The Coronavirus Ain't Leaving So Fast

In a recent Time article entitled Nearly Half of Coronavirus Spread May Be Traced to People Without Any Symptoms by Alice Park, The Annals of Internal Medicine concluded "at minimum, 30%, and more likely 40% to 45%," were spreading the virus to others without realizing they were also infected at all. There is a name for those people without symptoms (fever, fatigue, shortness of breath, coughing) to the COVID-19: asymptomatic.

Eric Topol and his co-author, Daniel Oran hunted for studies that included asymptomatic people and focused on different groups of people tested for COVID-19 worldwide. Among others, included were:

• More than 13,000 people in Iceland who volunteered to be tested for COVID-19
• Residents of Vo, Italy
• Passengers on the Diamond Princess cruise ship where an outbreak was witnessed
• Visitors to homeless shelters in Boston and Los Angeles 
• Prison inmates
• College students
• Nursing home residents in King County, WA.

Follow-up testing of those participants showed that only a small fraction who were asymptomatic when they tested positive on the first go-round went on to develop symptoms, permitting the researchers to choose between people who were pre-symptomatic (who went on later to develop symptoms) and those who are accurately asymptomatic and test positive for COVID-19 but never develop obvious symptoms. For example, among the more than 2300 people tested in the Vo population, 41% who had no symptoms when they tested positive and never developed symptoms over a 14 day period.

Topol and Oran concluded that while they may not be showing any signs of illness on the outside, asymptomatic people are still transporting a dangerous and infectious virus that they can spread to others.
"The virus may be damaging the bodies of asymptomatic in other ways," says Topol. Among the 331 passengers aboard the Diamond Princess ship who tested positive but did not have symptoms, it was revealed that 76 CT scans of their lungs showed signs of lung tissue damage typical of coronavirus infection.  

In another study, this one in South Korea, that studied 10 asymptomatic people from a group of 139 COVID-19 patients and warranted similar findings. The lung was affected in all asymptomatic patients, and researchers decided it was necessary to extend the evidence of COVID-19 testing.

"Given that public health officials aren’t testing the entire population, there are still huge gaps in understanding what asymptomatic disease," Topol says.

Then there is the question of how long asymptomatic people are infectious. No one for sure, but wearing masks in public settings means less infection from those who are asymptomatic. So does social distancing and washing hands frequently given the numbers of asymptomatic people.

“If even a portion of the 100 million Americans who have a smartwatch or fitness band are involved, then we could go in and do studies for information we are missing now—antigen testing, antibody testing and we can look for transmissibility,” says Topol. “The priorities during a pandemic are absolutely to look after the sick. But we also shouldn’t miss how important this area of asymptomatic spread is to understand. For every one person who is sick, there are a whole lot of people who have the virus and don’t know it.”

So what does all this mean for the public? Remember the numbers: "at minimum, 30%, and more likely 40% to 45%." Scary though it is, I, for one, won't be going to the beach where people sit willy-nilly next to each other. No public settings at all for me like concerts or sports events that may open to the public, until much more is known about asymptomatic people. You can't spot one because they're like the rest of us, except they're harboring a death-defying  disease silently.

Simple Pleasures for This Simple Stroke Survivor

Looking back over my life, I had very complicated pleasures. But as a stroke survivor, I found that my preferences transformed into simple ones. Here are ten of them, all of which I didn't do before my stroke:

Waking up to greet the day

Waking up every day is my top simple pleasure. What do I do to achieve that goal? Well, there are no guarantees in life, but switching over to the vegan diet a year ago gave me so many chances to stay healthy. In pretending about the pandemic, I maintain that eating high Vitamin C oranges somehow kept me immune from the coronavirus. That theory is not on the proven list, but consuming Vitamin C is great for preventing or lessen the severity of so many other diseases anyway. 

Adding the perfect amount of water to my oatmeal

I actually celebrate with an audible "Yes!" multiple times when my oatmeal comes out of the microwave perfectly. Of course, nobody is there to hear it, but I find that action reassuring. It's a game I play with myself, guessing which amount of water is suitable to add to the instant variety. Somebody who lives with one or more people doesn't get it, but I get it. I am the only one I have to please. 

Watching the washer wash

I like the sound of the washer wash clothes. I like the "Spin" cycle the best. Oftentimes, I find myself watching the washer wash the clothes--my clothes, mesmerized. The washer sound is relaxing. 

Balancing my checkbook

I used to balance my checkbook as drudgery, something I had to do to keep my sanity in "check," often getting frustrated when I reversed numbers or got the period in the wrong place. Now, I welcome it every month because I remembered my math functions. And I like the way my handwriting improved in 13 years post-stroke, keeping the figures inside the lines.

Monitoring the vegan cooking

I was always a participant, from jumping rope as a youngster, to playing my songs as a teen in the talent show, to throwing events as an adult. Now, cooking-wise, I'm still a participant. My caregiver who prepares all my meals brings the pot over to me to check on the consistency or taste or color. I'd rather cook myself, but have got the handle on do's and dont's. This method is the next best thing.

Observing the houses surrounded by nature

Normally, in those normal times before the stroke, I went around the block and that was it, not noticing the fine points. Now, my friend and I find something new every time we go, like a new fence, plants and trees in bloom, or a missing shingle on the roof. That's the game we play, because remembering what I  found a few days ago keeps my memory sharp. 

Making a schedule

Every time my caregiver comes which are on weekdays, I present her with a to-do list of things that should be done. I can move the entries if she doesn't have time to finish, and she likes to check off completed tasks. Most importantly, this system, too, helps me remember the current and future tasks.

Pronouncing words until I say them perfectly

I have trouble pronouncing some words, or most words my critics would say. Sometimes, if I say it over and over in a day, that will be enough for future times. Sometimes, like with the "scr" words, as in prescription and subscription, having practiced for 8 years, I still get tripped up. I used to be a public speaker so it's difficult to admit I can't do that anymore, but just saying words correctly is the next best thing in order to communicate effectively. When somebody says, "I can't understand you," my heart just breaks.

Getting a coffee package from Amazon

Not that trillionaire Jeff Bezos need free advertising, but I look forward to this Amazon Seattle coffee coming because it wakes me up with a jolt in the morning. A jolt equals instant awareness of my surroundings so that I have an uninterrupted and clutter-free path when I'm going to walk around. In a sense, priceless.

Counting the birds that fly by in 10 minutes

Birds, predominantly crows, fly by in groups. I never see one crow without another one to follow. Especially now that it's mating season, the crows are frequent. 

Today, I find peace and contentment in the current list. Tomorrow, or maybe next week, who knows! I'll have a new list, like watching Poldark again, or rereading the high-drama books by Nelson DeMille, or watching the Ninja blender grind the very last bit. 

New Facts on COVID-19: "Don’t Come In Unless You’re Short of Breath" Doesn't Apply Anymore

I had an annoying, dry cough in the beginning of February. Then the cough roared like a hungry beast. No fever ever. Just the cough, with shortness of breath and fatigue that escalated quickly over a two-week period. I drank at least three strong coffees a day. Nothing. Was it COVID-19, I asked myself repeatedly? I don't know now, and maybe I wouldn't ever know, unless the testing starts very shortly to all people, rich or poor, healthy (for the asymptomatics amongst us) or sick, despite what Jared Kushner, the Moron and Golden-Spoon-in-Mouth syndrome, says, as a spokesman for President Trump, there are enough tests for now. I haven't had one at the peak of coughing/shortness of breath/fatigue. Have you? Just to make sure what you thought were cold symptoms wasn’t the dreaded coronavirus? Wouldn’t you like to know, through antibodies, if you already had it?

But with Trump in charge, forget that option. "Coming up shortly," or "Within the next two weeks," or, my favorite, "Soon" is Trump-speak, when most people, after the passage of time, forget he made those promises in the first place. But I remember. You can count on that.

WIRED had an article written by Megan Molteni who says that scientists are running like crazy to comprehend why some patients also develop neurological ailments like confusion, stroke, seizure, or loss of smell. Stories of other, stranger symptoms like severe headaches, tingling and numbness, or the loss of smell or taste have been going on for weeks. 

“The medicines we use to treat any infection have very different penetrations into the central nervous system,” says S. Andrew Josephson, chair of the neurology department at the University of California, San Francisco. He is saying that most drugs can’t pass through the blood-brain barrier, a living wall around the brain. He also says if the coronavirus is penetrating the barrier and infecting neurons, that could make it more difficult to find appropriate treatments.

When the virus first started in Wuhan, China, health records indicate that 214 patients admitted to the Union Hospital of Huazhong University of Science and Technology, 36.4 percent of the patients showed signs of nervous-system-related issues, including headaches, dizziness, confusion, strokes, prolonged seizure, and a slowly disappearing sense of smell, some before the fever and cough were apparent. 

“We’ve been telling people that the major complications of this new disease are pulmonary, but it appears there are a fair number of neurologic complications that patients and their physicians should be aware of,” says Josephson.

Without that information, datasets in particular, there’s no way to know how to interpret reports on patients, and "single cases are tantalizing, but they can be fraught with coincidence,” says Josephson.

COVID-19’s horrendous death toll, 61, 656 as of this writing, is other-worldly, science fiction-like worthy, and not many autopsies are being done. Only some pictures of the lungs, but a good chance that there’s some viral invasion of the brain.

A paper in the New England Journal of Medicine examining 58 patients in Strasbourg, France, found that more than half were confused or agitated, with brain imaging suggesting inflammation.

“You’ve been hearing that this is a breathing problem, but it also affects what we most care about, the brain,” says Josephson. “If you become confused, if you’re having problems thinking, those are reasons to seek medical attention,” he added.

Viruses affect the brain, explained Michel Toledano, a neurologist at Mayo Clinic in Minnesota. The brain is protected by something called the blood-brain-barrier, something that Josephson says, too, which blocks foreign substances but could be penetrated if compromised.

Since loss of smell is one of the symptoms of COVID-19, some have hypothesized the nose might be the pathway to the brain. But in the case of the novel coronavirus, doctors hold on to current evidence that the neurological impacts are more likely the result of overactive immune response rather than brain invasion.

Jennifer Frontera, who is also a professor at NYU School of Medicine, explains documenting notable cases including seizures in COVID-19 patients with no prior history of the episodes, and new patterns of small brain hemorrhages.

“We’re seeing a lot of consults of patients presenting in confusional states,” said Rohan Arora, a neurologist at the Long Island Jewish Forest Hills hospital, adding that more than 40 percent of recovered virus patients. "Returning to normal," added Arora, "appears to be taking longer than for people who suffer heart failure or stroke." [Apparently, Dr. Arora hasn't worked extensively with stroke patients. After 11 years, I'm still recovering. Just sayin'.]

Anyway, good advice if you have any of those symptoms--headaches, dizziness, confusion,  prolonged seizure, and a disappearing sense of smell--go to the doctor. Many doctors are seeing patients through tele-conference now. If you had a stroke as a result of COVID-19, you probably have already gone to the hospital where there are tests but not too many of them.

One more thing. How about Trump supporters try injecting or swallowing disinfectants to see if they work or this headline: Online demand for hydroxychloroquine surged 1,000% after Trump backed it, study finds. I say that statement with sarcasm, but unlike Trump, he said it confidently when he recommended Lysol, Clorox, and hydroxychloroquine, despite his walkback when people were alarmed and others broke into peals of laughter. It's on tape, Mr. President.