What We Have Learned About COVID-19

Jerry Levine, M.D., FACP, Vice President Medical Director

SARS-CoV-2, the virus that causes COVID-19, has spread rapidly over the past year. In Maryland, as of December 29, there have been 269,442 cases and 5,740  deaths. As Maryland is now experiencing an increase in COVID-19 activity there is substantial information to give you the facts on how the virus is spreading and how you can protect yourself and your family.

How the coronavirus spreads

Strong evidence from published reports indicates that respiratory transmission is the primary way COVID-19 is spread. Direct contact spread by touching contaminated surfaces is presumed but is likely only an unusual method of transmission.

If you have the virus, infectiousness peaks about a day before you show any symptoms and decreases within a week of symptoms onset. This virus has a variable transmission biology. Most people who are infected do not transmit the virus, however some may transmit the virus in clusters called “superspreading” events.  It appears that a combination of viral, host (an infected individual), and environmental factors affect the transmission of COVID-19.

The virus spreads in large droplets or fine aerosols that are expelled from an infected person. Droplets are large particles that fall to the ground within six feet, but aerosols are smaller particles that can remain suspended in the air for longer periods. These particles can be transmitted in exhaled breaths and likely become aerosolized by coughing, sneezing, or singing.

Individuals who are infected with SARS-CoV-2 virus can transmit the virus whether they show symptoms or not. Some individuals remain without symptoms (asymptomatic). Based on case reports, it appears that you may be infected for about five days before you start experiencing symptoms, and infectious spread begins about two days before any symptoms start, peaking around one day before symptoms develop.

In a community the amount of pre-symptomatic spread will vary based on the extent of active cases and successful isolation and quarantine of close contacts. It has been shown that the proportion of pre-symptomatic individuals will be higher in areas without case tracking and isolation of contacts.

Evidence shows proximity, how close you are to an infected individual, is a key factor for spreading the virus – that’s why social distancing is so important. Poor ventilation has also been shown to increase transmission, resulting in cluster transmission in areas where people gather. Studies have found masking, in health care settings and in the community, decreases transmission. Allowing for air flow, opening windows, improving ventilation, and events being held outside will reduce spread of the virus. Regular hand washing is paramount to infection control overall.

How COVID-19 affects your body

Early in the disease, the SARS-CoV-2 virus initially affects the upper respiratory tract (nose and throat) and then spreads to the lower respiratory tract. The virus has a viral spike (S) protein that attaches to our angiotensin-converting enzyme receptors (ACE2 receptors) in our respiratory tract. Children younger than 10 have about half as many receptors compared to adults. This may explain why Children are about half as likely as adults to get infected.

While the long-term outcome of having COVID-19 is not fully known or understood, most individuals experience mild illness. However, there can be significant effects on your heart, brain, and lungs. Other challenges such as physical weakness, fatigue, and GI symptoms have been noted. The majority of symptomatic adults with COVID-19 return to their usual state of health within three weeks of testing positive.

Prospects for a vaccine

Since the beginning of this pandemic, there has been a tremendous effort to create a COVID-19 vaccine as soon as possible. Vaccine safety remains paramount, and safety will not be compromised. Clinical trials have included groups at highest risk.

The Maryland Department of Health has published its COVID-19 Vaccination Plan, which would distribute the vaccine in three phases.  Initially the vaccine will be available to first responders, essential health care workers, individuals with high-risk medical conditions, and adults 65 and older. We remain months away from having a vaccine available to the general public.

MPCP has confidence in the process of vaccine development and distribution. We look forward to being part of vaccine distribution and will communicate details when they are available.

What you can do now

• Masking and social distancing remain the best way to prevent the spread of the disease.
• Hand hygiene – washing and using sanitizer – is key for infection control.
• If you have been exposed to COVID-19, tell your MPCP healthcare provider immediately so we can evaluate your level of risk. If your exposure is high risk, we recommend quarantine isolation to lower the risk of spreading the virus.

What MPCP is doing to meet your health care needs while keeping you safe

• Safety of our patients and staff is our primary concern; we are working to minimize your risk of exposure during office visits.
• We are asking patients with an acute illness, especially a respiratory illness, to call our offices –don’t just walk in.
• Our providers are able to communicate and see patients via Audiovisit and TeleMedicine visits as well as in-office visits.
• Patients are undergoing testing for COVID-19 when clinically appropriate. We also offer antibody testing when appropriate.
• Patients are encouraged to maintain their scheduled elective visits.
• We are providing safe access to the use of our laboratory.

Be diligent with hand washing and wear your mask! Cover sneezes and coughs, increase your hydration, maintain social distancing, and minimize non-essential travel. Our mission continues to be guiding you through this crisis. We are available for you.