Dissecting Coronavirus: A Medical Explanation
By Dr. Dhaval Bhatt
Having observed the evolution of COVID-19 closely in patients, Dr. Dhaval Bhatt explains the etiology and management of the novel virus.
What is Coronavirus?
Virus is defined as a strand of RNA or DNA which cannot survive on its own till the time it embeds ina live cell of a human or an animal body. Coronavirus is basically a RNA strand which in vitro (outside our body) is not capable of producing disease. It needs to embed in human cells.
Hence, detecting a stand of RNA of the virus— whether from the surface of your hand, skin, throat or nose— is of no value unless it has embedded into cells of the body; and as a result,one starts developing symptoms.
Real time polymerase chain reaction (RTPCR) is a method to detect only the stand of RNA of coronavirus.It does not detect or give guarantee that this strand will cause diseases in your body.
What happens once Coronavirus embeds into your body cell?
The surface of coronavirus is made up of lipid; and hence it’s easier for the virus to embed into mucous lining membranes like nose, ears, mouth eyes etc.
What are the various phases of coronavirus in a humanbody?
Embedding Phase (Initial Phase / Prodrome):
Once the embedding process commences, so does the local symptoms associated with the place where the virus is embedding. For example sneezing or loss of smell incase of nose, altered taste in case of mouth, dry cough incase of throat, redness or watering incase of eyes.
The embedding phase generally starts within 24 hours of virus exposure to mucous membranes and get completed within 2 to 3 days.
Multiplication Phase:
Once the virus embeds into the nucleus of the cells, it starts taking control over routine physiological functions of cells e.g. mucin secreting cells turn dry leading to stuffiness of nose, oxygen ad carbon dioxide exchanging cells of the arterioles in the lungs swell up leading to their rapture and hypoxia in the body. Moreover, the multiplication of the virus inside the cells also starts.
Hence it is during this phase that the immune system of the body begins a vigorous fight against the virus leading to high-grade fever.
This is the most critical phase of the diseases— if not treated well, hyper response of the immune system ends up damaging vital organs by producing toxic chemicals. This may lead to permanent damage to lungs, kidneys, heart , liver etc.
The multiplication phase starts postembedding and last for 7 to 10 days
Receding Phase:
COVID 19 is a self limiting infection whereby the virus runs its course in the host body— either the immunity of the person overcomes the virus or the host succumbs to the virus. The outcome of this phase depends on intervention during the multiplication phase.
What are the various preventive measure that can be taken?
Preventive options:
Cover the common orifices leading to mucous membranes like nose, mouth, eyesand ears, with masks or scarves
Avoid touching the nose, mouth, eyes and ears, urethra or anus with unwashed hands
Wash your hand as frequently as possible with soap or (60%) alcohol based sanitizer
Maintain social distancing
Avoid sharing food, utensils clothes, papers, files etc
Wash your clothes in bleach-based detergent in water (45 degree Celsius)
Avoid social visits to patients in hospitals or at home
Avoid crowded places like markets, trains, buses, malls, theatre, hotels etc.
Identify vulnerable family-members at home— those above age of 60 years, diabetic patients, asthma patients, cancer patients, dialysis patients, pregnant women— and take special care of them with respect to making sure they wear mask, follow hand hygiene practices washing and maintain social distancing
HCQ (Hydrochloroquine) is slightly basic in PH and has capability to impair the endosome mediated viral entry into the target cell in the human body thereby preventing or reducing the embedding of the viral RNA.
Multi-vitamin is used for health prophylaxis and improvement of the immunity.
Vitamin C is also popularly used as an Immuno booster; it supports in creating an epithelialbarrier against pathogens like bacteria and viruses and promotes oxidant scavenging activity.
Arsenic Album is a homoeopathic medicine recently made popular as an immuno booster does not work as a preventive drug against the diseases but is found to be useful if taken when the patient develops symptoms mentioned in the prodrome stage. Hence this drug will be useful only to those who turn mildly symptomatic or before the multiplication phase.
Ashwagandha (Withania Somnifera) an ayurvedic medicine is also found to have a phytochemical that has inhibitory effect on the receptor binding domain (RBD) of the spike on viral surface. It thus does not allow the binding of virus with host cell; and hence helps in preventing embedding of the virus into host cell.
Steam inhalation to open airways and help lungs drain mucus. This may improve breathing and help loosen mucus inside the airways and lungs.
Yoga & Meditation: Yoga has been used for centuries in keeping the body functioning fit and fine, holistically. However, the benefits of yoga are not just limited to stress relief and mental wellness. If practised properly, yoga can recharge your body, get rid of the toxins, negative energy and keep your vital organs functioning well. It can help you build resilience both inside and out. Regular Kapalbhati and Anulom-viyom keeps lungs and airway path in good condition. The Harvard Medical School said in its latest health guideline that, yoga, meditation and controlled breathing are "some tried and true ways to relax.” They have recommended yoga, meditation and controlled breathing to address anxiety issues related to the novel coronavirus.
What are the available treatment options?
Most of the patients in the multiplication phase require institutional hospital care to support the functions of vital organs.
Symptomatic lines of treatment are as follows:
Fever- Paracetamol, a non steroidal anti inflammatory drug effective for fever and body ache
Acidity- Pantoprezol to reduce it
Dry Cough- Codeine Cough Syrup to reduce the coughing reflex
Vomiting- Emset / ondestroen to act as anti emetic to reduce nausea and vomiting
Broad spectrum antiviral- Remdesivir has shown limited results in reducing the viral load
Immunity boosting multivitamins- Like Zinc, B12 , Vitamin C help in boosting immunity
Immuno response modulation-Steroid like methyl prednisolone have shown good response in reducing hyper immune reaction
HCQ- It inhibits the replication of the virus as it alters the PH to basic whereas the virus requires acidic PH in the intracellular environment thereby not allowing binding of virus particle
Supportive treatment with oxygen mask, non-invasive ventilators or mechanical ventilators is also available. Here I would like to mention that any patient whose oxygen saturation when measured on a pulse oximeter is found to be below 95% is generally considered hypoxic i.e. the systemic oxygen is not enough to sustain the entire body. However, in case of COVID-19 patients, it has been observed that they are generally in happy hypoxia state, whereby even if they are not put on mechanical ventilators they oftenrecover well. This is one practice we are observing that is different from the West; and may be the reason for low mortality amongst COVID-19 patients in India.
In addition to this practice, treating the patient on the principles of asthma or allergic bronchitis with steroids and bronchodilators has also provided good results.
Till date, Kokilabaen Dhirubhai Ambani Hospital have treated close to 100-plus patients and managed to discharge more than 98% of the patients; with a mortality rate of less than 2% by adhering to these practices.
Will vaccine or permanent immunity arrive anytime soon?
The coronavirus is a mutating strain.To get a vaccine which produces immunoglobulin or antibodies against all strains is going to be difficult.However we may gradually evolve vaccines covering majority of the strains but this is a time-consuming process and only future will tell.
Until then, we need to innovate and learn to live with the virus; so that we can normalize our physical, mental and social health.
Author: Dr. Dhaval Bhatt, General Manager at Kokilaban Dhirubhai Ambani Hospital