by Kenji Irie, M.D.
The Coronavirus Pandemic does not seem to be slowing down. The situation in Italy is dreadful. The distance between Japan and China where the infection reportedly began is much less than that between the U.S. and China; however, it is much worse here in the U.S. than in Japan. It is also fearful for the Medicare generation to know that seniors are more susceptible to the virus and easier to become critically ill than the younger generations.
This virus is a challenge for us seniors and is one which needs to be fought back. Preventative measures are very important. Coronavirus is said to be a common enemy of all human beings. what is then Coronavirus? Let’s start from that issue.
1. What is Coronavirus?
Virus is the smallest micro-organism. All living things on the earth are believed to have originated from a single virus many million years ago.
There are 7 typess of so-called Coronavirus. One of them is the New Coronavirus (COVID-19 or SARS-CoV2) which started infecting people in the city of Wu Han (武漢) in China in December of 2019. Four other types cause the regular cold (“flu”) and their symptoms are generally mild. Two remaining types include the one which caused SARS (Severe Acute Respiratory Syndrome) in 2002 and another which caused MERS (Middle East Respiratory Syndrome) in 2012.
2. Route of infection
So far there has been no definite theory regarding how the virus was originally transmitted to human beings. The genetic structure of the Coronavirus in bats is extremely similar to that of human beings, and as a result, it is generally believed that the transmission to humans occurred from bats. Person to person transmission of the virus occurs in one of two ways:
1) Through droplets. When an infected person sneezes or coughs, droplets from the individual carrying the virus containing can fly and reach another individual who would breathe in the droplets.
2) Through contact. An infected person’s hands and lips carry the virus with high probability. The individual would give it to another person by shaking hands, touching, kissing, etc. A healthy individual can get the virus by touching an object (door knobs, rails, electrical switches, etc) which might have the virus through contact by an infected person’s touching or by droplets from the mouth/nose.
3. Latent period
It is considered to be 1-14 days with average of 5 days (per WHO). Thus once infection is suspected, the individual is to rest and self-observe for 14 days even if you feel quite healthy.
4. Who is susceptible to the virus?
People above age 65 (Medicare age), and those with diabetes or chronic illnesses of the heart, lung, or kidney. Also, pregnant women and people receiving chemotherapy for cancer or immuno-suppressive agents (such as anti-rheumatic medications). Also, people with HIV infection.
5. Symptoms
The triad (3 main symptoms): Fever > 100 degree F, severe fatigue, and coughing with breathing difficulty. Even if there are only one or two symptoms, one should be alarmed.
6. Diagnosis
In addition to thesymptoms and physical findings, there is a need for the PCR test to confirm the infection. A negative result does not necessarily exclude the diagnosis. PCR stands for Polymerase Chain Reaction. The test examines the viral activities inside of human cells. To see if an infected person has developed immune resistance to the virus, a specific antibody to the virus needs to be detected in the blood.
You can find the L.A. County drive-through PCR testing locations (21 sites as of 4/9/20) per the online LA Times listing. You have to make reservations online placing your symptoms. There is no charge for testing, and those above 65 are given priority.
7. Prevention
This is the main topic of this article. Basically, there is no difference between the preventative measures of this New Coronavirus and those of common cold. The point to be stressed here is how to do them tenaciously and thoroughly.
1) Hand washing and sanitizing fingers. If you go outside of the home, frequent hand washing is necessary. As soon as coming home, you should carefully wash your hands with soap. To sanitize the fingers, regular 70 % rubbing alcohol is effective. We should refrain from putting fingers into the mouth and the nostrils.
2) Avoid going outside as much as possible. If you have to, you should wear a mask. If available, wear a type which tightly closes gaps around the nose and the mouth. If you use a handmade cloth-mask, you should make several of them. After using it, you should sanitize it by boiling. Water at 70 degree Celsius or higher kills the virus (boiling water: 100 degree Celsius).
3) While outside, avoid crowded places. Even in the house, keep a distance from each other. The distance should be 6 feet or more. When such distance is not possible (ex.: during family meals), shorten the time of gathering as much as possible.
4) In Japan, it is strongly recommended that people avoid the 3 Cs :(1)Closed space (like elevators) (2) Crowded gatherings (3) Close contacts (such as shaking hands, hugging, kissing, etc). The goal of the recommendation is to prevent massive infections.
5) Rubber gloves. Wearing rubber gloves is not generally recommended, except for workers at hospitals and healthcare facilities. However, considering the possibility of merchandise at stores being infected by the virus, protecting your hands by wearing rubber gloves is advised. Gloves for dish washing will do for this purpose.
8. Treatment
Sadly much needed specific medications for treating the COVID-19 cases have not been developed yet. There are no vaccinations, either. Just like during the yearly influenza season, remedies for symptoms such as coughs, fever, congestions, and headaches/bodyaches are being used. Resting, gargling with salt water, removing (spitting) phlegm, drinking sufficient liquids and taking extra Vitamin C are recommended.
For hospitalized patients, medications known to be effective for the diseases caused by other viruses are being used. They start with drugs for regular influenza such as Tamiflu (generic name: Oseltamivir) . Some antibiotic agents are also administered to prevent secondary bacterial infections. To ease the breathing difficulty of those with pneumonia, respiratory therapies such as hand-held nebulizer and oxygen inhalation are used. When breathing becoming seriously difficult, artificial breathing would be started in the ICU using
a respirator.
An anti-influenza virus medication ,named Avigan (generic name: Favipiravir), is a topic in the U.S. media since it was recommended by the Japanese Prime Minister Abe to President Trump. The drug is capable of interfering with the activity of an enzyme, RNA Polymerase, which triggers the proliferation of the virus within human cells. Clinical studies are now being conducted in Japan to find if the drug is actually effective against COVID-19 (Kyodo Press 4/2/20).
9. What to do if you feel sick?
If you are coughing, having fever, and feeling very tired, you should not waste any time and take necessary actions. Examples:(1)Call your primary care physician and ask for a quick referral to an infectious disease specialist if indicated.(2)Contact your nearby urgent care center and ask if they are set up for PCR testing. If so, go immediately.(3)Go to the emergency room (ER) of a large hospital in your vicinity. If you develop chest pain, decreased
consciousness or confusion, and bluish/purplish discoloration of the face/lips (cyanosis) in addition to the triad (fever, fatigue, and coughs), rush to ER( or call 911). When you go, be sure to wear a mask, gloves, and a cap, in order to protect yourself and others. Your family (or friends) accompanying you should do the same.
What I explained here is only an outline of the entire problems associated with the COVID-19. I apologize for the lack of details. I would like to add another point, especially for seniors: It is extremely important to maintain general health by watching your diet, having enough sleep, and doing regular exercises. When the balance of these simple factors in your daily life deteriorates, your immunity (immune resistance) decreases making you vulnerable to the virus and prone to serious conditions.
Let’s fight back !
(This article was originally written for the monthly journal of the Southern California Gardeners’ Federation “Turf & Garden”)