Recap on How the Medical Field has Handled the Coronavirus (COVID-19) Outbreak

Updates on the COVID-19 pandemic have come out almost daily. Whether it’s social distancing guidelines, facemask recommendations, treatments, or the possibility of a vaccine, the flurry of information has been overwhelming.

Two things that have remained relatively unchallenged during the pandemic are:

• Stay home if you feel sick
• Social distance

People showing possible symptoms of COVID-19 are asked to self-quarantine at home for at least two weeks. Symptoms of COVID-19 can range from mild to severe—some people may show no symptoms at all. If they do present, it’s typically two to 14 days after contracting the virus. Signs of COVID-19 may include (but are not limited to):

• Fever or chills
• Cough
• Shortness of breath/difficulty breathing
• Muscle or body aches
• Now loss of taste or smell
• Diarrhea
• Fatigue

The other guideline that has generally remained the same since the onset of the pandemic is social distancing. Experts believe that maintaining a distance of about six feet can help protect people from getting the virus or spreading it to others, so social distancing is important if you are around people who don’t live in your household or people in your household who are infected. Some experts and studies suggest that the virus is less transmissible outdoors, but social distancing is still recommended.

Here’s a breakdown of what else we’ve been told about different things pertaining to the COVID-19 pandemic.

Facemasks

The use of cloth facemasks has caused great controversy during the pandemic, with debate sparking on whether they were actually effective. Currently the Centers for Disease Control and Prevention (CDC) recommends almost everyone (more in that in a bit) wear a facemask when you are around others who do not live in your household and when social distancing (maintaining six feet of distance [about two arms’ lengths]) is not possible or is difficult to maintain.

Cloth masks will not prevent you from getting the virus, so they are not meant as a substitute for social distancing. The purpose of wearing a cloth mask is so those around you are protected in case you are an asymptomatic carrier. It’s believed that if everyone wears a mask, in conjunction with social distancing, frequent handwashing, and disinfecting oft-touched surfaces, this can help greatly reduce the transmission of the virus.

The CDC recommends face masks be worn by everyone except people aged younger than two years, those with difficulty breathing, and anyone who is unconscious or cannot remove the covering without assistance.

What To Do If You Think You Have COVID-19

If you’re experiencing mild symptoms of COVID-19, it is recommended that you stay home and self-isolate, except to receive medical care. Avoid contact with people who do not live in your home, and try to stay in a separate room away from the other members of your household; use a separate bathroom if possible. If you do have to leave your home, make sure to wear a face covering. Most patients with mild symptoms are able to recover at home without receiving medical treatment. It’s recommended that you first call your doctor to discuss what you’re feeling to determine if you should come in. If you have trouble breathing, persistent chest pain/pressure, new confusion, difficulty waking up/staying awake, or bluish lips/face, seek medical care immediately as these could be indicative of an emergency.

As of now there is no CDC-recommended antiviral treatment for COVID-19, so only symptoms can be treated. If you are recovering at home, it’s recommended to treat the symptoms that you are experiencing, and to rest, hydrate, and take over-the-counter acetaminophen when necessary.

Medications That Have Been Tried

Although there is no dedicated COVID-19 drug yet, the Food and Drug Administration (FDA) issued emergency use authorization for antiviral drug remdesivir. Patients hospitalized with severe COVID-19 may receive intravenous remdesivir. The FDA subsequently issued a warning that remdesivir may be less effective when administered with chloroquine phosphate or hydroxychloroquine sulfate.

Many studies have been conducted on hydroxychloroquine as a potential COVID-19 treatment, with conflicting outcomes.

An observational study published in JAMA concluded that “treatment with hydroxychloroquine, azithromycin, or both, compared with neither treatment, was not significantly associated with differences in in-hospital mortality.”

A study published this month in the International Journal of Infectious Diseases, meanwhile, observed that hydroxychloroquine, either alone or in combination with azithromycin, was associated with reduced COVID-19 mortality.

In June the Food and Drug Administration (FDA) revoked its emergency use authorization for hydroxychloroquine in COVID-19 patients, “based on recent results from a large, randomized clinical trial in hospitalized patients that found these medicines showed no benefit for decreasing the likelihood of death or speeding recovery.” On July 1 the FDA published a summary review highlighting the safety issues associated with hydroxychloroquine use in COVID-19 patients. Associated events include “reports of serious heart rhythm problems and other safety issues, including blood and lymph system disorders, kidney injuries, and liver problems and failure,” according to the FDA.

COVID-19 Vaccines: Where Are We?

As social distancing, masks, and frequent hand washing have all become part of everyday life, the latest topic to dominate the COVID-19 conversation is the one on vaccines. As of now there are more than three dozen potential COVID-19 vaccines in preclinical trials or already being explored in trials.

Recently, data have been published regarding a vaccine being tried by Oxford and AstraZeneca. The Oxford-AstraZeneca randomized, controlled phase 1/2 trial results were published in The Lancet on July 20. Healthy adults aged from 18 to 55 years were randomized to receive either the COVID-19 vaccine (n=543) or a meningitis vaccine (n=534). Ten patients in the COVID-19 vaccine group were assigned to receive the vaccine in two doses, receiving a booster dose 28 days after the initial injection. After the first dose, COVID-19 antibodies were identified in 91% of the COVID-19 vaccine group; 100% of patients had antibodies after the second dose. No serious adverse events emerged; side effects in the COVID-19 vaccine group included “pain, feeling feverish, chills, muscle ache, headache, and malaise.” The researchers stated that the results “supported clinical development progression into ongoing phase 2 and 3 trials.”

Another trial, being conducted by CanSino Biologics, has also garnered attention. In this phase 2 trial, the results of which also appeared in The Lancet, 509 patients were randomized to receive either a high or low dose of a COVID-19 vaccine, or placebo (n=126). Half of the cohort was male, and the mean age was 39.7 years. The researchers observed neutralizing antibody responses in about half of participants in both vaccine groups. The study authors concluded, “One immunisation of the Ad5-vectored COVID-19 vaccine at 5 × 1010 viral particles has a good safety profile (limited to common adverse reactions following immunisation) and could elicit significant specific immune responses to SARS-CoV-2, making it a potential candidate for emergency vaccination of acute protective response.”