Author: Dr Khan

Corona virus disease, covid-19, is a global pandemic happening right now. The data related to disease is getting mature day by day and our understanding of the disease is improving.

As of today, people with low risk are relatively safe with very low mortality rate from coronavirus infection. In fact 80 percent of low risk group patients may have only mild symptoms or have no symptoms at all.

However patients in high risk group, are well, at high risk.

Please note one thing, everyone is at risk for getting the virus into their body. However this post discusses about those people who are at higher risk of getting the disease and its complications, and possibly higher risk of death, as a result of covid-19.

High Risk patients for Covid-19

High risk patients not only have higher rate of symptoms, but also higher mortality rate due to covid-19.

People at higher risk of developing symptoms and getting complications from covid-19 include:

• Elderly patients: 60 years or above are at very high risk. 40 and above are also at risk though but the risk jumps dramatically with 60 plus
• Patients with pre-existing diseases: like:
  • Hypertension (high blood pressure)
  • Diabetes
  • Asthma
  • Or any other heart or lungs disease
• Smokers
• Health care workers
• Or anyone who deals with public regularly, especially in close contact

High risk patients should self quarantine

It is recommended for high risk patients to self quarantine, even if they don’t have the symptoms of disease.

This is because they are at higher risk of developing severe disease once they get it.

Self quarantine should especially be ensured if anyone in your surrounding has covid-19. Obviously that person should quarantine themselves too, but the high risk group individuals around him or her should also be careful and protect themselves.

What is meant by Self Quarantine?

Self quarantine means that isolate yourself from the community and avoid any physical interaction, including shaking hands, with others.

Also keeping medicines and groceries supplies for at least a month so that they don’t have to go to market regularly for that.

Patients on regular medication should keep medical supplies and medicines of at least a month with them for sure. However those patients who don’t have regular need for medication, like asthmatics, they should also have the emergency medications including inhalers of bronchodilators, nebulisation medicines, etc. available with them for dealing with any emergency.

Steps to decrease risk of COVID-19

These steps should be taken by anyone who has covid in their community, however those at high risk should follow them more.

• Social distancing. Minimise contact with general public. Only contact with other people or go out when absolutely necessary, when benefit outweighs the risk.
• Wash your hands. Use gloves when you’re in risky environment. Also do wash your hands when you return from such environment. Also wash your hands before eating anything.
• Avoid touching your face. Avoid touching your face uselessly. Especially mouth, nose and eyes.
• Avoid physical contact. When in public, avoid shaking hands, hugging or making any unnecessary physical contact with individuals around you.

Gold standard for diagnosing coronavirus covid-19 infection

The gold standard test for diagnosing coronavirus infection is RT-PCR (Reverse transcription – Polymerase Chain Reaction) test.

However there is a problem with it. Current data suggests that RT-PCR is sensitive for around 30-70% of cases only in acute infection. Which means we can have a 70% false negative with it.

In simple words, if we test 10 confirmed cases of coronavirus infection, 7 of those confirmed covid-19 cases can get negative results from RT-PCR test. Which makes it practically unreliable.

This can be due to several reasons, including that in acute phase of covid-19, there is not much virus in the blood to be detected by this lab technique. It can also be due to poor laboratory techniques in non-standardised hospital and labs setups around the globe.

Chest CT is more reliable than RT-PCR in diagnosing Covid-19 currently

Around 95% of cases can be screened more accurately using chest ct findings for coronavirus infection, which makes it more reliable than current gold standard technique of RT-PCR.

Chest CT can thus be used especially in setups where laboratory techniques are not efficient or kits are not readily available and result in long wait times for RT-PCR test results.

Chest X-Ray findings vs Chest CT in Covid-19

When someone acquires flu like symptoms or symptoms related to coronavirus infection, they get chest x-ray in most setups as an initial checkup.

Chest X-ray findings in Covid-19

On chest xray, a covid-19 patient would likely show Ground Glass Opacities. Which means that some portion of their lungs will have a hazy grey opacity instead of normal appearance.

Chest CT scan findings in Covid-19

Chest CT will also show ground glass opacities.

Are chest xray sensitive to covid-19?

No. Chest x-ray are not very sensitive to coronavirus infection and thus are not a reliable diagnostic or screening tool for coronavirus patients.

Thus patients with high suspicion of covid-19 should get a chest ct-scan, even if their initial chest xray was negative for any ground glass opacities or signs of coronavirus infection.

What is the cause of ground glass opacities in covid-19?

Ground glass opacities represent the fluid accumulation in alveoli, the air sacs in lungs.

As the infection progresses and becomes more severe, more lobes of the lungs will get damaged and show such opacities on chest x-ray and ct scan. However it can also progress to solid white opacities or consolidations.

Crazy Paving Pattern

However in much later stages and as a result of continuous damage, the interstitial space gets swelled along the walls of lobules of the lungs. This results in much thicker walls, which appear as thick white lines in front of the white background of ground glass appearance.

Note that these findings in chest ct scan of covid 19 patient can be isolated or in combination with each other. While ground glass opacities are mostly the first sign, and is then followed by any one or both of the other two findings shown in image above.

These findings usually occur in both lungs and in multiple lobes. Most likely the peripheral or outermost part of the lungs get damaged more often than the other parts.

Can CT scan finding be seen in one lobe only?

Yes. In mild cases of recovering cases, the finding may be isolated and appear in only one lobe of the lungs too.

Chest CT scan findings proportion to covid-19 severity

The disease severity is proportional to the lungs findings in chest ct scan of a coronavirus infection patient.

Thus it can also be used as a prognostic test in covid 19 patients, however x-rays exposure should be kept to minimum.

Chest CT findings Absent in Covid-19

We commonly do not see these findings in coronavirus patients’ ct scan:

• Pleural effusion – fluid collected in pleural space outside the lungs, more common in bacterial pneumonia or CCF (congestive cardiac failure)
• Enlarged mediastinal or hilar lymph nodes (in center part of the chest cavity) – commonly seen in other types of penumonia
• Cavities in lungs – usually seen in bacterial or fungal pneumonia, as a result of lung tissue necrosis resulting in air filled cavities

Covid-19 CT scan findings can be seen in other diseases

It’s also important to note that the ct-scan findings of covid-19 can also be seen in other types of viral pneumonias. For example influenze and adenovirus.

Also note that these findings can be seen in non-infectious diseases of the lungs too.

Chest CT is sensitive or specific for Covid-19?

Chest CT is sensitive to Covid-19. However it is not specific to coronavirus infection as the findings of covid-19 can also be seen in some other disease conditions.

Thus anyone who gets chest ct-scan done for coronavirus infection, should also get detailed history and other tests done for a confirmation to help identify the cause of the disease.

Role of CT scan in different severity & prevalence of covid-19

Patients with mild symptoms or asymptomatic ones, might have a 50% sensitivity from chest CT and get a negative chest ct, however they might get a positive RT-PCR.

Also chest CT is not a good screening tool for areas with very low prevalence of coronavirus, as findings might be due to other causes and infections in that area too.

However in areas where covid-19 is highly prevalent, if a patient gets acutely ill and is symptomatic, then chest CT scan is a more reliable tool for screening. Patients showing ct scan findings in areas of outbreak should be considered a presumptive covid-19 case, even if their initial RT-PCR is negative.

Conclusion

RT-PCR test is the gold standard test for coronavirus infection screening. However the test is currently evolving and adapting, and during this phase it’s not accurate or reliable in many cases. In those cases, CT scan can be more sensitive, especially in regions where prevalence of covid-19 is high.

This page lists some of the frequently asked questions related to coronavirus disease (covid-19), answered by medical doctors.

Please add more queries that you have through comments or our facebook page: https://www.facebook.com/medicalodyssey

Is there any treatment for Coronavirus covid-19?

Unfortunately No. The treatment for now is only supportive. But this doesn’t mean that once you get coronavirus you will not have any medicines to help you get rid of it. The supportive medicines help you fight the disease by dealing with the symptoms it produces and also by improving your immune system, so that it can fight against the corona virus itself in a strong way.

Some medical setups in countries around the world are using certain medicines like chloroquine, ritonavir and remdesvir, which help fight the infection too. However they are not confirmed as definitive treatment of coronavirus infection yet.

Is there any vaccine of coronavirus developed or coming soon?

Certain firms have announced development of vaccine against coronavirus infection. However they are all in testing and trial phase currently.

However we are optimistic that a vaccine will soon be released. Please note, it won’t be very soon though and may take many months to reach the market.

What are the risk factors for CoronaVirus infection Covid-19?

World health organization (WHO) has declared covid-19 as a global pandemic. Thus anyone can get infected from it. However there are certain individuals who are at higher risk of developing the disease and need more care to help them recover once they get the infection. If left untreated, the disease can result in relatively higher percentage death rate in this high risk group.

Risk factors for Covid-19 include:

• Recent travel history to any country where the virus is prevalent
• Patients above 40 years of age. However 60 and above are at higher risk
• History of chronic diseases like diabetes and hypertension
• History of respiratory diseases
• Smokers

If you’re in the high risk group, and develop any symptoms related to respiratory system then you should immediately get checked for possible coronavirus infection.

What are the symptoms of Covid-19?

Coronavirus infection can present with a range of different symptoms, such as:

• Pneumonia like symptoms
• Flu like symptoms
• Difficulty in breathing
• Fever
• Cough

Note that the condition can deteriorate any time and thus don’t wait for the last moments to go to the hospital, especially if you’re in the high risk group for coronavirus infection.

Is coughing a symptoms of Covid-19?

Yes. Coughing can be a symptom of coronavirus disease. However not every sort of cough can be considered a coronavirus infection. You need to be evaluated as a whole to assess if you’re suffering from coronavirus infection or not. If you’re in high risk category for coronavirus and have other symptoms too, then you should go to the doctor and get yourself checked.

What can we eat to enhance immunity against Covid-19?

Strong immunity is the best defence against coronavirus or any other infection. Eat a balanced healthy diet. Include organic protein in your diet and avoid broiler chicken. You can read in detail about diet to boost immunity against covid-19.

Do we need to wear masks all the time?

No. Mask is only necessary in cases where:

1. You’re diagnosed with coronavirus infection, so you need to use mask to prevent spreading the virus to other people and infecting them
2. If you’re a health worker or otherwise surrounded by coronavirus infected people, means you’re at a very high risk of encountering coronavirus if you don’t wear a mask

Will coronavirus die in summer?

A lot of people are assuming that the intensity of covid-19 will reduce in summer. However evidence does not support that.

There is an outbreak of covid-19 in Australia too, while the temperature in Australia and many other countries is warm right now, and they’re still facing the coronavirus infection issue.

Probably very high temperatures in coming months will help in denaturing the virus, but nothing can be said for certain unless we practically see the summer effect on coronavirus.

Any more questions?

If you’ve got any more questions, please ask in the comments. Our medical doctors will reply them as soon as possible.

The current coronavirus outbreak has troubled everyone around the globe. While everyone is waiting for vaccination or treatment to be released, the ideal way right now is to prevent the infection by taking safety precautions. However if you do get infected by coronavirus, then the most important thing in protecting you is your immune system.

In this post we will discuss how can we improve our immune system to fight against not coronavirus infection primarily, but also against any other such foreign bodies trying to infect us.

Diet to increase immune system efficiency against CoronaVirus

While most of the people start the list of diet from the minor ingredients, lets not forget the major ones first. Don’t get me wrong, minor ones are equally important too, however they are of no use if your body is not getting the major bulk of nutrients it needs to improve your immune system.

If we define the diet to increase your immune system in one word, then it has to be: Balanced diet. Lets see what that balanced diet is and how can we optimize it to help us against the cooronavirus infection (covid-19).

Macro Nutrients

Have your macronutrients in sufficient amounts. You should have all of these in healthy amounts on daily and regular basis:

1. Carbohydrates
2. Proteins
3. Fats

People who’re on low fat diet or low carb & high fat diet (keto diet for example). You should start taking all three macronutrients in optimum quantity, your weight loss can wait if you remain alive, as probably there’s no point in doing keto diet so that your dead body has lesser weight only.

Best sources for these macronutrients can be summarized as:

• Carbohydrates:
  • Whole weat flour. Try to avoid refined wheat or white bread and prefer to use whole wheat bread or chapati. Note that there is a difference between bran bread and a whole wheat bread. Bran bread simply focuses on adding bran to the flour while it may or may not contain all other parts and nutrients of the whole wheat. Having whole wheat bread or roti helps you get all the nutrients that wheat has to offer.
  • You should also use other carbohydrate sources like potatoes, rice, etc. in optimum quantity
• Proteins:
  • Proteins are the most important nutrient that help your immune system. Remember to take healthy amounts of proteins on daily basis to help your body fight against the diseases and coronavirus.
  • Sources of protein matter a lot. The broiler / white chicken is a big NO when it comes to sources of protein. Not only its protein is of low quality, white / farmi chicken also contains many harmful chemical and hormones which reduce the immunity of our body, along with many other side effects. So basically avoid eating the white broiler checked.
  • However if you eat the organic chicken meat, which was also fed on natural diet, then its protein is helpful. However not as helpful as that of meat or beef.
  • Meat and beef are much preferred sources of protein as compared to chicken, especially broiler white chicken.
• Fats:
  • Fats are also essential for our body systems, including immune system. However the usual source of fat, the oils that we use, are not of high quality to provide all the benefits.
  • The fat is useful not just as a compound itself, but also because it contains fat soluble vitamins, when it comes from a healthy source like cattle in the form of meat or beef.
  • So the ideal fat is the one which you get from the animal too. For example if you eat beef or meat, then eat the fat in it too as a regular dish. Don’t add extra fat from the animal to your plate, but let the natural fat part of the meat which you’re eating, come to your plate.
  • Again, broiler chicken is not a good source of fat and infact harmful. As the harmful chemicals and hormones are also saved in the fat of that chicken, and thus harm the human body after consuming it and may also reduce the immunity.
  • Do include butter and cheese in your diet. Make sure it’s a butter and not margarine. Look for best brands around you which provide original butter or else try to get the desi / organic butter and cheese. Remember, do not eat margarine.
• Water:
  • Hydrate yourself with plenty of water. Take fluids whenever you feel like.

Micro Nutrients

Micronutrients are used by many enzymes in our body and are part of many systems and pathways. They have a very important role and need to be provided in healthy quantity to the body too.

Remember that if your source of macronutrients is healthy and organic, then you will also be getting most of the micronutrients from the same source too. For example if you’re having healthy meat and fat from the cattle which grazed on organic diet, then you’ll also get fat soluble vitamins from its fat and water soluble from the muscles and other fluid part of its meat.

Supplements however, can also be used, especially when your diet is not healthy and can be deficient in the required micronutrients in sufficient quantity.

You can ask your doctor for advice about the best and optimum multivitamins available around you. Remember to go for a balanced multivitamin, not some brand which has extra quantities of the micronutrients. Remember that overuse of any micronutrient, vitamins and minerals, can also damage the body and have adverse affects.

Vegetables

Vegetables are not a separate category for nutrients, but I wanted to include it as many useful nutrients are in good quantity in them.

Try to get organic vegetables when you can. For example market is full of chinese vegetables too, including turmeric and garlic, etc. So try to get the local organic one when you can.

Also note that dark green leafy vegetables are rich in proteins too.

Sun exposure

Bonus: Sun exposure. Expose arms till elbows for example and sit in sun or walk for at least 10 minutes a day. This does not have to be hot sun bath. You can do it in healthy sunlight too which you can easily bear or in fact enjoy. If the weather is harsh then you can do it in breaks too. But do it on daily basis and ask all your family members to do this too, especially elders and kids.

Remember, you don’t need to burn or roast yourself in the sunlight. It has to be pleasant.

Dry fruits & Fruits

A handful of dry fruits a day and any fresh fruit of the season is an awesome addon to your balanced diet.

Summary & Example diet

To summarize, you should be using this sort of diet:

1. Whole grain wheat
2. Mutton or beef
3. Natural fat, butter, cheese
4. Green leafy vegetables
5. Other vegetables too
6. Balanced Multivitamin supplements
7. Sun exposure on daily basis
8. Fresh fruit & handful of dry fruit

Note: If you’re suffering from any disease like heart issues, diabetes, etc. then do consult your doctor to get advice on diet and follow diet prescribed by your doctor only.

A fake UNICEF issued guideline image is circulating on the internet these days. Please refrain from sharing the fake picture. The guidelines contain some wrong information too.

Unfortunately, till today, many reputable hospitals and medical setups are still using fake guidelines floating around on internet.

As an advice, always verify the data before sharing it. Also emphasise the original poster to share the link to the official site from where he got that data or image.

Fake image of UNICEF guidelines for Corona

The following image is being used:

lets breakdown the points in this letter and see what’s wrong with them.

The article shows that it is dated 04 march 2020. On top we can see that it’s issued for the hostel of Indian Institute of Science. Hence it’s not even displayed as UNICEF official document anyway.

Now looking at each point.

Corona virus is large in size where the cell diameter is 400-500 micro and for this reason “any mask prevents its entry”

Absolutely wrong statement.

1. Corona size is not 400-500 micro, it’s around 120 nanometers
2. CoronaVirus is not a cell, and thus the statement is not at all appropriate
3. So obviously, any mask can not prevent its entry

The virus does not settle in the air but is grounded, so it is “not transmitted by air”

Again wrong statement.

1. The virus does get transmitted by air, but for a lesser distance and for lesser time
2. The virus can also survive and transmit in droplets too

The virus remains in air for some time, depending upon many factors including environmental factors, and then settles (that too is controversial if it settles in all cases).

“Gargle with warm and salt water” kills the tonsils germs and prevents them from leaking into the lungs

This is not only incorrect, it’s also poorly formatted statement.

1. Gargles do not kill tonsils germs as such. Tonsils are lymph nodes, and water does not get into them directly through gargles
2. CoronaVirus is not hidden inside tonsils
3. Corona Virus does not leak into the lungs from tonsils, it goes in directly through air we breath in or through the fluid inside our mouth
4. Tonsils role is very less in this situation

UNICEF clarified that this notification is not issued by them

UNICEF has already clarified that this notice is not published by them. Facecheck AFP covered this issue too and confirmed that UNICEF did not publish any such guidelines for coronavirus pandemic. https://factcheck.afp.com/unicef-officials-refute-false-claim-agency-released-coronavirus-prevention-guidelines

Also note that UNICEF means United Nations International Children’s Emergency Fund. It has nothing to do with CoronaVirus directly or to give statements about such things. This sort of guidelines are given by World Health Organization (WHO).

Summary & Conclusion

The virus does not get denatured by general heat. It may require temperature up to 70 degrees to kill it, which will probably kill the human too.

Also, most of the points mentioned in this article shared by the indian institute are wrong.

Please stick to the proper guidelines and advice by the experts only, to prevent yourself and your loved ones from catching coronavirus infection (covid-19).