coronavirus image by the CDC

Figure II. SARS-CoV-2, shared by the CDC.

Its containment is the big challenge of this virus for the medical community and the population in general. This is due to the fact that it is much more infectious than other known pandemic viruses.

Incubation

Moreover, the incubation period of the virus is extremely high, which is how long a person starts to experience the symptoms of the disease. In fact, it can take up to 12 days approximately (with an average of 5 days).

Proportion of symptomatic cases

Figure III. Logarithmic curve of the onset of the symptoms depending on the days since the infection.

Detection

Early detection of the infection is quite complex. Therefore, our ability to contain it is limited, which is why now we are talking about a pandemic.

Distribution of coronavirus cases

Figure IV. Distribution of the areas infected by COVID-19.

Despite all this, the mortality rate of the virus is very low. On March 10th 2020, 9AM (GMT), the total number of infected people is 113 702, of which 4012 have passed.

Therefore, COVID-19 has a mortality rate of 3.528%.

Ways of becoming infected

  • It is spread between humans through the exchange of bodily fluids, mainly through droplets (like a sneeze).
  • Contact with infected materials and/or people.
  • And possibly through fecal matter (Wu, Chen y Chan, 2020).
We suppose that infection between animals and humans is plausible because the initial source could be animals.

How can I prevent and face COVID-19?

Currently, there is no vaccine for SARS-COV-2 (which has two profiles L- and S-) because of its recent discovery and our inability to contain it. 

Nevertheless, there are many research groups working on the genomic analysis of the virus to find the way to expose our organism to an antigen The aim is to trigger a safe immune response to obtain the vaccine that we so desperately need.

Haplotype analysis

Figure V. Haplotype analysis of the virus SARS-CoV-2.

For now, all we can do to prevent the virus is to follow the advice from the:

1. Wash your hands frequently and properly

An extremely high percentage of the population does not keep their hands properly clean.

Hands are the main vehicle for the infection through which the pathogen can be transmitted and spread. Washing your hands properly is the first measure established by the global health organizations to prevent COVID-19.

You should wash your hands regularly throughout the day:
  • Before the meals
  • After urinating and defecating
  • After touching elements from the public domain (like parks, subway or buses)
  • Always before touching your eyes, nose or mouth

Washing technique

It has to be thorough and long enough.

It has to last 15 seconds at least, but it would be better to spend 20 seconds. Use anti-microbial soap, although you can also use normal soap. Rub the palms and back of your hands.

Handwashing technique

Figure VI. Handwashing Technique

Alcohol disinfectants are effective when it comes to dealing with infections. Coronavirus are particularly susceptible to being removed with this practice, while other pathogens are more resistant.

However, using disinfectants is significantly less effective than washing your hands, so they are not interchangeable (Tamimi et al., 2014).

2. Avoid contact with sick people

This will help to lower the risk of exposure.

Using disposable masks is not recommended by any of the health organizations. In fact, they claim that it is not an effective way of preventing the infection.

It is an useful tool, but which only provides marginal protection (Raina et al., 2017), which is why it is only advisable to use it in:

  • The elderly
  • Immunocompromised people
  • People with moderate respiratory disorders
In other words, population at risk.

Those who suffer COVID-19, diagnosed or not, must use disposable masks to avoid spreading the infection.

Healthy people should simply keep a distance of one meter with sick people and reduce their exposure, as well as having a good hygiene in general

3. Keep stress under control

Stress is a factor that regulates the immune system.

Acute or chronic exposure to stimuli that trigger a physiological stress response can positively or negatively affect our ability to deal with infections.

Stress spectrum

Figure VII. Immunomodulating effects of acute and chronic stress.

Those who suffer chronic stress due to demanding work environments, too much cognitive and physical workload, patients, injured people…

Are more susceptible to being infected by a pathogen.

Effects of acute and chronic stress

Figure VIII. Immunomodulating effects of acute and chronic stress.

In these circumstances, changing our lifestyle is key in order to reestablish the physiological balance between the nervous system and immune system.

Central nervous system and immune system

Figure IX. Bidirectional relation between the central nervous system and the immune system.

Adaptogens

Some supplements from the “adaptogen” category, such as Panax Ginseng and specially Ashwagandha Extract can buffer the endocrine-metabolic response to stimuli that trigger chronic stress.  Consequently, they could indirectly improve our immunity (Lopresti et al., 2019; Chandrasekhar et al., 2012).

Effects of ashwagandha

Figure X. Effects of taking Ashwagandha for 60 days about the reports on anxiety and stress.

4. Rest and improve your quality of sleep

Sleep is an important factor when it comes to regulating the immune system.

Both processes are interconnected in a complex bidirectional system. Both the quality and quantity of sleep will affect the ability of our immune system to maintain the balance between:

  • Cytokines
  • Leukocytes
  • Immune system cells
  • Antibodies in charge of facing infections caused by pathogens
The hyper-activation of the immune system shortens both the REM phase as well as the deep stages of the NREM phase.

Immune system activation

Figure XI. Effects of the activation of the immune system on sleep and viceversa.

Having a good quality of sleep is a very important factor in order to maintain the homeostasis. We are not only talking about the immune system, but also about other organic systems that can indirectly affect our susceptibility to an infection.

Melatonin is a supplement that can improve the quality and efficiency of our sleep. It is not a treatment for any infection, but it can be a useful prophylactic remedy to strengthen your defenses.

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5. Useful supplements

Before anything, let’s not forget that there is no treatment for COVID-19. Moreover, we have not been able to assess the effects of supplements on certain prophylactic mechanisms against traditional infections (like colds or the flu). Consequently, you should consult a healthcare professional before using any of them.

Still, there are some food supplements that can improve the functioning of the immune system.

For example:

Vitamin C

Vitamin C is an effective product when it comes to preventing mild infections such as the common cold caused by the rhinovirus.

The effects of these nutrients are trivial on healthy population, but they can be useful for athletes, reducing the risk of infection up to a 50% (Hemilä and Chalker, 2013).

The lowest effective dose seems to be 250mg. while the most common dose used in clinical trials is 1g. Although some methodologies have used up to 8g of daily supplementation, a practice that we strongly disapprove of.

Vitamin C plays a clear role on the immune system, not only at a biochemical level, but also at a physical one, preserving the integrity of the first barriers that protect us. For example, we are talking about the skin epithelium, the gastric mucosa…

Our “guardians” protect us from the viruses that try to enter our vascular system.

Effects of vitamin C supplementation

Figure XII. Physiological effects of vitamin C supplementation.

That is why vitamin C is one of the most useful food supplements when it comes to dealing with common infections.

Zinc

But it has to be taken orally, not swallowed. We have to dissolve it in the mouth (preferably using lozenges). This has been related to a higher concentration of oro-pharyngeal zinc. Therefore, it could be a protective mechanism against viruses and bacteria through this pathway.

A recent meta-analysis from 2017 has proven that 80mg of elemental zinc a day distributed in 6 servings : does not reduce the onset of infections, but it shortens their duration (a presumably, their severity) in a 35%.

Zinc supplementation

Figure XIII. Daily dosing and frequency of Zinc supplementation in scientific trials.

Probiotics

The issue of probiotics is more delicate, since we do not only have to take into account the number of colony-forming bacteria (CFU). In fact, we need to consider the specific strain that we want to use.

Saying “probiotic” is the same as saying “nootropic” or “adaptogen”. Each family of bacteria and each strain is unique and it has unique properties too.

Probiotics can be useful when it comes to preventing and treating intestinal dysbiosis (improving the intestinal epithelium). Moreover, they can reduce the frequency, duration and severity of upper respiratory tract infections:

Some bacterial strains like:

  • Lactobacillus casei Shirota 1010 CFU (Gleeson et al., 2014);
  • L. helveticus Lafti L10 (Michalickova et al., 2016);
  • L. fermentum VRI-003 PCC® 109 CFU (West et al., 2011; Cost et al., 2010); o
  • Lactococcus lactis JCM 5805 1010 CFU (Komano et al., 2018);
Reduced the onset of upper respiratory tract infections.

Let’s not forget that SARS-CoV-2 is a virus that causes an acute respiratory syndrome. That is why most of the infected people experience moderate coughing and respiratory tract problems. While other patients can experience shortness of breath and respiratory failure, which are obviously more severe symptoms.

In fact, one of the unofficial but potentially useful diagnosis protocols is a CT scan (see following image).  This could be important if we take into account that one of the main signs of COVID-19 is pneumonia.CT scan

Figure XIV. CT scan of an old patient with a serious case of COVID-19 and onset of pneumonia.

What should we do now?

If you are wondering what to do… nothing relevant really.

You should avoid being exposed to the virus. In other words, avoid contact with sick people and crowds as much as possible and a good hygiene.

Take care of yourself, relax, sleep tight, eat healthy, do some exercise to strengthen your immune system, and eat broccoli!

The caption reads: “Food shortage but you are not even touching the broccoli, huh?”

The organisms that watch over the microbiological safety of the citizens are working non-stop to contain and deal with the infection.

If you are not feeling good, stay home and avoid contact with others.

You can always contact the healthcare authorities through special phone lines to talk to them about your situation. Specially if the symptoms do not improve in the first 48 hours, you have fever, respiratory problems, or you feel worse.

Information for Healthcare Professionals

If you are a health professional, you may be interested in knowing more about the coronavirus and the action protocol.

A case becomes suspicious if the person has at least two of the following conditions:

  • Fever and/or respiratory symptoms (coughing, myalgia, fatigue, respiratory distress…).
  • Medical imaging compatible with viral pneumonia.
  • Normal or low count of leukocytes or lymphocytopenia at early stages of the disease.

One or more of the following circumstances 14 days before the onset of the symptoms:

  • Trip or residence in Wuhan or other areas affected by the local transmission of the infection. Or in a local community with confirmed infected patients.
  • Close contact with a patient with COVID-19 confirmed in a laboratory (positive results in a nucleic acid).
  • Close contact with people from Wuhan or close areas, local communities with cases of fever or respiratory symptoms.
  • Onset of several of the symptoms.
Patients that have not been exposed need to meet the 3 conditions of the first section in order to be treated as a patient at risk.

Protocol in case of infection

Currently, the symptoms of pneumonia, as well as the CT scans are not a protocol approved by the CDC or the WHO, except for the region of Hubei. However, it is interesting to take them into account due to the high prevalence of the cases the show lung opacities.

If a patient has been “clinically diagnosed” with COVID-19, we have to start a PUI protocol (Person Under Investigation) The patient has to be isolated and the healthcare professionals that have been in contact with the patient need to be under supervision for 14 days after the encounter.

Moreover, we need to automatically contact the center to control and prevent diseases by exposing the medical proofs and symptoms of the patient.

The CDC will send a specialist that will confirm the case by applying the reverse transcription polymerase chain reaction (RT-PCR) in real time. Moreover, we will have to look for the gene sequence provided by the Healthcare clinical center from Shanghai and the public health school from the university of Fudan, Shanghai.

In fact, you can consult the complete genome of the virus in the GenBank database.

It corresponds to the following graphic sequence.

Coronavirus genome sequence

Figure XVI. SARS-CoV-2 complete genome sequence.

Sample collection

In order to collect samples, we need to extract them through venous puncture and store it in a vacutainer. I have not been able to find if it is necessary to use an anticoagulant for the sample or not.

According to the indications of the WHO, the respiratory samples need to be from both the upper and lower respiratory tract:

  • Nasopharyngeal sample
  • Oro-pharyngeal sample
  • Sputum by expectoration or endotracheal suction, depending on the respiratory capacity. It is advisable to use bronchoalveolar lavage for those patients who have respiratory support
Preserve these samples at 4ºC until performing the diagnosis in a laboratory by a virology specialist.

Myths

There are many myths surrounding the virus. I do not want to talk too much about this. In fact, you can consult everything in the WHO website, but:

There is no cure or vaccine for the virus yet, which is why…

  • The virus will not go away if we sweat a lot (hot baths or physical exercise) or with ice baths.
  • Garlic does not cure the virus.
  • Mosquitoes or domestic pets do not spread the virus (according to the information that we have).
  • PLEASE! Do not use antibiotics, it is a virus, not a bacteria.
  • The products that come from China are not contaminated.
  • This virus resists high and low temperature, which is why the lower infection rate in places like Greenland or Africa is exclusively due to the lower circulation rate than the weather.
  • We still do not know how long the virus can survive on surfaces, so avoid touching things in public domains.

Advice

The best thing you can do is take care of yourself, sleep well and rest in general.

If you feel sick, isolate yourself and wait to recover from what may possibly be just a cold. If the symptoms get worse, call the emergency number and calm down.

Your chances to survive an infection are very high if you are not at risk.

Meme

Figure XVI. A meme, laugh and relax.

Bibliography

Study 1-10

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  9. Hemilä, H. (2017). Zinc lozenges and the common cold: a meta-analysis comparing zinc acetate and zinc gluconate, and the role of zinc dosage. JRSM Open, 8(5), 205427041769429.
  10. Hemilä, H., & Chalker, E. (2013). Vitamin C for preventing and treating the common cold. Cochrane Database of Systematic Reviews, 2013(1), CD000980–CD000980.

Study 11-18

  1. Kogan, A., Segel, M. J., Ram, E., Raanani, E., Peled-Potashnik, Y., Levin, S., & Sternik, L. (2019). Acute Respiratory Distress Syndrome following Cardiac Surgery: Comparison of the American-European Consensus Conference Definition versus the Berlin Definition. Respiration, 97(6), 518–524.
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Study 19-27

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  9. Zu, Z. Y., Jiang, M. Di, Xu, P. P., Chen, W., Ni, Q. Q., Lu, G. M., & Zhang, L. J. (2020). Coronavirus Disease 2019 (COVID-19): A Perspective from China. Radiology, 200490.
Coronavirus: A Critical Approach Review

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About Alfredo Valdés
Alfredo Valdés
A specialist in Pathophysiology and biomolecular effects on nutrition and sportive activity who will show you the elaborate world of sports nutrition in his articles, employing a simple and critical writing.
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