We are all living in unprecedented and unpredictable times. While there has been a lot of coverage on the importance of wearing masks when indoors or enclosed spaces, many have continued to challenge this health directive and many have compared this virus to the flu. It’s understandable because media coverage has continued to weigh these comparisons as well as governmental leadership when discussing protocols, guessing possible outcomes, and more. My nearly 30 years of experience in healthcare in both clinical and leadership positions has taught me that when you want to convey information, there are important considerations if you really want to see behavioral change. Anyone who has tried to stick to a diet or stop smoking can confirm that it helps to become educated on what you are trying to achieve and I believe the most important part of education is the “why.” I’m told that as a toddler “why” was my favorite response to every piece of new information I learned and while I don’t recall that about myself, it only seems reasonable to want to know why something is, or why something should be, or why a recommendation has been made. I hope to share enough here to help others understand how this virus is different and why it’s dangerous to compare it to something as simple as the influenza (flu) virus.
What Are Viruses?
A virus is a microscopic infectious particle that consists of an RNA or DNA genome enclosed in a protein shell. It is not able to reproduce on its own. It can only make more viruses by entering a cell and taking it over.
When a virus infects a host cell, it removes its protein coat and directs the host cell to transcribe and translate its genetic material. The hijacked cell assembles the replicated components into thousands of viral offspring, which can rupture and kill the host cell. The new viruses then go on to infect more host cells.
Viruses are usually classified by their morphology, their nucleic acid type (DNA/ RNA), method of replication, host organisms, and by the type of illnesses they cause.
- DNA carries the genetic blueprint and instructions needed to create proteins, specific molecules essential to the development and functioning of the body. In viruses, RNA sometimes does this job.
- DNA is double-stranded, while RNA is single-stranded. RNA contains ribose as a sugar, while DNA contains deoxyribose. Also, three of the nitrogenous bases are the same in the two types (adenine, cytosine, and guanine), but DNA contains thymine while RNA contains uracil.
Main Types of Viruses
- Respiratory Viral Diseases
- Gastrointestinal Viral Diseases
- Exanthematous (maculopapular eruption) Viral Diseases
- Hepatic Viral Diseases
- Cutaneous Viral Diseases
- Hemorrhagic Viral Diseases
- Neurologic Viral Diseases
1. Respiratory Viral Diseases:
Transmission: Are contagious & spread by droplets in coughing or sneezing or contaminated objects like doorknobs, tabletops, etc. Essentially, they are spread mostly either from breathing in droplets in the nearby air or hands can become infected from touching infected objects where hand to face contamination can occur, and affect upper or lower parts of respiratory tract.
Duration: Historically most of these are what we would consider short lived. Most healthy people for example usually get over a cold in 7 to 10 days, flu symptoms are usually gone after about 5 days, and all symptoms are usually gone within 1 to 2 weeks.
Examples:Influenza (flu), Common cold, Some Adenoviruses, RSV (Respiratory Syncytial Virus), SARS (Severe Acute Respiratory Syndrome)
2. Gastrointestinal Viral Diseases:
Transmission: Contagious & shed in stool via bowel movements and can be spread in food or water contaminated by feces and sharing utensils or personal objects.
Duration: Most healthy people usually get over GI symptoms within a few days.
Examples: Norovirus, Rotavirus, Astrovirus, and Some Adenoviruses
3. Exanthematous Viral Diseases:
Transmission: Contagious & spread by droplets in coughing or sneezing; Some like chickenpox and smallpox are spread through contact with fluid from broken skin lesions, while shingles can only develop in those who have had chickenpox when the varicella-zoster that was lying dormant awakens.
Duration: Most symptoms are usually gone within 1 to 2 weeks, although some like smallpox have stages that can last longer, but luckily, we have vaccines for these.
Examples: Measles, Roseola, Rubella, Smallpox, Chickenpox/ Shingles, Fifth Disease
4. Hepatic Viral Diseases:
Transmission: Contagious & spread differently depending on type (see below examples)
Duration: Hepatitis A and E are typically short lived but the others are more serious and while we have a vaccine for Hepatitis B and some newer drugs for Hepatitis C that seem to eradicate the virus so far, Hepatitis viruses are still very serious and can be life-threatening.
5. Cutaneous Viral Diseases:
Transmission: Contagious & spread in various ways depending on type, they cause lesions or papules on the skin that can linger or disappear and reappear.
Duration: While there is no cure for most of these, and they are very contagious, they aren’t life-threatening.
Examples:Oral herpes, Genital herpes, Warts & Genital warts, Molluscum Contagiosum
6. Hemorrhagic Viral Diseases:
Transmission: Contagious & spread differently by type. They are severe, deadly conditions that cause damage to the circulatory system. Dengue fever and yellow fever are spread through insect bites, Ebola is spread through contact with blood or body fluid, Lassa fever is spread by inhaling or consuming dried feces or urine from a rodent with the virus. There are no treatments other than trials and supportive measures
Examples: Ebola, Dengue fever, Lassa fever, Yellow fever, Marburg hemorrhagic fever, Crimean-Congo hemorrhagic fever
7. Neurologic Viral Diseases:
Transmission: Contagious & many are spread through the bite of an infected animal or bug (mosquitos and ticks). Poliovirus and other enteroviruses are very contagious and are spread through close contact with an infected person or contaminated objects.
Duration: Some of these can get better with treatment, but some are life threatening requiring hospitalization, and others can impair you for life.
Examples: Polio, Rabies, Viral Meningitis, Viral Encephalitis
COVID-19 is a novel (new) virus we have never seen before. This virus is different from other viruses, including other coronaviruses that we know about.
Virus name: SARS-CoV-2 Disease name: COVID-19
Symptoms may not appear for up to 2 weeks, and some may not show symptoms at all and be carriers. How the virus affects each person can vary based on factors like age, other medical problems that a person may already have, and how much of a “dose” of the virus the person took in when when infected.
Microscopic droplets in the air that you cannot see with the human eye are the reason masks are important.
What we know so far about COVID-19 is that it is spread mainly through 2 ways:
- Person to person through droplets produced from an infected person when they speak, cough, or sneeze, and
- Object to person (Fomite transmission) from objects touched like door knobs, utensils, coffee pot handles, microwaves, etc.) where an object is touched, and the hands are infected and then the infected hands touch your face or someone else’s before proper handwashing technique.
Mask wearing is not about personal liberties or choices. Allow me to explain: Someone I know is a breast cancer survivor and her office pressured everyone to come back into the office too soon. The leadership in that office had only instilled policies that you had to wear a mask coming into the building and that you could choose to remove your mask once you arrive to your cubicle or desk area and while they were asking people regularly about their potential exposures and taking temperatures they did not stop to consider fomite transmission from common objects within the office and they also did not instill proper safety precautions by requiring everyone to wear a mask at all times while indoors. (Which is what most responsible business offices and landlords of business buildings are doing.) They also did not consider the role AC unit fan systems play in spreading viral particles within a building. Not requiring everyone to wear a mask whenever they are indoors is forcing all others who might have a medical condition or worried about catching the virus to be exposed to all of the air droplets coming out of the mouths of people who refuse or choose not to wear a mask. This person was very uncomfortable with the requirements of the office but needed her job and so she wore a mask in the building every day and one of her coworkers even ridiculed and laughed at her for wearing the mask. In less than two weeks time someone reported that they had tested positive and everyone was allowed to go back to work at home again for a short period of time until they could regroup.
The point of sharing this story above is to encourage everyone to stop for a moment and think about who they are exposed to and who they might be exposing. None of us could possibly guess the medical conditions that people might have that we walk past in a grocery store, or a restaurant, or any other public place. The person that you’re walking by might have a child at home with sickle cell anemia, or a family member going through chemotherapy for cancer, or they themselves may have an autoimmune disorder of which you could not possibly be aware. While wearing a mask does decrease your risk of getting the virus by five times, it also decreases your risk of unintentionally sharing infected particles that could be coming from your speaking or breathing in the vicinity.
Virus Are Unique in Survivability
- Rhinovirus (common cold) lives on surfaces less than an hour
- Noroviruses (GI) can survive for weeks on surfaces
- HIV can only live outside the body for 9-11 seconds
- Hepatitis B can live on surfaces for over 60 days
How long COVID-19 can live on surfaces is not fully understood so cleaning regularly around anyone infected or suspected to be infected is important.
Your Body’s Defenses
Antibody, also called immunoglobulin, is a protective protein produced by the immune system by B cells (lymphocytes, a type of white blood cell) in response to the presence of a foreign substance, called an antigen.
During the last 3 months of pregnancy, antibodies from the mother are passed to her unborn baby through the placenta (passive immunity) – Antibodies are also passed through breast milk. After this start in life boost, other antibodies are made through either obtaining vaccines to create them or by contracting an illness and fighting the illness off.
Antibodies recognize and latch onto antigens in order to remove them from the body. Antigens can include disease-causing organisms and toxic materials such as insect venom.
B-cells fight bacteria and viruses by making Y-shaped proteins called antibodies, which are specific to each pathogen and lock onto the surface of an invading cell and mark it for destruction by other immune cells.
There are two main types of T-cells: helper T-cells and killer T-cells. Helper T-cells stimulate B-cells to make antibodies and help killer cells develop. Killer T-cells directly kill cells that have already been infected by a foreign invader. T-cells also use cytokines as messenger molecules to send chemical instructions to the rest of the immune system to ramp up its response.
Cytokines are small proteins that coordinate a response against infection and trigger inflammation. Sometimes the body can go into overdrive and cause unintentional consequences.
COVID-19 enters the body and triggers an immune response calling immune cells to the region to attack the virus. It results in inflammation and that inflammation then activates more immune cells in a vicious cycle that can harm or kill the person the immune system is trying to protect. This is called a Cytokine Storm.
Cytokine storms are a common complication of many respiratory diseases like coronaviruses, SARS, MERS, and non-infectious diseases like multiple sclerosis, pancreatitis, and rheumatoid arthritis.
With most coronavirus strains, once infected and then recovered, the remaining antibodies have given immunity to patients to the specific virus for months or sometimes years, but COVID-19 carries a big question mark.
There have been reports of patients who seem to have recovered, but then tested positive again. Some scientists believe that these cases might represent cases where there was lingering infection as opposed to reinfection, but we still have more to learn.
Antibodies are normally produced in the body around 7-10 days after the initial onset of a virus. A positive test after recovery might also be detecting residual viral RNA after the actual virus has stopped.
We still do not yet know for sure how long one remains immune (if at all) to a reinfection of COVID-19.
Herd Immunity Isn’t an Option
Some of you may have seen many people promoting the idea of herd immunity. The idea of herd immunity is that we should allow everyone to become infected knowing that some people will not make it. This idea is a survival of the fittest concept that seems archaic and inhumane in a modern society.
One should also consider the many articles, journals, and scientific papers that have come forth over the last several months demonstrating long-term health consequences of a large percentage of people who have had this virus. Complications such as myocarditis and neurological complications are not the type of aftermath that people are accustomed to after their body fights off a virus. We also do not know what long-term consequences the virus might have on the human body and it will be some time before we have enough information to better understand its behavior and its overall effect on our systems.
I have seen social media sites aflutter with the left upset with those on the right for not wearing masks or calling it a hoax (when it clearly is a very real problem) and those on the right upset blaming the protestors (although I saw most of them wearing masks and distancing). We must work to stop this infighting and come together.
At this point, does it really matter who started the fire? We clearly have a massive fire to put out. We can sort the rest out later.
I implore you to please take this pandemic seriously and wear masks at all times whenever you are indoors or in enclosed spaces and even consider them when you are in crowds outside and cannot distance.
Brian Boyce, BSHS, CPC, CPC-I, CRC, CTPRP is an AAPC-approved PMCC medical coding instructor, and ICD-10-CM trainer and the author of the AAPC CRC® curriculum. He has specialized in risk adjustment from the very beginnings of these models being utilized and has assisted large and small clients nationally. He has special interest in ethics, patient safety, disease management, and management and leadership of people. Brian is a veteran of Desert Storm, where he served on active duty with the US Air Force with a job specialty of Aeromedical Evacuation. He went into physician practice management and medical coding after an honorable discharge. He is the CEO of ionHealthcare® LLC, a company that specializes in healthcare consulting, risk adjustment coding, management & support services. For additional inquiries contact ionHealthcare® at info@ionHealthcare.com.