Access Afya’s Dr. Eric Mbuthia leads the first medical ‘Ask Me Anything’ as part of the #UnitedAgainstCorona partnership. Reblog from Fuzu.

Thank you for submitting your coronavirus medical questions. These are your top 8 questions from March 30th and answers from Dr. Eric Mbuthia, MD, MSc from Access Afya. Eric is a medical doctor with 10 years experience as a General Practitioner here in Nairobi. He had a degree in Health Informatics from Swansea University in Wales. He leads the technical team for Access Afya – a network of tech-enabled clinics and pharmacies across Nairobi. 

If you have medical questions related to coronavirus and want to get them answered by local doctors, please submit them as a comment or send us a message on our social accounts! We are in this together and always here to support you!

 

What are the signs and symptoms of Covid-19? Can you have COVID-19 and show no symptoms?

COVID-19 is the disease caused by the newly discovered coronavirus, SARS-CoV-2. The time for symptoms to begin showing ranges from 1 to 14 days, most commonly within 5 days.The most common symptoms of COVID-19 are fever, tiredness, and dry cough. Some patients may have aches and pains, nasal congestion, runny nose, sore throat or diarrhoea. A new emerging symptom is a temporary loss of sense of smell and taste (thought to be caused by destruction of sensory cells in the nasal passage).

These symptoms are usually mild and begin gradually. Some people become infected but do not develop any symptoms and do not feel unwell. COVID-19 illness is generally mild, especially for children and young adults. Most will recover from the disease without needing specialised treatment. However, it can cause serious illness: about 1 in every 5 people who catch it need hospital care. Those developing severe disease will have difficulty in breathing which would require oxygen supplementation.
 

I have heard some people sharing cases of having Covid-19 like symptoms over the past few months only for those symptoms to disappear? Could it be that this virus has been with us all along, but it hits harder among other people than it does others?

The common symptoms of COVID-19 are fever, nasal congestion, runny nose, sore throat, headache, fatigue and generalised aches. These are very similar to those of the seasonal flu (caused by the influenza virus) and common cold (caused by another kind of coronavirus).

True, most people have very mild forms of the disease with the mentioned symptoms and others seem to develop no symptoms. In a setting where potential contact with a person who is returning from a country reporting cases or a person taking care of COVID-19 infected people is absent, the likelihood of having COVID-19 is low. The symptoms are likely more attributable to the common cold or seasonal flu.

However, as the disease is now progressing, the chance of acquiring community infection increases. Even more, reason to practise good hand hygiene and social distancing recommendations.

How can I self-test if I haven’t felt the Corona symptoms yet?

Confirmation of infection begins with screening first for suspect cases, which then receive a confirmatory test. Suspect cases are first identified through screening which evaluates for common symptoms (fever, cough, difficulty breathing) and potential positive contact history. In limited resource settings such as ours, the advice has been for clinicians to use their judgement to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested.

Testing priority has so far been initially given to those hospitalised, those with pre-existing conditions and immunosuppressed states (compromised immunity) and healthcare workers who are in direct contact with suspect or confirmed cases. In Kenya, testing is being largely coordinated centrally by the National Influenza Centre Laboratory. In a bid to ramp up testing, countries like the United Kingdom have launched home testing kits to faster identify cases; these, however, are not locally available. Should symptoms appear, contact your nearest healthcare provider or the COVID-19 hotline for initial evaluation and guidance on next steps.

How long does it take to recover from the disease, and what are the chances of recovery?

For most people, COVID-19 illness is generally mild. Older people and people with pre-existing medical conditions such as high blood pressure, diabetes, heart disease, lung disease or cancer appear to develop more severe illness than others.

Initial data suggests that fevers subside within 4 days, while the median time to a negative test is 11 days. This has been the guidance behind two weeks self-quarantine for suspect and confirmed cases. The current confirmed criteria for recovery is two negative tests taken at least 24 hours apart. 

How susceptible to Covid-19 are individuals who suffer from allergies like chronic Rhinitis, Diabetes? Is it true that men are more vulnerable to Covid-19?

It is assumed everyone is susceptible, though patterns have been varied for different populations. Evidence is rapidly increasing on COVID-19. Risk factors for developing severe disease and increased risk of death are older age, hypertension, diabetes, cancer, chronic respiratory disease and cardiovascular disease. The numbers for severe disease appear to be higher in males.

For instance, Italy has the oldest population in Europe; 28.6% of the population are at least 60 years old (second in the world after Japan, 33%), according to the 2015 “World Population Ageing Report.) In Italy, 75% of the cases are individuals over 50 years old and most of the deaths (90%) are in those over 60 years old. Severe disease was reported in more men than women which could be partly due to their higher rates of smoking and subsequent comorbidities. A similar picture has been seen in China where the majority of the deaths were in older men who were smokers. 

Contrast this with South Korea, where the outbreak has mostly affected much younger people, with the largest group affected being in their 20s. Only 20% of cases have occured in those at least 60 years old. COVID-19 is primarily a disease of the lungs which are in the lower respiratory tract.

Development of severe disease is not a death sentence. It has been showed that recovery is possible in the elderly with reports of a Chinese grandmother, 103 years old, recovering and being discharged from care. She goes on record as the oldest person to beat coronavirus and return home. There is also a report of a 9-month old baby on record as the youngest case.

Rhinitis which presents with inflammation of the nasal passages with increased mucus production is a condition of the upper airway. 

In the event that an employee of an organization gets Covid-19, what is your advice to the employer to ensure the wellbeing of the staff?

Key would be to develop a plan of what to do if someone becomes ill with suspected COVID-19 in the workplace. The plan should cover putting the ill person in a room or area where they are isolated from others, limiting the number of people coming into contact with the sick person and contacting the local health authorities using the hotline numbers provided or a telehealth service such as ours.

Employers should also consider how to support ill employees without inviting stigma and discrimination in the workplace. This is even more essential for persons who may be at risk (people with travel to areas reporting cases and those with conditions putting them at risk of developing severe disease).

Some precautions to implement to reduce the risk of spread of COVID-19 in the workplace are

• Wherever possible, encourage workers to work remotely, from home.
• Workers developing symptoms should be encouraged to follow stay-at-home recommendations and contact authorities for testing.
• Ensure the workplace is clean and hygienic through regular disinfection of surfaces.
• Promote regular and thorough handwashing by employees, contractors and customers. This could be by having clear and visible posters, placing hand washing stations or hand-sanitisers in prominent places (especially entry points).
• Promote good respiratory hygiene in the workplace through appropriate distancing (2 metres), keeping the workplace well-ventilated.

Can I improve my immunity against the virus by working out and eating a balanced diet? Also, what is the effectiveness of vitamin c in matters covid? Which diy home cures would you recommend for prevention?

Healthy people tend to develop only mild forms of the disease, though there have been a few cases where young, healthy people have gone on to develop severe disease. Leading a healthy lifestyle including maintaining a healthy diet and fitness would reduce your risk of getting severe disease. The mainstays to infection prevention and to slow transmission of COVID-19 remain:

• Washing your hands regularly with soap and water or cleaning them with an alcohol-based sanitiser.
• Keeping at least 2 metres distance between you and people who are coughing or sneezing.
• Avoiding touching your face.
• Covering your nose and mouth when coughing or sneezing.
• Practising social distancing by minimising unnecessary travel and avoiding large gatherings of people.

There have been some reports of re-infections with patients who had recovered and had been considered immune. Would the second infection be more severe than the first?

There still is not enough evidence that recovering from COVID-19 illness induces long-term immunity. So far, testing in animals suggests that immunity is developed. However, it is still early to determine if the immunity developed is long-term and what that would look like as the virus mutates. 

The tests for COVID-19 have a specificity of about 90%. This means that there is a 10% chance that a still positive case would be recorded as being negative. It was noticed that patients who initially tested negative would have a subsequent positive test. The current criteria for recovery is two negative tests taken at least 24 hours apart. 

Typically, infection by a strain of a virus and recovery normally results in immunity to that specific strain. We see this typically with the viral/seasonal flu caused by the influenza virus. Infection by one strain confers lifetime immunity to that strain. As the virus mutates and new strains appear, these new strains cause new infections. The common cold, a different kind of virus, caused by another kind of coronavirus induces immunity that is relatively short-lived for about 3 months. 

 

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