The Winter Bug
By: Kenneth Q
Tags: 2020, Covid 19, Healthcare, Doctors

Back in March/April, I was working in the hospital and saw how sick SARS-COV2 (the virus responsible for COVID-19) could make people. I watched people deteriorate quickly after admission and got fairly acquainted with the awful lung imaging associated with COVID-19. Nine months later I’m back in the hospital after 6 months of working only in the outpatient setting. The virus obviously hasn’t gone anywhere, but what we’ve learned and what I’ve experienced has, so I wanted to write up brief update.

Up first is a clarification which needs to be made because people still do not seem to understand the difference. SARS-COV2 (Severe Acute Respiratory Syndrome COronaVirus 2; sequel to COV1 which caused the SARS outbreak of 2003) is the virus responsible for COVID-19 (COronaVIrus Disease of 2019). COVID is easier to say and catchier so it’s largely used in places where people mean SARS-COV2; most notably when people say they are getting COVID tested. Here’s why it matters.

Back in March testing was scarce. Strict guidelines determined who could even get tested. In the most simplified sense, only those who had a significantly high probability of having the virus got tested. Therefore, only those who had obvious signs of COVID-19 got tested for SARS-COV2 and therefore a positive COV2 test became synonymous with having COVID-19. Today we not only have tests for pretty much everyone, we have different types of tests from a variety of manufacturers. Now anyone from the curious asymptomatic person to the intubated ICU patient all get tested. This has revealed the asymptomatic COV2 carrier — a patient who otherwise feels well, but tests positive for the virus — which means positive COV2 can no longer be synonymous with COVID-19 positive. You can develop COVID-19 from a COV2 infection but you cannot “test positive/negative for COVID”. If you feel unwell and test positive for COV2 during your illness, you are diagnosed with COVID-19. COV2 infection is a lab finding, and COVID-19 is a clinically relevant disease due to the infection.

Over the last 2 months, I’ve also been working extensively at several urgent care centers where I’ve seen at least a hundred plus patients with COV2 in a non hospitalized setting. Thanks to the media which likes to pair any story about COV2 with pictures of ICU beds and people in hazmat suits, patients understandably express concern and sometimes distress when they hear they tested positive. The questions are pretty much all the same so I will address the top FAQs

Am I going to die/do I need to go to the hospital? COV2 infection creates a spectrum of illness from asymptomatic infection to ICU stay with multi organ failure. Luckily, most people fall on the less severe side of the spectrum with simple cold/flu symptoms- fatigue, headache, congestion, body aches, fever, cough, sore throat. Unique to COV2 are loss of taste and/or smell and diarrhea. Symptoms usually self resolve. Shortness of breath can present in people with more severe forms of COVID-19, but does not always lead to hospitalization. Checking your oxygen levels at home can be a way of staying out of the hospital, assuming you have a reliable pulse oximeter and know what normal is. However, if the shortness of breath is significant or rapidly worsening, a trip to the emergency room is highly recommended.

What can I do now? There are loosely defined and ever changing protocols for hospitalized patients, but for those who don’t need hospitalization, the recommendation is simply to stay home, isolate, and rest. There is debate about the usefulness of Vitamin C, D, and zinc supplementation, so while I do not promise any benefit, there’s no downside to supplementing it at the daily FDA recommended doses. And of course with diarrhea, make sure to stay hydrated and replenish your electrolytes with a sports drink (cut with water to prevent dehydration) or some good old chicken noodle soup.

How long do I quarantine? CDC guidelines are changing as knowledge grows about the virus. Refer to their website for quarantine/isolation rules. States also have their own modifications/clarifications of the rules.

Do my close contacts need to get tested? No. Even with a negative test, quarantine is recommended for those who are defined as having close contact.

Earlier I alluded to having different tests. The two main tests now are the gold standard PCR test and the rapid antigen test. Viruses are built of proteins and genetic material. Rapid antigen tests take about 15–20 minutes and check for proteins specific to the virus. This is the same technology that’s been used for rapid flu and rapid strep tests. The PCR test checks for viral genetic material and can take several days to result. Besides for the time difference, rapid antigen and PCR tests differ mostly in sensitivity. PCR testing has a much higher chance of picking up viral infection if present than rapid antigen testing. Most places that offer rapid antigen testing will have guidelines to obtain the test in order to reduce the odd of a false negative.

Many people have visited the ER or their local urgent care centers for COV2 testing (on their own without a mandate from work or other authority). This is a similar behavior to the rise in ER/UC visits every winter; frankly, a behavior which baffles me. Most cold symptoms are caused by a virus. Medicine has yet to develop a good treatment for viruses and most cold viruses are self limiting, meaning if you sat at home and just napped, you would feel better in several days. Even Oseltamivir, the medicine used for influenza, only decreases the duration of illness by 1–2 days max and it’s only effective if taken within 48 hours of symptom onset. To be clear, for severe symptoms such as but not limited to shortness of breath, significant fatigue, intractable nausea/vomiting/diarrhea are present, please go to an ER or urgent care. But if all you have are some body aches and sniffles, you’re probably better off staying home. Testing may satisfy the itch of curiosity, but for the most part doesn’t change the management. If you have minor symptoms and test positive for flu or COV2, rest and quarantine. If you have minor symptoms and test negative, rest and quarantine anyways. You are also more likely to catch a/another bug at the testing site compared to staying at home.

Finally, number of infected keep going up which is in part due to several factors.

Detection: a. Testing has drastically increased and b. Many jobs, schools, and pre travel rules are requiring testing which has caused detection of many asymptomatic people who otherwise wouldn’t get tested Environment: Winter increases the prevalence of influenza and other cold viruses (hence why it’s called “the cold”). Coronaviruses are a family of viruses which are responsible for a portion of the “common cold”. COV2 happens to just be an angrier, more famous member of said family. The fact that transmission is up in the winter should come as no surprise based on the behavior of other cold viruses. There are theories as to why winter brings viral illness including, drier air, more use of heating, and lower vitamin D levels, but nothing definitive has been proven. Encounter: Asymptomatic/mild symptom spreaders. I’ve come across plenty of service industry people who test positive after being at work for several days with symptoms. I’ve also come across people who test positive and have no idea where they could’ve gotten it from because they wear a mask when they’re out and were never around symptomatic people. As we knew back in March, wearing a standard cloth or paper face mask does not guarantee protection from infection, it simply decreases the risk of transmission — a good enough reason to still wear a mask everywhere in public. While nothing is 100%, trying to reduce risk is still the smartest thing to do — wear a mask, go out only if necessary, avoid gatherings as much as possible (the Thanksgiving bump was very real. Post Thanksgiving I had full 7–10 hour shifts where I did nothing but test people for COV2 and ~95% returned positive).

There is still much to be said about antibody testing and the vaccine, but we are still in the early days of those topics, so I may revisit those at a later date.

TL;DR:

SARS-COV2 does not = COVID-19

Infection with COV2 is not always fatal and does not guarantee hospitalization

Mild COVID-19 seems to go away by itself without intervention

There’s no reason to get tested for the sake of getting tested. Rest and quarantine if you have mild symptoms

The current wave is multifactorial and not particularly surprising

Minimize your risk- wear a mask, stay home, don’t gather

Standard medical disclaimer: This is informational and based on my own reading/observations/opinions and not to be used as medical advice. Find yourself a good primary care doctor who you trust and can ask questions specific to yourself.