What is Features, Evaluation, and Treatment of Coronavirus (COVID-19)?
COVID-19 is an incredibly infectious disease caused by the virus known as SARS-CoV-2. The disease has had devastating impacts around the globe, leading to more than 6 million deaths worldwide. The virus first appeared in Wuhan, China, in late 2019 and quickly spread to all corners of the world, leading the World Health Organization (WHO) to declare it a global pandemic in March 2020.
Even though lots of progress has been made in understanding the SARS-CoV-2 virus, repeated outbreaks are still happening in many countries. These outbreaks are largely due to different versions of the virus, called mutant variants, that have evolved over time. Like other RNA viruses, SARS-CoV-2 changes over time and develops mutations, resulting in these new variants. Some of these variants may behave differently compared to their original versions. There are many variants now, but only a few are considered variants of concern by the WHO. These include:
- Alpha: First found in the UK in late 2020.
- Beta: First seen in South Africa in December 2020.
- Gamma: First identified in Brazil in early 2021.
- Delta: First reported in India in December 2020.
- Omicron: Found in South Africa in November 2021.
Though vaccines against COVID-19 have been developed at an unheard-of pace and vaccination programs are being carried out worldwide, the emergence of new SARS-CoV-2 variants can potentially disrupt the progress made to control the disease. This article aims to provide a broad overview of the causes, spread, physical effects, and symptoms of COVID-19. It also outlines the different SARS-CoV-2 variants and the treatment recommendations (as of January 2023) for managing this disease.
What Causes Features, Evaluation, and Treatment of Coronavirus (COVID-19)?
Coronaviruses are RNA viruses that have a “crown” appearance under an electron microscope due to spiked proteins on their surfaces—hence the name, which comes from the Latin word for crown. These viruses come from four main groups: alpha, beta, delta, and gamma.
Research has shown that bats and rodents are likely sources of the alpha and beta types, while birds seem to be the source of the delta and gamma types. Coronaviruses can cause various diseases in animals such as camels, cattle, cats, and bats, affecting the lungs, intestines, liver, and nervous system. These viruses can also jump from animals to humans.
Seven types of coronaviruses can infect humans—their discovery occurred between the mid-1960s and early 2000s. On average, roughly 2% of the population are healthy carriers of coronaviruses, responsible for up to 10% of acute respiratory infections.
These human coronaviruses include common ones such as HCoV-OC43, HCoV-HKU1, HCoV-229E, and HCoV-NL63, which usually cause mild cold-like symptoms. But for people with weakened immune systems or in older patients, these viruses can lead to more serious lower respiratory tract infections.
More severe coronaviruses include SARS-CoV and MERS-CoV, known for their ability to cause serious respiratory disease outbreaks. SARS-CoV-2, the virus that causes COVID-19, is a new strain of coronavirus related to SARS-CoV and MERS-CoV.
SARS-CoV-2 is vulnerable to heat and sunlight but can survive at lower temperatures. Researchers are still studying how best to inactivate it, but they found that the virus can be neutralized on a stainless steel surface at a temperature of 130 degrees Fahrenheit within roughly 36 minutes. Certain lipid solvents, such as ethanol and a chlorine-containing disinfectant, can also effectively inactivate these viruses.
Scientists believe that SARS-CoV-2 originated from bats, although other animals like pangolins and minks could have served as intermediaries before infecting humans. The virus has since evolved into different strains, or “variants”, with varying levels of severity and transmissibility.
One of the latest and most vivid of these is the Omicron variant. Identified in South Africa in November 2021, the Omicron variant has caused concern due to its numerous mutations and rapid spread. These mutations affect the spike protein, part of the virus that helps it enter human cells, potentially increasing the virus’s ability to latch onto and infect cells.
The primary way to catch SARS-CoV-2 is through exposure to respiratory droplets—tiny bits of fluid expelled when someone with the virus talks, coughs, or sneezes. Touching surfaces contaminated with the virus and then touching the face can lead to infection too, but this is thought to be a less common route of transmission. There’s also evidence indicating that the virus can be found in the stools of infected individuals, suggesting a possible route of infection through contaminated food or water. Vertical transmission (from mother to baby during pregnancy) is possible but rare.
Risk Factors and Frequency for Features, Evaluation, and Treatment of Coronavirus (COVID-19)
In 2020, COVID-19 was the third leading cause of death in the U.S., following heart disease and cancer, causing about 375,000 deaths. Everyone can catch this disease, but some people are at higher risk, such as those over 60 years old and people with preexisting conditions like obesity, heart disease, kidney disease, diabetes, lung disease, smokers, cancer patients, and those who have had organ or stem cell transplants.
- The chance of becoming seriously sick or dying from COVID-19 increases with age, and age is the most significant factor for severe disease. Those aged 50-64 have 25 times the risk compared to those younger than 30. The risk increases to 60 times for those aged 65-74 and 340 times for individuals over 85 years old.
- People with preexisting medical conditions were six times more likely to need hospitalization and twelve times more likely to die than those without such conditions.
- Men are also at a greater risk of severe illness and death from COVID-19 compared to women. A study found a higher death rate in men (12.5%) compared to women (9.6%) in the U.S.
- Racial and ethnic minorities have a higher percentage of COVID-19-related hospitalizations than White patients. Minority groups like Black, Hispanic, and Asian communities are at increased risk of getting and dying from the disease.
- Among all, the death rates were the highest in Hispanic communities. Also, members of sexual minorities were found to have a higher prevalence of the preexisting conditions that increase the risk of severe COVID-19, across the general population and within specific racial and ethnic groups.
Signs and Symptoms of Features, Evaluation, and Treatment of Coronavirus (COVID-19)
The virus that causes COVID-19 usually takes around 5.1 days to produce symptoms after infection. However, not everyone with the virus will exhibit symptoms. It’s estimated that between 17.9% and 33.3% of infected individuals show no symptoms at all.
Typically, people who do show symptoms experience fever, cough, and shortness of breath. Less commonly, they could have a sore throat, loss of smell or taste, fatigue, muscle pain, and diarrhea among others. Some infected individuals may also exhibit abnormal lab results such as low levels of lymphocytes and increased levels of proteins associated with inflammation (C-reactive protein), liver enzymes, and more.
There are different levels of severity for COVID-19.
- Asymptomatic or Presymptomatic Infection: People test positive for the virus but do not show any symptoms.
- Mild Illness: People experience symptoms like fever, cough, sore throat, nausea, vomiting but do not have any shortness of breath or abnormal chest imaging.
- Moderate Illness: People have evident symptoms or evidence of a lung-related disease on an imaging test, and their blood oxygen level is at least 94% at room temperature.
- Severe Illness: People have a blood oxygen level less than 94% at room temperature, a respiratory rate of more than 30 breaths per minute, or lung infiltrates that cover more than 50% of their lungs.
- Critical Illness: People suffer from breathing failure, septic shock, or failure of multiple organs.
Some COVID-19 patients can develop ARDS (Acute Respiratory Distress Syndrome), typically about one week after symptoms start. ARDS causes intense breathing difficulties and often requires a ventilator.
The risks with COVID-19 are not only limited to the lungs. Other issues may include kidney injury, which is the most common non-respiratory problem in those diagnosed with the virus. Heart problems and abnormal signs in the blood such as high levels of clotting factors are also common. Gastrointestinal symptoms like diarrhea, vomiting, loss of appetite, and abdominal pain can occur too. Some might even experience neurological and skin conditions.
Testing for Features, Evaluation, and Treatment of Coronavirus (COVID-19)
Diagnostic Testing in COVID-19
– A nasopharyngeal swab for SARS-CoV-2 nucleic acid using a real-time PCR assay is the standard diagnostic test.
– Commercial PCR assays have been authorized by the USA Food and Drug Administration (FDA) for the qualitative detection of SARS-CoV-2 virus using specimens obtained from nasopharyngeal swabs as well as other sites such as oropharyngeal, anterior/mid-turbinate nasal swabs, nasopharyngeal aspirates, bronchoalveolar lavage (BAL) and saliva.
– The sensitivity of PCR testing depends on multiple factors, including the specimen’s adequacy, time from exposure, and specimen source.
– However, the specificity of most commercial FDA-authorized SARS-CoV-2 PCR assays is nearly 100%, provided there is no cross-contamination during specimen processing.
– SARS-CoV-2 antigen tests are less sensitive but have a faster turnaround time than molecular PCR testing.
– Despite the numerous antibody tests designed to date, serologic testing has limitations in specificity and sensitivity, and results from different tests vary.
– According to the NIH guidelines, diagnosing acute SARS-CoV-2 infection based on serologic testing is not recommended.
– There is insufficient evidence to recommend for or against using serologic testing to assess immunity, even if it is used to guide clinical decisions about COVID-19 vaccines/monoclonal antibodies.
Other Laboratory Assessment
- – Complete blood count (CBC), a comprehensive metabolic panel (CMP) that includes renal and liver function testing, and a coagulation panel should be performed in all hospitalized patients.
- – Additional tests, such as ESR, C-reactive protein (CRP), ferritin, lactate dehydrogenase, and procalcitonin, can be considered in hospitalized patients. However, their prognostic significance in COVID-19 is not clear.
- – A D-dimer level is required as it guides the use of therapeutic versus prophylactic doses of anticoagulation.
Imaging Modalities
– This viral illness commonly manifests as pneumonia, so radiological imaging such as chest x-rays, lung ultrasounds, and chest computed tomography (CT) are often obtained.
– When obtained, the chest X-ray usually shows bilateral multifocal alveolar opacities. Pleural effusions can also be demonstrated.
– The most common CT chest findings in COVID-19 are multifocal bilateral ground glass opacities with consolidation changes, usually in a patchy peripheral distribution.
– Radiologic imaging is not a sensitive method for detecting this disease. A retrospective study of 64 patients with documented COVID-19 reported that 20% had no abnormalities on chest radiographs during the illness.
– A chest CT is more sensitive than a radiograph but is not specific. No finding on radiographic imaging can completely rule in or rule out COVID-19 illness. Therefore the American College of Radiology (ACR) advises against the routine use of chest CT for screening or diagnosis of COVID-19.
Treatment Options for Features, Evaluation, and Treatment of Coronavirus (COVID-19)
The National Institutes of Health (NIH) states that the two main processes leading to COVID-19 are the replication of the virus in the early stages of the illness and a strong immune response that can lead to tissue damage in the later stages. Therefore, the recommended treatments are antiviral medications to stop the virus from replicating in the early phase, and medications that modulate the immune response in the later phase.
The only antiviral drug the Food and Drug Administration (FDA) has approved for COVID-19 is Remdesivir. Other medications like ritonavir-boosted nirmatrelvir and molnupiravir, as well as high-titer COVID-19 convalescent plasma have been authorized for emergency use. There are also monoclonal antibodies that have received emergency use authorizations, however, some have been revoked as they became ineffective against newer variants of the virus.
The latest NIH treatment guidelines as of January 3rd, 2023, recommend against using certain treatments like dexamethasone or other systemic corticosteroids in patients who do not show signs of low blood oxygen levels. In high-risk patients, they recommend ritonavir-boosted nirmatrelvir, which has shown success in reducing hospitalization and death rates in high-risk, non-vaccinated, non-hospitalized patients when given early into the onset of symptoms.
Remdesivir, another treatment option, is a medicine that inhibits the virus that causes COVID-19. Molnupiravir is an antiviral agent that comes with certain risks and should only be used if both ritonavir-boosted nirmatrelvir and remdesivir are unavailable or cannot be given. Pregnant patients should avoid this medication due to the risk of genotoxicity (ability to damage DNA).
For hospitalized adults suffering from COVID-19, but not requiring supplemental oxygen, the NIH advises against the use of dexamethasone or other systemic corticosteroids. For hospitalized patients suffering from COVID-19 and requiring oxygen, they recommend a treatment mask that includes dexamethasone plus remdesivir.
According to the Centers for Disease Control and Prevention (CDC), several conditions are associated with a higher risk of severe COVID-19. These include asthma, cancer, kidney disease, liver diseases, mental health conditions, obesity, smoking, and several others.
The authorities advise against using certain drugs for treating COVID-19, including chloroquine, hydroxychloroquine, azithromycin, among others.
For protection against infection with SARS-CoV-2, the NIH recommends tixagevimab plus cilgavimab, which are powerful neutralizing antibodies obtained from patients infected with the SARS-CoV-2 virus.
What else can Features, Evaluation, and Treatment of Coronavirus (COVID-19) be?
The early signs of this disease can be quite generic, making it hard to identify. A doctor will need to consider a variety of illnesses that affect the lungs and can be either contagious or not, before making a diagnosis. These can include:
- Pneumonia that’s caught in everyday life
- Viral pneumonia, which is a lung infection caused by a virus
- The flu
- Aspiration pneumonia, which can occur when you accidentally inhale food or drink
- Pneumocystis jirovecii pneumonia, a type of fungal pneumonia
- MERS (Middle East respiratory syndrome)
- Various forms of the bird flu
- Tuberculosis, a contagious bacterial lung disease
What to expect with Features, Evaluation, and Treatment of Coronavirus (COVID-19)
The outcome of COVID-19 is influenced by several factors, including a person’s age, the severity of the disease when they first sought treatment, any pre-existing health conditions, how quickly they received treatment, and how well they responded to that treatment. The World Health Organization (WHO) currently estimates that 2.2% of all confirmed COVID-19 cases globally have resulted in death.
A study based in Europe, which monitored a group of 4000 severely ill COVID-19 patients, reported that 31% of them died within 90 days. Elderly patients, as well as patients with diabetes, obesity, and severe Acute Respiratory Distress Syndrome (a severe lung condition), were noted to have a higher chance of mortality.
Possible Complications When Diagnosed with Features, Evaluation, and Treatment of Coronavirus (COVID-19)
COVID-19 is a virus that affects several key body systems. It’s particularly dangerous for older adults and those with existing health conditions like obesity, diabetes, lung disease, heart disease, kidney disease, liver disease, and certain types of cancer. Severe COVID-19 can cause a decline in health leading to respiratory failure, acute respiratory distress syndrome (ARDS), or multiple organ failure, which can be deadly.
Additionally, those suffering from COVID-19 are at a higher risk of developing blood clot-related complications like lung clots, heart attacks, strokes, and arterial blood clots.
Here’s a list of the complications associated with Coronavirus:
- Respiratory failure
- Acute respiratory distress syndrome
- Multiple organ failure
- Blood clot-related complications
- Heart-related issues including abnormal heart rhythms, heart muscle damage, and shock caused by heart issues
- Digestive problems like poor blood supply to the bowels, liver inflammation, gastrointestinal bleeding, pancreatitis, Ogilvie syndrome, bowel area poor blood supply, and severe inactivity of the intestine
- Acute kidney failure
- Increased likelihood of developing disseminated intravascular coagulation, a condition that causes blood clots and bleeding
Sometimes, after people recover from a COVID-19 infection, some continue to experience symptoms. This is referred to as “post-acute COVID-19 syndrome.” A six-month follow-up study found that several patients reported lasting symptoms such as fatigue, muscle weakness, difficulty sleeping, and anxiety. Patients who were very sick during their illness also had a higher chance of having ongoing lung problems.
In a different study including over 200,000 patients, significant cases of brain-related issues (like bleeding and strokes) and mental health problems (like anxiety and psychotic disorders) were reported six months after COVID-19 diagnosis.
People recovering from COVID-19 are at risk of getting secondary fungal infections. Factors increasing this risk include uncontrolled diabetes, diminished white blood cells, and the excessive use of certain medications like corticosteroids.
Preventing Features, Evaluation, and Treatment of Coronavirus (COVID-19)
The National Institutes of Health (NIH) COVID-19 Treatment Guidelines strongly recommend that all eligible individuals get vaccinated against COVID-19 as soon as possible. In the US, this eligibility is determined by the CDC’s Advisory Committee on Immunization Practices. So far, four COVID-19 vaccines have been approved or authorized for use in the country.
According to the NIH, the most recommended vaccines are the Pfizer-BioNTech’s mRNA vaccine BNT162b2, Moderna’s mRNA-1273, and Novavax’s recombinant spike protein with matrix-M1 adjuvant vaccine NVX-CoV2373. The Johnson & Johnson/Janssen’s adenovirus vector vaccine Ad26.COV2.S is considered less preferred due to the potential risk of serious side effects.
Everyone over 6 months of age in the United States is recommended to get a primary series of COVID-19 vaccination. Two months after receiving the primary vaccine series or a booster dose, people are advised to get a bivalent mRNA vaccine, which provides protection against both the original SARS-CoV-2 virus strain and its Omicron subvariants.
