Covid-19: Information and Update

November 12, 2020

Dr. Tom Weida, chief medical officer at University Medical Center and chief COVID-19 officer for The University of Alabama, provided information about the virus (with data as of October 30) during a recent Mini Medical School presentation. Mini Medical School is a partnership of the UA College of Community Health Sciences, which operates UMC, and the University’s OLLI program that provides updates and information about trends in health and medicine. Weida also presented the information at a recent University Medical Center Town Hall. In addition to his chief medical officer role, Weida is associate dean of Clinical Affairs and professor of family medicine for CCHS. Here are key takeaways from his presentation:

Coronaviruses

Coronaviruses comprise a large family of viruses that can cause illness in humans. They include cold viruses (four that are known), Severe Acute Respiratory Syndrome (SARS-CoV-1), Middle East Respiratory Syndrome (MERS) and Coronavirus Disease 2019 (COVID-19)

COVID-19 Emergence

COVID-19 was first identified in Wuhan, China, in December 2019 and is caused by the SARS-Cov-2 virus. Cases spread quickly due to “travel-related exportation,” Weida said. “We live in a mobile society, so it didn’t take long for COVID-19 to spread. No country has been spared, although Greenland and Mongolia have very few cases. The United States is a hotspot.”

There are approximately 45 million cases of COVID-19 in the world; in the U.S., there have been 8.9 million cases of COVID-19 and 228,627 deaths.

In Alabama, the 25 to 49 age group has recorded the most positive cases, Weida said, but hospitalizations have largely occurred among people age 65 and older, particularly those over the age of 85. “When we talk about those who have died, 77% are over the age of 65.”

Weida said 81% of people positive for COVID-19 have mild or moderate cases, while 14% have severe cases and 5% have critical cases. “The case-fatality rate is 2.3%, which is high.” He said for the worst year of the flu, there were 68,000 deaths. “We’ve been with COVID-19 for less than nine months and have had more than 220,000 deaths.”

How COVID-19 Attacks

COVID-19 invades the body’s cells and creates inflammation along blood vessel and cell walls, “making walls leaky and allowing fluid to get through and build up in the lungs. It causes clots to develop and the immune system to go haywire. It’s not just a lung infection; it has impacts to other parts of the body,” Weida said.

How COVID-19 is Transmitted

The virus is spread in particles or droplets in the air that are transmitted between people in close contact. Particles or droplets can travel six feet, but can travel farther when people cough, sneeze, laugh, yell or sign. COVID-19 can live on surfaces, but there must be a certain amount there for a length of time to transmit the virus when surfaces are touched. “Handwashing can take care of this,” Weida said.

Risk of Transmission

Close contact without protective measures is a primary risk of transmission. Current guidelines from the U.S. Centers for Disease Control and Prevention state that close contact is being within six feet of a COVID-19 positive or suspected positive individual for 15 minutes or longer with neither wearing a mask. “It’s believed that approximately 40% to 45% of people infected with COVID-19 have no symptoms,” Weida said.

High-Risk Transmission Areas

Restaurants, gyms, bars, coffee houses, churches, and gatherings in enclosed spaces

Symptoms of COVID-19

Fever or chills (90% of cases), new loss of taste or smell, reported in 64-80% of cases), cough (60-86% of cases), shortness of breath or difficulty breathing (53-80% of cases), fatigue (38% of cases), muscle or body aches (15-44% of cases), diarrhea, nausea or vomiting (15-39% of cases), headache, nasal congestion or runny nose, sore throat and COVID-19 toe, “this is rare and is where toes get red, which we think is caused by small blood clots,” Weida said.

He said some of these symptoms persist beyond 10 to 14 days of COVID diagnosis, including fatigue, joint and chest pain, heart palpitations, shortness of breath, impaired lung function, brain fog, anxiety and depression, headaches, loss of taste and smell and numbness.

Co-morbidities of Hospitalized COVID-19 Patients

Hypertension (48-57% of cases), heart disease (21-28% of cases), diabetes (17-34% of cases), malignancy (6-8% of cases), chronic lung disease (4-10% of cases), chronic kidney disease (3-13% of cases) and chronic liver disease (less than 5% of cases)

Complications of COVID-19

Respiratory failure (17-35% of hospitalized patients; of patients in hospital intensive care units, 29-90% require a ventilator), kidney and liver problems, bleeding and blood clotting disorders, septic shock (infection), cerebral encephalitis (inflammation of the brain), myocarditis (inflammation of the heart), Cytokine Storm (immune system goes haywire), Multi-system Inflammatory Syndrome in Children, although this is occurring in adults as well, Weida said. He said children represent 10% of all COVID-19 hospitalizations, both in Alabama and the U.S.

COVID-19 Positive, Now What?

Isolate for 10 days. “Separate sick people from those not sick, no sharing of items, no visitors,” Weida said.

Quarantine for 14 days. “This comes into play if you were exposed, to see if you become sick. Stay home and away from others as much as possible,” he said.

Treatment for COVID-19

Preventing COVID-19

Masks should be worn in common areas, when you are within six feet of another individual. “Your best protection, best prevention, are masks,” Weida said.

In addition, social distance and stay six feet apart from others; frequent handwashing, for 20 seconds, including when using hand sanitizer; avoid large crowds; avoid indoor gatherings; outdoors is better; and assume everyone is infected.