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streamxuhddotcom · 4 years ago

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Coronavirus, COVID-19

Coronaviruses, like the new COVID-19 outbreak that began in China, cause mild to severe respiratory illness including death. COVID-19 has since spread worldwide. The best preventive measures include wearing a mask, staying six feet apart, washing hands often, avoiding sick people, keeping your hands away from your face and getting adequate rest and nutrition.

What is coronavirus? Coronaviruses are a family of viruses that can cause respiratory illness in humans. They get their name, “corona,” from the many crown-like spikes on the surface of the virus. Severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and the common cold are examples of coronaviruses that cause illness in humans.

The new strain of coronavirus, COVID-19, was first reported in Wuhan, China in December 2019. The virus has since spread to all continents (except Antarctica).

How many people are infected with COVID-19? The number of people infected changes daily. Organizations that collect this information, including the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), are gathering information and continuously learning more about this outbreak. As of this writing (05/11/2021), more than 159,000,000 people in the world have been infected. Over 3,300,000 people have died. Some 192 countries and territories on all continents (except Antarctica) have now reported cases of COVID-19. The U.S. has the highest number of cases, with more than 32,000,000 people infected and over 580,000 deaths. India has nearly 23,000,000 cases and 250,000 deaths. Brazil has more than 15,200,000 cases and 420,000 deaths. France has over 5,800,000 cases; Turkey has over 5,000,000 cases; Russia and England have over 4,400,000 cases; Italy has more than 4,100,000; Spain and Germany have over 3,500,000 cases; Argentina and Columbia have more than 3,000,000 cases; Poland and Iran have over 2,600,000 cases and Mexico has over 2,300,000 cases. For the latest statistics, see the World Health Organization's situation reports and Johns Hopkins Coronavirus Resource Center map references at end of article.

How does the new coronavirus (COVID-19) spread from person to person? COVID-19 is likely spread:

When the virus travels in respiratory droplets when an infected person coughs, sneezes, talks, sings or breathes near you (within six feet). This is thought to be the main way COVID-19 is spread. When the virus travels in small respiratory droplets that linger in the air for minutes to hours from an infected person who is more than six feet away or has since left the space. This method of spread is more likely to occur in enclosed spaces with poor ventilation. From close contact (touching, shaking hands) with an infected person. By touching surfaces that the virus has landed on, then touching your eyes, mouth, or nose before washing your hands. (Not thought to spread easily by this method.) COVID-19 enters your body through your mouth, nose or eyes (directly from the airborne droplets or from transfer of the virus from your hands to your face). The virus travels to the back of your nasal passages and mucous membrane in the back of your throat. It attaches to cells there, begins to multiply and moves into lung tissue. From there, the virus can spread to other body tissues.

Governments, health agencies, researchers and healthcare providers are all working together to develop policies and procedures to limit the spread of this virus both globally and from individual to individual.

How long is a person infected with COVID-19 considered contagious? Researchers are still learning about COVID-19. What IS known is that people infected with COVID-19 can spread the virus to others before experiencing symptoms themselves (while people are still “asymptomatic”). Once you do have symptoms, the CDC says you are no longer contagious 10 days after your symptoms began.

Until everything about COVID-19 is fully understood, the best advice from healthcare providers to remain safe is to:

Stay six feet away from others whenever possible. Wear a cloth mask that covers your mouth and nose when around others. Wash your hands often. If soap is not available, use a hand sanitizer that contains at least 60% alcohol. Avoid crowded indoor spaces. Bring in outdoor air as much as possible. Stay self-isolated at home if you are feeling ill with symptoms that could be COVID-19 or have a positive test for COVID-19. Clean and disinfect frequently touched surfaces. How soon after becoming infected with COVID-19 will I develop symptoms? This so-called “incubation period,” the time between becoming infected and showing symptoms, can range from two to 14 days. The average time before experiencing symptoms is five days. Symptoms can range in severity from very mild to severe. In about 80% of patients, COVID-19 causes only mild symptoms.

Who is most at risk for getting COVID-19? Persons at greatest risk of contracting COVID-19 are:

People who live in or have recently traveled to any area with ongoing active spread. People who have had close contact with a person who has a laboratory-confirmed or a suspected case of the COVID-19 virus. Close contact is defined as being within six feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period. People over age 60 who have pre-existing medical conditions or a weakened immune system. Have certain ethnic groups been harder hit by COVID-19? Yes. Many researchers have been analyzing data across the country and in some large cities, looking at number of confirmed cases and deaths based on race and ethnicity and related factors. What they found is that African Americans and the Latino-Hispanic populations have disproportionate higher rates of hospitalizations and deaths due to COVID-19.

There are several reasons why researchers suspect these populations are more affected. They believe these ethnic groups tend to:

Live in more crowded housing situations -- living in densely populated areas and in multi-generational households -- making social distancing practices difficult. Work in consumer-facing service industries and are more likely to use public transportation to get to work, putting them at risk for increased exposure to COVID-19. Be at increased risk of severe illness if they get COVID-19 because of higher rates of existing medical conditions, such as high blood pressure, diabetes, obesity, asthma, and heart, liver and kidney diseases. Be more likely to be uninsured or lack a consistent care source, which limits access to COVID-19 testing and treatment services. Researchers are still studying other factors that may make ethnic groups more susceptible to negative COVID-19 outcomes, including genetics and possible differences in lung tissue as well as socioeconomic status and the social environment and systems.

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If I recover from a case of COVID-19, can I be infected again? The U.S. Centers for Disease Control says that "the immune response to COVID-19 is not yet understood." Because this is a new strain of coronavirus, scientists are still collecting information and research on the virus so it's still too early to know if you can get it a second time if you've had it once.

In a related theme, scientists are seeing a subset of patients who have COVID-19 and have symptoms that continue off and on for weeks and even months. These patients are called coronavirus long haulers. Scientists continue to follow these patients.

Where do coronaviruses come from? Coronaviruses are often found in bats, cats and camels. The viruses live in but do not infect the animals. Sometimes these viruses then spread to different animal species. The viruses may change (mutate) as they transfer to other species. Eventually, the virus can jump from animal species and begins to infect humans. In the case of COVID-19, the first people infected in Wuhan, China are thought to have contracted the virus at a food market that sold meat, fish and live animals – but they are still investigating. Although researchers don’t know exactly how people were infected, they already have evidence that the virus can be spread directly from person to person through close contact.

SYMPTOMS AND CAUSES What are the symptoms of the novel coronavirus (COVID-19) infection? The CDC says you may have coronavirus if you have these symptoms or combination of symptoms:

Fever or chills. Cough. Shortness of breath or difficulty breathing. Tiredness. Muscle or body aches. Headaches. New loss of taste or smell. Sore throat. Congestion or runny nose. Nausea or vomiting. Diarrhea. Additional symptoms are possible.

Symptoms may appear between two and 14 days after exposure to the virus. Children have similar, but usually milder, symptoms than adults. Older adults and people who have severe underlying medical conditions like heart or lung disease or diabetes are at higher risk of more serious complication from COVID-19.

Call 911 and get immediate medical attention if you have these warning signs:

Trouble breathing. Persistent pain or pressure in your chest. New confusion. Inability to arouse (wake up from sleep). Bluish lips or face. This list does not include all possible symptoms. Contact your healthcare provider if you are concerned you may coronavirus, have other symptoms or have any severe symptoms.

DIAGNOSIS AND TESTS How is coronavirus diagnosed? COVID-19 is diagnosed with a laboratory test. Your healthcare provider may collect a sample of your saliva or swab your nose or throat to send for testing.

When should I be tested for the coronavirus (COVID-19)? Call your healthcare provider if you:

Feel sick with fever, cough or have difficulty breathing. Have been in close contact with a person known or suspected to have COVID-19. Your healthcare provider will ask you questions about your symptoms. Your healthcare provider will tell you if you need to be tested for the novel coronavirus, COVID-19 and where to go to be tested.

If I have a positive test for coronavirus, how long should I self-isolate? According to current CDC recommendations, you should self-isolate until you've met all three of the following criteria:

It's been 10 days since your symptoms first appeared. You've not had a fever for 24 hours and you've not used fever-lowing medications during this time. Your COVID-19 symptoms have improved. While at home, ideally self-isolate within separate room of your home if possible to limit interaction with other family members. If you can’t stay 100% isolated in a separate room, stay six feet away from others and wear a cloth mask, wash your hands often/family members wash hands often, and frequently disinfect commonly touched surfaces and shared areas.

You don't need to be retested to be around others outside your home. However, since everyone and every case is unique, follow your healthcare provider's recommendations for testing.

If you have a weakened immune system or have had a severe case of COVID-19, the CDC's criteria do not apply to you. You may need to stay home for up to 20 days after your symptoms first appeared. Talk with your healthcare provider about your situation.

How long do I need to isolate myself if I’ve been around a person with COVID-19? According to the CDC, if you’ve been in close contact with a person who has COVID-19, your safest strategy is to stay home for 14 days after you’ve last seen this person.

Recently, the CDC updated its guidance. Alternatives to the 14-day quarantine are:

End your quarantine after 10 days without a test if you've had no symptoms at any time over these 10 days. End your quarantine after seven days if you've had no symptoms at any time over these seven days and have tested negative for COVID-19. Your COVID-19 test should be obtained no earlier than day 5 of your quarantine. If you get a negative test result back before day 7, stay isolated for the full seven days. If you don't get results back by day 7, continue to quarantine until you do, up to day 10. Is it possible to test negative for COVID-19 and still be infected with the virus? Yes. This is possible. There are several reasons for “false negative” test results -- meaning you really DO have COVID-19 although the test result says you don’t.

Reasons for a false negative COVID-19 test result include:

You were tested too early in the course of illness. The virus hasn’t multiplied in your body to the level that it could be detected by the test. A good specimen was not obtained. The healthcare personnel may not have swabbed deeply enough in the nasal cavity to collect a good sample. There could also be handling errors and transportation errors, as the sample must be transported to a lab to be tested. The COVID-19 test itself was not sensitive or specific enough to detect COVID-19. “Sensitivity” refers to the ability of the test to detect the smallest amount of virus. “Specificity” refers to the ability of the test to detect only the COVID-19 virus and not other similar viruses. Many different commercial and hospital laboratories have developed tests for COVID-19. All must meet standards, but no test is 100% sensitive and 100% specific for COVID-19. This is why there is always a possibility of “false negative” and “false positive” tests. If you think you might have COVID-19 even if your test is negative, it’s best to follow the current CDC recommendation. Stay home for 10 days if you think you are sick. Stay six feet away from others (“social distancing”) and wear a cloth mask. Contact your healthcare provider if your symptoms worsen. Contact your healthcare provider when your symptoms improve – don’t decide on your own if it’s safe for you to be around others.

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streamxuhddotcom · 4 years ago

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Everything you should know about the coronavirus pandemic

The latest information about the novel coronavirus identified in Wuhan, China, and advice on how pharmacists can help concerned patients and the public.

A novel strain of coronavirus — SARS-CoV-2 — was first detected in December 2019 in Wuhan, a city in China’s Hubei province with a population of 11 million, after an outbreak of pneumonia without an obvious cause. The virus has now spread to over 200 countries and territories across the globe, and was characterised as a pandemic by the World Health Organization (WHO) on 11 March 2020[1],[2].

As of 3 May 2021, there were 152,534,452 laboratory-confirmed cases of coronavirus disease 2019 (COVID-19) infection globally, with 3,198,528 reported deaths. The number of cases and deaths outside of China overtook those within the country on 16 March 2020[3].

As of 3 May 2021, there have been 4,421,850 confirmed cases of the virus in the UK and 127,539 of these have died (in all settings, within 28 days of the test).

This article gives a brief overview of the new virus and what to look out for, and will be updated weekly. It provides answers to the following questions:

What are coronaviruses?

Where has the new coronavirus come from?

How contagious is COVID-19?

How is COVID-19 diagnosed?

What social distancing measures are being taken in the UK?

What is happening with testing for COVID-19?

What should I do if a patient thinks they have COVID-19?

What can I do to protect myself and my staff?

What about ‘business as usual’ during the pandemic?

Will the government provide financial help during the pandemic?

How can cross-infection be prevented?

There has been a lot of talk in the news and on social media about how certain medications can exacerbate the symptoms of COVID-19, what is the current advice around these medications?

Where can I find information on managing COVID-19 patients?

Is the coronavirus pandemic likely to precipitate medicines shortages?

Are there national clinical trials of potential drugs to treat COVID-19?

Is there a vaccine for COVID-19 and, if so, will pharmacy staff be involved in its roll out?

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What are coronaviruses? SARS-CoV-2 belongs to a family of single-stranded RNA viruses known as coronaviridae, a common type of virus which affects mammals, birds and reptiles.

In humans, it commonly causes mild infections, similar to the common cold, and accounts for 10–30% of upper respiratory tract infections in adults[4]. More serious infections are rare, although coronaviruses can cause enteric and neurological disease[5]. The incubation period of a coronavirus varies but is generally up to two weeks[6].

Previous coronavirus outbreaks include Middle East respiratory syndrome (MERS), first reported in Saudi Arabia in September 2012, and severe acute respiratory syndrome (SARS), identified in southern China in 2003[7],[8]. MERS infected around 2,500 people and led to more than 850 deaths while SARS infected more than 8,000 people and resulted in nearly 800 deaths[9],[10]. The case fatality rates for these conditions were 35% and 10%, respectively.

SARS-CoV-2 is a new strain of coronavirus that has not been previously identified in humans. Although the incubation period of this strain is currently unknown, the United States Centers for Disease Control and Prevention indicate that symptoms may appear in as few as 2 days or as long as 14 days after exposure[6]. Chinese researchers have indicated that SARS-CoV-2 may be infectious during its incubation period[11].

The number of cases and deaths outside of China overtook those within it on 16 March 2020

Where has the new coronavirus come from? It is currently unclear where the virus has come from. Originally, the virus was understood to have originated in a food market in Wuhan and subsequently spread from animal to human. Some research has claimed that the cross-species transmission may be between snake and human; however, this claim has been contested[12],[13].

Mammals such as camels and bats have been implicated in previous coronavirus outbreaks, but it is not yet clear the exact animal origin, if any, of SARS-CoV-2[14].

How contagious is COVID-19? Increasing numbers of confirmed diagnoses, including in healthcare professionals, has indicated that person-to-person spread of SARS-CoV-2 is occurring[15]. The preliminary reproduction number (i.e. the average number of cases a single case generates over the course of its infectious period) is currently estimated to be between 1.4 to 2.5, meaning that each infected individual could infect between 1.4 and 2.5 people[16].

Similarly to other common respiratory tract infections, MERS and SARS are spread by respiratory droplets produced by an infected person when they sneeze or cough[17]. There is also some evidence that SARS-CoV-2 can spread by airborne transmission. Measures to guard against the infection work under the current assumption that SARS-CoV-2 is spread in the same manner.

How is COVID-19 diagnosed? As this coronavirus affects the respiratory tract, common presenting symptoms include fever and dry cough, with some patients presenting with respiratory symptoms (e.g. sore throat, nasal congestion, malaise, headache and myalgia) or even struggling for breath.

In severe cases, the coronavirus can cause pneumonia, severe acute respiratory syndrome, kidney failure and death[18].

The case definition for COVID-19 is based on symptoms regardless of travel history or contact with confirmed cases. Diagnosis is suspected in patients with a new, continuous cough, fever or a loss or changed sense of normal smell or taste (anosmia). A diagnostic test has been developed, and countries are quarantining suspected cases[19].

What social distancing measures are being taken in the UK? The government launched its coronavirus action plan on 3 March 2020, which details four stages: contain, delay, mitigate, research[20]. On 12 March 2020, the UK moved to the delay phase of the plan and raised the risk level to ‘high’.

On 16 March 2020, Johnson announced social distancing measures, such as working from home and avoiding social gatherings, as well as household isolation for those with symptoms[21],[22].

Further social distancing measures were announced on 18 March 2020, including closing all schools in the UK except for vulnerable children and those of key workers, such as pharmacists and other health and social care staff, teachers and delivery drivers. Restaurants, cafes, pubs, leisure centres, nightclubs, cinemas, theatres, museums and other businesses were also told to close.

On 22 March 2020, Johnson announced that the most clinically extremely vulnerable people, including those who have received organ transplants, are living with severe respiratory conditions or specific cancers, and some people taking immunosuppressants, should stay in their homes for at least the next 12 weeks (see Box 2).

Since this date, shielding in England, Scotland and Wales has been eased and brought back in several times in line with lockdown restrictions. And on 16 February 2021, a new risk assessment model was introduced in England to help clinicians identify adults with multiple risk factors that make them more vulnerable to COVID-19, resulting in an additional 1.7 million people being added to the shielding list. Shielding ended in England and Wales on 1 April 2021 and in Scotland on 26 April 2021.

Box 2: Shielding from COVID-19

Those classed as “clinically extremely vulnerable” may include the following (disease severity, history or treatment levels will also affect who is in this group):

Solid organ transplant recipients People with cancer who are undergoing active chemotherapy People with lung cancer who are undergoing radical radiotherapy People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment People having immunotherapy or other continuing antibody treatments for cancer People having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors People who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary People with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency, homozygous sickle cell) People on immunosuppression therapies sufficient to significantly increase risk of infection Adults with Down’s syndrome Adults on dialysis or with chronic kidney disease (stage 5) Women who are pregnant with significant heart disease, congenital or acquired Other people who have also been classed as clinically extremely vulnerable, based on clinical judgement and an assessment of their needs. GPs and hospital clinicians have been provided with guidance to support these decisions A strict lockdown started in the UK on 23 March 2020, with people told to stay at home except to buy essential food and medicines, one form of exercise a day, any medical need, and travelling to and from essential work. Gatherings of more than two people in public was not allowed and all shops selling non-essential goods, libraries, playgrounds, outdoor gyms and places of worship closed. All social events, including weddings, baptisms and other ceremonies, but excluding funerals were cancelled.

A relaxation of the lockdown was announced by Johnson on 10 May 2020. The government published a 60-page ‘recovery strategy’ on 11 May 2020, which sets out the next phases of the UK’s response to the virus, including easing some social restrictions, getting people back to work and reopening schools.

Local lockdowns were introduced at the end of June 2020 to try to control the spread of coronavirus in particular regions in England but cases continue to rise and a second national lockdown was imposed from 5 November 2020 for four weeks. A three-tier system of restrictions will follow the national lockdown in England. In Scotland, a five-level alert system was introduced on 2 November, which will allow different restrictions to be imposed in local areas depending on the prevalence of the infection. A fire-break lockdown came into force in Wales from 23 October 2020, and ran until 9 November 2020.

On 19 December 2020, new tier-four restrictions were imposed in London, Kent and Essex and other parts of the South East of England, meaning that individuals in those areas had to stay at home and not meet up with other households. On 31 December 2020, further areas of England including the Midlands, North East, parts of the North West and parts of the South West were also escalated to tier four.

A new national lockdown was imposed in England and Scotland from 5 January 2021, and similar restrictions were introduced in Wales shortly after. The lockdowns began to lift in steps from the end of March 2021.

What is happening with testing for COVID-19? Tests can now be accessed by anyone with symptoms via nhs.uk/coronavirus.

An NHS test and trace service was launched across England on 28 May 2020, with similar services starting in Scotland and Wales around the same time. Anyone who tests positive for the virus is contacted to share information about their recent interactions. People identified as being in close contact with someone who tests positive will have to self-isolate for 10 days, regardless of whether they have symptoms.

Testing is also now available to care home staff and residents in England, and NHS workers where there is a clinical need, whether or not they have symptoms.

Pharmacy staff in England and Scotland should book tests online via gov.uk and they will be conducted at drive-through testing sites across the country, as well as via home testing kits.

Pharmacy staff in Wales with symptoms of COVID-19 are able to access testing through their Local Health Board.

The government has also announced the start of a new national antibody testing programme, with plans to provide antibody tests to NHS and care staff in England from the end of May 2020. Clinicians will also be able to request the tests for patients in both hospital and social care settings if they think it is appropriate.

Regular testing of asymptomatic patient-facing staff delivering NHS services using lateral flow antigen tests was introduced in NHS trusts in November and expanded to primary care services in December 2020.

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