At this point, COVID-19 needs no introduction. It has spread rapidly through communities across the United States and is continuing to maintain a global health threat. More and more people are becoming familiar with the various symptoms of the virus, as well as the method through which it is spread. However, one thing you may be wondering is how the virus is contracted and whether it is as contagious as people are saying. While this is still being investigated by researchers, here are some of the basics about how COVID-19 is contracted. 

The first step to becoming infected is to contract the virus. COVID-19 is most commonly contracted in the air by inhaling the virus, but it can also be contracted by touching surfaces with the virus on them. Viruses work by infecting healthy cells within the body and are ineffective without a host cell. Until they have joined with a host cell, they are simply known as a virion.  

COVID-19 is an enveloped virus, meaning that it has a layer of protective lipids (fats) around its protein capsid and virion genome. Envelope viruses are highly sensitive and can be destroyed by stomach acid, heat, dryness, and disinfects like ethanol or propanol. However, envelope viruses are also able to “hide” from the body’s natural defense system. 

The SARS-CoV-2 virion contains spiky outer proteins that attach themselves to the ACE receptors of healthy cells. These receptors are primarily found in the lower airway, which is why the virus affects the lungs. However recent research has found that these receptors are also on goblet and ciliated cells in the nose, as well as on the tongue and within the mouth. This explains how the virus enters the body primarily through the mouth or nasal passages. 

Once fused with the plasma membrane (external wall) of the host cell, the virion genome is released into the cytoplasm (interior) of the cell. Since it is released into the cell’s cytomplasm, SARS-CoV-2 is an RNA virus. This means that the viral DNA is transformed into messenger RNA (mRNA) and used to create viral proteins. 

These viral proteins are then used for one of three things: 

• Create special enzymes needed for viral replication
• Inhibit host cell DNA, RNA, and protein synthesis
• Create structural proteins used to construct new virions

Simply stated, once the SARS-CoV-2 virus has entered the cell, it then uses the cell to produce millions more copies of the virus. According to a study performed by German microbiologists, there are an average of 676,000 copies of the virus on a single swab taken from the mouth and nose during the first five days of symptoms. However, this number is believed to drop starting on day one and continuing until it is almost undetectable in most people by day ten. This trend suggests that the most copies of the virus are present before symptoms occur and is the main reason why the virus can spread so rapidly. 

Additionally it is important to understand the mathematical and epidemilogical term R₀ (R naught). R₀ is used to describe the average amount of people who can contract a contagious disease from a single infected individual. R₀  is calculated by taking into account a diseases’ infectious period, contact rate, and mode of transmission. Longer periods of infectiousness, frequent contact with others, and airborne illness tend to have a higher R_0. 

Here’s how it works: 

• If R₀ <1, then one infected person can cause less than one infection. In these cases, the disease will eventually die out
• If R₀=1, then one infected person can cause one new infection. In these cases, the disease will be infectious, but not cause an outbreak
• If R₀>1, then one infected person can cause more than one infection. In these cases, the higher the R₀ value, the more infections the disease is

Initially, researchers believed that the SARS-CoV-2 virus had an R₀=2.2-2.7, indicating that a single infected person could infect 2-3 people. However, more recent research suggests that SARS-CoV-2 actually has an R₀=5.7, meaning that a single infected person can infect 5-6 people. To put things into perspective, the 1918 pandemic flu had an R₀ = 1.4-2.8,  the 2009 H1N1 virus had an R₀= 1.4-1.6, and the annual flu has an R₀=1.3. These numbers clearly suggest that COVID-19 is significantly more contagious than other viruses we’ve seen in the past. 

Since R₀ is calculated considering the infectious period, contact rate, and transmission method of a disease, it can change over time. While the infectious period and transmission method cannot easily be controlled, the contact rate can. With that being said, medical experts are urging people to practice social distancing as a way of lowering the contact rate and thus the overall R₀ of COVID-19. 

For More Information:

https://www.livescience.com/new-coronavirus-compare-with-flu.html

https://www.medicalnewstoday.com/articles/covid-19-what-happens-inside-the-body

https://www.nature.com/articles/s41586-020-2196-x

https://www.ncbi.nlm.nih.gov/books/NBK21523/

https://www.healthline.com/health/r-nought-reproduction-number#how-its-calculated

This Week in Virology Podcast: https://www.microbe.tv/twiv/

The recent outbreak of the SARS-CoV-2 virus, also known as COVID-19 or Coronavirus, has led to federal recommendations calling for social distancing practices as a way to slow the spread of the virus. Consequently, many medical offices are responding by offering video appointments to their patients. Known as telemedicine, this approach lets doctors provide care to their patients without the risk of spreading this highly-contagious virus. 

With telemedicine, instead of visiting your doctor’s office for an appointment, you simply login to a HIPAA-compliant platform for your video appointment. This allows you to see and speak with your doctor about your non-urgent medical concerns from the comfort of your own home. Not only does this protect you from unnecessary exposure, but it helps to alleviate the pressure on emergency rooms and urgent care clinics. With that being said, video appointments are intended for non-urgent medical concerns. If you are experiencing a possible health emergency, it is recommended to skip the video visit and call 911. 

The day of your appointment, it is recommended that you login about 10-20 minutes before your scheduled appointment time to make sure everything is working on your end. Although you don’t need to physically visit your doctor’s office, it is still recommended to treat the video appointment as you would an office visit. Therefore, you should jot down and questions or concerns you have for your doctor ahead of time. Additionally, you will want to have a list of your current medications handy as well. 

What Can Telemedicine Treat?

Depending on your medical condition, your video appointment will vary. Telemedicine works well to treat the following conditions: 

• Allergies
• Arthritis
• Asthma
• Bronchitis
• Cellulitis
• Colds and flu
• Diarrhea
• Infections
• Insect bites
• Pharyngitis
• Conjunctivitis
• Rashes 
• Respiratory infections
• Sinusitis
• Skin inflammation
• Sore throats 
• Sprains and strains
• Bladder infections
• UTIs
• Sports injuries
• Vomiting 

What Happens During a Telemedicine Appointment?

As a general rule, you can expect to discuss the things that you would normally discuss during an in-office appointment such as chief complaints, medical history, symptoms you are experiencing, family history, medication review, allergies, and history of the illness (if chronic). Additionally, you can expect to perform a provider-directed self-examination. 

After your appointment, your doctor may prescribe certain medications to treat the diagnosis. This is especially common if you have an established relationship and/or a chronic health condition. In other cases, your doctor may direct you to come into the office for further examination or diagnostic tests. They may also provide you with other guidelines to follow in the meantime. 

How to Have a Good Appointment

While telemedicine offers a variety of benefits, it still has a few shortcomings. Therefore, here are a few tips to help you with your telemedicine appointment: 

Start Early

As mentioned before, it is a good idea to login about 10-20 minutes before your scheduled appointment time to make sure everything is working on your end. This also allows you to be ready for your appointment once your doctor is. 

Be Professional

Another way to benefit from your telemedicine appointment is to be professional. Basically, this just means that you will treat a video appointment like you would an office visit. This means getting dressed, and picking a quiet location to carry out your appointment free from distractions. 

Use Video

If you are faced with the decision  between using audio only or using video, it is recommended that you choose video. This is because the large amount of body language and facial expressions are lost with the visual component of communication. Simply stated, video appointments can make you feel more comfortable and help foster trust. 

As of January 22nd, 2020, there was only one reported case of COVID-19 in the United States. A week later there were 5 cases. A month later there were 15 cases. Then in the beginning of March the number of cases almost doubled overnight going from 30 reported cases on March 1st to 53 cases on March 2nd. By St. Patrick’s Day, this number had grown to 7038. As of March 30th, there are currently 163,539 cases of COVID-19 in the United States according to the Centers for Disease Control and Prevention. On March 31st, the South Carolina Department of Health and Environmental Control (DHEC) noted that there are a reported 1,083 cases in 42 counties of South Carolina. Currently Lancaster County has 15 confirmed cases of COVID-19. 

As this pandemic continues, there has been talk about social distancing practices intended to flatten the curve. Yet, not everyone is adhering to social distancing guidelines. In fact, the lack of adherence to social distancing guidelines inspired Republican Gov. Henry McMaster’s decision to close access points to the state’s beaches, as well as public boat ramps and access points to rivers and lakes. Previously, the governor of South Carolina had made the decision to close dine-in restaurants and bars. However, he has yet to issue a stay-at-home order. As of March 30th, 30 states have issued stay-at-home orders, while another 4 states have ordered all non-essential businesses to close. 

Even without a statewide stay-at-home order, South Carolina residents are still adhering to The President’s Coronavirus Guidelines for America, which are based upon slowing the spread of the virus. In fact, slowing the spread or flattening the curve are two phrases that are being thrown around as the primary motivation for stay-at-home orders and the closing of public places. 

Using acquired knowledge about how pandemics function, health professionals and researchers agree that the best way to control the current situation is through nonpharmaceutical interventions (NPIs), or community mitigation measures. NPIs are a set of guidelines that individuals and communities are recommended to follow in order to slow the spread of respiratory viruses in order to reduce the number and severity of cases. 

Until a vaccine is widely available, research has indicated that the best way to slow viral transmission from host to host is to reduce opportunities for exposure. Research also indicates that it can take up to 6 months to develop a safe pandemic vaccine. Therefore, NPIs are the best method for dealing with a pandemic caused by a novel virus. 

While NPIs like hand-washing and social distancing will not entirely stop the spread of virus, they do interrupt the natural way a viral outbreak occurs. When looking at the above diagram, you will notice that the red curve indicates rapid spreading of the virus that results in large amounts of the population all being infected around the same time. Conversely, the blue curve shows a slower spread of the virus with less people being infected. 

Additionally, it is important to note the dotted line in the middle, which indicates the available number of medical resources needed to treat the virus. As you can see, the red curve extends far beyond that dotted line. What this means is that only the infected individuals below the dotted line can be treated. Therefore, anyone above that line will not receive the treatment needed to recover. 

Conversely, looking at the blue curve, you will notice the curve does not cross the dotted line. This is because slowing the spread of the virus decreases the likelihood that the number of cases will peak all at once. Although there is still a peak, this peak lasts longer and is much lower than it would have been without practicing social distancing. 

Still, some people may argue that coronavirus is simply like the flu and social distancing is an overreaction. However, one main difference between the two is that most people have partial immunity to the flu. This is not the case with COVID-19 since it is an entirely new virus. Therefore, the opportunity for people to become infected with the virus is much higher than that of the flu. 

Not only that, but there is historical evidence that shows social distancing works. In 1918 during the outbreak of the Spanish flu, two U.S cities responded very differently. The first city, Philadelphia, continued with business as usual and even carried out a parade with thousands of people in attendance. Unfortunately, this resulted in death from the Spanish flu 48-72 hours later. In total, the city lost 16,000 individuals in six months. 

Conversely, St. Louis implemented social distancing strategies, closed schools, and limited travel. Allow there were still deaths associated with the pandemic, St. Louis lost 2,000 individuals instead of 16,000. At that time, St. Louis was the fourth largest city in the United States, yet it had the lowest mortality rate for its size. 

While no one can accurately predict what will happen next, there are several hypotheses backed by medical and history evidence that suggest social distancing is a key way to overcome the COVID-19 pandemic. Therefore to protect yourself and your family, stay home and stay safe. 

***If you believe you are experiencing symptoms of COVID-19, call us at (803)283-2300***

Along with the new decade came a new strain of the coronavirus that has sparked fear and worldwide panic. Originating in Wuhan, China, Coronavirus now has confirmed cases in 81 other countries, with 80 confirmed cases in the United States. As of March 4th, 2020, the Centers for Disease Control and Prevention (CDC) reports that 13 states including Arizona, California, Florida, Georgia, Illinois, Massachusetts, New Hampshire, New York, North Carolina, Oregon, Rhode Island, Washington, and Wisconsin have cases of Coronavirus. Currently, 9 people have died due to the virus. 

Coronaviruses were initially discovered by scientists around the 1960s. It earned its name from the crown shaped protrusions that cover its surface. There are seven strains of Coronavirus that affect humans, including:

• 229E (alpha coronavirus)
• NL63 (alpha coronavirus)
• OC43 (beta coronavirus)
• HKU1 (beta coronavirus)
• MERS-CoV (beta coronavirus that causes Middle East Respiratory Syndrome MERS)
• SARS-CoV (beta coronavirus that causes severe acute respiratory syndrome SARS)
• SARS-CoV-2 (novel coronavirus that causes coronavirus disease 2019, aka: COVID-19)

Every year, people around the world are affected  by coronavirus 229E, NL63, OC43, and HKU1. In fact, these strains have affected almost every person during some point in their lifetime. The 229E, NL63, OC43, and HKU1 strains of coronavirus generally cause symptoms such as runny nose, headache, fever, sore throat, cough, and a general unwell feeling. More serious cases have also been known to develop into pneumonia or bronchitis. 

Animals such as cattle, camels, and bats are also susceptible to certain strains, and can even pass these strains to humans. In the past, this has occurred with SARS-CoV and MERS-CoV. It is believed that this may also be the case for COVID-19. Research has suggested that the virus originated from bats, was spread to humans at a live animal market, and then continued to spread from person to person. The virus spreads through community spread, which means it tends to affect people in the same area. 

Beyond the fact that COVID-19 affects people in the same area, it is known for sure how the virus spreads. However, other types of common human coronaviruses can be transmitted by air that has been infected with coughing or sneezing, close personal contact or touching, and touching an infected surface and then touching your eyes, nose, or mouth. 

Based on this, scientists believe the virus is spread through close contact and through respiratory droplets that contain the virus. They also believe that the virus is the most contagious when a person is actively experiencing symptoms, although it is possible to spread the virus without symptoms. The virus may also spread from touching infected surfaces and then your mouth, nose, or eyes. 

The CDC has noted that there is a high potential threat for both the United States and other countries. Currently, however, the virus is not considered to be rapidly spreading through the United States and the majority of the population will not be immediately exposed. Nevertheless, the virus will likely reach the level of global pandemic and the risk to the United States may change at any time.

As a precaution, the CDC recommends taking the following steps:

• get a flu shot
• cover your cough or sneeze
• wash your hands often, especially before facial contact
• stay home when you are sick
• avoid close contact with others
• clean surfaces

To stay up to date on the latest news regarding COVID-19, visit the Centers for Disease Control and Prevention website. They post regular updates about cases of COVID-19 in the United States Monday through Friday. 

Did you know that cardiovascular disease kills more women than all types of cancers combined? In fact, cardiovascular disease has been deemed the #1 cause of death in women. Unfortunately, however, many people are unaware of how serious this problem is. For this reason, the American Heart Association (AHA) has established February 7th as Wear Red for Women day as part of their Go Red for Women campaign. 

Wear red day is intended to raise awareness about how heart disease affects women, as well as to advocate for more research and care focused on the correlation between the two. Because women experience heart disease differently than men, there needs to be more patient education, research, and specialized care in order to reduce the mortality rate. In fact, the American Heart Association notes that almost 80% of cardiac events can be prevented, showing that spreading awareness can help to reduce the prevalence of severe cardiac events in women. 

Not only that, but the Go Red for Women campaign also highlights the scarcity of research focused on how heart disease is exhibited in women. This is because they found that less than half of any trial participants are women and that many studies do not pay attention to the biological differences between the sexes. Therefore, much of what we have been told about heart disease is actually centered around how it is exhibited in men. 

However, there is definitely some overlap in the way that men and women experience heart disease. For example, a couple of common symptoms that occur in both men and women can include chest pain and shortness of breath. Additionally, however, women may also show signs that may not immediately be connected to heart disease, such as: 

• Nausea or vomiting
• Fatigue
• Lightheadedness
• Sweating
• Pain in the neck, jaw, throat, upper abdomen, or back

In most cases, women with heart disease tend to experience symptoms while resting, but there are cases where symptoms may be brought on by emotional stress.  Additionally, symptoms can affect women differently and not every symptom must be present to indicate the presence of heart disease. Any of these symptoms suggest that a visit to your local cardiologist is needed to determine whether or not they are caused by heart disease. 

It is important to visit your cardiologist if you are at an increased risk of developing heart disease, especially if you are experiencing early symptoms. Some things that can indicate an increased risk for cardiovascular disease include: 

• Menopause
• Pregnancy complications
• Family history of heart disease
• Depression 
• Unhealthy diet and/or stationary lifestyle
• High blood pressure
• Obesity
• Excessive alcohol intake
• Diabetes

While women with these conditions may be at an elevated risk of developing cardiovascular disease, all women are potentially at risk. Therefore it is necessary to attend yearly physicals to monitor your blood pressure, as well as blood sugar and cholesterol levels. 

Overall, heart disease in women poses a serious potential threat to women everywhere, especially being the #1 cause of death in women. However, about 80% of cardiac events can be prevented, meaning that there is definitely hope for the future. In order to educate more women and advocate for women-centered heart disease research, the AHA urges people to wear red on February 7th.