Flattening the Curve for Coronavirus in Detroit Michigan
Coronavirus is here in Michigan. As of now, there are 53 cases in the State of Michigan. So what can we do to prevent the spread of the virus? What does it mean to practice social distancing? What does it mean to flatten the curve?
What’s the best thing you can do to prevent the spread of the Coronavirus?
The best thing to do to prevent the spread of the virus is to act as if you already have the virus and do everything that you can to prevent transmitting it to your loved ones and vulnerable people in the community.
What is social distancing?
Social Distancing is a term applied to certain actions that are taken by Public Health officials and all of us to stop or slow down the spread of a highly contagious disease. Cancelling events that are likely to draw crowds is an example of social distancing enacted by Public Health officials. Social distancing enacted by us as individuals means deliberately increasing the physical space between yourself and the people in the community. This may look like staying at home away from other people or it may mean keeping a 6 foot space between yourself and other people in the community.
What does it mean to flatten the curve?
To flatten the curve is to decrease the rapid transmission of the Coronavirus and therefore decrease the peak number of actively infected individuals at any one time. This is important because if there are too many infected individuals, we will exceed our hospital bed and ventilator capacity. If we don't flatten the curve, there will be unnecessary deaths due to the spread of the Coronavirus.
What is the most common presentation for the Coronavirus?
A: The most common presentation for the Coronavirus is a one-week prodrome of myalgia or muscle aches, malaise or generally not feeling well, cough, and low-grade fevers. This gradually leads to more severe trouble breathing in the second week of illness. There is an average of eight days to the development of dyspnea and an average nine days to onset of pneumonia or pneumonitis.
How is the presentation of Coronavirus different from the presentation of Influenza?
A: Coronavirus tends to have a gradual onset. Influenza tends to have a sudden onset. Coronavirus tends to have a cough and fever. Influenza tends to have fever, chills, muscle aches, nausea, vomiting, and diarrhea.
What are the lab findings like for the Coronavirus?
A: The most consistently present lab finding was lymphocytopenia (with either leukocytosis or leukocytopenia). Lymphocytopenia is the condition of having an abnormally low level of lymphocytes in the blood. Lymphocytes are a white blood cell with important functions in the immune system. It is also called lymphopenia. The opposite is lymphocytosis, which refers to an excessive level of lymphocytes. During other infections, we typically see lymphocytosis or an increase in white blood cells to fight off the infection. Aside from the depressed white blood cell count, other markers like C-reactive protein or pro-calcitonin were not as consistent.
What are the most common radiographic findings for Coronavirus?
A: The most consistent radiographic finding, discovered on chest x-ray, is bilateral interstitial infiltrates also known as ground glass infiltrates or ground glass opacities. A radiograph is an image produced on a sensitive plate or film by X-rays, gamma rays, or similar radiation, and typically used in medical examination.
Can you get a co-infection with another virus or bacterial infection when you get the Coronavirus?
A: Co-infection rate with other respiratory viruses like Influenza or respiratory syncytial virus (RSV) is less than two percent. Basically, if you have a positive test for another respiratory virus, then you do not test for COVID-19. This information is based on a large dataset from China.
When people get the Influenza virus, they don’t often die from the Influenza virus, but from a subsequent and opportunistic bacterial infection like a bacterial pneumonia. Is this the case for Coronavirus?
So far, there have been very few concurrent or subsequent bacterial infections, unlike Influenza where secondary bacterial infections are common and a large source of additional morbidity and mortality.
How much does it cost to get the Coronavirus test?
A: It depends on the lab, the health system, and the insurance company. LabCorp is offering a test for roughly $50, Quest Diagnostics is offering a test for roughly $250, and the test may be free for those who have insurance, depending on your symptoms.
What can we do to treat the Coronavirus?
A: To date, patients with severe disease are mostly getting Remdesivir from Gilead through compassionate use. However, the expectation is that avenue for getting the drug will likely close shortly. It will be expected that patients would have to enroll in either Gilead’s randomly controlledtrial or the National Institute of Health’s “Adaptive” randomly controlled trial (Remdesivir vs. Placebo). Others have tried Kaletra, but that medication was not beneficial.
How long are patients contagious after they contract the Coronavirus?
A: The short answer is that patients are likely contagious for 20 days after contracting the Coronavirus. The more complicated answer is that patients can shed RNA from one to four weeks after symptom resolution, but it is unknown if the presence of RNA equals presence of infectious virus. For now, COVID-19 patients are cleared of isolation once they have two consecutive negative RNA tests collected more than 24 hours apart.
Thanks for reading and stay safe out there.
-Dr. Paul Thomas, MD with Plum Health DPC