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.

I would love for you to start following Watercress Words : use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn. Thanks so much.

                              Dr. Aletha 

Measles- not gone, not forgotten

After the measles vaccine was introduced in 1963 the number of reported cases was reduced by 99%. In 2000 measles was declared no longer endemic ( occurring routinely) in the United States. U.S. public health officials consider an outbreak a major setback in the control of infectious disease.

A “RASH” OF MEASLES CASES

Measles in the U.S. has climbed to its highest level in 25 years, closing in on 700 cases this year in a resurgence largely attributed to misinformation that is turning parents against vaccines.

“This is alarming,” said Dr. William Schaffner, a Vanderbilt University vaccine expert. Not only is measles dangerous in itself, but its return could mean other vaccine-preventable diseases seemingly consigned to the past may be coming back as well, he said.

APNEWS.COM, APRIL 24, 2019

The rash of measles, also known as rubeola, starts on the head and spreads to the trunk (chest and upper back) , arms, and legs over a few days .

What is measles?

At one time, measles was one of the “usual childhood diseases” that most of us over age 55 years contracted as children, prior to the use of the vaccine. It is caused by a virus in the Paramyxoviridae family and spread by person to person contact.

The other childhood diseases were

  • Rubella, or  German measles
  • Chicken pox, or  varicella
  • Roseola
  • Fifth Disease, or erythema infectiosum

These all cause a rash, called an exanthem.

Mumps was also a common childhood disease but does not usually cause a rash.

Symptoms of measles include cough, nasal drainage, reddened, inflamed eyes, and a rash as pictured below.

the rash of measles
image courtesy of the CDC- Centers for Disease Control , U.S. government

There is no specific treatment and it runs its course in about 1-2 weeks. Antibiotics are not effective .

Most of those infected recover uneventfully but there can be serious complications including pneumonia and encephalitis (inflammation of the brain).

Preventing measles and other exanthems

After the measles vaccine was introduced in 1963 the number of reported cases was reduced by 99%. In 2000 measles was declared no longer endemic ( occurring routinely) in the United States. U.S. public health officials consider an outbreak a major setback in the control of infectious disease.

Measles vaccine is usually administered as a “3 in 1” vaccine- the MMR, which has been vilified as a possible cause of autism, although that has been thoroughly discredited.

The other two letters in the mix stand for mumps and rubella (also known as German measles) both of which are also caused by viruses and for which no treatment exists.

No vaccine exists for roseola or Fifth Disease, but we have an effective vaccine for varicella, commonly called chickenpox.

MEASLES OUTBREAK ELSEWHERE

According to the World Health Organization, WHO, Europeans are also contracting the most measles cases in 30 years.

The WHO European Region comprises 53 countries, from Andorra to Ukraine. According to data from the WHO, 41,000 measles cases were reported from January to June 2018 across those countries, including 37 deaths — a record-high number of fatalities since the 1990s.

CBSNEWS.COM, JUNE 17, 2019

sharing the HEART of health

My family receives vaccines and believe any potential risk is worth the benefit. I urge you to think carefully and talk to a trusted physician before you decide to forgo vaccination for yourself and especially for your children.

Thanks for visiting this blog and considering this vital information as we explore the HEART of health together.

Dr. Aletha 

2019 Women’s health update- hormones, the heart, and HPV

results of the Nurses Health Study over 18 years shows no increase in incidence of these complications in women who used vaginal estrogen, suggesting this is a safe option for women who elect to use estrogen. (from the journal Menopause)

Multiple health issues impact women exclusively or differently than men, so new and updated information is important to share. The issues we women face vary with our age, stage of life and health status.

Let’s look at some medical news about women’s health issues, information I picked up recently from several medical journals I follow.

This is current, general medical information that helps a doctor and patient make decisions about what is right for her. Medical recommendations and practice changes as we learn new things.
If you deal with any of these issues , please discuss with your doctor before  taking any action.

I’m illustrating this post with photos of art featuring women. I’ll tell you more about the source at the end.

statue of a woman holding an infant

Human papillomavirus and cancer 

Infection with the human papillomavirus, HPV, can cause  genital warts and cervical cancer.

The percentage of young women with confirmed HPV (human papillomavirus) infection  in the United States fell significantly from 2006 to 2012. Women who had received the HPV vaccine showed the greatest decline in infection rates, compared to those who had not. Even one dose was effective, even though 2 or 3 are recommended.

A new study reported by the New England Journal of Medicine shows that women who become infected with the HPV strains 16 and 18 have a much higher risk of changes in their cervix called CIN-cervical intraepithelial neoplasia-which can be a precursor to cancer. These changes may not be picked up by a Papanicolaou (Pap) test.

Thus, protection against infection with HPV should also provide protection against cancers caused by HPV.

Human papillomavirus vaccine

Gardasil, a vaccine which targets the HPV has been available to females and males from 9 years old to 26 years old. Now the age has been extended through age 45 years for both genders.

Here is a link to detailed information about HPV vaccination from the National Cancer Institute.


Human Papillomavirus (HPV) Vaccines

statue of a pioneer woman with rifle and infant

Long-acting reversible contraception-LARC  

Two forms of long-acting reversible contraception are available to women in the United States.

Nexplanon, a contraceptive implant, slowly releases the hormone progestin and does not have estrogen. It can be used in women who cannot take estrogen, such as those with uterine fibroids or endometrial cancer.

Intrauterine devices, IUDs, containing copper only are appropriate for women with past or present breast cancer, ischemic heart disease, and women at risk for blood clots.

Use of LARCs accounts for 12% of all contraceptive use. Additional benefits include controlling excessive menstrual bleeding, potentially saving women from surgery.

Here is a link to Quick Fact about intrauterine devices and other forms of contraception from the Department of Health and Human Services

Intrauterine Device

statue of woman, holding infant, standing next to a child

Hormone therapy and prevention of heart disease

A 2015 Cochrane review of 40,410 postmenopausal women examined the use of oral hormone therapy (estrogen with or without progesterone) taken for at least six months, compared with placebo (no real drug), to determine the effect on death from any cause, and deaths caused by heart disease, stroke, and blood clot in a leg or lung.

The review found no benefits for preventing heart attack (fatal or nonfatal), or death due to any cause.

In women who took hormones they found

 
1 in 165 women had a stroke
1 in 118 women had a blood clot in the leg or lung
1 in 242 women had a blood clot in the lung

The women in this study were all older than 60 years old, so it is possible there might be benefit in younger women.

statue of woman with arm raised and holding an infant

Vaginal estrogen and heart health

While estrogen replacement after menopause is effective at controlling the undesirable effects of night sweats, hot flashes, and vaginal dryness, it potentially increases the risk of developing cardiovascular disease-heart attacks and stroke, and some cancers-breast and uterine.

However, results of the Nurses Health Study over 18 years shows no increase in incidence of these complications in women who used vaginal estrogen, suggesting this is a safe option for women who elect to use estrogen. (from the journal Menopause)

The photos- a tribute to women

I took these photos during a recent visit to Woolaroc ,a museum and wildlife preserve located in the Osage Hills of Northeastern Oklahoma. Woolaroc was established in 1925 as the ranch retreat of oilman Frank Phillips. 

These statues displayed there were all models considered for a larger project now known as the Pioneer Woman Statue in Ponca City, Oklahoma.

What do you think? Would you have chosen one of the other statues for the final version?

More women’s health info

exploring the HEART of women’s health

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

I would love for you to start following Watercress Words : use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn. Thanks so much.

                              Dr. Aletha 

a statue of a woman holding a child, "CROSSING THE PRAIRIE"
“CROSSING THE PRAIRIE” by Glenna Goodacre, Broken Arrow, Oklahoma
Shop To Fight Breast Cancer! Every Purchase Helps Give Free Hospital Mammograms To Women In Need!

AAPTIV- what I’m using to stay fit now.

This post contains affiliate links which, by paying a commission if used for a purchase, help me fund this blog and share the HEART of health around the world.

 

Vaccination prevents disease- part 1

 

Prevention is a focus in healthcare now  and immunization has  been one of the most effective ways to prevent disease ever developed.

The list of diseases that are “vaccine preventable” is long and continues to grow.

Vaccine recommendations may be based on a person’s

  •  age,
  • gender,
  • ethnicity and
  • concurrent conditions, especially diabetes mellitus, chronic lung diseases, heart disease and  immune suppressing disorders.

Vaccine administration may vary by

  • the number of doses recommended,
  • how far apart the doses should be given, and
  • which vaccines can be administered at the same time.

 

Immunization protocols have  become so complex that even physicians have difficulty keeping it straight without the use of paper or digital checklists. This is one area where the Internet and EMRs (electronic medical records) can be useful.

Create an immunization schedule for your child from birth to 6 years of age

2016 recommended immunizations for children
2016 recommended immunizations for children (the 2017 schedule is available on the CDC website)

 

Vaccines for infections caused by bacteria

I use the name of the disease and/or the bacteria, rather than the vaccine name, since there are different brand names for the vaccines depending on the manufacturer.

So successful have these vaccines been that most young doctors have never seen a patient with these diseases (unless perhaps they specialize in infectious disease, immunology, emergency medicine or critical care). And even I, who graduated medical school in 1978, have only seen a few, and none in recent years.

Diphtheria-primarily a respiratory tract illness in young persons

Pertussis, better know as whooping cough, also a respiratory illness, which has made a comeback in recent years, apparently due to a waning of immunity

Tetanus, also called “lockjaw”– due to a toxin which may contaminate a dirty wound

Menigococcal disease, which is one of many causes of meningitis (inflammation of the brain lining), but one of the most deadly, even with treatment

Streptococcal pneumoniae disease; the vaccine is often referred to as the “pneumonia vaccine”, but the bacteria can also cause ear infections, sinusitis, meningitis and sepsis (bloodstream infection)

Haemophilus disease is similar to pneumococcal, but more of a concern in infants and children

 

Six Things YOU Need to Know about Vaccines

 

 

 Pneumococcal Vaccination from JAMA

infections caused by Streptococcus pneumoniae

 

 

 Pandemic- a book review

Infection is still a major health issue worldwide

and epidemics are still a threat. This book explains why.                 Pandemic by Sonia Shah

Vaccination prevents disease, part 2

The rash that spreads- what you need to know about measles

Measles and mumps- 2 old diseases that are making a comeback #measles#mumps

You may continue reading here, but there is an updated version at this link

Measles, not gone, not forgotten

The rash of measles, also known as rubeola, starts on the head and spreads to the trunk (chest and upper back) , arms, and legs over a few days .

What is measles?

It used to be one of the “usual childhood diseases” that most of us over age 55 years contracted as children, prior to the use of the vaccine. It is caused by a virus in the Paramyxoviridae family and spread by person to person contact.

The other childhood diseases were

  • Rubella, or  German measles
  • Chicken pox, or  varicella
  • Roseola
  • Fifth Disease, or erythema infectiosum

These all cause a rash, called an exanthem.

Mumps was also a common childhood disease but does not usually cause a rash.

Symptoms of measles include cough, nasal drainage, reddened, inflamed eyes, and a rash as pictured below.

the rash of measles
image courtesy of the CDC- Centers for Disease Control , U.S. government

There is no specific treatment and it runs its course in about 1-2 weeks. Antibiotics are not effective .

Most of those infected recover uneventfully but there can be serious complications including pneumonia and encephalitis (inflammation of the brain).

Preventing measles and other exanthems

After the measles vaccine was introduced in 1963 the number of reported cases was reduced by 99%. In 2000 measles was declared no longer endemic ( occurring routinely) in the United States. Thus public health officials consider an outbreak a major setback in the control of infectious disease.

Measles vaccine is usually administered as a “3 in 1” vaccine- the MMR, which has been vilified as a possible cause of autism, although that has been thoroughly discredited.

The other two letters in the mix stand for mumps and rubella (also known as German measles) both of which are also caused by viruses and for which no treatment exists.

No vaccine exists for roseola or Fifth Disease, but we have an effective vaccine for chickenpox.

You can listen to  2 DOCS TALK  about mumps at this link or read the transcript.

Mumps – The Disease, the Vaccine, the Problem

“But recent increases in those who choose to have their children forego vaccines has led to a loss of herd immunity and an increase in these outbreaks.

To further complicate the issue, it seems that immunity wanes with time, which is why many college students (hello spring break!) find themselves falling ill eight to ten years after their last booster at age 12 to 15.”

My family receives vaccines and believe any potential risk is worth the benefit. I urge you to think carefully and talk to a trusted physician before you decide to forgo vaccination for yourself and especially for your children.

Thanks for visiting this blog and considering this vital information as we explore the HEART of health together.

Dr. Aletha