Coronaviruses are a large family of 
viruses that are common in people and in animals. At the end of 2019, a novel coronavirus was identified as the cause of a cluster of pneumonia cases in Wuhan, a city in the Hubei Province of China. It rapidly spread, resulting in an epidemic throughout China, followed by an increasing number of cases in other countries throughout the world. In February 2020, the World Health Organization designated the disease COVID-19, which stands coronavirus disease 2019. The virus that causes COVID-19 is designated as SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). By March 2020, the World Health Organization declared it to be a pandemic. Since then, there have been over 225 million cases and 4.6 million deaths worldwide. Within the United States, there have now been more than 40 million cases and over 600,000 deaths.
SYMPTOMS OF COVID-19
Symptoms typically occur between 2-14 days after exposure. The virus is spread mostly from person-to-person via respiratory droplets. Symptoms can range from asymptomatic (without symptoms), mild, or severe symptoms.
Common symptoms include:
- Fever
- Cough
- Shortness of breath
- Trouble breathing
- Fatigue
- Chills, sometimes with shaking
- Body aches
- Headache
- Sore throat
- Congestion/runny nose
- Loss of smell or taste
- Nausea
- Diarrhea
In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure, septic shock and death.
TESTING FOR COVID-19
Viral tests – these test if you have current infection
- NAATs = nucleic acid amplification tests. These tests can reliable detect small amounts of SARS-CoV-2 and are unlikely to return a false-negative result. Tests results can be rapid or delayed by 1-3 days.
- Ag = Antigen. These tests check for viral antigen or protein. Tests results can be rapid, within few minutes. These tests tend to have a higher false-negative rate.
Antibody tests
An antibody test (also known as a serology test) might tell you if you had a past infection. Antibody tests should generally not be used to diagnose a current infection with the virus that causes COVID-19. An antibody test may not show if you have a current infection because it can take 1 to 3 weeks after the infection for your body to make antibodies.
TREATMENT FOR COVID-19
For mild symptoms, treatment includes: acetaminophen or ibuprofen for fever, increased water intake/hydration and rest.
For those who are considered high risk for severe disease, outpatient treatment for those patients also include monoclonal antibodies. There are several monoclonal antibodies available through emergency use authorization. These are given intravenously as a single dose and must be given early in the course of illness:
- Casirivimab-imdevimab
- Sotrovimab
- Bamlanivimab-etesevimab
For moderate to severe disease, hospitalization is likely. Inpatient treatment includes but not limited to:
- Dexamethasone and other forms of corticosteroids
- Monoclonal antibodies, such as, Baricitinib, Tocilizumab
- Anti-viral medications, such as Remdesivir
- Convalescent plasma – this is blood which is donated by people who have recovered from COVID-19. This type of blood can be given to people with COVID-19to boost their ability to fight the virus.
- Oxygen and ventilator support if needed
RECOVERY AND LONG-TERM COMPLICATIONS
Individuals with mild infection are expected to recover quickly (within 2 weeks); however, those with severe disease may have a longer time to recovery, sometimes 2-3 months. Some individuals may experience long-term complications including fatigue, dyspnea, cough, anxiety, depression, inability to focus (“brain fog”), gastrointestinal problems, decreased sense of smell, sleep difficulties, joint pain, and chest pain lasting for months after infection. Long-term studies are being conducted to better understand these complications. It is estimated that 20-40% of patients may experience long-term symptoms.
PREVENTION
Washing hands often, cleaning surfaces, avoiding close contact with those who are sick, avoiding large crowds and mask-wearing are just a few simple measures to help decrease the spread of SARS-CoV2.
The best way to prevent illness, long-term complications, hospitalizations and death from COVID-19 is to get vaccinated!
VACCINATIONS
Vaccines against COVID-19 are safe and effective.
There are currently 3 available vaccines in the U.S:
- Pfizer-BioNTech mRNA COVID-19 vaccine: Emergency use authorization on December 11, 2020 for 16 years of age and older. Emergency use authorization on May 10, 2021 for 12 years of age to 15 years of age. Full FDA approval on August 23, 2021 for 12 years of age and older. Two dose vaccine, separated by 21 days.
- Moderna mRNA COVID-19 vaccine: Emergency use authorization on December 18, 2020, for 18 years of age and older. Two-dose vaccine, separated by 28 days.
- Janssen/Johnson & Johnson vaccine: Emergency use approval on February 27, 2021, for 18 years of age and older. This is a one-dose vaccine.
In order to receive EUA (emergency use authorization), it has to meet rigorous safety standards set by the FDA showing safety and efficacy. Over 70,000 people participated in clinical trials prior to the EUA. Currently in the US, more than 360 million doses have been administered as of August 21, 2021.
Both safety and efficacy has been shown among different ages, races, genders, and also among those with underlying medical conditions.
Clinical trials for these vaccines happened quickly compared to usual and this is not only because of the need for an effective vaccine to help control the pandemic, but also because research scientists and drug companies had already learned a lot from working on other vaccines.
As of August 12, 2021, the FDA modified the EUAs for both Pfizer-BioNTech mRNA COVID-19 vaccine and Moderna mRNA COVID-19 vaccine to allow for administration of an additional dose (i.e., a third dose) of an mRNA COVID-19 vaccine after an initial 2-dose primary mRNA COVID-19 vaccine series for immunocompromised and immunodeficiency patients.
As of October 21st, 2021, if you have received any of the three vaccines (Pfizer-BioNtech, Moderna, or J &J), a booster vaccine is recommended for 18 years and older. You may choose which vaccine booster you would like to receive. The CDC’s recommendations now allow mix and match dosing for booster shots.
Updated information on COVID-19 vaccine booster shots can be found here:
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html
UPDATE ON VARIANTS
Viruses constantly change through mutation, and new variants of a virus are expected to occur. Sometimes new variants emerge and disappear. Other times, new variants persist. Multiple variants of COVID-19 have emerged in the United States. Regardless of the variant type, the current approved or authorized vaccines work against these variants and help prevent severe illness, hospitalization and death.
There are currently 4 variants of concern in the US:
- Alpha – first identified in the UK; spreads much faster than previous strains; more severe disease and/or death; current treatments are effective against this variant
- Beta – first identified in South Africa; may spread faster than previous strains; current treatments are effective against this variant
- Gamma – first identified in Japan and Brazil; may spread faster than other variants; current treatments, such as monoclonal antibodies are less effective against this variant
- Delta – first identified in India; spreads much faster than previous strains; more severe disease and/or death; current treatments, such as monoclonal antibodies are less effective against this variant
OUR COMMITMENT
Our physicians at North Texas Allergy and Asthma Center have been following the pandemic, CDC guidelines, WHO guidelines as well as U.S. and state guidelines, and are committed to doing our part to help decrease the spread of COVID-19. Vaccines to prevent COVID-19 are considered the most promising approach for curbing the pandemic and to help decrease morbidity and mortality from COVID-19 infection. We are currently offering the 2 dose Moderna mRNA COVID-19 vaccine series to our patients, a third dose for our immunodeficiency and immunocompromised patients, and a booster vaccine for our patients. If you are a patient of NTAAC and have not been vaccinated, contact our office for an appointment.
For more information regarding COVID-19 Vaccinations, please refer to the updated COVID-19 vaccines article on our website.
Information is constantly evolving in regards to COVID-19 and COVID-19 vaccines. There will likely be more information available over the next several months.
Sincerely,
Samuel Foster MD, Roshni Foster MD, PhD, Shikha Mane MD and B.A. Badie, MD
Board-Certified Allergists
Adult and Pediatric Allergy and Immunology
