AFVOA Newsletter 03 of 2020

Section 5 - Memoirs CV 2 No. 03 / 2020 Page 68 of 167 Exposure to contact & onset of Symptoms takes 5-6 days; Virus shedding is highest in the early phase of the disease in the first 7-10 days; After 10 days the virus dies hence transmission risk is less. So, 14 days Quarantine was enforced for all travelers in the world. Exposure to virus followed by complications & death happens within 3weeks. Those who have escaped death, it took 6-8 weeks for a patient to recover fully. Sounds terrible isn't it? Persons with Hypertension, diabetes: why are they easily prone to this deadly virus? This virus has the worst effect on the vulnerable. Basic pathology in cytokine storm is extensive cell damage of the delicate endothelial lining inside the blood vessels of all vital organs like Lungs, Kidney& the delicate Broncho-alveolar cells of lung tissue. Presence of ACE2 RECEPTORS in these organs make them an easy culprit because Covid-19 viruses have affinity for ACE2 RECEPTORS and quickly get attached to these sites (spikes facilitate it). Both chronic Hypertension & diabetes affect smaller blood vessels of vital organs like Kidney, heart, Retina. Hence already damage to vessels have taken place with Co- morbidities and virus attack is like fuel adding to the fire and these patients succumb to rapid multi organ failure. Inflammation causes chain reaction and small blood vessels in vital organs also get clogged (micro vascular thrombi). Use of Steroids & Heparin counters these two aspects of cytokine storm and should be started early before the organ is damaged. Children do not have these well-developed ACE2 RECEPTORS in their tissues, thus to some extent they get protected whereas aged population have already damaged organs due to comorbidities hence easily go for multi-organ failure. WHAT ARE RISK-FACTORS & WHO IS A SUSPECT? Patients with acute respiratory illness like- FEVER, BODYACHE, DRY COUGH, SORE- THROAT & SHORTNESS OF BREATH. MOST IMPORTANT SYMPTOM IS FATIQUE (80%). ONE OF THESE SYMPTOMS IS ENOUGH TO WARRANT INVESTIGATION. These are flu-like symptoms but common cold has running nose which is not seen with Covid-19. Some cases presented with nausea, vomiting & diarrhoea. In 30% of cases loss of smell & loss of taste for sweet & salt seen. Health care workers have to use PPE kits & Front line workers if they test positive irrespective of his clinical status is quarantined