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COVID-19: The Evolving Threat

*Originally posted on September 9, 2020

It’s tough to understand how an RNA virus called the coronavirus has kicked the world in the ass. Even more surprising is how it has devastated the 400-pound economic gorilla, the United States. There are millions of COVID-19 cases throughout the country and close to 200,000 deaths. Over 44 million Americans have lost their jobs, and the entire country is coping with a new chaotic normal. I will try not to be too political but having been a physician since 1985; I know this has been the most mismanaged health crisis in the past 100 years.

This is one of the most contagious and lethal viruses since the Spanish flu pandemic of 1918. The first confirmed case in the U.S. occurred on January 21, 2020. The simplest of solutions, wearing a mask and social distancing became political weapons that contributed to this viral wildfire burning out of control in many parts of the country to what we have today, September 9, 2020:

6,416,615 confirmed cases and 192,538 deaths.

Now that it is here and national (and local) responses are out of our control, we must learn how to deal with our new reality safely.

COVID-19 Symptoms

I’m a urologist, but I also care for patients with other diseases like Covid-19. The fascinating thing about this unique virus is the many different symptoms that it can produce, moving from host to host silently.

You can potentially experience the following:

Fever Loss of smell or taste

Shortness of breath Headache

Cough Chills

Sneezing Sore throat

Abdominal pain Vomiting

Nausea Fatigue

Body aches Loss of appetite

Diarrhea Excessive phlegm or mucus

Signs of deteriorating health that require urgent attention by a physician or a trip to the hospital include:
  • Bluish lips

  • Constant pain or pressure in the chest

  • Stroke

  • Heart attack

  • Sudden confusion

Unusual symptoms of Covid-19 include:

Pink eye (conjunctivitis) Kidney failure

Swollen eyes Guillain-Barre syndrome

Seizures Liver damage

Fainting Heart damage

Blood clots Skin rash

Symptoms in children may be similar to those seen in adults but milder:
  • Fever 56%

  • Cough 54%

  • Shortness of breath 13%

  • Covid toes (purple or blue spots on a child’s feet & toes)

  • Pediatric multisystem inflammatory syndrome (PMIS) (Kawasaki-like syndrome)

This is an overwhelming list, but it should heighten your awareness that almost any symptom might be secondary to Covid-19. Strict adherence to wearing “appropriate” masks, regular hand washing, and social distancing (I say greater than 6 feet apart) can save you and your family a lot of heartaches. I know that it may seem like too much and that you are tired of the inconvenience, but this virus is real. I was on the fence until seeing our hospital bed full of the infected and several deaths. I predict that by the end of the year everyone in the country will know someone who is infected or has died from this virus.

Lasting Affects – “Long Haulers”

The Covid-19 infection has shown an ability to cause long-term symptoms and damage to the body. The CDC has confirmed that 35% of patients who tested positive for symptomatic COVID-19 had not returned to normal health up to 3 weeks after they were interviewed. A survey from the British Medical Journal confirmed that 3729 physicians in the country confirmed treating COVID patients with long term loss of smell and chronic fatigue. I have several patients that have recovered but report lingering shortness of breath, fatigue, and mental fogginess for many weeks (even months) since the initial infection. Some patients report muscle weakness. Those who have suffered strokes and cardiac events will never return to normal function. To avoid becoming an unfortunate “long hauler,” don’t take risks! Avoid gatherings of more than 10 people, wear a mask, avoid handshakes without gloves, avoid hugs outside your family pod, wash your hands and practice social distancing.

How to Approach the Vaccine Rush

Having been in medicine for almost 40 years, I always proceed cautiously with “new” treatments, especially vaccines. It appears that an excessive amount of political pressure is being applied to the companies that are in “Project Warp Speed.” That name is scary enough. The leaders of several companies in the race, AstraZeneca, BioNTech, GlaxoSmithKline, Novavax, Pfizer, and Sanofi, pledged “high ethical standards and sound scientific principles” in their vaccine development process. This statement sounds good, but it does not give me comfort. I will find comfort in the process, the science, and the data!

Just yesterday, AstraZeneca had to pause its clinical trial due to a female study participant in the UK developing an unknown illness. Reportedly she had symptoms consistent with a rare but serious spinal inflammatory disorder (probably transverse myelitis*). She is reportedly recovering, but this highlights the need to adhere to the standard of practice for vaccine clinical trials. I would not trust any vaccine that is rushed to the public. I’m not a conspiracy theorist, but I do believe in the clinical trial process. This process is tried and true with vaccines, especially when children will be treated.

[*Transverse myelitis – An inflammatory reaction of an entire section of the spinal cord. This condition can result in permanent damage to the myelin sheaths of the nerves, which is the insulation of the nerve fibers. This can result in pain, paralysis, numbness, and bowel and bladder dysfunction. It can be caused by certain viruses that can trigger an auto-immune response that results in transverse myelitis.]

The Testing Dilemma

The most significant incompetence of the pandemic, which continues to occur, is the lack of large-scale testing. This is the most important aspect of battling a highly contagious infectious disease like Covid-19. We must perform tests to identify those who are infected, especially the asymptomatic carriers. Those individuals who test positive must be isolated (quarantined) from the uninfected for 2 weeks and re-tested to confirm they are negative before interacting with others. I have identified multiple asymptomatic individuals with absolutely “no” symptoms and “no” fever. A very healthy 60-year-old African American male patient of mine who was scheduled to undergo robotic surgery for prostate cancer developed a fever of 101 the Saturday before his procedure. He then tested positive for Covid-19, and surgery was postponed for 2 weeks. Surprisingly, his wife tested positive with no symptoms and the two teenagers in the household tested negative, even though they were equally exposed. This is a very unusual, potentially deadly virus, and testing must be vigorously employed if we are to successfully open schools and return to normal.

“Health knowledge is more important now than ever; it will be the key to your future wealth in these uncertain times.”
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