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Health Matters: The latest on COVID-19

Conway McLean, DPM, Journal columnist

Fears about the COVID-19 pandemic continue to rage, some unfounded, some appropriate. As with any new infectious disease, it takes time and research to learn the intricacies of any new contagion, especially one as complex and variable as a SARS virus. There are many contagious respiratory illnesses, from Legionnaires to measles, from the flu to corona. Viruses are different from bacteria in so many ways, although both have existed on earth for millions of years.

Viruses are not even considered truly alive, according to the definition, since they do not have the ability to reproduce themselves. Viruses are bundles of DNA or RNA, devoid of the cellular equipment to reproduce unless able to invade cells of some living organism. Viruses invade some plant or animal, in effect, hijacking the host cell’s machinery to churn out more individual viral particles. But they can be nasty, and do cause a host of diseases, including the current COVID-19 pandemic.

Although COVID-19 is a brand new (ie “novel”) virus, we have learned a great deal about it. We now know these viral particles can spread via a mist-like aerosol that will linger in the air for some time. In addition, it is clear the loss of a sense of taste and smell is a reliable indicator of the COVID infection, regardless of any other symptoms.

A variety of skin manifestations appear to be associated with the SARS-CoV2 (the designation for the COVID-19 virus), although no definitive explanation for these has yet been determined. Some of the skin changes have included a measles-like rash, the development of watery blisters, or digits turning bright red in response to cold. This latter variation has been labeled COVID Toes and was the earliest recognized skin change.

Likely more concerning to physicians everywhere is the relationship between COVID-19 and diabetes. On one hand, diabetes is associated with an increased risk of having severe complications from a COVID-19 infection. Studies have revealed about 25% of patients who died with COVID-19 had diabetes. On the other hand, new-onset diabetes is a frequent finding in people with COVID-19.

Children and adults produce different types and amounts of antibodies in response to many infections. This is also true for an infection due to the new coronavirus. The differences in antibodies suggest most children easily clear the virus from their bodies.

Likely one of the most important questions about this new disease concerns the mortality rate: how deadly is COVID? Due to inadequate testing, we are still unable to answer this question accurately. People with minimal symptoms have been tested much less frequently than those with significant signs of the infection. This means our numbers are skewed and not an accurate count of confirmed case. The mortality rate is a ratio of the number of deaths from the virus divided by the number of infections. Thus, we have an artificially low total of infections because of the large number of undetected cases. The effect would be to make the virus look deadlier than it is.

The mortality rate of the SARS CoV-19 virus is affected by multiple factors, including the general health of each population. The status of the health care system in any region of the world has obvious consequences on how many survive the COVID respiratory infection. Still, the most significant factor in development of the severe respiratory complications is obesity. Multiple studies have reported that among people with COVID-19, those who are obese are at higher risk of hospitalization, ICU admission, invasive ventilation, and death. People with a BMI of 35 and higher have a dramatically increased risk for death. This population is at greater risk and should take extra precautions such as social distancing, mask use and sanitizing.

Research has been on-going, in centers around the world, working to develop a vaccine for the COVID-19. Global trials involving tens of thousands of participants are well underway, in hopes of defining better the effectiveness of each version of the vaccine. One Middle Eastern country has started inoculating frontline workers with a vaccine developed by the Chinese. They are just the latest of several countries who have granted emergency approval for a vaccine before finishing safety tests. Russian has already started inoculating on a mass scale, all after less than two months of human testing.

Although some afflictions make us more prone to complications from a COVID-19 infection, there are some simple measures we can take to reduce the severity. Research has found patients hospitalized with COVID-19 who had sufficient vitamin D levels had significant reductions in severe outcomes and a lower risk for death. Another study found that those with sufficient vitamin D levels had as much as a 54% reduced risk of becoming infected with COVID-19.

Physicians have recognized an increased risk of clotting problems in those afflicted with COVID-19. This condition can lead to clots forming in the heart, other organs, or the lungs, termed a pulmonary embolism, all dramatically raising the possibility of death. The latest research reveals simple, inexpensive aspirin may help those so afflicted survive by reducing the likelihood of these clots forming. Interestingly, the latest studies show COVID-19 does not independently increase the risk of pulmonary embolism or other clotting problems. Instead, the risk of these blood clots forming is no higher than patients hospitalized for other diseases.

As a novel, ie new, virus, much was unknown regarding the behavior and dangers of this infection. We know the SARS-CoV2 virus spreads twice as fast as the flu. If left unchecked, it has the ability to race through populations like wildfire. We know the viral “dose” likely influences illness severity, which means masks and social distancing can mitigate the disease. We know that a large majority of the US population remain unexposed and susceptible. If infected, we know some of these people will die.

We have learned a lot in the past few months about COVID-19 as well as the pneumonia associated with it. We know to avoid intubation as long as possible, and how to more effectively use corticosteroids to treat some of the consequences of the virus. We cannot say just yet what the mortality rate is, but we are certain its virulence is astonishing. And we know this is nothing like the flu.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments at drcmclean@outlook.com.

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