There has been a lot of speculation about the Coronavirus — how it started, what it does to the body, and how it can be treated. With the number of cases across the world surpassing the 3 million mark, a lot of people are wondering what people infected with Coronavirus experience, especially for those who end up in the hospital.
While the virus is still too novel for a standardized protocol on how and when to treat patients, there is a relative timeline that can be followed to know if some needs to be hospitalized, and it has a lot to do with a patient’s symptoms.
According to The Guardian’s health editor, Sarah Boseley, people who become infected with the coronavirus can be distributed in 3 groups: those who are asymptomatic, those with mild symptoms, and those who need medical care.
People who are asymptomatic or with mild symptoms
“Those two groups [asymptomatic people and those with mild symptoms] would make up about 80% of the total,” Boseley said. “And then there are the severe cases, about 20%, and those are the people who will end up in hospital. Some of those small proportions unfortunately and very sadly will die.”
Those who are asymptomatic would have a harder time knowing that they are affected by the disease, however, they can still transfer the virus to others and have the same odds of ending up at the hospital after a few days. There is of course then the people who have the symptoms that we have all heard about: dry cough, fatigue, body aches and fever. However, symptoms may vary from patient to patient, and the The Centers for Disease Control and Prevention (CDC) recently added six more symptoms to be aware of, including loss of smell and taste and headaches.
“I started to cough, but the cough was very light; I didn’t think it was anything,” Sara Muinos, who contracted the coronavirus last month, told Revolution English. “I then started experiencing migraines, but again, I still didn’t make the connection. It wasn’t until I stopped savoring food that I realized it could be corona.”
Muinos says she believed she contracted the virus on a night out with friends in Los Angeles, just four days before the shelter in place order from California’s Governor, Gavin Newsom. A lot of bars were already closed, but she says that she and her friends figured that it would be okay since “the U.S. government was saying that it was all just precaution and that people were exaggerating the situation.” She and her group of friends, six people in their 20’s, started showing symptoms four to six days after the outing.
“[After losing my sense of taste] I started to get really bad tummy aches. Then, the fever followed and it would last for, like, hours,” she said. Muinos, who is asthmatic, says she feels lucky that her cough never got “too bad,” but says three of her friends had trouble breathing.
“Most of all it was joint pain. I had to put ice packs on my knees all night to at least feel like burning ice instead of pain,” she said. “All of us were also really tired. We couldn’t stop sleeping.”
Muinos says her symptoms lasted a little more than a week, but she only had a fever for about 3 days. It is common for COVID symptoms to last an average of 10 days, but that timeline is also essential when determining who should go to the hospital.
It is important to remember that if you believe that you might be sick with COVID-19, the CDC recommends to stay home and not visit any public areas except to get medical care. Additionally, tests might be very limited depending on the state you live in. Fortunately, if you are a California resident, you can get tested for free even if you are not presenting symptoms.
“If your symptoms get worse over the course of that week or you still are running a temperature by the end of seven days, you really do need to seek medical help,” Boseley said. “Now, those include having a severe shortage of breath or difficulty breathing, coughing up blood, blue lips or face feeling cold and clammy with pale or mottled skin collapsing or fainting. New confusion, becoming difficult to rouse so you feel very lethargic and really can’t take much notice of what people are saying and little or no urine output.”
Depending on the severity of their condition, the patient might be taken straight to the Intensive Care Unit (ICU) or might have to go through other steps in order to determine whether they need to be admitted.
“The first step at most hospitals is a survey of the patient to see how likely it is that they have contracted the disease and how serious it may be,” Dr. Isabella Suarez told Revolution English.
“Doctors will typically be looking for information on how exposed to the disease the patient has been, such as if he recently traveled to another country or they have been in close contact with someone who has it,” she said. “After the assessment, doctors will ask the patient about their medical history, because underlying diseases such as HIV can mean the patient has a weakened immune system. They will also look for signs of respiratory distress.”
What follows is a number of tests that will determine if the person is in fact infected with the virus and to check how well their immune system is working.
“It’s very important to know how the immune system is doing because there is a second phase of the disease for some people where the immune system actually goes into overdrive and produces something called a cytokine storm,” Boseley said. “That’s where the immune system actually attacks the body itself and that can result in damage to organs such as the heart, the kidneys or the liver.”
There are several things doctors look for in determining a patient’s condition. A respiratory rate of more than 30 per minute, oxygen saturation less than 90%, nasal fluttering, and neurological deterioration (like slurred speech) are all warning symptoms that the body is not receiving enough oxygen, according to Dr. Suarez.
The following steps largely depend on how the body of each specific patient is reacting to the virus. Most will be given ultrasound tests or CT scans in order to have a look at how the lungs are coping, while others will require oxygen delivered through a facemask. Gravely ill patients who have trouble breathing even with the facemask will be sedated and put on a ventilator that will take over their breathing function.There will also be an electrocardiogram test to check that the heart is working, since it can suffer from lack of oxygen. However, treatment remains highly experimental.
“The medication administered to the patient depends on the protocol in place at the hospital,” Dr. Suarez said. “In some hospitals they are trying hydroxychloroquine while others choose to use retroviral drugs. But everything depends on the condition of the patient since there are many contraindications; especially with the use of hydroxychloroquine.”
Leaving the hospital
When it comes to deciding whether the patient can be discharged, Suarez said some doctors like to wait about seven days after the critical period in order to monitor them. Most of the time, though, it is more straightforward.
“In general, it is best to wait until the patient hasn’t had a fever in two days or more,” Suarez said. “Their respiratory parameters [would have to have] improved, which means their respiratory rate would have to be less than 20, their saturation 90% or higher, and so on. But, if the patient is on a ventilator, it takes a little bit longer to get there.”
For those in the ventilator, the key is taking it step by step to ensure that the patient can start breathing on their own. That is achieved by removing oxygen assistance little by little and monitoring lung capacity improvement by measuring the levels of saturation and respiration.
“Only when a patient reaches the aforementioned respiratory level, has not had a fever, shows hemodynamic stability, which means their blood pressure is normal, and shows overall improvements in all of their symptoms, they can be discharged,” Suarez said.
After that, Suarez said, most patients have to continue some sort of treatment at home. More importantly, they should be isolated in their homes for some time, ideally 14 more days.
According to Johns Hopkins University’s tracker, of the almost 3 million people infected around the world, more than 972,000 of them have recovered. That is four times more than the figure of those who have died from it. However, pinpointing the exact number of cases, recoveries and deaths is difficult.
Even though there is hope that once you catch the disease you can’t get it again, there is little evidence of how long immunization to the new virus lasts. Some people have been reported to get the virus after recovering from it, but that may be due to tests that incorrectly recorded that they were already free of the virus. Additionally, some people might end up having long-term health problems depending on how severe their condition was.
“Understanding the progression of Coronavirus can actually seem a bit scary, particularly when we’ve heard about children and young people and fit people even actually suffering and dying from this,” Boseley said. “But they are rare and in fact, there are anomalies at the other end of things too. So some quite elderly people and even people with cancer conditions have come through this and done fine. It’s worth remembering that the vast majority of people are going to recover.”