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 more likely to become critically ill than the younger generations.
This virus is a challenge for us seniors and is one that needs to be fought against. 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?
A virus is the smallest micro-organism. All living things on the Earth are believed to have originated from a single virus many millions of years ago.
There are seven types of coronavirus. One of them is the new coronavirus (COVID-19 or SARS-CoV2), which started infecting people in the city of Wuhan (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 that caused SARS (Severe Acute Respiratory Syndrome) in 2002 and another that 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:
• Through droplets. When an infected person sneezes or coughs, droplets from the individual carrying the virus can fly and reach another individual who would breathe in the droplets.
• 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 (doorknobs, railings, electrical switches, etc.) that might have the virus through contact by an infected person’s touch or by droplets from the mouth/nose.
3) Latent period
It is considered to be one to 14 days with an average of five days (per WHO). Thus, once infection is suspected, the individual is to rest and self-observe for 14 days even if he/she feels 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, lungs, or kidneys. 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 (three main symptoms): Fever > 100 degrees 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 the symptoms 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 **L.A. Times** listing. You have to make reservations online describing 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 the common cold. The point to be stressed here is how to do them tenaciously and thoroughly.
• Hand-washing and sanitizing fingers. If you go outside of the home, frequent hand-washing is necessary. As soon as you come 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.
• Avoid going outside as much as possible. If you have to, you should wear a mask. If available, wear a type that 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 degrees Celsius or higher kills the virus (boiling water: 100 degrees Celsius).
• 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 (such as during family meals), shorten the time of gathering as much as possible.
• In Japan, it is strongly recommended that people avoid the 3 C’s: Closed space (like elevators), crowded gatherings, and close contact (such as shaking hands, hugging, kissing, etc). The goal of the recommendation is to prevent massive infections.
• 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 dishwashing 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, congestion, 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 a 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 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 News, 4/2/20).
9) What to do if you feel sick?
If you are coughing, having a fever, and feeling very tired, you should not waste any time and take necessary actions. Examples:
• Call your primary care physician and ask for a quick referral to an infectious disease specialist if indicated.
• Contact your nearby urgent care center and ask if they are set up for PCR testing. If so, go immediately.
• 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 the 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 problems associated with 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 exercise. 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.”