The Coronavirus-COVID-19 Pandemic

Case Report 

 

 

Mr. Ben McAdams, individual suffering from COVID 19  

“On Saturday evening (March 14th, 2020), after returning from Washington, D.C., I developed mild cold-like symptoms. In consultation with my doctor on Sunday, I immediately isolated myself in my home.  I have been conducting all meetings by telephone.  My symptoms got worse and I developed a fever, a dry cough and labored breathing and I remained self-quarantined. On Tuesday, my doctor instructed me to get tested for COVID-19 and following his referral, I went to the local testing clinic for the test. Today I learned that I tested positive.”

Congressman Ben McAdams statement on COVID-19 illness March 18, 2020

 

"I am at home, feeling about as sick as I've ever been"  March 20th, 2020

Case Report 

Mr. Ben McAdams, a 45-year-old congressman, who was in good health developed COVID 19 after community exposure of an unknown nature. 

Infection date: Likely between March 7th and March 12th 

Symptom onset likely  March 12th, 2020 

Symptoms developed: feeling sore, feverish and winded -- even from eating and drinking, cough labored breathing, "I feel short of breath” feels like I have a belt around my chest that's really tight. Loss of appetite

When he coughs, “my muscles are so sore, so I just feel pain every time I cough, which is frequently ".

 

Review of systems:

General: Fatigue , Loss of appetite

Respiratory:  "But a lot of times when I eat or drink, I lose my breath again," as well as "when I get up and walk if I go downstairs or walk around."

Signs:  Fever of about 102.

Laboratory: coronavirus positive (March 19, 2020)

 

Impression: Mr. McAdams suffers from COVID 19 currently experiencing moderate to severe symptoms. 

 

Discussion: Mr. McAdams presents with symptoms of COVID 19. His disease was diagnosed by a test to identify viral fragments. He was exposed in a community setting without clear identified infector. He was asymptomatic while infected for at least 4 days, it is unclear how infective he was (Although it doesn't appear that many of his congressional colleagues  were exposed or infected). His medical treatment was managing symptoms, i.e. reducing fever, fluids, and cough suppression) He self isolated, although if he were in a different setting a surgical mask would have been indicated while in public. He should continue with "radical" hand hygiene, and following recommendations by the CDC. He should be in contact with his healthcare provider, and if he developed respiratory distress, go to a medical facility.  

Problem list: 

1. COVID 19 symptoms 

2. Risk for infecting others

3. Concern for deteriorating respiratory function 

Recommended treatment:

  1. Monitoring at home: self-isolation 

  2. Fluids: force himself  to drink fluids

  3. Activity as tolerates  

  4. Symptom relief: Medications 

  5. Medical contact: Ongoing 

  6. Hospitalization: If increase in difficulty breathing

The Coronavirus -COVID 19 Tracer 

All Americans 
First US case of COVID 19 
January 20th, 2020
 T-1
First Case of 2019 Novel Coronavirus in the United States Patient arrived at Providence Regional Medical Center in Everett, WA
Exposed to Coronavirus  
No symptoms of COVID-19 
Not Infected 
Infected with Coronavirus 
Symptoms of COVID-19 
Mild Respiratory 
Respiratory Symptoms 
Moderate Respiratory 
Severe Respiratory 
Acute respiratory
distress syndrome
(ARDS) 
Hospital
ICU
Ventilator
Testing
March 14th
March 20th
March 24
Recovery 
Full
Sequela  
Exposed to Coronavirus
March 30,2020
T 58
Death
Leave Hospital 

All Americans

At point T1 there were no Coronavirus 2 infected individuals in  the USA.  

Number of Americans by age group (State): Data and graph

U.S. Census Bureau United States Population Growth by Region

Exposed to Coronavirus 

Number of people exposed at a given point in time? Can be determined if can identify the index "case" for example at a party, plane, cruise ship. 

How Likely Is Someone To Contract Covid-19 After Close Contact With Symptomatic Cases?

EVIDENCE BITE: Not likely. Roughly <1-5% of close contacts end up falling ill with Covid-19, and about 10-15% of within-household close contacts do.

SUMMARY: There is a broad experience with rigorous contact tracing, quarantining close contacts (usually defined as those within 1 meter for more than 15 minutes, or in some cases 1 hour), and watching for development of disease. According to the WHO and reports from the Chinese CDC and American CDC, the overall rate of new Covid-19 infection in these settings ranges from 0.5% to nearly 5%. Within households, close contact led to predictably higher transmission, but still only 10-15%.

Obviously, avoiding all contact with patients suffering any level of illness from Covid-19 is the safest approach. However, it is notable that tracing consistently shows low attack rates among even close contacts. This strongly suggests social distancing and other physical measures can be effective means of lowering the R-naught.

First, people with COVID-19 were found to be most infectious to others before and within 5 days of symptom onset. Within 5 days of symptom onset, the attack rate was 1.0% (95% CI, 0.6%-1.5%). With exclusive presymptomatic exposures, the attack rate was 0.7% (95% CI, 0.2%-2.4%), and with exposures 6 days or more after symptom onset, there were 0 cases from 852 contacts (95% CI, 0%-0.4%).1

Exposure:  Transmission seems to occur primarily through sustained exposure in the absence of basic protection or through the lack of hand hygiene after contact with secretions.

Close contact” means fifteen minutes at a distance of less than six feet and without the use of a surgical mask; in Singapore, thirty minutes. 

If the exposure is shorter than the prescribed limit but within six feet for more than two minutes, workers can stay on the job if they wear a surgical mask and have twice-daily temperature checks. People who have had brief, incidental contact are just asked to monitor themselves for symptoms.

Testing for the Coronavirus

Current Situation

​Testing for the Coronavirus: Consider the facts at this point 

  • The testing provides an important tool to identify individuals who may be infected thus helping maintain people who are not infected so they continue to function and to limit resources necessary for fighting the epidemic. 

  • In Wuhan, where testing became widespread and more than seventy-two thousand coronavirus cases were identified, just one per cent never developed symptoms. 

  • Aboard the Diamond Princess cruise ship, where, following an outbreak, more than three thousand passengers and crew were quarantined and tested—allowing one of the most complete evaluations of any affected population—six hundred and thirty-four people proved to have the virus. Most had no symptoms at the time of testing, but they proved to be pre-symptomatic: over several days, they developed recognizable signs of the disease. Just eighteen per cent were persistently asymptomatic.​

    • What went wrong with the Coronavirus testing 

Challenges: The test is a one time picture of status of the patient tested 

Infected with the Coronavirus 

Many of the people infected with the Coronavirus have few symptoms and my not recognize that they have been infected.  A certain percent will not have any symptoms. It is not clear how infectious these individuals are to others . Additionally, we don't know what characteristics of the host and virus cause infection, symptoms and severity of the illness caused by Coronavirus 2. 

Questions to consider: 

  • What are the characteristics of the person? Age, Gender, Ethnic Background, medical conditions. 

  • Medications: NSAIDs like ibuprofen, Steroids 

  • Viral load that they were exposed to . 

      •  

  1. The rate of infection: (With and without social distancing) RO

  2. Risk for infection 

COVID 19 Symptoms 

Currently we have some information about the number of people who develop symptoms and the nature of the symptoms. 

  • Number of people who are infected 

    • Severity of COVID 19 manifestation 

      • Mild

      • Moderate 

      • Severe 

  • Fever, cough and shortness of breath are the most common symptoms of disease.

  • Similar to many respiratory virus infections including influenza.

  • 80-85% of infected people have mild disease and do well.

  • 15-20% of infected people develop severe disease including pneumonia.

    • Most people with severe disease are 60 or older and have medical problems such as heart disease, COPD and diabetes.

  • The time when a person exposed until symptoms emerge: 2-14 Days 

  • Period of time infective: 

  1. The rate of infection: (With and without social distancing) RO

  2. Risk for infection 

COVID 19 Respiratory Symptoms 

  • Mild Respiratory 
  • Moderate Respiratory 
  • Severe Respiratory 
  • Pneumonia 
  • ARDS
  • Percent of individuals who develop respiratory symptoms:

  • Percent of people who develop pneumonia:

  • Percent of people  who progress to ARDS:

  • Percent of people who die of ARDS:

  1. The rate of infection: (With and without social distancing) RO

  2. Risk for infection 

COVID 19  Outcomes

  • Well-being  
  • Home
  • Hospital  
  • ICU 
  • Death 

  1. The rate of infection: (With and without social distancing) RO

  2. Risk for infection 

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The COVID 19 Pandemic Project is  an initiative of Citizens4Health, a group of committed citizens motivated by the belief that citizen participation will contribute to solutions to the big problems that confront our nation.

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