How long before I show signs and symptoms?
Available evidence supports that half of those infected will display symptoms of the illness five days following exposure, with 97.5% developing signs and symptoms of the illness within 12 days of exposure to COVID-19.
Data culled from 181 individuals who tested positive for COVID-19, whose exposure to an individual with COVID-19 had been confirmed and whose onset of symptoms was documented, provided the evidence for these conclusions about incubation. Although some developed symptoms between 12-14 days following exposure, only 2.5% of the test group (approximately four individuals) fell within this parameter. Results of this study can be found here.
Clinical signs and symptoms of mild-to-moderate COVID-19 can be found here. If you have symptoms that are more significant than those reported here, seek treatment from your physician.
How long am I contagious?
Little data is available that provides an adequate answer to this question as there is insufficient data to understand for how long COVID-19 makes a person contagious. However, looking to the timeline of other viruses does add some perspective to this question.
Clarifying terminology is initially important. When discussing the period during which a disease can be transmitted from one person to another, the terms “contagious” or “infectious” are routinely used. “Viral shedding” is another term used by scientists and medical professionals to define this period of contagion. During a viral shedding period, the viral host can actively shed the disease to others when the illness is present in the host.
A study performed in Nicaragua to determine the transmission of influenza in children and adults can be used to understand the length of time a person is infectious or can “shed” the virus. Between 2012 and 2014, the period over which four influenza variants had been detected in hosts, 144 cases and 112 household contacts were enrolled in the study. Over a period of 10-14 days after testing positive via the QuickVue Influenza A+B rapid test (a qualitative nasal/oral swab test), five home visits were conducted during which additional respiratory samples were collected from the infected individuals, and those in the same household with the infected individual.
Results of this study revealed the following:
Why should this influenza investigation be used as a guide to understand COVID-19?
What does this influenza study reveal about COVID-19?
Although we still do not know how long viral shedding occurs before a person displays symptoms of COVID-19, or for how long he or she is infectious after symptoms are detected, the fact that a person can be contagious for this period explains the need for social distancing, hand washing and other sanitary measures.
In the United States, medications and tests utilized to asses medical conditions may only be introduced into the stream of commerce once they pass numerous, stringent requirements. However, when a public health emergency surfaces that could be managed effectively with products and therapies not yet approved, provisions in the law permit the FDA to fast track biologics, diagnostic tools and other medical equipment.
On February 4, 2020, the Secretary of the Department of Health and Human Services (HHS) determined that COVID-19 posed a public heath emergency to U.S. citizens. By declaring this public health emergency, the Secretary of HHS triggered section 564(b)(1)(C) of the Federal Food, Drug and Cosmetic Act. In accordance with this provision, the FDA Commissioner may allow unapproved medical products, or unapproved uses of approved medical products, to be used to test for or to treat the life-threatening disease causing the health crisis. For each item approved to assess, treat or protect against COVID-19 during this time period, an Emergency Use Authorization (EUA) is issued.
To date, the following EUAs have been issued:
March 28, 2020
February 4, 2020
In the above list, 27 products have been approved to provide a qualitative assessment of COVID-19 in the upper and/or lower airway. Three of those products can be performed at the location where the patient is being tested. One additional product has been approved to test for antibodies in whole blood, serum or plasma.
Normally, it takes months or years to have a new test approved or to have a medication approved for off-label use. Under this circumstance, the speed with which these tests was developed is truly remarkable. Also, national testing will certainly be accomplished more rapidly as a result of the FDA’s issuance of these EUAs.
If you know someone who is exhibiting signs, tell that person to do a search for testing locations in or around their communities. As the number of companies approved to manufacture tests increases, the number of available tests will increase, and commensurately, the number of testing sites will increase. Early detection can help manage the virus.
QUESTIONS YOU MAY HAVE
Below is a link to the FDA website listing all EUAs issued to date in response to COVID-19:
Generally, mild to moderate symptoms of COVID-19 include body aches, headaches, low grade fevers (under 101F), nasal congestion, sneezing, nasal drip, loss of smell, loss of taste, and redness around the eyes. You may have one or a few of these symptoms.
It is important to note that symptoms vary from person to person. If you contract this virus, what you experience may not be what another person in your family may experience.
Managing your symptoms is critical. If you have a fever or body aches, use over-the-counter pain relievers that are also known to reduce fevers. Tylenol (acetaminophen) and Advil/Motrin (ibuprofen) are routinely used for this purpose. Use the drugs as directed.
Certain outlets have reported that Advil can exacerbate COVID-19. According to the FDA, no evidence exists to support this contention. However, the FDA is investigating this further, as noted in the advisory linked here.
Hydration is also a key component. In addition to water, any drinks that replenish necessary electrolytes, such as Gatorade, will help as your body’s immune system continues to battle the virus. Do not discount food, either. Although you may not be hungry, your body needs the energy to continue fighting against the disease. Consider something easy to manage, such as crackers, that can provide a carbohydrate boost.
If your symptoms progress and you begin to experience any of the following symptoms, immediately seek treatment from medical professionals: chest pain, difficulty breathing, a productive cough, fever over 101F.
Late last week, the first human clinical trial of an investigational vaccine began. Researchers at NIH’s National Institute of Allergy and Infectious Diseases (NIAID), in conjunction with individuals at Moderna, Inc., a biotech company out of Cambridge, Ma, developed this potential vaccine. Under the Phase I study, safety and efficacy of this vaccine will be tested in 45 healthy adults. If the vaccine passes this initial trial, larger clinical trials will be conducted to further confirm its efficacy and safety.
At that point, if all indicators point to a safe and effective vaccine, then large-scale production of the virus will occur. Production of vaccines in the quantity necessary to immunize all US citizens will take 12-18 months.
Refer to the NIH website for additional information about the development of this vaccine.
OFF-LABEL USE OF ANTIMALARIAL DRUG HYDROXYCHLOROQUINE
Chloroquine is an antimalarial drug. As the qualification suggests, the medication is intended to prevent or reduce the symptoms of malaria in children and adults. As it has been found to reduce rheumatoid arthritis symptoms and to aid those who suffer from lupus, scleroderma sarcoidosis and other immunological diseases, clinicians prescribe chloroquine to individuals suffering from this condition as well. Hydroxychloroquine is a drug also derived from quinine, which is also used to treat malaria and other immunological diseases. As effective as chloroquine, hydroxychloroquine produces fewer side effects.
“Off-label” use means that a drug is being utilized to treat a condition for which it was not approved by the FDA, and thus has little research to support safe use or efficacy beyond anecdotal evidence (e.g., word-of-mouth reports of how the drug positively impacted patients). Using chloroquine or hydroxychloroquine to treat is considered an off-label use because neither drug was approved by the FDA to treat viruses. However, anecdotal evidence from clinicians indicates that using chloroquine or hydroxychloroquine in conjunction with the antibiotic azithromycin has assisted in the recovery of those with COVID-19. Specifically, this drug combination appears to reduce symptoms and improve recovery time.
So, why would an antimalarial drug work here? Scientists postulate that chloroquine drugs could change the acidity at the surface of a cell. By altering the surface, COVID-19 would be prevented from infecting the cell.
To test the efficacy of hydroxychloroquine in patients with COVID-19, a group of physicians in France conducted a study with 20 subjects. Separated into three groups – those receiving hydroxychloroquine, those receiving hydroxychloroquine and the antibiotic azithromycin, and a control group who did not receive any medication) - over a two week period, the clinicians administering the study tracked each patient’s “viral load,” or how much of the virus remained in the nasal passageway of the subject. By Day 5 of the study, the viral load of patients that received hydroxychloroquine gradually dropped from Day 1. Those who received hydroxychloroquine in combination with the antibiotic azithromycin displayed a marked reduction in viral load by Day 5. As expected, the control group’s viral load remained high throughout the study.
Noting that this was a small group study, the clinicians involved in the research clarify in their paper that these results are preliminary. However, due to the nature of this pandemic, they published their results “given the urgent need for an effective drug” against COVID-19.
To understand more about the manner in which the study was conducted, a copy of the study can be found here:
Anecdotal evidence suggests that this combination of drugs is shortening the duration of symptoms. Investigations into the use of hydroxychloroquine to treat patients with mild-to moderate symptoms are underway by the FDA and the World Health Organization.
UPDATE: on March 28, 2020, the FDA approved off-label use of chloroquine and hydroxychloroquine to treat COVID-19. Because the request made the by the U.S. Department of Health and Human Services met the requirements to issue an Emergency Use Authorization (EUA), and in-vitro and anecdotal evidence suggest that these drug reduce the symptoms of COVID-19, Dr. Denise Hinton, Chief Scientists at the FDA, issued an EUA permitting immediate use of these drugs to treat COVID-19.
OTHER TREATMENTS BEING EXPLORED/UTILIZED
Remdesivir is an antiviral developed by Gilead Sciences. Testing in vitro (test tube) and in vivo (using animal subjects) provided evidence that Remdesivir effectively reduced viral activity of the following pathogens: MERS, SARS (two other coronaviruses), Ebola and Marburg virus. Because of the efficacy noted in vitro and in vivo, the National Institute for Allergy and Infectious Diseases (NIAID) is conducting a clinical trial for Remdesivir. Also, the manufacturer of Remdesivir, Gilead Sciences, just began two Phase III trials of this drug in Asia.
Regeneron Pharmaceuticals, in conjunction with Sanofi, began a clinical trial of sarilubam, an antibody to a specific receptor in the body known to play a key role in driving the inflammatory immune response. Aiming to learn if the drug can modify the inflammatory response triggered by COVID-19, the study is being conducted in New York medical centers.
Also being investigated is the use of antibody-rich blood products taken from people who have recovered from the virus.
More information about the above treatments can be found at the websites/articles linked here.
Human blood has many components. One way to classify human blood is by blood type. Four blood types exist: Type A, Type B, Type AB and Type O. What distinguishes one type of blood from another are the antigens on the surface of the cell. Antigens are proteins on the surface of a blood cell that play a role in identifying foreign cells in the blood stream. Those with Type A blood have antigens different from those with Type B blood. Individuals with Type AB blood possess antigens particular to Type A blood and Type B blood. Those with Type O blood have no antigens on the surface of their red blood cells.
In the United States, about 45% to 50% of individuals have Type O blood. Type A blood is present approximately 35% to 40% of the US population. Type B blood is present in about 15% of the population. As the math suggests, Type AB is the least common blood type, as it is found in only about 5% of the US population.
Recently published data collected from patients treated at Wuhan Jinyintan Hospital in China reports a link between blood type and susceptibility to COVID-19. Reviewing blood group distribution in 1,775 individuals who tested positive for COVID-19, the affected individuals had the following blood types:
To understand the incidence of particular blood types in that region of China, researchers also collected data from 3694 healthy individuals who resided in Wuhan. Within that group, blood types were observed with the following frequency:
Although individuals with Type O blood made up the greatest percentage (33.84%) of Wuhan residents who were healthy, the researchers found that individuals with Type A blood made up the greatest percentage (37.75%) of those who had fallen ill. Although more people in Wuhan have Type O blood, more people with Type A blood fell ill.
Based upon their evaluation of this evidence, the researchers concluded that individuals with Type A blood are at higher risk for contracting COVID-19. Conversely, individuals with Type O blood have a lower risk of contracting COVID-19.
As this article has yet to undergo the rigorous peer evaluations that are required before a medical study like this one can be published, its findings are preliminary. Nonetheless, it is likely that this correlation will be studied further as more data becomes available.
A copy of the article can be viewed here:
Viruses are not independent organisms. They cannot survive outside of a host for lengthy periods because viruses require the components of a cell to survive. In broad strokes, once a virus enters a host, it invades cells, replicates and then spreads to other cells. Sometimes, a virus can live within a host without causing illness to its host. Other times, the presence of a virus triggers the defense mechanisms available within the host.
Coronaviruses are so-called because under a microscope, crown-like projections emanate from the cell infected with the virus. When infected with a coronavirus, humans respond with symptoms akin to those seen with the common cold.
In late 2019, somewhere within the Wuhan province of China, this strain of coronavirus (COVID-19) that had not before been identified in a human host (which is why some refer to it as “novel”) moved from an animal host to a human host. Scientists determined that the strain of coronavirus causing illness had jumped from an animal host to human hosts based upon the organic structure of the virus.
With data stretching back to December 2019, scientists and medical professionals have drawn a few conclusions about COVID-19, in addition to making a few decisions related to prophylaxis and treatment of this virus. Here is what you need to know
What You Kneed to Know
What are the signs and symptoms of COVID-19?
How is it transmitted?
What population is most affected?
How should I proceed when I am in public?
Do I need to wear a mask?
What should I do if I think I have fallen ill?
Is there a drive-through testing location near me?
Before you seek testing, make sure to review the website for the provider and ensure you meet the criteria and/or have the necessary documentation to undergo testing at these sites.
If your state is not listed, continue to check the Department of Health website for your state for updated information about testing. Every state's Department of Health website can be found at this link:
Certain states may refer you to your county website for additional information.
Guidelines and recommendations about managing COVID-19 are available at the Center for Disease Control and Prevention: https://www.cdc.gov.