How is coronavirus diagnosed & what is the treatment for it?
The following are frequently asked questions by medical professionals regarding the coronavirus disease 2019 (COVID-19).
What is the treatment for confirmed coronavirus cases in Taiwan?
We give all patients the best supportive care, including intensive care ventilatory support and extracorporeal membrane oxygenation (ECMO) in life-threatening severe cases. Patients can get compassionate use of remdesivir if clinically indicated. Physicians treating COVID-19 patients are also kept informed on the evolving evidence on other potentially beneficial treatments, such as hydroxychloroquine.
Are anti-HIV and anti-malaria drugs effective against COVID-19?
As yet, there is no strong evidence that antiretroviral drugs used to treat HIV can be used to treat COVID-19. Several studies have shown promising results, however, the certainty of the evidence is very low due to limitations in the studies.
Clinical trials are also underway with two anti-malaria drugs – chloroquine and hydroxychloroquine. Currently, there is not enough data to assess how effective either of these medicines is in treating COVID-19 or preventing people from getting it.
How long can the virus that causes COVID-19 live on surfaces?
According to a recent study published in the New England Journal of Medicine, SARS-CoV-2, the virus that causes COVID-19, can live in the air and on surfaces for between several hours and several days. The study found that the virus is viable for up to 72 hours on plastics, 48 hours on stainless steel, 24 hours on cardboard, and 4 hours on copper. It is also detectable in the air for three hours.
How do coronaviruses differ from the viruses that cause the common cold and seasonal flu?
All three are what we would call RNA viruses (their genomes are made of RNA, not DNA) and all three are respiratory viruses. But all three are distinct in terms of their genetics, how the particles are put together, and in the severity of the disease that they can cause. Virologists use several characteristics to classify viruses.
For instance, coronaviruses and influenzaviruses have a lipid envelope (membrane) around the capsid (protein shell) and rhinoviruses, which cause the common cold, do not.
How does a vaccine work?
Vaccines reduce the risks of getting a disease by working with your body’s natural defenses to build protection. When you get a vaccine, your immune system responds by:
- Recognizing the invading germ, such as the virus or bacteria.
- Producing antibodies. Antibodies are proteins produced naturally by the immune system to fight disease.
- Remembering the disease and how to fight it. If you are then exposed to the same germ in the future, your immune system can quickly destroy it before you become unwell.
A vaccine is therefore a safe and clever way to produce an immune response in the body, without causing illness. Our immune systems are designed to remember. Once exposed to one or more doses of a vaccine, we typically remain protected against a disease for years, decades, or even a lifetime. This is what makes vaccines so effective. Rather than treating a disease after it occurs, vaccines prevent us in the first instance from getting sick.
Which body fluids can spread infection?
SARS-CoV-2 RNA has been detected in upper and lower respiratory tract specimens, and the SARS-CoV-2 virus has been isolated from upper respiratory tract specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in blood and stool specimens, and the SARS-CoV-2 virus has been isolated in cell culture from the stool of some patients, including a patient with pneumonia 15 days after symptom onset. The duration of SARS-CoV-2 RNA detection in upper and lower respiratory tract specimens and extrapulmonary specimens is not yet known but may be several weeks or longer. A duration of several weeks or longer has been observed in cases of MERS-CoV or SARS-CoV infection. While viable, infectious SARS-CoV has been isolated from respiratory, blood, urine, and stool specimens, viable, infectious MERS-CoV has only been isolated from respiratory tract specimens. It is not yet known whether other non-respiratory body fluids from an infected person including vomit, urine, breast milk, or semen can contain viable, infectious SARS-CoV-2.
Should a chest CT be used for diagnosis of COVID-19
Clinicians considering the use of chest CT scans for diagnosis or management of COVID-19 patients should consider whether such imaging will change clinical management. The American College of Radiology (ACR) recommends that CT should not be used to screen for COVID-19, or as a first-line test to diagnose COVID-19, and that CT should be used sparingly and reserved for hospitalized, symptomatic patients with specific clinical indications for CT. Appropriate infection control procedures should be followed before scanning subsequent patients. For more information see ACR Recommendations for the use of Chest Radiography and Computed Tomography (CT) for Suspected COVID-19.
How is coronavirus diagnosed with real-time RT-PCR?
A sample is collected from parts of the body where the coronavirus gathers, such as a person’s nose or throat. The sample is treated with several chemical solutions that remove substances, such as proteins and fats, and extracts only the RNA present in the sample. This extracted RNA is a mix of a person’s genetic material and, if present, the coronavirus’ RNA.
The RNA is reverse transcribed to DNA using a specific enzyme. Scientists then add additional short fragments of DNA that are complementary to specific parts of the transcribed viral DNA. These fragments attach themselves to target sections of the viral DNA if the virus is present in a sample. Some of the added genetic fragments are for building DNA strands during amplification, while the others are for building the DNA and adding marker labels to the strands, which are then used to detect the virus.
The mixture is then placed in an RT-PCR machine. The machine cycles through temperatures that heat and cool the mixture to trigger specific chemical reactions that create new, identical copies of the target sections of viral DNA. The cycle repeats over and over to continue copying the target sections of viral DNA. Each cycle doubles the previous amount: two copies become four, four copies become eight, and so on. A standard real-time RT-PCR setup usually goes through 35 cycles, which means that by the end of the process, around 35 billion new copies of the sections of viral DNA are created from each strand of the virus present in the sample.
As new copies of the viral DNA sections are built, the marker labels attach to the DNA strands and then release a fluorescent dye, which is measured by the machine’s computer and presented in real-time on the screen. The computer tracks the amount of fluorescence in the sample after each cycle. When the amount goes over a certain level of fluorescence, this confirms that the virus is present. Scientists also monitor how many cycles it takes to reach this level to estimate the severity of the infection: the fewer the cycles, the more severe the viral infection is.
How is coronavirus diagnosed with nucleic acid amplification tests?
Nucleic acid amplification testing requires respiratory samples from the patient because SARS-CoV-2 is a respiratory virus. Nasopharyngeal swabs are most commonly used. Lower respiratory secretions, such as sputum and bronchoalveolar lavage fluid, are also used if a patient has pneumonia or lung involvement with infection.
Samples are then processed and tested for SARS-CoV-2 RNA. The test includes extraction of RNA from the patient specimen, conversion to DNA, and PCR amplification with SARS-CoV-2-specific primers.
How are antibody tests performed?
The immune system naturally produces proteins, called antibodies, in response to infection. Antibodies recognize and bind to foreign molecules, called antigens, on the surface of pathogens. When an antibody binds to an antigen, it seeks to disable the associated pathogen through direct or indirect mechanisms.
Blood samples are used as the specimen type for antibody testing. SARS-CoV-2-specific antigens (SARS-CoV-2 spike or nucleocapsid proteins) are mixed with the patient’s blood, and if antibodies to SARS-CoV-2 are present in the blood, the two will bind to one another, resulting in a color change that marks the test positive.
It’s important to recognize that this test measures the number of antibodies produced in response to SARS-CoV-2 infection and does not test for the presence of the virus itself. Therefore, it does not indicate if a person is currently infected.
What does antibody testing reveal?
Antibody tests tell us if a person has been exposed to a virus or other infecting microorganisms. They detect the presence of antibodies that are produced in response to infection. Antibody tests will also identify if a person has been exposed to SARS-CoV-2 and developed immunity against SARS-CoV-2 infection.
Why did some patients test positive after having recovered from COVID-19?
This initially caused concerns, as experts feared the results might suggest patients had been reinfected. However, the World Health Organization has since said the results were false positives, a result of the test picking up particles of the virus within dead lung cells – but this is not an active virus. That’s because the PCR (or “have-you-got-it”) test is based on detecting genetic material from the virus – on its own, it does not reveal whether or not that virus is active and infectious.
Is there an accuracy concern with nucleic acid amplification testing?
Molecular tests can yield a false negative result if the level of viral RNA in a particular sample is too low for detection, and results can be skewed if steps are not taken to ensure that the tests are performing properly in the first place.
How long does it take for antibodies to develop?
According to the CDC, it typically takes 1 to 2 weeks for a patient to develop antibodies to SARS-CoV-2. Because of this delay, antibody tests are not currently recommended for the diagnosis of acute cases of COVID-19.
Will the pneumonia or flu vaccine help protect against coronavirus?
Some cases of coronavirus do lead to pneumonia. But pneumonia and flu vaccines do not protect against COVID-19.
According to Harvard Medical School, “Vaccines against pneumonia, such as pneumococcal vaccine and Haemophilus influenza type B (Hib) vaccine, only help protect people from these specific bacterial infections.”
However, other vaccines do help protect against a massive, unnecessary burden on hospitals already overwhelmed with coronavirus patients. The CDC estimates about 140,000 to 810,000 people are hospitalized with the flu every year in the U.S. About half of Americans don’t get vaccinated – including most children who die from the flu.
What is the role of forensic pathologists in a pandemic?
Forensic pathologists are physicians who integrate law and medicine to determine the cause, mechanism, manner, and time of a person’s death. Their everyday work has important legal, social, and economic consequences for family members of the deceased and the larger community.
During a pandemic, forensic pathologists are heavily involved in managing the crisis, either within their local communities or as part of a humanitarian mission working with vulnerable communities abroad.
Their role in these extremely challenging times is to ensure the proper management of dead bodies, minimizing the spread of the virus, and to guide authorities, hospitals and funeral directors about the “do’s and don’ts” of dealing with these bodies.
There is a general assumption in medicine that dealing with the deceased does not require the same urgency as working with an acutely ill patient, and normally that is true. However, in a pandemic like COVID-19, large numbers of the dead can quickly exceed local capacities if not managed promptly.
With highly infectious diseases, it is urgent that the post-mortem procedures – from death, examination, certification, registration and release of the body to safe cremation or burial – flow as properly and smoothly as possible.
Are the bodies of COVID-19 victims infectious?
While a lot is known about the coronavirus family, much is yet to be understood about the transmission modes and effects on the body of SARS-CoV-2, the virus that causes COVID-19. We don’t know whether human remains are infectious, but the likelihood is high. So forensic pathologists around the world are urging governments to restrict viewing and handling of the body after an examination is completed.
During the Ebola epidemic – which claimed around 11,300 lives in West Africa between 2014 and 2015 – handling of the dead was one of the main modes of transmission of the disease. So one of the lessons forensic humanitarians took from this experience – which is now being applied to coronavirus – was that untrained first responders should not be involved in handling human remains during outbreaks of highly contagious diseases.
What should physicians do when they have been exposed to COVID-19?
All health care professionals are at some risk for exposure to COVID-19, whether in the workplace or the community.
Health care professionals in any of the risk exposure categories (high, medium, low, or no risk) who develop signs or symptoms compatible with COVID-19 must contact their established point of contact (public health authorities or their facility’s occupational health program) for a medical evaluation before returning to work.
Facilities could consider allowing asymptomatic health care professionals who have had exposure to a patient with COVID-19 to continue to work after options to improve staffing have been exhausted and in consultation with their occupational health program.
Why is it important to properly maintain drainage pipes and regularly re-fill U-traps?
U-traps serve to stop foul smells and unhygienic substances (including bacteria and viruses) in the drainage system from entering living areas. Defective or dried U-traps could negate this important function. Pour half a liter of water into each drain outlet every week. Besides, one should regularly inspect their drainage pipes, U-traps, and sanitary fittings and arrange immediate repair if the damage is found. Water should also be added to the U-traps regularly to ensure they functioned properly.
Is ozone disinfection effective?
Ozone irritates the eyes and respiratory tract. It can cause serious damage to the lung if inhaled in high concentrations.
If used at concentrations that do not exceed public health standards, ozone applied to indoor air does not effectively remove viruses, bacteria, mold, or other biological pollutants.
Why is this stay at home order necessary?
The COVID-19 pandemic presents an unprecedented health threat to Illinois. To contain the spread of COVID-19, stay at home orders have shown by minimizing contact between people the chance of spreading COVID-19 is greatly reduced.
Can people without symptoms spread the virus?
The short answer appears to be yes, some infected individuals who have not shown symptoms can spread the virus and this remains an issue of great concern. This is why social or physical distancing is considered to be so critical to slowing or reducing the transmission of the virus.
Modeling studies in China and Japan and testing of those on the Diamond Princess cruise ship suggest that a small number of people who are infected do not develop symptoms. We don’t know much about how infectious these asymptomatic individuals might be, that is, how likely they are to spread the disease.
How long does the virus stay on surfaces?
A study published in the New England Journal of Medicine suggests the virus can survive for up to two or three days on some surfaces, particularly hard plastics and steel. It is also easier for people to pick up the virus if they touch these surfaces.
Which chemicals kill the virus?
Any soap or detergent will destroy the virus, as will solutions of bleach and water, Clorox disinfectant wipes, Lysol brand cleaners, Purell, etc.
Can COVID-19 cause long-term lung damage?
At this early stage of the pandemic, there is no evidence to show that permanent or long-term lung damage is a common consequence of infection. A report from Hong Kong suggests short-term declines in lung function among those recovering from COVID-19.
A recent report by Dr. Keith Mortman of George Washington University Hospital, circulated widely in the media, provides a graphic description of the extensive damage to the lungs caused by COVID-19 in otherwise healthy patients.
However, these reports describe currently ill or newly recovered victims of the disease. It is still too soon to know whether the damage caused by the infection is permanent or long-term.
Should I take ivermectin to prevent or treat COVID-19?
No. While there are approved uses for ivermectin in people and animals, it is not approved for the prevention or treatment of COVID-19. You should not take any medicine to treat or prevent COVID-19 unless it has been prescribed to you by your healthcare provider and acquired from a legitimate source.
What should children and adults with congenital heart defects, or those caring for them, be doing?
They should be doing the same as everyone else in terms of prevention and precautions. In addition, continue your regular medications and call your physician if there are any new symptoms or problems.
What do I need to know about the coronavirus if I have high blood pressure or diabetes?
Because of your condition, you face higher risks of complications from COVID-19 if you contract the disease, which makes caution extremely important. Do everything possible to avoid exposure to the coronavirus. Staying away from other people is critically important — especially if you are in your 60s or older. And don’t forget the safety basics: handwashing with soap and water for at least 20 seconds, not touching surfaces, and cleaning surfaces diligently.
If you are diagnosed with COVID-19, you should be fully evaluated before adding or removing any treatments. High blood pressure patients and diabetes patients should both keep in mind that your overall medical condition is much better if your blood pressure and diabetes are optimally controlled.
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