COVID-19: Symptoms, diagnosis and treatment

When I was in medical school I thought I had quite a few diseases that we read about. When I was in my second year I felt a lump in my neck that I thought for sure was Hodgkin’s disease. Almost 30 years later, the lump is still there and no Hodgkin’s. How about now? Raise your hand if you have said any of these things over the past couple of weeks: “My throat is a little sore.” “I just coughed.” “Is my forehead warm?” I had to pause typing because my hand was up.

These are all important questions because it is coming. The wave of COVID-19 cases in the Chicago area is behind that of New York. Yet we’re a big city, living and working one on top of another, so the disease will hit us, hard. Let’s hope as much as possible you were able to heed our early call for social distancing and Shelter at Home.

Even still, folks that did heed that call have gotten sick. We have three confirmed cases of COVID-19 in the practice with another four or five suspected cases. Today I’m going to run through what YOU should do if you think you have it. Keep in mind, what I write today could change tomorrow, but we’re trying to do the best we can to stay on top of things. PLEASE, members of Harper Health are welcome to call their provider anytime! We are here and eager to talk to you about what you’re experiencing. We are doing lots of phone calls and telehealth visits.

How do you get COVID-19?

I think it’s important to review the way we can acquire the virus that causes COVID-19. SARS-CoV-2 is in the family of viruses that cause the common cold. So, you could get the virus the same way you get the common cold. The primary way that we acquire the virus is by being in close proximity to someone who has the virus and they share it. We used to think that the person had to be sick with COVID-19 to share it with a cough or sneeze, but we now think that people who have no symptoms can infect others with whom they are in close proximity. That’s the reason we have slowed traffic into our practice locations. That is also the reason we recommended that you practice social distancing and then stay at home. If you are in limited contact with others, your chance of getting the illness goes down. Six foot zone of safety!

A second way we can acquire the virus is via fomites. If someone with the virus touches a surface with their dirty hands, that surface will hold the virus for a while. If the surface isn’t disinfected, a non-infected person could come by and TOUCH the surface and then TOUCH their mouth or nose potentially leading to infection. The virus does not jump from our hands to our face. We have to get it there. WASH YOUR HANDS!

A third way is fecal-oral. Ew. Yes, research has demonstrated that the virus can shed into the poop. While the CDC hasn’t updated their website to reflect this, we believe that if someone is sick with COVID-19 and they don’t properly wash their hands after using the washroom, their hands can become a vector for transmission. So does the toilet they just used. Ya. Ew. WASH YOUR HANDS (and disinfect the toilet)!

 What are the symptoms of COVID-19?

So, let’s say you get exposed. It takes about five to seven days for you to begin to express symptoms. The classic triad is fever, cough and shortness of breath, but we’ve seen other symptoms, too. The big one: FEVER. A persistent daily fever is typical. What is a fever? It’s a temperature over 100.5. We normally run about 98.6, so if you pop around 100, that’s a fever and you should call us. A mild sore throat is a common early sign, too. We’ve also seen fatigue – feeling like you’re just completely wiped out with no energy. The cough with COVID-19 is typically dry – not a lot of sputum. A couple of our patients have had pretty bad chest pain in the absence of significant cough and breathlessness. Short wind is another common feature, but that typically comes a bit later and in more severe cases. We definitely want to know about your symptoms before it gets this far. Please. Nasal congestion is rare as is sneezing, runny nose and symptoms like that.

What about this issue of loss of smell? While this is NOT seen in a large majority of cases of COVID-19, the presence of it raises suspicion. If you have a loss of the sense of smell (and the sense of taste that goes along with it) please reach out. If you don’t have this problem but have other symptoms, it does not rule out COVID-19.

If you have any of these problems or any concerns, please reach out so one of the Harper Health team members can talk with you.

How is COVID-19 diagnosed?

Some of you have called us when one of your children has had strep throat. You call because you have a fever and sore throat and tender lymph nodes in the neck. We sometimes say, “It’s likely you have it. We’ll just treat you.” That’s called a clinical diagnosis. In some cases, we have you come in, swab the throat, make the diagnosis and then treat. That is a confirmed diagnosis.

Do we need to confirm COVID-19 or can it be a clinical diagnosis? This is a HUGE question and will definitely change over the next 1-2 weeks. As I have said previously, the United States system is WOEFULLY behind on testing. There aren’t a lot of tests available and getting one has been a challenge. Yet I know many of you are anxious. You’ve seen the reports from Italy and New York so you want to know: “Do I have it???” I want to reassure you: 8 out of 10 people with COVID-19 have a mild case and it looks like at least 99 out of 100 people who get it will recover and become immune. For the most part, if you have it you’ll be fine.

So, why test for a disease? With strep throat, we test so we can treat. Without known proven treatments (see below) for COVID-19, there isn’t a lot of value RIGHT NOW to confirming a case. So, if you have suspicious symptoms we will likely make a clinical diagnosis of COVID-19 and treat you as if you have it (see below).

We’re reserving testing for people who are at high risk themselves and for those in contact with folks who are at high risk. Why? Testing in and of itself is risky to us, so we want to reserve testing at our clinic for those who are at high risk. According to the CDC it’s:

1.       People over the age of 65

2.       People who live at a nursing home or long term care facility

3.       Other high risk conditions

-          People with chronic lung disease or moderate to severe asthma

-          People who have serious heart conditions

-          People who are immunocompromised including cancer treatment

-          People of any age with severe obesity (body mass index [BMI] >40) or certain underlying medical conditions, particularly if not well controlled, such as those with diabetes, renal failure, or liver disease might also be at risk

4. People who are pregnant should be monitored since they are known to be at risk with severe viral illness, however, to date data on COVID-19 has not shown increased risk

Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications.” We are doing our best to reach out to those of our patients who are in one of these groups to reinforce the Shelter at Home recommendations and to remind you to call early with any symptoms.

We do have the capability to test people, but the turnaround time with our testing is still 4-7 days. We only do curbside testing and only at the Hinsdale facility. Hopefully soon we’ll have rapid tests; we’re working on that. Those will be a game-changer because depending how good the tests are we can rule out COVID-19 in low risk symptomatic people quicker.

What about treatment?

Whether a clinical or a confirmed diagnosis, we need to treat and protect those around you. There are two parts to caring for you once you’ve been diagnosed. One is directly treating you and the other is protecting those around you from getting sick, too. We don’t want to assume that everyone you have allowed in your six foot zone of safety is infected. So, once you get the clinical or confirmed diagnosis of COVID-19 you need to ISOLATE. This is different than social distancing and more strict. What does ISOLATION mean:

1.       If possible, separate yourself in a room all by yourself

2.       Use a separate bathroom. If not possible, disinfect the bathroom after you use it

3.       Don’t share towels, bedding, dishes or any other personal items. These items, if they are to be used by someone else, need to be washed thoroughly before use by someone else

4.      If you venture out of your room into common areas, such as the kitchen, make sure no one else is there. Disinfect all surfaces prior to returning to your room

5.       You need to self-isolate until your symptoms are gone, and for at least seven days from when your first symptom appeared. The CDC does give us some guidance, yet we will customize it for your particular situation.

Right now there are no proven direct treatments for COVID-19. It’s all just supportive: fluids, medicine for fever, and oxygen if required. If we feel you need oxygen, you need to be in the hospital. Over-the-counter symptom medications can be used, too. What over-the-counter medications might be good to help with your symptoms?

1.       Fever: acetaminophen/paracetamol/Tylenol.

2.       Cough/mucus: guaifenesin/dextromethorphan (Mucinex DM or the generic)

There is NO significant evidence that these supplements will help but if you want to try something, in the short term these may be helpful with little potential for harm. If your provider agrees, take them three times a week if you’re not sick. Take daily if you are, but please let us (or your own doctor) know if you are having symptoms and start taking supplements.

1.       Vitamin C (EmergenC) – 2000mg

2.       Zinc (Zicam) – 50mg

3.       Vitamin D/K (Xymogen)  – 5000IU

There are some other supplements that have been discussed such as elderberry and quercetin and we're not ready to suggest those. We had our supplement partner, Xymogen, create anti-viral packs which added some other ingredients. Those went fast, and we’ll let you know when they become available again.

Are ibuprofen/Motrin/Advil and other NSAIDS like naproxen/Aleve safe? Likely yes. There are not a lot of data that ibuprofen or other NSAIDs are bad for you if you have COVID-19. They were using it in China and they didn’t see that it was making people worse. The French Ministry of Health, not a doctor, put out a recommendation to not use it, but it seems the recommendation was early and based just on a speculated mechanism, not a true analysis of research. That being said, we have choices. And acetaminophen is safer than NSAIDs in most populations anyway. So, we recommend that folks who need a pain reliever use acetaminophen first line. If you take an NSAID for a medical reason (arthritis, for example), DON’T STOP the medication before reaching out to your provider.

Chloroquine, hydroxychloroquine and other specific drugs? Will they help? A lot more research need to be done to see where these medications fit in the treatment and prevention landscape. Active research is being done in multiple centers. We suspect that there will be a role, but we aren’t 100% sure yet and these medications aren’t without risk. I have one patient who takes hydroxychloroquine for a rheumatologic reason and I hope excess demand doesn’t prevent her from getting her supply.

Can I find out if I have been infected and whether I could get COVID-19 again?

This is an evolving question, also. Recent reports seem to suggest that the mutation rate of this particular virus is low, so that once you get it, you might be immune to it for a long time. It would also make sense that if in a few years it did change enough to re-infect you, the immunity you have built up against SARS-CoV-2 would prevent your illness from getting too bad.

We are waiting for a test to come out that will show if you’re immune to it. We have similar IgG tests that tell us if you’re immune to infections such as measles. I’ve read reports that Mount Sinai Hospital in NYC is developing a test that will prove immunity to SARS-CoV-2, and they’ve moved from the lab to the hospital for testing. I’m sure other places are developing similar tests. This will be welcome, as if we know we’re immune we can be around vulnerable people—and go to work—with some comfort.

What about a vaccine?

We’re still at least a year away from a vaccine specific to SARS-CoV-2. We can’t count on this in the short term.

Some have asked whether the pneumonia vaccine will help people against the pneumonia that one gets with bad COVID-19. No. The Pneumovax and Prevnar vaccines protect folks against pneumonia caused by certain strains of streptococcus pneumoniae (pneumococcus). This is a specific bacteria that causes a good percentage of pneumonias in the over-65 population and otherwise at-risk folks. These vaccines will NOT protect people against COVID-19 viral pneumonia, but MAY protect vulnerable populations against secondary pneumonia, meaning you get COVID-19 and your immune system is down and pneumococcus comes along and infects you. We don’t vaccinate everyone against pneumococcus, just those over 65 and those with diseases that put them at risk for pneumococcal pneumonia. Giving at-risk folks these vaccines is part of our routine annual physical. Should we vaccinate EVERYONE just in case? Well the vaccine manufacturers would love that, but there are no recommendations to do this, yet.

We hope this information helps you know what to look for in yourself and family members and how to take early action. If you ARE taking early action, please let us know, because we want to be in close contact with any of our patients who we suspect have COVID-19.