By Prof Rodney Adam, Infectious Disease Specialist and the Chair of Infection Control Taskforce at Aga Khan University Hospital, Nairobi
The name and origin of the virus
The name of the virus has rapidly evolved since the first cases in early December 2019 and the recognition that it was a new virus in late December. Viruses have been traditionally named after their location of discovery, so the initial designation was Wuhan coronavirus. However, no one wants it named after their place, so the agreed naming of the disease is COVID-19 (COronavirus VIrus Disease-2019) and the virus is coronavirus SARS-CoV-2. The sequence of the virus was released in January and made it clear that this virus is from a bat and related to SARS and MERS, but more closely to SARS; thus, SARS is part of the name. The other bat coronaviruses came to humans via another mammal (civet for SARS and camel for MERS) and that is also suspected for the new virus. The sequence also means that the conspiracy hypothesis about this being a lab-adapted virus are false.
About the COVID-19 Illness
What are the symptoms of COVID-19?
The two main symptoms of COVID-19 are fever and cough. The initial case definition also included shortness of breath, but that is true only for those who are more seriously ill. One of the more recently identified symptoms is loss of smell and/or taste. This may occur in up to half of symptomatic patients and when present, it is highly suggestive of COVID-19. Other common symptoms include fatigue, muscle pain and sore throat. Symptoms like runny nose or diarrhea are sometimes found, but may be found more often in other types of infections. Seek medical attention if you have these symptoms or have been in contact with someone who was diagnosed with or suspected to have COVID-19.
How does SARS CoV-2 (COVID-19) spread?
SARS CoV-2 spreads through droplets which are released when people sneeze or cough. These droplets may be large and only travel up to one meter or may be small, allowing them to travel several meters and cause infection when they contact the mucous membranes of the mouth, nose or eyes. The ventilation makes a big difference, so transmission is reduced substantially when you are outside or inside with windows open and good air flow. The infection may also spread from contaminated surfaces.
How long is the incubation period for COVID-19?
Incubation period is the time between catching the virus and when the symptoms of the disease start appearing. The average is about five days and ranges from two to 12 days in most cases.
What temperature is normal?
For most people, their temperature ranges between 36 to 37 degrees depending on the time of day and rarely someone's normal temperature may be up to 37.2 or 37.4 degrees. With COVID-19 infection, high temperatures, greater than 39 degrees are common but even temperatures of 37.8 degrees can be significant.
How do I know that I have shortness of breath?
First, shortness of breath does not mean that it's difficult to breathe because of a stuffy nose. It means that when you are breathing normally through your mouth, the activities that didn't bother you now make you feel like you don't have sufficient breath. For example, could you previously walk up a flight of steps and now you are short of breath after only a few steps?
How do I know if I have COVID-19 and not regular cold or flu?
The only way to know if you suffer from COVID-19 is through a special lab test called PCR. The PCR test is currently available through the Ministry of Health and at a number of other facilities, including AKUHN.
If I have symptoms should I walk into hospital or call first?
If you are sick enough that you might need to be hospitalized, you should come to the Accident and Emergency Department.
I've seen somewhere that 4 out of 5 spread COVID-19 when they don't have symptoms. Is this factual?
It is now clear that much transmission occurs from people who have no symptoms but it may be more common for transmission to occur from people with very mild symptoms. People are infectious beginning about 1 to 3 days before symptoms develop so transmission occurs commonly in this time period. There are others who transmit but never develop symptoms.
Who should be tested for coronavirus?
The highest priority people for testing include patients with severe symptoms that may be severe COVID-19, especially for older people or those with heart, kidney and lung disease. The major symptoms include fever and deep cough. Other people include those with exposure to COVID-19 and health care workers.
There is a role for testing asymptomatic people, especially if there is recent contact with a known case within the last few days, especially in households with someone who is infected since the likelihood of transmission in households is very common.
I have a cough, should I be tested?
You should call and obtain medical advice. It will depend on your likelihood of being infected yourself or of transmitting to someone else.
Quarantine and Isolation
What is physical/Social distancing?
The concept of social distancing has come from observations that in preceding outbreaks, such as the 1918 influenza pandemic. Cities that limited large gatherings had fewer cases. Now there is substantial evidence during the COVID-19 pandemic that physical distancing is very helpful. It is because the virus is spread primarily by respiratory droplets that are produced when coughing. These droplets quickly drop to the ground. A distance of 1.5 or 2 meters is recommended.
Which activities should physical distancing apply to?
This typically refers to public settings, especially in closed spaces. The risk should be minimal when outside and walking. Within households, physical distancing is appropriate when one person is infected and trying to prevent transmission within the household. That is notably hard to do but should still be done when there are elderly people or those with pre-existing conditions such as heart disease, lung disease and kidney disease.
How far should I be from someone?
It is recommended that you are 1 to 2 meters apart.
What is self-quarantine?
Normally that means separating yourself from others when you are having no symptoms, but have been exposed and are at risk. That is commonly done after high risk exposures and is typically for 14.
What practical steps should I take when on self-quarantine at home?
It is boring and you may get tired of television, so start a new book you have been waiting to read. Otherwise, watch for symptoms and if mild, continue away from others until at least 10 days after developing symptoms and 3 days after recovery. If possible, have a test done when you develop symptoms, especially if you are doing medical work. If you are more severely ill, come to the hospital but let the people in Accident and Emergency. Also wear a mask.
What is isolation?
Isolation refers to separating yourself from others when you have symptoms that may be due to COVID-19. This may be done at home when the symptoms are mild or at a health facility when the symptoms are severe.
Personal prevention and treatment
How can I reduce the risk of getting coronavirus from infected humans?
There is growing evidence on the importance of transmission through the air by respiratory droplets. These can be large droplets that drop quickly to the floor or may be smaller ones that spread farther. For this reason, there is growing evidence on the importance of the use of masks. Even cloth masks worn by both people who are in contact with each other are highly effective. The greater benefit is when the infected person is wearing the mask. In medical settings, the caregiver should wear an N95 mask if available and if not should use a surgical mask.
There has been much discussion about the potential role of transmission from a contaminated environment, but that is much less likely and has not yet been clearly documented. We do assume that directly touching the infected person or something that person coughed on is a risk factor. That means that the most important thing you can do is proper hand hygiene, either washing with soap and water or using an alcohol-based hand sanitizer when you have contact with someone who might have a respiratory illness.
Will a normal flu shot help me avoid the worst symptoms?
The flu shot is for preventing infection from influenza and will not prevent coronavirus infection. However, the illness caused by influenza is similar to the coronavirus infection, so if influenza is prevented, there is less chance of suspecting that you have the coronavirus when in fact, it is influenza. There is discussion about whether influenza vaccine prevents COVID-19, but that is not proven.
If I catch the virus what is the standard treatment?
Most of the important medications currently available work by inhibiting a portion of the immune response to the virus, such as dexamethasone or tocilizumab. Remdesivir is an antiviral drug that also has benefit. Remember that good supportive care is very important and nearly everyone can survive. That includes oxygen when needed and even a ventilator for those who are really sick.
I have a bad cough and would normally not see a doctor for it—but with this going on, should I go?
You should only be alarmed if you exhibit the two main symptoms of cough and fever and have been in contact with someone suspected to have COVID-19.
Given that the virus originated from animals should I stay away from meat and animal products? Should I worry how I handle animals?
The 2019-nCoV coronavirus is originally a bat virus but was likely initially transmitted to humans via another mammal. However, transmission now is human to human, so animal contact will not make any difference for this virus. However, do note that there are other infections that can be acquired from animals. For example, there is anthrax from dead cattle who are then butchered. There is brucellosis from goats, sheep and other animals, and Salmonella from chickens and eggs. And don't forget that if dogs haven't been immunized, they can transmit rabies when they bite. That means we must be careful with animals, but it will not be a factor to getting the coronavirus.
Can COVID-19 be treated with antibiotics?
No. COVID-19 is caused by a virus and antibiotics only work on bacterial infections.
How serious is COVID-19?
COVID-19 is usually a mild to moderate respiratory (lung) infection. In the elderly or those who are immunocompromised or have other chronic diseases, it may lead to a severe pneumonia and can be fatal. Children and young adults rarely develop serious disease.
What is the risk for health care workers?
There is definitely a risk but the magnitude of the risk is lower than initially thought. In China, the majority of HCW cases were actually acquired within their own households. However, when proper personal protective equipment is used, the risk is low.
What is Aga Khan University hospital doing for people who might have COVID-19?
If patients come with a potentially contagious illness they will be screened on entry to the facility and when necessary, appropriate precautions will be used.
What level of care will COVID-19 patients receive?
Patients with COVID-19 will receive the level of care that is required for their illness, including intensive care treatment and advanced medical treatment when needed, such as a breathing mechanical ventilation or kidney dialysis.
Where should a patient with suspected COVID-19 go?
All patients who have suspected Coronavirus symptoms and or have a travel history should call our hotline on +254 709 931700 before coming to hospital for guidance.