Post-Acute Sequelae of SARS-CoV-2 infection (PASC) or chronic COVID syndrome (CCS) and long-haul COVID or Long COVID.
Recent studies have shown that COVID-19 has long term impacts on patients health, irrelevant of their age and medical history. For example, 35% of COVID symptomatic adults with a positive outpatient test reported that even 2–3 weeks later they had not returned to their original state of health. Furthermore, 20% of the subjects between 18 to 34 years who were in good health, confirmed that some of the symptoms were prolonged. The US Center for Disease Control and Prevention (CDC) lists fatigue, shortness of breath, joint and chest pain as some of the long-term symptoms of COVID-19. Coronavirus long-haulers have also reported cognitive impairment, depression and headaches.
The impact of SARS, however, continues as survivors’ exercise capacity and health status are significantly impaired for over 24 months. Another study revealed that 40% of people recovering from SARS still had chronic fatigue symptoms 3.5 years after being diagnosed. This may be because long COVID affects organs and can cause inflammation of the heart muscles, pulmonary issues, hair loss and skin rashes. However, we still do not know just how long these symptoms will persist or why they occur.
At the Jin Yin-tan Hospital in Wuhan, over a span of 5 months, 1733 patients undertook a series of symptom questionnaires, physical examinations, and a six-minute walking test to study the long term impact of COVID. In it, 63% of subjects reported fatigue or muscle weakness and 26% had sleep difficulties. In addition, 23% of participants experienced anxiety or depression. Severely ill patients had significantly impaired pulmonary diffusion capacities, abnormal chest imaging manifestations, and had the longest recovery period. Furthermore, the decline of neutralising antibodies raises concern for severe acute respiratory syndrome coronavirus 2 re-infection.
As far as researchers know now, there is no one type of person who is more likely to suffer from long-term COVID-19 symptoms and issues, though some doctors say they are seeing far more females showing such symptoms. Ryan Hurt, an internist who leads post-COVID-19 syndrome research at the Mayo Clinic, said that even though only 10% of the approximately 20,000 COVID positive patients are considered long-haulers at the clinic, 60-80% of them are women.
Organ damage caused by COVID-19
Although COVID-19 is seen as a disease that primarily affects the lungs, it can damage many other organs, increasing the risk of long-term health problems. Organs that may be affected by COVID-19 include:
Heart- Imaging tests taken months after recovery from COVID-19 have shown lasting damage to the heart muscles, even in people who only experienced mild COVID-19 symptoms. Increasing the risk of heart failure and other heart diseases in the future.
Lungs- The type of pneumonia often associated with COVID-19 can cause long-standing damage to the tiny air sacs (alveoli) in the lungs. The resulting scar tissue can lead to long-term breathing problems.
Brain- Strokes, seizures and Guillain-Barre syndrome, a condition that causes temporary paralysis, have also been associated with COVID. Increase the risk of developing Parkinson’s disease and Alzheimer’s disease.
Blood clots and blood vessel problems
COVID-19 can make blood cells more likely to clump up and form clots. While large clots can cause heart attacks and strokes, much of the heart damage caused by COVID-19 is believed to stem from small clots blocking capillaries in the heart.
Other parts of the body affected by blood clots include the lungs, legs, liver and kidneys. COVID-19 can also weaken blood vessels and cause them to leak, contributing to potentially long-lasting problems with the liver and kidneys.
Problems with mood and fatigue
People who have severe symptoms of COVID-19 often have to be treated in a hospital’s intensive care unit and are often put on ventilators. Simply surviving this experience can make a person more likely to later develop post-traumatic stress syndrome, depression and anxiety.
Because it’s difficult to predict long-term outcomes from the new COVID-19 virus, scientists are looking at the long-term effects seen in related viruses, such as the virus that causes severe acute respiratory syndrome (SARS).
Many people who have recovered from SARS have gone on to develop chronic fatigue syndrome, a complex disorder characterized by extreme fatigue that worsens with physical or mental activity but doesn’t improve with rest. The same may be true for people who have had COVID-19.
Many long-term COVID-19 effects still unknown
Much is still unknown about how COVID-19 will affect people over time. However, researchers recommend that doctors closely monitor people who have had COVID-19 to see how their organs are functioning after recovery. Many large medical centres are opening specialized clinics to provide care for people who have persistent symptoms or related illnesses after they recover from COVID-19.
It’s important to remember that most people who have COVID-19 recover quickly. But the potentially long-lasting problems from COVID-19 make it even more important to reduce the spread of the disease by following precautions such as wearing masks, avoiding crowds and keeping hands clean.
Following months of research, development, and clinical trials, two COVID-19 vaccines were authorized for emergency use by the United States Food and Drug Administration (FDA). The first in this sequence was the Pfizer-BioNTech vaccine, authorized on December 11, 2020. This vaccine will be available for distribution to individuals over the age of 16. The second authorized vaccine authorized on 18th December 2020 was the Moderna COVID-19 vaccine, for those over the age of 18. Although immunization is now available for frontline workers such as residents of nursing homes and healthcare providers, it will be months before the average citizen is vaccinated. Nevertheless, fear has settled in the hearts of Americans, months or possibly a year in advance regarding a vaccine that isn’t even readily available for them. For the COVID-19 vaccine to effectively reverse the effects of the coronavirus in the United States, it is imperative for Americans to make an informed decision about receiving the vaccine. This begins with providing accurate facts, figures, and explanations regarding the immunization as quickly as possible.
The COVID-19 Vaccine Debate
A universal concern of the COVID-19 vaccine is whether or not it can be trusted due to its short timeline from research to distribution. Aware of this paradigm in vaccine development, scientists were methodic in not providing hope for immediate success. It is true that on average, vaccines take 10 years to fully develop and distribute. The quickest any vaccine had been developed prior to the 2020 COVID-19 vaccine was for mumps in the 1960s, with a development timeframe of four years (Ball, 2020.)
Today, the effectiveness or safety of medical developments cannot be assessed based on time alone. There are many factors to consider beyond time. As with the COVID-19 vaccine, some of the factors that have shortened the development timeline are the unique structural integrity of the virus itself and the innovative mRNA virus development stratagem.
COVID-19 Structural Analysis
The coronavirus protein contains a spike module (review figure A) which is compatible with mRNA retroviral immunizations. This protein has the potential for the optimization of antigen design. A strong antigen design ensures that the vaccine has pinpoint accuracy in targeting either the full-length protein of the virus or the receptor-binding domain (Lurie et. al, 2020.) Additionally, while COVID’s initial symptoms progress into acute respiratory disorders, the coronavirus is a type SARS/MERS virus. And as plenty of vaccinations for SARS/MERS viruses exist, built using different platforms, meant researchers could easily manipulate the structures of these existing vaccinations to create one that immobilizes the coronavirus. Thus, no time was spent on manufacturing specific vaccination bases (Lurie et. al, 2020.)
Figure A: The COVID-19 Module
*The red clusters indicate the presence of spike modules. These spikes, when replicated in a vaccine, allow for the effective inoculation of antibodies into the target virus cell.
Traditional Vaccine Development
Traditionally, making vaccines required live virus strains suspended in cell culture. The most common class of retroviral cell culture is a shell vial culture. In this type of culture, viral strains are centrifuged onto a single layer of cells and the growth of the virus is determined by changes in antigen patterning. Once these cultures displayed structural changes that hinder its ability to infect, also known as cytopathic effects, researchers were able to confirm that the culture is positive. These concoctions were then purified in bulk to regulate its effects in the human body (Neergaard, 2020.) It is expected that there is some level of safety concern among vaccine consumers due to mass vaccine production practices and possible errors.
mRNA Vaccine Development
The mRNA approach to vaccine fabrication is radically different from the conventional means of development. By eliminating the requirement for a live strain of the virus to be present in the vaccine. An mRNA vaccine replicates a harmless piece of the target virus with the purpose of generating an immune response. The vaccine then chemically synthesizes RNA to target infectious cells. This modern approach to vaccine production is activated by utilizing a snippet of genetic code that delivers instructions for producing polypeptide chains. These chains then target foreign virus proteins, starting the immune response (Neergard, 2020.) With novel viruses, such as COVID-19, the structure of the protein can be utilized with the advantage of presenting a promising immunogen in the vaccine itself. Another way that mRNA technology reduces the time traditionally associated with vaccine development protocols is that it uses a synthetic processing mechanism. This method does not require facilitating culture growth or fermentation on an inordinate scale. Already, this shaves off a significant portion of time in the development process that would otherwise be allocated to ensuring the safety of the vaccine.
What is in the Vaccine?
The second concern in question regards the composition of the vaccine. Currently, there are two widespread misconceptions that undermine the potential of the vaccine. First, it is alleged that the immunizations will contain microchip tracking devices. Second, there is a notion that live strings of the virus will be present in the vaccination. Moderna and Pfizer, the two major distributors of the COVID-19 vaccine in the United States have debunked these assumptions in their respective official statements with the FDA, confirming that these concerns are invalid.
The mRNA-1273 vaccination that has been authorized under the title of “Moderna COVID-19 Vaccine” by the FDA encodes an S-2P antigen in conjunction with a SARS-CoV-2 glycoprotein. This glycoprotein is an inactive protein agent of the virus. S-2P is stabilized with proline replacements at amino acid positions 986 and 987, located in the top of the central helix in the S2 subunit. These proline replacements ensure that the chemical body is stable. The lipid nanoparticles of the vaccine consisting of four essential fats in a 1:1 ratio of lipid to mRNA. Lipids act to replicate the outermost surface of the coronavirus on ordinary cells, promoting immunity. This concentrated solution is diluted in standard saline (FDA, 2020.)
The Pfizer vaccination authorized under the title of “Pfizer-BioNTech COVID-19” vaccine has a similar chemical composition to its Moderna counterpart. The primary differences between the two vaccines lie in the ingredients used to maintain the pH and stability of each respective vaccine. The Moderna vaccine is suspended in a solution of tromethamine, tromethamine hydrochloride, acetic acid, sodium acetate, and sucrose (FDA, 2020.) The Pfizer vaccine is suspended in potassium chloride, monobasic potassium chloride, sodium chloride, dibasic sodium phosphate dehydrate, and sucrose.
Although the ingredients lists are slightly different for each vaccine, ultimately the results are the same, states Jamie Alan, an assistant professor of pharmacology and toxicology for an interview with Prevention. However, the slight formulaic differences could explain the different storage requirements for each. The Pfizer vaccine must be stored at a strict -70 degrees Celsius. On the other hand, the Moderna vaccine must be shipped in -20 degrees Celsius but can be comfortably stored in a refrigerator unit for 30 days afterwards (Miller, 2020.)
*Although the ingredients of the vaccines slightly vary in nature, there are no significant differences between the two vaccines. One is not inherently better than the other. However, it is recommended to talk to your provider before receiving an administration of the vaccine to discuss safety concerns (allergies, possible reactions) pertinent to you.
There are two primary concerns for the American public with regard to the coronavirus vaccines. The first is a debacle of time. While historically vaccines have taken an average of 10-15 years for successful development and testing before public use. The vaccines by Moderna and Pfizer have been developed, tested and distributed in a matter of months. This concern is made invalid when one considers the technological advances made in vaccine development in the years prior to the coronavirus pandemic. Because COVID-19 replicates a SARS/MERS virus, researchers don’t require time to develop a specialized basic suspension for a COVID-19 vaccine. The second is a matter of safety. Both major distribution companies have announced that the vaccine is composed of mRNA, lipids, and a standard saline solution reassuring the public that there will be no viral strain in the vaccine.
Jackson, L., Al., E., Group*, F., Author AffiliationsFrom Kaiser Permanente Washington Health Research Institute (L.A.J.) and the Center for Global Infectious Disease Research (CGIDR), Heaton, P., F. P. Polack and Others, . . . Group, A. (2020, November 12). An mRNA Vaccine against SARS-CoV-2 – Preliminary Report: NEJM. Retrieved December 31, 2020, from https://www.nejm.org/doi/full/10.1056/nejmoa2022483
Lurie, N., Interview with Dr. Nicole Lurie on rapid vaccine development, Author AffiliationsFrom the Coalition for Epidemic Preparedness Innovations, F. P. Polack and Others, S. F. Lumley and Others, & Group, A. (2020, December 31). Developing Covid-19 Vaccines at Pandemic Speed: NEJM. Retrieved December 31, 2020, from https://www.nejm.org/doi/full/10.1056/NEJMp2005630
A new variant of the SARS-CoV-2, known as B.1.1.7, has been discovered in the rising cases in the United Kingdom and has been spreading very rapidly. The U.K. government estimates that the new coronavirus strain is more than 70% transmissible than other variants currently in circulation.
This new variant of the coronavirus has come to the attention of researchers in mid-December when there was a surge in coronavirus cases as well as it began to show up more frequently in patient samples from various parts of Southern England. However, it seems that this variant has been collected from patients from early September. The new variant of the disease was first detected in September, by November a quarter of new cases in London were attributed to it. However, by mid-December, it had reached three-quarters of all new cases. The mutated coronavirus strain that’s been spreading in the U.K. appears to be more contagious which will likely lead to higher levels of hospitalizations, placing further strain on health care systems around the world
The new variant of COVID-19 involves mutations in the structure of the virus. Jeffrey Barrett, director of the COVID-19 Genomics Initiative at the Wellcome Sanger Institute in the UK, noted that 23 nucleobases of the virus’s genetic code had changed, including 17 that could potentially impact the way the virus behaves and spreads.
Actions Taken Against the New SARS-CoV-2 Strain
Currently, over 40 countries have suspended travel with the United Kingdom in response to this new strain. Various European countries along with other countries are restricting travel from Britain since the new variant of the SARS-CoV-2 virus is spreading very rapidly in the United Kingdom. For example, according to the Ministry of External Affairs (MEA), India has temporarily suspended its Vande Bharat flights from the United Kingdom due to the emergence of a new strain of coronavirus.
Countries throughout Europe and the world announced that they would no longer admit any travelers from Britain, which includes Austria, Belgium, Italy, Ireland, Germany, France, and the Netherlands. Additionally, Boris Johnson, the prime minister of the United Kingdom, had introduced a new “Tier 4” level of restrictions, affecting 16.4 million people, including around 9 million people in all 32 London boroughs and much of southeast England.
Is the New Coronavirus Variant in the United States?
Currently, the new coronavirus variant has been identified the state of Colorado. No other US State has identified the variant yet. However, ongoing travel between the United States and the United Kingdom coupled with the increasing prevalence of the new variant in the UK makes the likelihood of it arriving in the US extremely high Furthermore, only about 51,000 viruses of the 17 million US cases have been sequenced. Given the small fraction of U.S. infections that have been sequenced, the variant could already be in the United States without having been detected.
Dr. Fauci, the United States leading infectious diseases expert, said on “Good Morning America” Tuesday morning that it’s “certainly possible” that the strain has hit the U.S. already. “When you have this amount of spread within a place like the U.K., you really need to assume that it’s here already … it certainly is not the dominant strain but I would certainly not be surprised at all if it is already here,” Fauci warns.
Implications of the New COVID-19 Variant
There are many potential consequences of the new COVID-19 variant. For example, the new COVID-19 variant is able to spread more quickly in humans. There is already evidence that one mutation, D614G, has this property to spread more quickly. In the lab, G614 variants propagate more quickly in human respiratory epithelial cells, out-competing D614 viruses. There also is evidence that the G614 variant spreads more quickly than viruses without the mutation.
Although there is currently no evidence whether or not the new COVID-19 variant is able to produce more severe illness than the other coronavirus variants, this new strain has the ability to cause either milder or more severe disease in humans. Furthermore, the new COVID strain has the ability to evade vaccine-induced immunity. This is because FDA-authorized vaccines are “polyclonal” which means that it has the capability to produce antibodies that target several parts of the spike protein. The virus would likely need to accumulate multiple mutations in the spike protein to evade immunity induced by vaccines or by natural infection.
Lastly, the new variant has the ability to evade vaccine-induced immunity. This brings up a concern that once a large proportion of the world’s population is vaccinated, there will be an immense amount of pressure that could favor and accelerate the emergence of such variants by selecting for “escape mutants.” Though there is no evidence that this is currently occurring, many experts believe that escape mutants are unlikely to emerge because of the nature of the virus.
Will the recent vaccines that are in the process of distribution protect us against the new COVID strain?
Pfizer and Moderna have recently started to administer COVID-19 vaccinations on health workers and at-risk people. With the discovery of the new COVID strain, Pfizer and Moderna are in the process of testing their FDA-authorized vaccines against the new strain of the virus. Both of these companies anticipate that it will take about a couple of weeks before they can confirm whether or not their vaccine will protect us against the new coronavirus strain. As of now, there is no evidence that the vaccines will not be effective against the new strain.
However, Moderna expects its mRNA-based vaccine, mRNA-1273, will provide immunity against the new strain. On the other hand, Pfizer is generating data on neutralizing the new strain from blood samples of people immunized with their vaccine.
Some experts believe that mRNA-based vaccines will likely be effective against the new coronavirus strain found in the United Kingdom. This is due to the fact that the genetic material in mRNA-based vaccines can be quickly re-engineered to match that of the mutated protein. However, many experts believe that the new strain may reduce the efficacy rates of the vaccines.
As countries around the world are beginning to roll out coronavirus vaccines, the U.K. reported yet another strain of the virus which is reported to be even more transmissible than the recently discovered B117 strain. At present, scientists and researchers have not found the said variant of the virus more deadly but have found it 70% more transmissible than its previous versions. Scientists are vigilantly researching this new COVID strain and are trying to determine the current vaccine efficacy against the new variant. The question of when COVID-19 will come to an end still remains unclear. The only way to find out is by testing patients and analyzing case studies to find answers to the questions and concerns on the rise regarding the new mutation of COVID-19.
Early Monday, November 9th, Reuters announced that a vaccine for COVID-19 was being developed by Pfizer and that it had demonstrated extraordinary results with the conclusion of their Phase 3 trial. Their vaccine has proven to be effective over 90% of the time. Yet, creating a vaccine this effective has been a particularly hard experience, not just scientifically but emotionally for millions of people worldwide. Until the vaccine becomes widely available is it essential that we all must continue to wear masks to ensure the safety of ourselves and those around us.
As of July, two vaccines had reached phase 3 in the world, both of which were being developed in Brazil. The first of these vaccines was developed by Oxford University in collaboration with AstraZeneca labs. The technical name of this vaccine is ChAdOx1 nCoV-19. ChAdOx1 is a non-replicating common cold vaccine, which was the foundation for this vaccine. ChAdOx1 nCoV-19 was tested on 5000 volunteers at an undisclosed location in Rio de Janeiro, São Paulo. Prior to this, the vaccine had already been tested on animals and smaller groups of people, showing promising results. This vaccine entered its final phase on July 27, and in less than a month, the Brazilian government began discussing the production of millions of doses with AstraZeneca. President Bolsanaro set aside $360 million for a licensing deal with AstraZeneca. These funds would have been able to cover up to 100 million doses of the vaccine if proven to be successful. However, at the beginning of the trial, the deal was to provide up to 30 million doses of the vaccine. It has also been said that if the vaccine works, then an additional 70 million vaccines will be produced by this company. The second major vaccine being developed in Brazil was created by China’s Sinovac Biotech. Sinovac Biotech worked in partnership with the Brazilian public health center, the Butantan Institute. The vaccine is called CoronaVac. Much like the Oxford vaccine, the Sinovac vaccine entered phase 3 of clinical trials relatively recently, on June 21. 9000 health care workers received the vaccine, and if the vaccine had proven to be effective, the Butantan institute had the right to produce 120 million doses.
Despite how renowned Brazil’s research institute is, its public healthcare system has suffered in recent years, experiencing budget cuts and also fighting against the spread of misinformation. These experiences were so detrimental that 2019 was the first time in 25 years where Brazil didn’t fulfill its vaccination goal for any of the shots it routinely administers. Money alone is not enough; experts believe that this process could take up to 10 years due to the difficulty of transferring technology and the underinvestment of the facilities. If Brazil’s institutions are unable to meet their goals, not only would that mark yet another failure in President Bolsonaro’s efforts to combat the virus, but it would also cause Brazil vulnerable and in desperate need of medical supplies.
Current Stance of Vaccine
While the vaccines are being developed in Brazil, early November 9th Pfizer announced that current data from its COVID-19 vaccine demonstrates the vaccine is more than 90% effective. The Pfizer team determined this statistic by analyzing the first 94 confirmed cases among their 43,000 volunteers who either received the trial vaccine or a placebo. Their analysis showed that fewer than 10% of infections were in participants who had been administered the vaccine, meaning over 90% of the positive cases were from those who had received the placebo.
While this is exciting news, it’s important to realize this does not mean that the vaccine is going to arrive in a matter of days; there is still much more testing left. On Sunday, November 8th, approximately 39,000 volunteers of the 43,000 volunteers who had participated in Phase 3 of trials received the vaccine. Their end goal is to reach 164 confirmed cases of COVID-19 infection. To achieve this goal, Pfizer has developed technology in which messenger RNA, mRNA, essentially tricks cells into producing a protein that resembles the virus. In theory, the immune system would learn to attack these placebos and would eventually respond the same way with the actual virus. Though it is unclear how long protection from the virus will sustain. The most likely case, of what’s to happen, is that the vaccine will be administered on a yearly basis.
Additionally, Pfizer believes that they are on track to create over 50 million doses by the end of this year and over 1 billion next year. They will be able to reach this extraordinary number as they have multiple manufacturing centers and have already signed production contracts with multiple governments.
The importance of this vaccine goes beyond medical advancements. It’s fair to say 2020 has not gone the way anyone has expected it to. Emotions have run high since March and this news could not have come at a better time, especially when the United States is reaching upwards of 100,000 new cases. The emotional aspect of the vaccine is equally as important as the medical advancement.
A highly effective vaccine is great news especially as we approach 8 months of quarantine. However, it is essential that we continue to listen to science these upcoming months. Until an effective vaccine is not only officially created, but also widely available, we have to continue to wear masks. Masks are currently the best way to combat the virus and until a vaccine is readily available this is the best way to protect ourselves and loved one from COVID-19.
Afifa Zahid, Youth Medical Journal 2020
Almeida, Nelson. “Chinese COVID-19 Vaccine Starts Final Tests In Brazil.” Barron’s, Barrons, 21 July 2020,www.barrons.com/news/chinese-covid-19-vaccine-starts-final-tests-in-brazil-01595362806.
With the election hovering over the heads of 328 million Americans, President Donald Trump and former vice president Joe Biden are projecting their final pitches to the American consensus in an effort to sway the course of this year’s election. Although a diverse range of issues have been front and center throughout both candidates’ campaigns, just one of those issues is exorbitantly more pressing to Americans: how each prospective administration would approach the novel coronavirus outbreak. In short, the outcome of the 2020 election hinges on the debacle of who will present the more captivating response to this imminent public health threat. While both candidates have clearly addressed this topic, only one address is considerably more attractive. This point is in favor of Joe Biden’s 7-point healthcare policy.
How Have Trump and Biden Addressed the Coronavirus?
As of August 2020, the United States accounted for 4% of the global population, but 25% of all coronavirus cases (Levitt, 2020.) On many occasions, President Trump has downplayed the severity of the pandemic and falsely suggested that the case count was escalating due to increased coronavirus testing. Thus far, he has pulled the United States out of the World Health Organization (WHO) and pushed for the reopening of schools. He has signed off on legislation that solely pertains to economic relief with no regard to the ongoing pandemic. In contrast, Biden has pledged to place his confidence in scientists and medical leaders. In addition, he would support expanded testing, reverse the decision to withdraw from the WHO, and provide essential workers with additional pay. He would only reopen schools “after sufficient reduction in community transmission” (Levitt, 2020.) These propositions are snippets from Biden’s 7-Point healthcare policy. Medical leaders agree that Biden’s plan is not innovative, but necessary. Dr. Ira B. Wilson, a professor and health service director at Brown University’s Warren Alpert School of Medicine, states in an interview for Healthline: “My perspective on the [Biden] plan is that it is not earthshakingly innovative or anything like that — it’s just the basic work of public health. It’s not like we don’t know how to do this.” Also, in an interview for Healthline, Dr. Amanda D. Castel, a tenured professor in the department of epidemiology at George Washington University, asserts that the issue within the pandemic is that there is a lack of federal strategy in public health crisis management (Mastroianni, 2020.) This brings into question the depth of Biden’s new policy and how the American electorate has reacted to it.
What is the 7-Point Healthcare Policy?
As the title suggests, there are seven sub-policies to execute under this stratagem:
1.“Fix Trump’s testing-and-tracing fiasco to ensure all Americans have access to regular, reliable, and free testing.”
A Pandemic Testing Board similar to former President Franklin Roosevelt’s war production board, which improved the efficacy of producing war goods, would be set up. By doing such, Biden hopes to magnify the number of coronavirus tests currently administered in the United States by at least double.
2.“Fix personal protective equipment (PPE) problems for good.”
Under this sub-policy, federal responsibility would be taken over marginalized and economically unable communities to ensure adequate access to PPE. Biden would also make certain that all goods are American-sourced and manufactured so that the United States wouldn’t be reliant on other countries during a time of crisis.
3.“Provide clear, consistent, evidence-based national guidance for how communities should navigate the pandemic — and the resources for schools, small businesses, and families to make it through.”
The responsibility of taking the lead on managing the public amidst the current state of public health would be handed to the Centers for Disease Control from the federal government. Instead, the federal government would help schools, small businesses, and families stay afloat during this time. The government would establish a renewable fund for state and local governments to prevent budgeting shortfalls and provide small businesses a “restart package” that would aid in covering the costs of necessary business adaptations to operate safely, such as Plexiglas and PPE.
4.“Plan for the effective, equitable distribution of treatments and vaccines.”
In the event that a vaccine is released and approved by the Food and Drug Administration, the federal government would introduce it to the market in a manner where price inflation does not occur. The vaccine would be available to all, as opposed to the wealthy and well-connected.
5.“Protect Older Americans and Others at High Risk.”
As proposed by senator Kamala Harris, this sub-policy intends to establish a COVID-19 Racial and Ethnic Disparities Task Force. This task force would provide oversight and recommendations concerning disparities present in the public health and economic response. Further, the flow of information about the coronavirus would be more transparent, assisting elderly Americans in being informed about what precautions they should take.
6.“Rebuild and expand the defenses that Trump has dismantled to predict, prevent, and mitigate pandemic threats, including those coming from China.”
The White House National Security Directorate for Global Health and Biodefense set forth by the Obama-Biden administration and eliminated by the Trump administration in 2018 would be reintroduced. The relationship between the WHO and the United States would be mended as it is fundamental to coordinating a global response.
7.“Implement mask mandates nationwide by working with governors and mayors and by asking the American people to do what they do best: step up in a time of crisis.”
This one is a no-brainer and should have been implemented right when the pandemic started. There would be a nationwide mandate on sporting face masks.
*All information under the heading “What is the 7-Point Healthcare Policy?” is derived from presidential candidate Joe Biden’s official campaign website. For more information on Biden’s policies, visit https://joebiden.com/. Please vote in an informed and responsible manner.
How Has the American Electorate Reacted to Biden’s Plan?
A recent survey publicized by the American Journal of Public Health finds that the number of citizens in the United States that would like the government to partake in a more overshadowing role in the healthcare system than during the first wave of the pandemic increased by an astounding 40%. This indicates that Americans believe that the federal government should quit hiding around and delaying a proper response to the pandemic. However, Dr. Wilson asserts that the difficulty that already surrounds implementing a proper coronavirus response has been gravely heightened because it has now been exposed to partisan lenses. A response to the virus is now political as opposed to protecting American citizens. If Biden wins the election, Wilson warns that federal infrastructure will have to be rebuilt, the WHO has to be re-entered, and American foreign relations must be restored, especially with the Chinese whose trust America has lost (Wilson, 2020.) The relationship with China is particularly of interest because the United States had engaged in a multitude of scientific collaborations with them. As it stands today, the current state of the United States will only make progress on resolving the coronavirus exceedingly difficult. Still, a secondary survey conducted by the American Journal of Managed Care insinuates that voters aged 18-29 trust Biden on taking the lead in healthcare over Trump on an outcome of 62% to 25%. Trump makes up for this gap with his supporters aged 65 and above but still falls short of Biden by five percentage points. It will be interesting to witness the outcome of this year’s election as the survey highlights that healthcare policy is the paramount deciding factor on who the electorate will confide their vote in for 71% of Americans.
This year’s election is likely to be settled based on which candidate presents a better agenda for healthcare policy. While Trump has built an agenda embedded in misinformation, Biden sets forth a plan that is not innovative or original in any form but is necessary to be implemented. Although Biden has maintained bipartisan support on his policies concerning the healthcare system and a proper response to the novel coronavirus pandemic throughout his campaign, undiscussed concerns still remain if Biden is elected president. These concerns are rooted in the extensive aggregate of time required to re-establish the role of the WHO in the United States, repair American relationships with foreign countries that have lost their credence in the United States, and rebuild federal infrastructure. Nonetheless, the 2020 election has been quite the spectacle up to date and will continue to be such no matter who will win the election. With this in mind, be sure to vote if you are eligible. Your vote is pivotal in not only deciding the direction in which healthcare policy will shift moving forwards, but all policy.
Sabriyah Morshed, Youth Medical Journal 2020
Barry, C. L., Han, H., Presskreischer, R., Anderson, K. E., & Mcginty, E. E. (2020). Public Support for Social Safety-Net Policies for COVID-19 in the United States, April 2020. American Journal of Public Health. doi:10.2105/ajph.2020.305919
COVID-19, also known as Severe Acute Respiratory Syndrome Coronavirus Two (SARS-CoV-2 for short), is an infectious respiratory illness that is the cause of the “COVID-19 Pandemic”. The first case of this respiratory illness was reported in late December 2019 in Wuhan, China. From December 2019 to present day, there has been a rapid increase in cases with the United States being a contender for the most cases at a total of more than seven million cases and approximately 210,000 deaths. Worldwide, there are a total of almost thirty-eight million cases with about one million deaths.
COVID-19 impacts the neurological functioning of many people diagnosed with this illness and causes detrimental effects to the nervous system. This is leading to a rise in mortality in the ceaseless COVID-19 pandemic. Currently, there are many efforts being made in research to uncover many of the neurological complications in patients affected by COVID-19. These complications include headache, dizziness, myalgia, loss of smell and taste, with more serious complications including the worsening of strokes and seizures. It remains uncertain where the development of these complications occur, although it seems that these complications are typically prevalent in older patients with pre-existing risk factors which include Type two diabetes, cancer, chronic kidney disease, sickle cell disease, coronary artery disease, etc. Neurological functioning is being impacted by COVID-19 mainly due to hypoxic-ischemic injury to the brain. In other words, COVID-19 is causing a lack of oxygen in the brain because of low oxygen levels in the blood.
Figure 1: SARS-CoV-2 invasion of the CNS and symptoms of the direct invasion.
CNS = central nervous system; BBB = blood-brain barrier
There have also been reports of brain inflammation as one of the neurological complications of COVID-19. Many of the people who went through the symptoms of having brain inflammation also experienced a rare disorder which is called acute demyelinating encephalomyelitis (ADEM). ADEM is triggered by the viral infections of the SARS-CoV-2 which leads to damage of the myelin sheaths that surround the nerves in the brain. This disturbs the homeostasis of the brain and causes death of the neurons.
In order for the brain to remain at the optimal level of homeostasis, the autonomic nervous system and its related limbs have to function properly. Another neurological disorder that is the result of COVID-19 is Guillain-Barré syndrome. Guillain-Barré syndrome is a rare neurological disorder in which the immune system attacks healthy nerves in the body. This disorder is also involved in the damage of the myelin sheath. Overall, the main neurological complications of COVID-19 include seizures, brain inflammation (ADEM), anosmia, hypoxia, Guillain-Barré syndrome (very rare), and stroke being a primary concern for many doctors and researchers.
According to the medical article, “Neuroinvasion, neurotropic, and neuroinflammatory events of SARS-CoV-2: understanding the neurological manifestations in COVID-19 patients”, the authors included a clinical study of seven hundred sixty-five COVID-19 patients. In a clinical study of seven hundred sixty-five COVID-19 patients, about 18% of the patients had neurological complications such as acute myelitis and Guillain-Barré syndrome. Clinical studies have also shown that the loss of the sense of smell is turning out to be one of the most common symptoms in patients diagnosed with COVID-19, indicating that olfactory dysfunction is a prognostic factor. Another article, “Neurological manifestations of COVID-19 and other coronaviruses: A systematic review” discusses seven case studies that were done in patients diagnosed with a positive coronavirus test result. The investigation had concluded that encephalitis was a prevalent disorder in the pediatric age range. The case study investigation had four hundred nine patients, who were diagnosed with COVID-19, had an onset of neurological complications such as headaches, dizziness, epileptic seizures, neuralgia, and only about 1.4 percent of the patients had the Guillain-Barré syndrome.
The coronavirus pandemic has caused a lot of tension throughout the world with a death toll of more than one million people and a drastic total of more than thirty-eight million cases. Doctors and scientists have found that some patients diagnosed with a positive coronavirus results also have an onset of neurological complications. Although many of the neurological complications aren’t life-threatening, about ten to 20 percent of the complications are requiring hospitalizations and are fatal. Such complications include brain inflammation, acute cerebrovascular diseases, meningitis, hypoxic encephalopathy and the most rare of all the complications which is Guillain-Barré syndrome. There have been many case studies done to highlight that some of the more crucial disorders are very rare with having only about one percent of the patients in a case study be diagnosed with a rare complication. These neurological complications raise concerns and questions regarding how much worse the complications could get if and when the virus strain gets more stronger, crushing the world with a possible second wave. The only way to find out is testing patients and analyzing case studies to find answers to the questions and concerns on the rise about COVID-19.
 Orsini, A., Corsi, M., Santangelo, A., Riva, A., Peroni, D., Foiadelli, T., … Striano, P. (2020). Challenges and management of neurological and psychiatric manifestations in SARS-CoV-2 (COVID-19) patients. Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 41(9), 2353–2366.
 Özdağ Acarli, A. N., Samanci, B., Ekizoğlu, E., Çakar, A., Şirin, N. G., Gündüz, T., … Baykan, B. (2020). Coronavirus disease 2019 (COVID-19) from the Point of View of neurologists: Observation of neurological findings and symptoms during the combat against a pandemic. Noro Psikiyatri Arsivi, 57(2), 154–159.
 Correia, A. O., Feitosa, P. W. G., Moreira, J. L. de S., Nogueira, S. Á. R., Fonseca, R. B., & Nobre, M. E. P. (2020). Neurological manifestations of COVID-19 and other coronaviruses: A systematic review. Neurology, Psychiatry, and Brain Research, 37, 27–32.
 Yachou, Y., El Idrissi, A., Belapasov, V., & Ait Benali, S. (2020). Neuroinvasion, neurotropic, and neuroinflammatory events of SARS-CoV-2: understanding the neurological manifestations in COVID-19 patients. Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 41(10), 2657–2669.
 Baig, A. M., & Sanders, E. C. (2020). Potential neuroinvasive pathways of SARS-CoV-2: Deciphering the spectrum of neurological deficit seen in coronavirus disease-2019 (COVID-19). Journal of Medical Virology, (jmv.26105). doi:10.1002/jmv.26105
Coronavirus, a disease that has taken hold on over 38 million people, and has killed over 1 million worldwide is the #1 concern of the world. It is increasingly vital that we achieve herd immunity. Herd immunity or community immunity is when a large part of a population becomes immune to a specific disease or virus. The idea is that if enough people obtain resistance to the cause of a specific disease or virus it has nowhere to spread. While this may not mean everyone is immune, with fewer at risk individuals the infection rates drop. This protects at risk populations like babies and elderly who have weaker immune systems.
Now how do we achieve immunity, there are two ways: vaccination or infection. As of right now there is no vaccine to protect against Covid-19 which means that to gain immunity you would have to catch the virus first. Anti-vaxxers (people who don’t oppose vaccinations despite scientific evidence) support the idea that a large number of people catch the virus, get sick, and then recover. The way this works is when you catch an illness your body will develop antibodies for that illness that will prevent you from being infected again. As of now the recovery rate for coronavirus infections is around 80%. However, the question is what percentage of the population must have built resistance before we reach the threshold for herd immunity? This is all dependent on the R0, (R-naught), which tells us the average number of people an infected person can spread the bacteria or virus to. Recent data has put the R0 for the novel
Coronavirus to be 2-3, which means for every 1 person with the virus that person can infect 2-3 more. In comparison, the 1918 Spanish Flu which has been compared to Covid-19 numerous times is estimated to have an R0 of 1.4-2.8. Measles, the most infectious disease known has an R0 of 15! Though this seems high several factors make it less worrisome including there being a vaccine, it’s a well-known disease, and is treatable with modern medicine. To reach herd immunity scientists have estimated that between 50-67% of the population would need to be resistant for infection rates to drop.
Natural vs. Vaccination
The question is natural or vaccine immunity? With recovery rates being relatively high could we attempt to naturally achieve herd immunity? Yes, but with so many unknowns we shouldn’t consider it . There are also questions raised about how long natural immunity will last and even if someone has immunity, can they still spread the virus? Dr. Stuart Ray, an expert of infectious diseases at John Hopkins University School of Medicine says that vaccines, on the other hand, can be made to trigger stronger immunity than natural infection.
Politics in Public Health
In past weeks, U.S. President Donald Trump has claimed that the coronavirus would simply “go away,” as people developed “herd mentality.” Herd mentality is “the tendency of the people in a group to think and behave in ways that conform with others in the group rather than as individuals.” Clearly, the President had a mix-up with words. And just recently Senator Rand Paul suggested during a hearing that the decline in New York City cases is due to herd immunity over public health precautions such as wearing masks and social distancing. These claims were shut down by Dr. Anthony Fauci who is the top U.S. infectious disease official who stated that only 22% of the New York City population had coronavirus antibodies. This ties back to the estimation that to achieve herd immunity 50-67% of the population would have to be immune. When looking at possible cases where herd immunity has shown promising results Sweden is often referenced. Again that has been proven to be a poor comparison by health experts including Fauci.
High Risk Communities
Because, the U.S. has a more diversified population, with vulnerable groups such as Black and Latino Americans being at a higher risk. We need a vaccine to safely build immunity within these communities. According to the Pew Research Center, Black Americans are more likely to live in dense populated communities, more likely to have other health conditions that can put them at higher risk, less likely to have adequate access to health care, and more likely to work in industries that require contact with the public. Coastal cities also have the most largely dense populations and will become more dense as time goes by. This is due to economic benefits including transportation link, industrial and urban development, and revenue from tourism. Today nearly 3 billion people like within 200 kilometers from the coastline, and this figure is set to double by 2025. This puts coastal cities all over the world at high risk.
In conclusion, natural immunity is not an effective nor ethical way to tackle the virus. By developing and administering a vaccine the majority of the population we can achieve herd immunity without risking the lives of billions. In a time of numerous misinformation by politicians it’s more important than ever to take precaution and listen to your local health officials as they will provide you with best measures against Covid-19.
Brian Ngo, Youth Medical Journal 2020
Pattani, Aneri. “Why ‘Herd Immunity’ Can’t Save Us from COVID-19.” Yahoo! News, Yahoo!, 29 Sept. 2020, news.yahoo.com/why-herd-immunity-cant-save-194943708.html.
Viruses are mainly thought to be infectious diseases that spread easily, originating from a cough or sneeze, or even out of nowhere. Although this is partially true, there is much more behind the development of a virus. Tracing the origins of viruses can be quite difficult because they do not necessarily leave behind any ‘fossils.’ Rather, they only make copies of themselves which means studying their ancestry requires pinpointing the host cell and trying to deduce its origins.
A virus is a non-living microscopic agent that has attachment proteins that act as receptors. Viruses are extremely small, approximately 20 to 400 nanometers in diameter. By comparison, a human red blood cell is about 6,000 to 8,000 nanometers in diameter. The structure of a virus has a center of nucleic acid (either DNA or RNA), and is enclosed in a defensive layer of protein called the capsid. A capsid is composed of protein subunits also known as capsomeres. Its envelope and the cell membrane are also made up of similar material.
Viruses have either single-stranded DNA, single-stranded RNA, double-stranded DNA, or double-stranded RNA. The type of genetic material found in a particular virus depends on the nature and function of the specific virus. The viral genome can consist of very few genes or up to hundreds of genes depending on the type of virus. The genetic material is not typically exposed but is covered by the capsid in order to be protected from damage.
Scientists have been able to theorize how viruses may develop based on the fact that the genes of many viruses, like those that cause herpes, share similar characteristics with the genes from cells. This theory is known as the Cellular Theory. This theory implies that viruses first started as big pieces of cellular DNA and eventually became independent. Others speculate that viruses came along very early in evolution, and some of their DNA stayed in cells’ genomes. This is known as the Theory of Evolution for Viruses. The fact that viruses infecting humans share similar structural features with viruses could mean that all of these viruses have a common origin, dating back billions of years.
Not all viruses look exactly the same in appearance, but they all share a similar structure. The shape of viruses varies widely. In general, viruses fit usually into two different visual categories. Viruses of humans, animals, and plants are typically spherical and rod-shaped, sometimes consisting of many sides. Viruses of bacteria (bacteriophages) are often shaped almost like a spaceship.
Figure 2: Visual of the structure of a virus that has a “spaceship” appearance.
Because viruses can not exist independently, they must take over a living cell in order to survive and reproduce. When a virus comes into contact with a susceptible host cell, it will latch itself onto the surface using its receptors. The virus will then inject its nucleic acid into the host cell. After, the virus will enter the cell in order to take control of the host by using the protoplasm,the living part of a cell that is surrounded by a plasma membrane, inside of it to create new viruses. Once these new virus particles assemble, they will leave the original host cell and find new host cells and repeat the same process, called the lytic cycle. There is no cell division within the development and replication of viruses. Viruses are only able to be replicated through the chemical synthesis of viral nucleic acid and capsid proteins. In the ending stage of virus replication, host cells that have been attacked may be completely destroyed or suffer little or no harm.
Few viruses go through an additional phase before replication, known as the lysogenic or dormant phase. During this phase, the virus can remain inside the host cell for extended periods of time without causing any changes to the cell. Once activated, however, these viruses can immediately enter into the lytic cycle.
Figure 3: Diagram of a lytic cycle, the process of virus replication.
Viruses cause a number of diseases in the organisms they infect. Human infections and diseases caused by viruses include Ebola fever, chickenpox, influenza, AIDS, and herpes. Plant diseases include mosaic disease, ringspot, leaf curl, and leafroll. Viruses known as bacteriophages cause disease in bacteria and archaeans. Humans can contract viruses through ingestion, sexual transmission, from the air, and many other ways.
Figure 4: Illustration of how airborne diseases can spread.
Vaccines have been effective in preventing some types of viral infections, such as smallpox and the flu. They work by helping the body build an immune system response against these specific viruses. However, it is important not to forget that many viruses can still cause serious damage to living things, and some can actually be fatal. Viruses like COVID-19, are examples of diseases that morphed into a strong and deadly virus that attacks the body and has the ability to kill.
Coronaviruses are a family of viruses that can cause illnesses such as the common cold and it is essentially made up of Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). However, the newly discovered coronavirus, COVID-19 or SARS-CO-V-2, became so severe that it caused a worldwide pandemic and has resulted in hundreds of thousands of deaths. Experts say SARS-CoV-2 originated in China and was passed from bats to humans.
Figure 5: Diagram depicting the human-to-human transmission of coronavirus and its effects on the body.
The name “coronavirus” is derived from Latin: corona, meaning “crown” or “wreath.” Coined by June Almeida and David Tyrrell who studied the human coronavirus, the name was meant to refer to the appearance of the virus. Coronaviruses are large, roughly spherical shaped particles with viral spike peplomers which are actually proteins that lie on the surface of the virus. On average a coronavirus particle has 74 surface spikes all around. The average diameter of a virus particle is around 125 nm (.125 μm). They also contain a positive-sense, single-stranded RNA genome.
Figure 6: Image depicts the COVID-19 virus and its anatomy.
Inside their envelope lies the nucleocapsid, which is formed from multiple copies of nucleocapsid protein. They are bound to the positive-sense single-stranded RNA genome in a “continuous beads-on-a-string type conformation.” The lipid bilayer envelope, membrane proteins, and nucleocapsid protect the virus when it is outside the host cell.
Figure 7: Infographic detailing the structure and makeup of a COVID-19 virus particle.
A virus infects the body by entering healthy cells and going through the lytic cycle. There, the infector makes copies of itself and multiplies throughout the body. The new coronavirus would then latch its spiky surface proteins to receptors on healthy cells, especially those in the lungs, and this is why those who have contracted the coronavirus experience respiratory issues. Eventually, the virus kills off some of the healthy cells.
COVID-19 begins with droplets from an infected person’s cough, sneeze, or breath. They could travel through the air or be on a surface that someone may touch before touching the eyes, nose, or mouth. That gives the virus a passage into the mucous membranes and allows it to segway into the throat. Within 2 to 14 days, the immune system may respond with symptoms including a fever, cough, body aches, headaches, shortness of breath, chills, loss of taste, loss of smell, nausea, and other symptoms. The virus moves down into the respiratory tract, the airway that is connected to the mouth, nose, throat, and lungs. Because the lower airways have more ACE2 receptors compared to the respiratory tract, COVID-19 is more likely to travel deeper than the average cold.
Viruses are very complex in the way they manifest, and there is still much research that has yet to be discovered about viral infections. Doctors are continuously working close with researchers to develop stronger and more efficient ways of combating these infections. Currently, there are different vaccines being made in order to eventually fight COVID-19 virus cases.
Figure 8: A visual referencing the symptoms that may come with COVID-19.
The COVID-19 pandemic is taking a great toll globally. To control the situation effectively, measures to lower the death rate have to be taken. Doctors have already stated that people with comorbidities like diabetes are at a higher risk of getting severe symptoms of COVID-19 infection.
Increase in Risk
The fluid and electrolyte balance of the body is maintained with the help of the renin-angiotensin system. When a person complains of low blood pressure, the renin (present in the kidney) forms angiotensin I by breaking down the enzyme angiotensinogen. Angiotensin-converting enzyme(ACE) converts angiotensin I into angiotensin II to activate it. This Angiotensin-converting enzyme (usually present on the lungs, kidney, and heart) binds to the Angiotensin-converting enzyme receptors and squeezes the blood vessels, thus raising the blood pressure of the body. Then the Angiotensin-converting enzyme-2 (ACE-2) breaks down the angiotensin II into molecules that neutralize its harmful effects.
SARS-CoV-2 has a high affinity for ACE-2 receptors present on the surface of healthy cells. Thus it attaches itself to the ACE-2 and attacks the lungs, kidney, and heart. The levels of ACE-2 increase in a diabetic person (a condition with high blood glucose levels, hyperglycemia) allowing the virus to attack the organs of the diabetic person more disastrously. Acute hyperglycemia upregulates ACE-2 expression on cells which might facilitate viral cell entry. Chronic hyperglycemia downregulates ACE-2 expression making the cells vulnerable to the inflammatory and damaging effects of the virus.
Link Between COVID-19 and Diabetes
COVID-19 is an acute respiratory infection caused by a coronavirus named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and is spread through air droplets or close contact with an infected person. Often older people(above 65 years of age) & people with pre-existing diabetic conditions are affected.
The risk of a fatal outcome from COVID-19 is up to 50% higher in patients with diabetes. When diabetic patients develop a viral infection it can increase inflammation and the treatment is hard because of fluctuations in blood glucose levels and the presence of diabetic complications. This is because of the compromised immune systems making it difficult to fight with the virus leading to a longer recovery period.
Linked Complications & Risk Factors
Complications like Acute respiratory distress syndrome (ARDS) & multi-organ failure are prevalent in prediabetic Covid-19 patients. It involves the lower respiratory tract which can offset pneumonia, rapidly progressing to ARDS associated with multi-organ failure. Acute respiratory distress syndrome (ARDS) is a severe lung condition causing fluid accumulation in the alveoli, progressive fibrosis which comprises the gas exchange. The type 1 & 2 pneumocytes lining the alveoli become dysfunctional leading to a decrease in surfactant levels & the ability of lungs to expand causing Sepsis (a serious infection which causes the immune system to attack the body) and Severe pneumonia (Pus collection in air sacs).
COVID-19 prediabetic patients have direct viral invasion which causes functional immune deficiency and directly reduces immune cell function. This leads to diminished bactericidal clearance, increased infectious complications, and protracted sepsis mortality. Thus they may develop pneumonia leading to sepsis. SARS-CoV-2 infects the upper respiratory tract & circulating immune cells (CD3, CD4, and CD8 T cells) inducing lymphocyte apoptosis with elevated inflammatory biomarkers such as C-reactive protein, serum ferritin, and IL-6. The T cells inhibit the overactivation of innate immunity resulting in lymphocytopenia, which suppresses the innate immune system and enhances the cytokine secretion resulting in a cytokine storm causing a multi-organ failure.
Body mass index (BMI) in obesity of 30 or above increases the risk. Abdominal obesity is associated with a higher risk involving abnormal secretions of adipokines and cytokines like TNF-alpha and interferon which may induce an impaired immune response. Obese people also experience mechanical respiratory problems, with reduced ventilation of the basal lung sections increasing the risk of pneumonia.
If a person with diabetes has a fever from COVID-19, they lose additional fluids. This can lead to dehydration, which may require intravenous fluids.
Diabetes damages arteries with fatty material deposition on their inner walls (atherosclerosis) which can cause Hypertension. Arterial hypertension is also highly prevalent in Covid19 patients due to the use of ACE inhibitors since SARS-CoV-2 binds to ACE2 to enter target cells. ACE inhibitors and angiotensin receptor blockers increase the expression of ACE2 which facilitates target organ infection and promote the progression of the disease.
Management of Diabetes in Patients with COVID-19
In COVID-19 the endothelial dysfunction associated with hypoxia causes intravascular disseminated coagulation. It involves the formation of abnormal clumps of thickened blood clots inside the blood vessels, leading to massive bleeding in other places causing inflammation & infection. Diabetes is associated with a pro-thrombotic state, which plays a key role in blood clotting with an imbalance between clotting factors and fibrinolysis. Pre-Diabetic patients with COVID-19 have a longer prothrombin time and higher concentrations of D-dimer(a small protein fragment in the blood after a blood clot). Other risk factors such as obesity, older age, and being admitted to the hospital could increase the pro-coagulative state and the risk of thrombotic complications.
Diabetes causes disturbance of glucose homeostasis and worsening of hyperglycemia(a characteristic of Diabetic Ketoacidosis). In diabetic patients with Covid-19, there is a direct effect of SARS-CoV-2 binding to ACE receptors expressed in pancreatic tissue and β-cells harming the β-cell function. Therefore there is an acute loss of insulin secretory capacity, stress condition, and a cytokine storm resulting in Diabetic Ketoacidosis (DKA).
Figure 1 : Synopsis of reciprocal effects of diabetes and COVID-19
Poor glycemic control is a risk factor for serious infections but is useful in some conditions like bacterial pneumonia. To maintain optimal glycaemic control it requires frequent blood glucose monitoring and continuous change in anti-diabetic treatment after the measured glucose levels.
Pre-Diabetic patients with COVID-19 infection should have regular blood glucose monitoring and adequate glycemic control which might reduce the risk of this severe infection. Special considerations to avoid certain antihyperglycemic agents should be noted. In Type 2 diabetes, Metformin (initial drug of choice) possesses a risk of dehydration & lactic acidosis hence should be avoided in patients who have greater potential to progress to severe COVID-19. Dipeptidyl peptidase (DPP)-4 inhibitors are well tolerated & can be used as an alternative to Metformin. Sodium-glucose cotransporter-2 inhibitors have risks of dehydration & Diabetic Ketoacidosis which is one of the complications hence avoided. Similarly, Glucagon-like peptide 1 receptor (GLP-1) agonists have a risk of dehydration so patients on these medications should be closely monitored. If any anti-hyperglycemic drugs are discontinued alternate treatment is usually Insulin and it should be continued if it is already ongoing in a patient.
In type1 diabetes frequent blood glucose monitoring every 3-4hrs & adjustments of insulin dose based on blood glucose values is needed. Urine ketones along with blood glucose should be monitored if fever with hyperglycemia occurs. Systematic screening for pre-diabetes in patients with proven COVID-19 infection is advisable.
There is a bidirectional relationship between Covid-19 and diabetes. On one hand, diabetes is associated with an increased risk of severe Covid-19 while on the other hand new-onset diabetes and severe metabolic complications of preexisting diabetes, including diabetic ketoacidosis and hyperosmolar for which exceptionally high doses of insulin are warranted, have been observed in patients with Covid-19.
It is important to recognize the importance of diabetes as a vital comorbidity in patients with COVID-19. Any prediabetic patient who develops COVID-19 symptoms should contact their healthcare provider as soon as possible. Although people with diabetes are at a risk of more serious complications from COVID-19, it is possible to reduce the risk by maintaining ideal blood sugar levels and following infection prevention measures.
This article will be examining and summarizing two forms of Coronavirus detection. This information was gathered and analyzed using the CDC’s official website and other trusted webpages. This information was analyzed in a way for the average person to understand.
I preface by giving a warning that the FDA has seen multiple unauthorized testing kits for COVID-19 sold online. These kits can conclude to be hazardous and you should always just go to your local testing site.
The most common testing method in the United States consists of a healthcare worker using a long swab to grab a sample which will then be sent out for testing. Other countries may use blood samples. Both Blood and the swab sample take up to a week for results.
Tests using Q-tips are known as molecular tests. These molecular tests detect active infection. In other words, it checks for the presence of coronavirus. The tests are run through what is known as Real-time reverse-transcription polymerase chain reaction, or rRT-PCR. Currently, laboratories are required to have a positive result from the rRT-PCR assay in at least two specific genomic targets (an assay is essentially an analytic procedure completed in laboratories). Laboratories check for a single positive target with sequencing of a second target to get confirmation that coronavirus is present in the sample.
Overall, the success of the molecular test relies on many factors. That is why the CDC has strict guidelines for how to handle and work with molecular test samples. To get a more accurate result scientists are recommended to get multiple samples. These samples are various types of respiratory samples, serum, and stool specimens. A single negative result for coronavirus does not result in the guarantee that a person does not have coronavirus, so they are put “under investigation”. This test only takes a couple of hours to run.
Tests using blood samples are called a serology test. These tests look for previous infection or antibodies for coronavirus. The presence of these antibodies tells the scientists that person had the virus and developed an immune response to it. These tests are not flawlessly accurate but scientists are working to make them precise, using information on how the virus is transmitted. The CDC requires a two phase approach for these serology tests. Phase one uses two screening tests while phase two uses one confirmatory test to detect coronavirus antibodies.
Phase one includes the enzyme-linked immunosorbent assay and the microneutralization assay. The enzyme-linked immunosorbent assay is also known as ELISA. This test is used to discover whether there is concentration of specific antibodies. The microneutralization assay is used to measure antibodies that can neutralize the virus. This test takes a minimum of 5 days to find results.
The following are how the CDC determines the results of the serology tests:
If a clinical sample is positive by either ELISA, or positive by micro neutralization, the specimen is determined to be confirmed positive.
If a clinical sample is positive by both ELISAs, and negative by micro neutralization, the sample is determined to be indeterminate.
If a clinical sample is positive by only one ELISA, and negative by micro neutralization, the sample is determined to be negative.
If a clinical sample is negative by both ELISAS, the sample is determined negative.
The differences between the two tests are, a serological test can detect antibodies even if a patient has recovered, whereas a molecular test can detect the virus only if the person is currently infected. Both the molecular tests and the serological tests are risk free, but you may feel some discomfort or pain while someone is getting a sample.
The tests I did not discuss are Nasal aspirate, Tracheal aspirate, and the Sputum Test. These tests are less common, but you are encouraged to research them.
Some hospitals and various agencies have set up Drive-through coronavirus testing centers. Be sure to do your own research on these.
Rapid PCR tests are currently being developed. Scientists are working very hard to find a more convenient and less cost effective way to detect coronavirus. Currently, the coronavirus tests developed by the CDC, Washington, and New York are PCR tests.
Some good information to know:
COVID-19 tests are very new and false negatives can occur.
At home tests are to be used with precaution as the quality of the specimen is largely unknown.