Friday, March 13, 2020

Coronavirus: #COVID19 Symptoms, Assessment and Management of Illness


Recognizing & Managing Symptoms of #COVID19

COVID-19 is the disease that is experienced by those who have been infected by Novel Coronavirus (SARS-CoV-2). As an infectious, or communicable disease, the virus can be transmitted from people who carry the virus to others. 

The current research tells us people who have been exposed, but don’t have symptoms (“asymptomatic), can apparently transmit it to others. 

To limit the transmission to others, if you have any of the symptoms outlined below, or have been in reasonably close contact with anyone who has it, or is suspected to have #COVID19 it is probably a good idea to self-isolate, and/or stay away from others as much as possible for at least 14 days. 

The research isn’t clear on the exact period of time people can transmit or shed the virus. The most likely time we can transmit the virus appears to be in the early phase of developing symptoms. 

Location-based and surface transmission risks does not appear to be well understood at this time. However, surface contamination does happen, which is why improving our cleaning and disinfecting surfaces and objects with bleach-based products at home is very important. 

Top symptoms associated with #COVID19:

  1. High fever/temperature: Adults 37°C +/- 0.6°C; 98.6°F; +/-1°F; Fever: 37.6°C (99.7°F)
  2. Cough – Dry cough, or could have a “productive” cough, with phlegm.
  3. Respiratory symptoms: Shortness of breath; difficulty breathing, decreased airways function. 
  4. Pneumonia in lungs
  5. Runny nose
  6. Fatigue (worse than normal for some)
  7. Malaise (feel “unwell”, lack energy)
  8. Dizziness 
  9. Headache
  10. Muscle aches 
  11. Sore throat
  12. Gastro-intestinal – nausea, vomit, diarrhea, abdominal distress, pain. 
  13. Pink eye - Conjunctivitis
  14. Rash on your body
Tracking COVID-19 Symptoms

COVID-19 Symptom Tracker: http://www.bccdc.ca/resource-gallery/Documents/Guidelines%20and%20Forms/Guidelines%20and%20Manuals/Epid/CD%20Manual/Chapter%201%20-%20CDC/ADM_Form_Case.pdf

Emergency Symptoms that Require Immediate Medical Attention

  1. Respiratory symptoms: Acute difficulty breathing/shortness of breath/laboured breathing
  2. Persistent pain or pressure in your chest
  3. New confusion or inability to rouse
  4. Bluish lips, or face
Severe Symptoms

  • Requires emergency and intensive medical intervention 
  • High Breath Rate: Over 30 breaths/min
  • Oxygen Saturation: < 93%; PF ratio > 300
  • Pneumonia à >50% of lung fields
  • Long-term impacts of COVID-19 cannot be known at this time. 

Critical Care 

  • Highest mortality rate (50:50 in first large scale research from China)
  • Respiratory system failure: patient cannot breathe on their own, requires mechanical support. 
  • Acute Respiratory Distress Syndrome (ARDS) à Can be fatal.
  • Septic shock
  • Multiple Organ dysfunction and failure: lungs; heart; kidneys; liver
  • Death: 50:50 ratio in largest research cohort in the early part of outbreak in China. 
  • Case Fatality Rate (CFR): # of deaths/ # of cases X 100 = CFR. Current CFR is between 2%-4%. (Some regions are seeing higher rates for reasons that aren't clear). 
Those with the highest risks of developing more severe or critical cases are: People with histories of respiratory illnesses; people with cardio-vascular issues; people with immune-suppression and complex health conditions; individuals with diabetes; those of older ages; and smokers.

Assessment

Call a Local Nurse Line: In BC call 8-1-1 to speak with a nurse who can do over-the-phone assessments with you.  They can assess our symptoms and recommend whether we should seek medical attention, and what urgency there is for that. 8-1-1 has translation services in 130 languages.

Call your local public health unit to find out where you should go to be assessed and tested for COVID-19.

Contact a local Centre for Disease Control (CDC) to find out where you should go to be assessed for COVID-19. In BC call the BCCDC @ phone: 604-707-2400

Email: admininfo@bccdc.ca

In BC if you have been tested for COVID-19 you can call 1-833-707- 2792 to speak with a nurse to get your test results. This line is available 7 days/week from 8:30 AM - 4:30 PM.

Seek medical attention at your family doctor, or local walk-in clinic: If symptoms worsen, you have complex health conditions, especially respiratory illnesses and immune-suppression. Phone the office ahead of your visit to advise of cold/flu symptoms and office protocols. 

Online Medical Care: You may want to consider signing up for, or downloading an app to receive assessment from doctors online. Ensure you understand the privacy and security issues with this. 

Check out Clinic Wait Times: There are websites that allow you to determine approximate wait times at local clinics. Medimap is one of those in BC. 

Urgent and Primary Care Centre: If your community has one of these you may be seen quicker. It is a step down from hospital, and suitable for less severe symptoms. 

BC Urgent and Primary Care Centres can be found here:

Go to your local hospital if symptoms become acute: if your breathing has become very laboured and difficult, having increased cardiac symptoms, or other symptoms worsen, call 911, or get to hospital ASAP.

Online Information and Resources

HealthLink: Tons of information about different health concerns and conditions. https://www.healthlinkbc.ca/


Coronavirus Disease (COVID-19) Center for Disease Control: https://www.cdc.gov/coronavirus/2019-ncov/about/symptoms.html

Diagnostic Tests for Assessing COVID-19

  • Physical exam by treating physician: Listen to your lungs and breath; may examine your lymphs in your neck.
  • Nasopharangeal and/or throat swab: Sample will be tested for the presence of flu viruses (influenza A, B & SRV) and COVID-19 (if you meet the local testing and exposure criteria). 
  • Vitals: Heart rate; blood pressure; temperature. 
  • Bloodwork: C-Reactive Protein: measure of inflammation in your body (can be due to infection); others doctor feels are necessary. May get blood sugars tested if diabetic, or borderline. 
  • Urine sample may be requested to query bacterial infection
  • X-ray of lungs
  • CT scan of lungs (computer tomography) for more severe cases of respiratory distress.

WHO Report about Mild to Moderate Cases of COVID-19

Early research from China suggests that 81% of individuals who contract COVID-19 will have mild or moderate cases. While they are symptomatic they are capable of spreading the virus to others, including through community transmission. 

On March 10, 2020, the WHO held a media briefing in which the following was reported:
  • People with mild to moderate cases of COVID-19 can develop pneumonia.
  • Those who do develop pneumonia can require more intensive health care interventions.
Proactive Personal Management of COVID-19
At this stage, if you, family members, work colleagues, or others have these symptoms, you should consider yourself to possibly have an infectious disease. From there, move into an immediate plan to manage, and contain the virus from spreading. 
Self-isolate/self-quarantine
Wear a mask when being around others. 

Wash your hands A LOT, for 20 seconds. Warm, soapy water. Sing ‘Happy Birthday’ while washing, do this with your kids too. 

Disinfect surfaces and objects in your home, or other areas you have spent time, such as work. 
Become more conscious about not touching your face. Teach your kids to be more aware of this too. 

Find ways to boost your immune system. 

Improve eating, diet and nutrition: Increasing antioxidant foods increasing the bodies way of fighting off infections, and improving our immune system. 

Change your habits while in public spaces: Increase physical distance from others. Wear gloves at the gym. Consider moving your workouts, yoga and other physical exercise to home settings.

Social distancing: Consider restricting your work and community participation and travel for a time, including decrease attendance in group settings, crowds, or other events. This is especially important for those in the higher-risk categories.  Read this for more information about this behavioural method of stopping the spread. 
Hold off on travel, especially international travel: You may have to self-isolate for at least 14 days upon returning to BC, or Canada if you do. 

What to Do If You are Refused Testing or Health Care for COVID-19
Unfortunately, across BC, Canada, and other jurisdictions, people have been refused testing for COVID-19, which is called 'test suppression.' One of the outcomes of this is that there is that BC, and most other jurisdictions do not have an accurate count of all of the people with COVID-19, because the majority of people who now have it can't get tested.

Overwhelmed health care systems are also refusing health care (which includes testing) due to capacity issues. 

Email, or contact your MLA to ask where you, or your family members can get tested for COVID-19 in your community. 

Change the COVID-19 Testing Criteria: When emailing your MLA, please also tell them you want the BC to change the exposure criteria so that more testing for COVID-19 can occur in your community. 

Report local test refusals and refusals of health care to your MLA: Advise them if you, anyone in your family, or in your community has been refused testing for COVID-19, or health care. 

Find out your MLA’s contact information here:

Find MLA’s by name: https://www.leg.bc.ca/learn-about-us/members

Search for your MLA by Postal Code: https://www.leg.bc.ca/Pages/BCLASS-Member-Search-PostalCode.aspx

Email, or contact your MP (Member of Parliament) and Senators: Tell them you want them to advocate for the exposure criteria to be changed and updated in BC and that more testing for COVID-19 can occur in Canada.

Report local test refusals to MP’s and senators: Advise them if you, anyone in your family, or in your community has been refused testing, or health care for COVID-19. 

Find out your MP’s contact information here: https://www.ourcommons.ca/Members/en

Find Your Local Senators here: https://sencanada.ca/en/senators-list/

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