| Submit your comments on this article |
| -Signs, Portents, and the Weather- |
| A doc's comment on Covid-19 |
| 2020-03-17 |
| [Facebook] Over the past 20 years, several coronaviruses have crossed the species barrier into humans, causing outbreaks of severe, and often fatal, respiratory illness. Since SARS-CoV was first identified in animal markets, global viromics projects have discovered thousands of coronavirus RNA sequences in diverse animals and geographic regions. Unfortunately, there are few tools available to functionally test these viruses for their ability to infect humans, which has severely hampered efforts to predict the next zoonotic viral outbreak. The virus that causes COVID-19 is designated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This virus information is up to date as it can be. Most case patients were 30 to 79 years of age (87%), 1% were aged 9 years or younger, 1% were aged 10 to 19 years, and 3% were age 80 years or older. I am pointing out what may be helpful. Interestingly a lot of studies were in progress on this type of virus right when the pandemic started. They were able to demonstrate how SARS-Cov2 or Covid 19 viruses can gain entry into human cells, and confirm that human Angiotensin converting enzyme 2 or ACE2 is the receptor for the recently emerging SARS-CoV-2 virus. This is not that important to most but those on DPP-4 inhibitors and high blood pressure drugs that block this receptor. Studies are ongoing to see if these drugs help or hurt when we are taking them while infected. If this hypothesis were to be confirmed, it could lead to a conflict regarding treatment because ACE2 that is being blocked reduces lung inflammation and has been suggested as a potential new therapy for inflammatory lung diseases, cancer, diabetes, and hypertension. A further aspect that should be investigated is the genetic predisposition for an increased risk of SARS-CoV-2 infection, which might be due to ACE2 polymorphisms that have been linked to diabetes mellitus, cerebral stroke, and hypertension, specifically in Asian populations. Summarizing this information, the sensitivity of an individual might result from a combination of both therapy and ACE2 polymorphism. Keep aware of this issue if it pertains to you. Research has shown this viral cell-human cell fusion can only take place in the presence of trypsin or proteases (enzymes that cut the spike of the virus to help it bind to the ACE2 receptor and enter the cell). The human respiratory tract of individuals with normal lung function maintains a fine-tuned balance, being asymptomatically colonized by the normal microbiota in the upper airways and sterile in the lower tract. This equilibrium may be disrupted by the exposure to insults such as cigarette smoke, car fumes, irritants and prior viral infection. Be aware your stress affects the microbiome and thus bacteria in a bad way and in the human gastro-intestinal tract commensal bacteria studies we find stress can lead to inflammation which pours these chemicals out. These proteins are called Siropins, which efficiently inhibited two human proteases reported to be associated with inflammatory bowel diseases and viral entry. Pregnant women — Minimal information is available regarding COVID-19 during pregnancy. Intrauterine or perinatal transmission has not been identified. In two reports including a total of 18 pregnant women with suspected or confirmed COVID-19 pneumonia, there was no laboratory evidence of transmission of the virus to the neonate. However, two neonatal cases of infection have been documented from contact with family. Wash hands before and every 10 minutes when handling an infant. SYMPTOMS Pneumonia appears to be the most frequent serious manifestation of infection, characterized primarily by fever, cough, dyspnea, and bilateral infiltrates on chest imaging. There are no specific clinical features that can yet reliably distinguish COVID-19 from other viral respiratory infections. One comment suggested inability to breath hold for 10 seconds. In a study describing 138 patients with COVID-19 pneumonia in Wuhan, the most common clinical features at the onset of illness were: ●Fever in 99 percent The dyspnea (shortness of breath) developed after a median of five days of illness. Acute respiratory distress syndrome developed in 20 percent, and mechanical ventilation was implemented in 12.3 percent. TREATMENT Home care — Home management is appropriate for patients with mild infection who can be adequately isolated in the outpatient setting. We treat like a flu or severe cold and observe for complications. Number two in the management of such patients should focus on prevention of transmission to others. A patient with COVID-19 should stay at home and try to separate themselves from other people and animals in the household. They should wear a facemask when in the same room (or vehicle) as other people and when presenting to health care settings. The animals cannot transmit directly but the virus can be on their fur and mouths. Learn from China - The timing of the COVID-19 outbreak, prior to China’s annual Lunar New Year holiday, was an important factor as China considered how to respond to the outbreak. Culturally, this is the largest and most important holiday of the year. It is the expectation that people return to their family homes, which is the cause for the several billion person-trips made by residents and visitors during this time, mostly on crowded planes, trains, and buses. Knowing this meant each infected person could have numerous close contacts over a protracted time and across long distances, the government needed to quickly act. However, it was not only the speed of the government’s response, but also the magnitude of that response that were influenced by the impending holiday travel time. Knowing that specific treatment and prevention options, such as targeted antiviral drugs and vaccines, were not yet available for COVID-19, China focused on traditional public health outbreak response tactics—isolation, quarantine, social distancing, and community containment. Identified case patients with COVID-19 were immediately isolated in designated wards in existing hospitals, and 2 new hospitals were rapidly built to isolate and care for the increasing numbers of cases in Wuhan and Hubei. People who had been in contact with COVID-19 cases were asked to quarantine themselves at home or were taken to special quarantine facilities, where they could be monitored for onset of symptoms. Enormous numbers of large gatherings were canceled, including all Lunar New Year celebrations, and traffic in Wuhan and in cities across Hubei was restricted and closely monitored. Virtually all transportation was subsequently restricted at a national level. All of these measures were instituted to achieve social distancing. In addition, an estimated 40 million to 60 million residents of Wuhan and 15 other surrounding cities within Hubei Province were subjected to community containment measures. Although these types of traditional outbreak response actions have been successfully used in the past, they have never been executed on such a large scale. Emerging Treatments – In recent studies mercaptopurine and melatonin showed strong effect against this virus. This identified mercaptopurine as a selective inhibitor of both SARS-CoV and MERS-CoV by targeting papain-like protease. Melatonin was reported in potential antiviral infection via its anti-inflammatory and antioxidant effects. Melatonin indirectly regulates ACE2 expression, a key entry receptor involved in viral infection of 2019-nCoV/SARS-CoV-2. Specifically, melatonin was reported to inhibit calmodulin and calmodulin interacts with ACE2 by inhibiting shedding of its ectodomain, a key infectious process of SARS-CoV. In summary, combination of mercaptopurine and melatonin may offer a potential combination therapy for 2019-nCoV/SARS-CoV-2 by synergistically targeting papain-like protease, ACE2, c-Jun signaling, and anti-inflammatory pathways. Several other possible drugs that are already in production are being tested at present. A SERM drug, an aldosterone receptor blocker, 6MP chemo drug, even Paxil (paroxetine) which is an antidepressant all have some theoretical effectiveness. Greg E. Sharon MD |
| Posted by:3dc |
| #1 But some news sites (Guardian?) still claim a runny nose is a symptom. CDC says fever, cough, and shortness of breath. |
| Posted by: Bobby 2020-03-17 12:38 |