From common colds to COVID-19-Respiratory infections update 2020

This year’s cold/flu season is complicated by a new player- COVID-19, caused by the SARS-CoV-2. If you get sick, please do not assume your illness is “just the flu” ; this could have serious, perhaps fatal consequences for you and your loved ones.

Where I live, North America, we’ve just observed the first day of fall, also known as the autumnal equinox. And especially in healthcare, we unofficially view it as the start of the “cold and flu” season. To those of you in the southern hemisphere, happy spring. You also have a respiratory illness season during fall/winter.

Respiratory infections

By “cold and flu” we means acute respiratory infections caused by a variety of viruses including

  • influenza
  • respiratory syncytial virus (RSV)
  • adenovirus
  • rhinovirus
  • coronavirus

and less often several bacteria, most commonly

  • Streptococcus
  • Mycoplasma
  • Haemophilus
  • Legionella
  • Pertussis (whooping cough)

These cause diseases called by various names including

  • colds/flu
  • influenza
  • pharyngitis (throat infection)
  • otitis media (ear infection)
  • bronchitis
  • sinusitis
  • pneumonia
  • laryngitis
  • COVID-19
  • whooping cough
  • bronchiolitis-infants and children
  • croup-mostly children

This year’s cold/flu season is complicated by a new player- COVID-19, caused by the SARS-CoV-2.

Acute vs chronic

We call these illnesses acute because they (usually) come on fairly suddenly, run their course within a few days to sometimes a few weeks, and then resolve. Sometimes they don’t resolve and become chronic.

Some underlying factor may prevent healing. There may be a chronic condition that is out of control, or has not been previously diagnosed. You may need a doctor’s evaluation to determine whether it’s “just a cold” or perhaps asthma, COPD ,or allergic rhinitis.

Many of these illnesses tend to occur seasonally, such as influenza and RSV. Others can occur year round. So far we don’t know if COVID-19, due to the SARS-CoV-2 , will be year round or seasonal. Unlike influenza, it did not abate during the summer this year.

What are respiratory symptoms?

Symptoms of respiratory illness involve some combination of the nose, sinuses, ears, throat, larynx (voice box), trachea, bronchus, and lung

  • Sneezing, stuffy  or runny nose,
  • Sinus pain, pressure
  • coughing, wheezing, shortness of breath
  • sore throat, hoarseness
  • ear pain, fullness

often along with systemic symptoms such as

  • fever and/or chills
  • body aches, fatigue, 
  • nausea, vomiting, diarrhea 
  • headache
  • loss of appetite

 

Coping with respiratory illness

Although these infections make us miserable and can temporarily disable us from work and school, most otherwise healthy people recover uneventfully, even from COVID-19. Nevertheless, we should take them seriously.

 

 

Don’t panic.

Fever ,especially in children, alarms parents. Don’t ignore it but don’t panic either. Reading this post should help you keep calm about fever .

a woman taking her temperature
This photograph depicted a woman who was using a modern, battery-powered oral thermometer, in order to measure her body temperature. In order to return an accurate reading, this particular type of thermometer needed to be placed beneath the user’s tongue, for a set amount of time, beeping when the ambient, sublingual temperature was reached. Photo credit-James Gathany, CDC, public domain

Some  people are at risk of developing  severe symptoms and serious complications from respiratory illnesses, so seek medical help sooner, rather than later. These include

  • Infants, especially under one month old
  • Older adults,starting at about age 50, with risk increasing with age, especially combined with chronic disease
  • Those with chronic lung disease, like asthma, COPD, emphysema, cystic fibrosis
  • People who smoke cigarettes or vape
  • People on medications or with diseases that suppress the immune system
  • Serious chronic diseases – diabetes, liver disease, kidney disease, heart disease, cancer 
  • Obesity (a risk factor for COVID-19 complications)
  • Pregnancy

If you are not sure if you fit into one of these categories, ask your doctor.

Stay home.

These illnesses spread person to person, so minimize contact.

Keep your kids home from school and stay home from work, at least the first few days, when you are  the most contagious. When  there is widespread illness in your community, avoid crowds and public gatherings.

Resting, getting extra sleep, drinking fluids and staying warm and dry  make staying at home therapeutic.

Wash hands.

Speaking of person to person contact, the best way to avoid getting or giving germs is to wash your hands often, but especially after being with others ,using a restroom,  and before cooking or eating. Cleaning household surfaces helps too, as well as clothing and linens. Don’t forget to clean your cell phone, tablets, and keyboards too. Use hand sanitizer if hand washing can’t be done.

Wear a mask

You probably remember that early on in the pandemic, the CDC did not recommend wide spread wearing of masks. I suspect this was to prevent hoarding of masks (remember toilet paper? ) and because they did not know how widely the virus was circulating in the United States.

But that has changed; when experts learn new information they reassess and update recommendations. Whenever you expect to have close contact with people outside your household wear a mask that covers your nose and mouth. In some situations, eye coverings are also warranted but that is not universally recommended now.

Use medication wisely.

Some of these illnesses have a specific medication that clear it faster- strep throat, influenza, pneumonia. The others will “run their course” and meds are used to help relieve symptoms.

Many people assume that any illness with fever, sore throat and cough will improve with an antibiotic. The fact is, most will not. Antibiotics only treat infections caused by bacteria, and most of these are caused by viruses. To learn more read about

These illnesses cause the greatest overuse of antibiotics, contribute to the cost of health care, and the development of antibiotic resistance. Please do not insist on an antibiotic if the doctor says you don’t need it; if offered an antibiotic, ask why.

 

 

6 smart facts about antibiotic use

 

 Be patient

The “24 hour virus” is for the most part a myth. Expect to be ill anywhere from 3 to 10 days; some symptoms, especially cough, can linger for weeks. If you are a smoker, this is a great time to quit. 

But if after 7-14 days you are not getting better or are getting progressively worse, something more may be going on, so it’s wise to seek professional medical help.

Is it flu or is it COVID?

The arrival of COVID-19 this year creates a dilemma since symptoms overlap other respiratory infections and the possible outcomes run the gamut of no symptoms to death.

So this year, if you develop respiratory symptoms, healthcare clinicians will likely test you for COVID-19 , both to guide your care and to protect your family, co-workers, and healthcare workers.

Please do not assume your illness is “just the flu” ; this could have serious, perhaps fatal consequences for you and your loved ones.

Prevention of respiratory infections

Respiratory infections don’t have to happen. We know that they are mostly spread person to person, so what we each do matters. So what can you do?

  • Stay home when you are ill.
  • Observe physical distancing when disease is spreading in your community.
  • Wear a mask when recommended by public health professionals.
  • Practice careful hygiene on hands and surfaces.
  • Get available vaccinations.

 

 

 

exploring the HEART of respiratory illness

I would love for you to share this  information (but not your germs) on your social media pages.

FLU VACCINE: We all have a role in protecting each other.
used with permission CDC

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn .


                              Dr. Aletha 


Why COVID-19 and other infections are not “just a virus”

Unless you haven’t listened to any news for the past 8 weeks, you are well aware of the “challenge” the whole world has been confronting over what some do call “just a virus”; and you know that it has caused much critical illness and death, leading to “public” and private anxiety.

” In a very short period, health care and society have been severely challenged by yet another emerging virus. Preventing transmission and slowing the rate of new infections are the primary goals.

However, the concern of COVID-19 causing critical illness and death is at the core of public anxiety.”

JAMA, March 11, 2020 “Care for Critically Ill Patients with COVID-19”
“just a virus”

You’ve probably visited your doctor or your child’s doctor for an acute illness that started suddenly or over a few days. Likely the symptoms included some combination of

  • fever and/or chills
  • sore throat, runny nose, and/or sneezing
  • cough
  • joint and/or muscle aches
  • vomiting with or without diarrhea
  • rash
  • redness with or without drainage from the eyes
  • headache and a general miserable feeling
This illustration depicted a 3D computer-generated rendering of a whole influenza (flu) virus with a light grey surface membrane, set against a white background. The virus’ surface proteins, hemagglutinin (HA) and neuraminidase (NA), were depicted in light and dark blue, respectively. HA is a trimer, which is comprised of three subunits, while NA is a tetramer, which is comprised of four subunits, with a head region resembling a 4-leaf clover. CDC/ Douglas Jordan, public domain

And you were probably told that you or your child had “a virus”,or viral infection, followed by one or more of the following phrases-

  • there is no treatment but it will go away
  • the treatment will not cure it, but it will help the symptoms
  • it has to run it’s course
  • it resolves without treatment
  • you caught it from someone else
  • it is contagious
  • the symptoms will go away, but it stays in your body
  • you may get it again
  • you won’t get it again
  • there is a vaccine to prevent this
  • there is no vaccine to prevent this
This image depicted a Centers for Disease Control and Prevention (CDC) scientist interacting with her Caliper LifeSciences’ Zephyr Molecular Biology Workstation, working with samples to be tested using a real-time PCR machine, known as a themocycler (see PHIL 22904), in order to identify the various types of poliovirus contained therein. The data from this analysis is stored in a computer, while the software further analyzes the data before being reviewed by a scientist. The themocycler can vary the temperature, which is important, for PCR requires multiple test rounds at different temperatures. In the instrument, viral RNA is copied into DNA and then the DNA is amplified. Specific probes bind to the DNA, in order to determine what type of polio present. One hundred ten labs around the world can run this assay, and can tell if an isolate contains polio, or not, and if so, what kind.CDC/ Holly Patrick, MS, MPH

And finally, you may have heard a phrase I hope you never hear, and I hope we doctors never use again-

“It’s JUST a virus.”

Why it’s never “just a virus”

The quote at the beginning of this post is from an article in the Journal of the AMA . Unless you haven’t listened to any news for the past 8 weeks, you are well aware of the “challenge” the whole world has been confronting over what some do call “just a virus”; and you know that it has caused much critical illness and death, leading to “public” and private anxiety.

But we shouldn’t have been surprised. Viruses have been around probably as long as humans have, we just didn’t know much about them until the past century or so. After all, viruses are made of genetic material DNA or RNA, like us and animals; when viral DNA/RNA invades our bodies and enters our cells, they start reproducing (replicating), causing disease. (This is a simplified explanation of what viruses do.)

Transmission electron microscopic image of an isolate from the first U.S. case of COVID-19, formerly known as 2019-nCoV. The spherical viral particles, colorized blue, contain cross-sections through the viral genome, seen as black dots.CDC/ Hannah A Bullock; Azaibi Tamin
How do doctors know it’s a virus?

Until fairly recently, viral infections were diagnosed by typical symptoms and characteristic physical exam findings, especially fever and rash, and many are still diagnosed that way. Then laboratory scientists developed tests for some viruses, which help confirm the diagnosis , important when a treatment is available. The tests can also be used to know if someone is or is not already immune to a disease, if a vaccine is available.

So what infections are caused by viruses?

Lots of them are, but fortunately most are not nearly as serious as the novel coronavirus that causes COVID-19, or the 2 previous coronavirus outbreaks, SARS and MERS. You’re probably quite familiar with some of them. Here’s what I think is an easy to understand way to categorize them.

This illustration provides a 3-dimensional (3D) graphical representation of a tightly packed, icosahedral, poliovirus particle that consists of 60-copies each of capsid polypeptides, designated as pink VP1 (viral protein1), green VP2, purple VP3, and though not shown here, VP4. This particle was composed of units of four capsid polypeptides, which interact in groups of five, resulting in a viral particle that has, what is referred to as 5-fold (pentameric), and 12-fold symmetry. Note the deep canyon on the capsid’s surface surrounding the apex of each pentamer of the virus. The canyon, together with the pentamer apex, is used as the site for capsid binding to cellular receptors.CDC/ Sarah Poser

categories of viral infections

This is how they behave without previous vaccination or treatment (when available) .This is not an exhaustive list, just some of the most common. These all spread person to person.

Short duration, followed by life-long immunity
  • measles
  • mumps
  • rubella
  • polio
  • hepatitis A
Short duration, followed by short-lived immunity
  • RSV- respiratory syncytial virus
  • influenza
  • rhinovirus (common cold)
  • coronavirus
Persistent infection, life-long carrier of virus, virus inactive at times, not always passed to other people
  • HSV-herpes simplex virus
  • VZ-varicella/zoster (chicken pox-shingles)
Persistent infection, life-long carrier of virus, virus always active and can be passed to other people
  • HIV/AIDS-human immunodeficiency virus
  • Hepatitis B
  • Hepatitis C
  • HPV-human papilloma virus
Viruses that spread from animals to humans
  • Avian influenza
  • Rabies
  • West Nile virus
Viruses that spread from animals to humans-and sometimes then to other humans
  • yellow fever
  • coronavirus
  • Ebola
Centers for Disease Control and Prevention (CDC) activated its Emergency Operations Center (EOC) to assist public health partners in responding to the coronavirus disease 2019 (COVID-19) outbreak first identified in Wuhan, China.
How serious are viral infections?

How serious a viral infection is depends on how you want to define “serious”. Even a “mild” illness can be a major problem if it’s you or your family that is sick. With a mild illness, you still may feel too sick to work or go to school, which you should not do anyway, so not to transmit it to other people.

The above classification is quite simplified, a framework for looking at infections that you’ve probably heard of. They range from the common cold, with no risk of death, to HIV/AIDS and rabies, which are always fatal without treatment.

People with the short duration infections usually recover but some carry risk of progressing into life threatening respiratory events, due to RSV, influenza, and now the coronaviruses. Polio frequently left its victims paralyzed for life and measles can cause permanent deafness.

The herpes virus and VZ virus cause recurrent outbreaks of painful skin sores. . Hepatitis B and C viruses can lead to chronic liver disease and liver cancer. HPV causes benign warts but also cancer of the cervix.

This illustration, created at the Centers for Disease Control and Prevention (CDC), reveals ultrastructural morphology exhibited by coronaviruses. Note the spikes that adorn the outer surface of the virus, which impart the look of a corona surrounding the virion, when viewed electron microscopically. In this view, the protein particles E, S, and M, also located on the outer surface of the particle, have all been labeled as well. A novel coronavirus, named Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), was identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China in 2019. The illness caused by this virus has been named coronavirus disease 2019 (COVID-19).CDC/ Alissa Eckert, MS; Dan Higgins, MAMS
“the challenge of emerging virus”

I hope that we all learn from this pandemic. I hope both physicians and patients take viral infections more seriously and appreciate the complexity and challenge they represent. We share something important with them-DNA, the genetic material that creates health as well as disease. Viruses aren’t static; like us they change and adapt.

We have vaccines that can dramatically reduce our risk of getting several of these diseases and I hope more people will use them. We have a few drugs which combat these diseases; fortunately some have been life saving, like those for HIV/AIDs.

Healthy lifestyles offer protection against infections of all kinds but we frequently overlook their value. You may be tired of hearing them but they include

  • hand washing- often and thoroughly
  • cleaning and disinfecting frequently touched surfaces
  • water and sanitation facilities
  • safe food handling and cooking practices
  • wise sexual practices
  • staying home when sick
  • limiting contact with animals and preventing insect bites
  • immunization

sharing the HEART of health

For this post I reviewed sections of the textbook Fenner and White’s Medical Virology, Fifth Edition , made available online free at ScienceDirect.com specifically to help medical professionals navigate the COVID-19 challenge.

You might want to check out some less technical references at these links.

Overview of Viral Infections

Viral Infection

Except for the cover photo, the pictures in the post are from the Centers for Disease Control and Prevention website, and are in the public domain.

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn .

                              Dr. Aletha