What are the symptoms of Coronavirus?

I am going to keep this answer updated with news about COVID19 and its effects and spreading - UPDATED 1st April

THE OPTIMISM THAT COMES FROM KNOWLEDGE

This post comes from Prof. Guido Silvestri and has been translated from Italian.

I write this post at the end of a 14-hour day between hospital and lab (and tomorrow will be even worse).

I am very tired, I have a headache, but I do it gladly because I firmly believe that doing GOOD INFORMATION is very useful in a difficult moment like this.

1. ORIGIN OF THE VIRUS. Two days ago a systematic study of the genetic sequences of SARS-CoV-2 (Andersen KG et al. Nature Medicine 2020) came out, which shows without a shadow of a doubt that the virus has a natural and zoonotic origin (from animals, and in particular bats and pangolins). Therefore, the history of the virus "created" in the laboratory is confirmed as a colossal hoax.

2. COVID-19 IN CHILDREN. The comprehensive study of COVID-19 infection in Chinese children shows that out of a total of 2145 cases more than 90% were asymptomatic, mild or moderate, with only one death found, for a lethality of the infection - defined as the number of deaths divided by the total number of cases - which is, for those infected under 18 years of age, equal to <0.05% (Dong Y et al. Pediatrics 2020).

3. LETHALITY OF COVID-19. While deaths increase dramatically both in Italy and in other countries, it is important to remember that on the basis of the overall data available the lethality is estimated to be less than 2%, which means that 98% of infected people recover (Fauci AS, personal communication). The high number of deaths that we observe in these days is therefore to be related to the high number of infected people, often with mild symptoms or even without symptoms. I also want to remember that all the available data confirm that the vast majority of deaths are over 60 years old and have important co-morbidities (diabetes, hypertension, COPD, ischemic heart disease, etc).

4. VIRUSES ON SURFACES. A recent study indicates that SARS-CoV-2 lives up to three days on certain surfaces such as plastic and steel, and only for a few hours on surfaces such as cardboard and copper. The virus seems to survive for a short time, a few hours at most, as aerosol (Van Doremalen et al., N Engl J Med 2020). We should avoid paranoia like "the virus survives in asphalt for months", which are based on nothing.

5. NATURAL IMMUNITY. The data on natural immunity to SARS-CoV-2 that is acquired by infected and cured people are not currently such as to allow peremptory claims, but as far as we know about other coronaviruses a natural immunity at least temporary should develop for a period of at least 6-12 months (Ralph Baric, interview in "The Week in Virology podcast" - I remember that Baric is to coronaviruses like Maradona is to football).

6. THERAPIES. At the moment the most important treatment in severe or critical cases of COVID-19 - which are a minority - is respiratory support, while there are no "magic drugs" to cure the disease, either in Russia or elsewhere. But reasonable hopes come from antivirals such as Remdesivir, and immunomodulators such as Tocilizumab, Baraticinib, and others. I would remind you that the latter are therapies to be reserved for severe or critical cases, while the mild and moderate ones heal on their own or with symptomatic therapy.

7. VACCINES. Work is being carried out intensively especially here in the USA on different vaccination platforms, in particular RNA vaccines and vaccines based on recombinant spike (S) protein. These vaccines could be ready for initial clinical studies (safety + immunogenicity) by next autumn, although actual clinical efficacy studies will probably take 12-18 months.

8. TEMPERATURE EFFECT. There are still indications - not evidence, but certainly clues - that the damage of the COVID-19 pandemic may at least partly mitigate with the arrival of spring. In this sense it will be important to follow the course of the epidemic in Africa, Latin America and South East Asia, in particular Malaysia, Indonesia, Philippines, India and Bangladesh (and perhaps also in Southern Italy).

9. CHARLATANS EFFECT. Please stop listening to them once and for all. I am referring both to the charlatans in bad faith -- who are just jackals, loafers and beggars -- and to those, alas, in good faith, that is, gullible and frightened people who spread disinformation because, quite simply, they do not know what they are talking about. Misinformation is never helpful in general, let alone in a situation like this.

10. OPTIMISM, ALWAYS. In spite of everything, I remain firmly optimistic, and I am convinced that in a few months we will live as before - indeed, that we will live better than before, if from this great fear we have learned the right lessons, as scientists, as citizens (both in Italy and in the USA) and as humanity in general. Because this is the real, great challenge that we must all win together - also to honour the victims of this disease in the best possible way.

As a note, COVID19 seems to favor some blood types: the 0 is the least affected by the virus, while the A is the most.

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IF YOU HAVE NO TIME, JUST READ THIS CAREFULLY

You are scared, and everbody is. Just remember that panic kills more than the virus. Be calm and logical.

First, the virus has no legs - we are its legs. So, if you avoid others, and respect the indications the authorities give you (you will find them reported below) you will probably be fine.

Second, COVID19 is very infectious, but hardly lethal. Over 80% of people catching it experience just a case of flu, and do not require hospitalization. While there is no age limit to catch the virus and unluckily, die (people aged 30 to 50 years old are getting ill in the US, and one of the youngest victim of COVID19 in the world was 21), this is rare.

Only 4% of affected people catch it in a severe form, thus requiring oxygen and auxiliary ventilation. Also, 99.6% of people dying with COVID19 were affected by other severe pathologies affecting their health.

The median age of people dying with COVID19 in Italy is 80 years, even if is getting down now. No-one is safe, but a healthy organism has more chances to fight it off.

Just remember that.

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Hey guys.

I am an Italian. I am writing from Italy, so I can tell you that I know a little bit the situation. Firsthand, not through the reports of a TV screen or a newspaper.

This post wants to explain you what is what. Many, for different reasons, want you to live in terror of this virus, like it was a horrible plague which will kill humanity.

No, it isn’t and it won’t.

Let me get this straight. This infection is serious business - much more than a cold (as it was speculated in the first days of the infection) - but we should confront with the issue as rational human beings, as we should be. Because the main problem of Coronavirus - better called SARS-CoV-2, and COVID19 are not its lethality, but its infectiousness, which could cause a collapse of the medical structures used to contain and cure it.

So, I will explain you how it is, and what to do if you think you - or someone else - is affected by it. Take what you read here with a grain of salt, as I am not an MD. Always reach out for an MD for specific consultations, as symptoms might vary and there at least two different active strains of the virus.

Ready?

What is COVID19

COVID19 is provoked by Coronavirus, and is labelled as “new” because it is a new mutation of an old virus, which has much in common with the one that caused SARS: in fact its technical name is SARS-CoV-2. Its main issue is that it causes pneumonia, which is something that many of us have had in our life. The issue is that this hasn’t happened with all of us TOGETHER AT THE SAME TIME. In the most severe cases, pneumonia requires assisted breathing through machines or using machines to oxigenize your blood - and these are limited.

More, the virus causing COVID19 is extremely virulent. That means that it is easy to transmit from one person to another, and the most recent data show that you could be positive to COVID19 and still show no adverse effects for some days.

While previous observations related to the possibility of the virus to stay aerial and infecting others at a distance of over 5 meters, this study has been proved wrong: the safe distance has been confirmed by authorities to be 1 meter.

How the virus of COVID19 is transmitted?

The virus is trasmitted by touch on tainted surfaces, and then, it gets into your body through your eyes, mouth and nose when you touch them with your hands, which have scooped up virus from a surface.

Another way the virus is transmitted is through droplets - minimal drops supended in an aerosol in the air. This means mostly coughs and sneezes from a person who has COVID. The droplets are heavy, so they fall down the ground quite quickly: they do NOT stay suspended in mid-air.

This is why you are urged to hold a 1 meter distance from others when you go out, and if you are coughing it is best to do it covering your mouth with your arm so to avoid spreading the droplets around.

Preliminary studies have determined that the virus has a half-life, becoming 50% less aggressive after 2 hours on copper, 5 hours on paper/cardboard, 6 hours on metal and 7 hours on plastics, and becoming almost inert after 24 hours, even is RNA traces can be detected on different surfaces for several days.

What are the most common COVID19 symptoms?

They are very similar to common cold, or hayfever - which is a bitch, as we are in Spring. But there are some key differences.

1. In the beginning of the illness COVID19 gives you a slight fever (37.5 °C);
2. COVID19 does NOT generally give you a runny nose - the nose usually stays dry;
3. Later, COVID19 gets you a dry cough, and thus begin the infection of your lungs, giving you its typical sensation of shortness of breath, which CAN become serious if you are affected by the disease and require hospitalization.
4. On one-third of the reported cases, patients have told that they have experienced alterations to their smell/taste. If you do, please sonsider consulting an MD asap.

Remember: these are the MOST COMMON symptoms. This does not exclude that they might vary from patient to patient.

In the majority of cases (80%), COVID19 victims do NOT require medical treatment, because a healthy organism is usually enough to fight its effects alone. In that 10 to 20% that requires treatment, only 1 case in 6 gets serious, needing breathing assistance.

COVID19 becomes highly problematic when it infects people who are already sick because of other illnesses, often provoking a rapid deteriorating of the overall clinical conditions, and of course, is very harmful for old people whose immune system is less responsive.

Is there a cure for COVID19?

As for now, there isn’t any specific cure. Patients are treated with a cocktail of medicines which are studied for every specific case.

Several teams worldwide are working on a vaccine on a race against time. The WHO has declared COVID19 a “pandemic”, thus shortening the time needed to develop vaccines - which normally should be tested throughly first on animales and then on man before being administered. This means that the first COVID19 vaccines - which some teams in China and Israel claim to have developed - will be experimental.

However, there are good news, as lots of people in the world are making researches as I am typing here.

There are several medicines which are proving effective against the virus.

One is coming from China and Italy though: after some first uses in China, a group of researchers from the University of Naples have continued the experimentation with an existing medicine used against arthritis, called Tocilizumab which seems to be effective against the pneumonia caused by COVID19. It has been tested on severely ill patients affected by interstitial pneumonia caused by COVID19, and the results are really encouraging, with several of them significantly improving their health in 24–36 hours from the administration. The experimental treatment is now being used also in other hospitals in Italy.

The company manufacturing it, which is Roche, has stated that it would give the medicine FREE to the Italian hospitals requesting it during the COVID emergency.

Others are the following (from healthline.com)

Remdesivir

Remdesivir is an experimental broad-spectrum antiviral drug originally designed to target Ebola.

Researchers have found that remdesivir is highly effective at fighting the novel coronavirus in

isolated cellsTrusted Source

.

This treatment is not yet approved in humans, but two clinical trials for this drug have been implemented in China. One clinical trial was recently also approved by the FDA in the United States.

Chloroquine

Chloroquine is a drug that’s used to fight malaria and autoimmune diseases. It’s been in use for more than

70 yearsTrusted Source

and is considered safe.

Researchers have discovered that this drug is effective at fighting the SARS-CoV-2 virus in studies done in test tubes.

At least

10 clinical trialsTrusted Source

are currently looking at the potential use of chloroquine as an option for combating the novel coronavirus.

Lopinavir and ritonavir

Lopinavir and ritonavir are sold under the name Kaletra and are designed to treat HIV.

In South Korea, a 54-year-old man was given a combination of these two drugs and had a

significant reductionTrusted Source

in his levels of the coronavirus.

According to the World Health Organization (WHO), there could be benefits to using Kaletra in combination with other drugs.

APN01

A clinical trial is set to start soon in China to examine the potential of a drug called APN01 to fight the novel coronavirus.

The scientists who first developed APN01 in the early 2000s discovered that a certain protein called ACE2 is involved in SARS infections. This protein also helped protect the lungs from injury due to respiratory distress.

From recent research, it turns out that the 2019 coronavirus, like SARS, also uses the ACE2 protein to infect cells in humans.

The randomized, dual-arm trial will look at the effect of the medication on 24 patients for 1 week. Half of the participants in the trial will receive the APN01 drug, and the other half will be given a placebo. If results are encouraging, larger clinical trials will be done.

Favilavir

China has approved the use of the antiviral drug favilavir to treat symptoms of COVID-19. The drug was initially developed to treat inflammation in the nose and throat.

Although the results of the study haven’t been released yet, the drug has supposedly shown to be effective in treating COVID-19 symptoms in a clinical trial of 70 people.

This is a chart detailing the main differences between COVID, Cold and Flu. As usual, take it as an indication and not a proof.

What to do if you think you think you have COVID19 symptoms

Reach out and ask to an MD what to do in your specific case. The procedures vary in every country, so I cannot tell you something valid for every country on the face of Earth. However there are some things that you can do on your own, and you are urged to do.

1. Avoid interactions with others. If possible try to stay home and monitor your health constantly, without panicking, for a couple weeks. There is no need to panic - it is not the Zombie Apocalypse. Really. The first is - avoid contact and crowds. Do not shake hands. Do not stay close to others. If you sneeze, cover your mouth with your arm or a tissue (not your hand) so to avoid spreading it around. The quarantine period should be of at least two weeks - 19 days, if we believe the latest news.
2. If you have to go out to buy food and supplies, protect yourself and others by wearing a surgical mask. Yes, you have read it right. Wearing a surgical mask avoids spreading the COVID19 virus around if you are infected. It is much less effective for avoiding getting it (there are many ways of catching it, as we will see).
3. Wash your hands every time you go out, and do it thoroughly for one minute under warm water using soap. The COVID19 virus can be picked up on metallic and plastic surfaces with your hands (it stays active for several hours), and then could end up in your organism when you rub your eyes. So, it is essential to wash your hands thoroughly when you come home for at least 30 seconds. You just need regular soap - no real need for anything else.
4. While this advice is controversial, some observations say that the COVID19 virus might be affected by warmth, as all virus of this kind are. This means that it would be good to drink hot tea and coffee, or just plain warm water, several times per day. As the main area where the virus settles first is your throat, this would have the effect of washing down the virus to your stomach, so you digest the little bastard. Even if this is not tested on THIS virus (we have far more urgent things to do now), keeping well-hydrated would actually do good to your body nonetheless.
5. Vitamin C has a healthy effect on your body, as it is one of the major factors of the oxygenation of your blood. So, drink orange and lemon juice, possibly freshly squeezed. It will do good to your body and it is also good.
6. Do not take medicines unless directed by your MD. Especially, do not take antibiotics, which are useless against viruses.
7. As I have said above, check your physical conditions. A good thing to do, every day, is taking in a deep breath of air in the lungs and retaining it for as long as you can. If you can go as far as 20/30 seconds or more, you could be fairly sure you are ok - but as always, check an MD before trusting the words of a stranger on the internet.
8. One of the main effects of COVID is that it hampers the oxygen exchange in the lungs, so there is less oxygen circulating through your body - affecting your brain. If you begin to experience an impairment of judging, confusion, and difficulties of reasoning, consider contacting an MD asap. A handy way to monitor your mental conditions is to do something that you need concentration on, like online gaming, crosswords, you name it. Do it every day, possibly at the same time during the day, so you check if your reasoning has been impaired somehow.

A note about Italy - UPDATED April 1

There are a lot of fake news on the internet, so, please, read what I have to say, and which comes from my presence on the field.

GOOD NEWS. The number of incections and deaths from the virus continue to slow down, demonstrating that the lockdown strategy is effective. The number of recovered patients is on the rise, finally beating the death rate. While this is not resolutive, it could mean that we have reached the maximum diffusion, and now the cases are beginning to spread themselves out, flattening the growth curve. And the hospital system, even if with difficulty, has been able to hold up the influx of patients.

Even if you think we Italians are dying in the streets by the hundreds, it ain’t so, but to avoid the continuous spreading of COVID19, from the evening of the 11th of March, the whole of Italy is now in total lockdown, which has been made more and more severe.

The decrees which was issued have been updated to include all of Italy. They expressly forbids to travel between cities except for work-related issues, medical treatments or urgent matters which require a personal presence.

Measures like these have been tested when there was a virus outbreak on ocean liners, and proved themselves very effective for containing the spreading of the virus.

Thus, every kind of public gathering has been suspended (theaters, movies, churches, sport events…). people are required to stay at 1 meter from each other in the few open public places and shops, which are almost only supermarkets and pharmacies and few others. Everything else, except the basic shops detailed above are closed until the beginning of April.

The health system is still efficient, and has responded quickly to the outbreak, so the situation is starting to stabilize, and we are hopeful it is going to get better soon, with less infections and more people healing from the illness. Also remember that Italy has a record for cases of COVID19 because it is the country that makes more tests on patients.

As of 8th of March, Italy had done almost 50,000 tests. One week before, it was at around 23,000, while France only 1,200, and Germany did not disclose its test numbers. This explains why Italy statistically has discovered and reported more cases of COVID19 (and also, of deaths for COVID19).

Number of tests for COVID19 done in the world:

Coronavirus Testing Criteria and Numbers by Country

This is not to accuse anyone of anything, but just to explain how the situation really is and explain the numbers which are circulating. Today, Italy is possibly SAFER than some other countries, as there are more checks and controls in place and the system is well-aware on how to treat suspicious cases. Not to mention that healthcare is free for everyone, Italian or foreigner.

In Italy, if you are chronically ill, old or whatever, you are not left to die alone in your house. You are treated. The medics try to save you, even if you have little chances of surviving. This is why we have lots of deaths: because we try EVERYTHING THAT WE CAN.

The warmer temperatures of the Spring should weaken the virus enough to make it recess enough to overcome the critical phase of the COVID19 outbreak: the limited number in hospitals for breathing-assisted bedplaces. Vaccines are going to be available soon - one should be ready in a month (news both from China and Israel) - as well as specific drugs, so it is just a question of time.

But we should become much more accountable for our actions, and think more about the community. There are people who escaped from the lockdown areas to some other “safe” areas - without thinking that they could have taken the virus with them as well. Or buying huge quantities of surgical masks while other people (mostly, people with chronic illnesses and older people) would need them most.

Please, people: be rational. And think about others as well. If we all did it, COVID19 would not represent an issue at all.

Can we do something to help you Italian guys out?

Yes, you can.

1. First of all, try to stay safe and healthy by following the basic rules I have pointed out above and the counsel of your Medical Doctors
2. If you can, urge your politicians to DO something. From out little corner of the world we see very little actions taken by some other governments. This virus is serious business, people. It’s not just your health at risk: it is the health of your parents, your grandparents, your relatives who are already hospitalized or suffering from chronic illnesses
3. If you can spare something and want to help Italy, there are many campaigns on crowdfunding portals to help Italy buy medical equipment to increase the care beds for COVID19 patients. One is promoted by the famous Instagram star Chiara Ferragni (who has donated 100,000 Euro herself). This is the LINK to contribute. Here is what they say in its description:
   
   For this reason, we thought of helping the intensive care unit at the San Raffaele Hospital in Milan. At this moment the equipment necessary to triple the intensive and subintensive care beds are:
   - Fans
   - Non invasive ventilation devices
   - Hemodynamic monitoring
   - Monitors
   Even a small donation can make a difference.

A message from an Italian MD working in a hospital and treating COVID19 patients.

The COVID19 problem has been difficult to understand even for me, as a specialist, because of the bad institutional and scientific communication here in Italy. The media have their responsibility as well, talking bullshit for days.

In the end the light, at least for me, came from the resuscitators' associations to which I still belong, who, being at the forefront of this problem, explained themselves clearly.

So how are things?

The coronavirus (infectious agent) produces a flu-like illness that has been called covid-19 (COronaVIrusDisease 2019). This disease is in the vast majority of cases a trivial flu, with coughs, colds and some fever and in many cases it is even asymptomatic (healthy carriers). However, a certain number of cases (5-10%) are complicated by interstitial pneumonia, which can quickly lead patients (70% of whom are males and many with obesity) to various degrees of respiratory failure.

This respiratory failure can be overcome with an oxygen therapy, but in many cases it needs to be treated with mechanical ventilator supports, the so-called "lung ventilators", which only the resuscitator specialists can use. Therefore, if a patient has to be intubated and ventilated mechanically, he must be admitted to resuscitation, AND THIS IS THE POINT.

Italian resuscitation departments, including the one where I work, have an average of 6-10 beds and must cover the whole range of patients who need resuscitation treatment (not only COVID19). If on those six beds, at a certain point 10, 15, 20 COVID patients show up at the same time, the system collapses and people die because they cannot be ventilated. This happened in Lombardy and also in Veneto, where colleagues had to put the COVIDs out of resuscitation bays, creating emergency places, because the resuscitation beds were absolutely insufficient.

However, you must note that this serious crisis has for now substantially affected only 4 hospitals in Lombardy and that the numbers are those, that is if compared to the general population, always very low. To this must be added that COVID pneumonia, if treated well in resuscitation, tends to evolve positively and within a fortnight patients can be extubated and transferred to normal wards. This means that mortality, in any case very low, is closely linked to the availability of resuscitation beds.

This explains the rush to hire resuscitators and to greatly increase the number of resuscitation beds in hospitals. However, that in my hospital we have only had three cases so far, which have been successfully resolved. The problem would be serious if the situation in Lombardy were to spread throughout Italy, so I believe at this point that they were right to take the drastic measures they have taken.

As for the Italian mortality rate, which appears to be very high, this is due to the fact that in Lombardy they were taken by surprise and had the mess I told you, but above all to the fact that now the tests are only done to the sick who arrive at the hospital, so the more serious ones.

Not all those who stay at home with only flu symptoms are tested and there are a lot of them, the same goes for the asymptomatic people who could be a lot as well. It is therefore evident that if mortality is calculated only on the most serious and hospitalized patients it is inevitably higher.”