What is COVID-19 ?

Coronavirus disease 2019, or “COVID-19,” is an infection caused by a virus called SARS-CoV-2. The virus first appeared in late 2019 in China but it has spread quickly since then, and is increasing in incidence in Europe, the United States, and the rest of the world.(1, 2) COVID-19 mainly spreads from person to person, similar to the flu. This usually happens when a sick person coughs or sneezes near other people. Doctors also think it is possible to get sick if you touch a surface that has the virus on it and then touch your mouth, nose, or eyes. There is  evidence to show that the virus also shed in your stools in many cases, but it is not clear that if the oro-fecal route is a mode of transmission.(3)

COVID-19 seems to spread most easily when people are showing symptoms, It is also possible to spread it without having symptoms, but experts don’t know exactly how often this happens.

What are some of the symptoms of COVID-19?

Symptoms will usually  start a few days after a person is infected with the virus. But in some people, it can take up to 2 weeks for symptoms to appear.

Symptoms can include:

  • Fever
  • Cough
  • Feeling tired
  • Trouble breathing
  • Muscle aches

Although it is less common, some people have other symptoms, such as headache, sore throat, runny nose, or problems with their sense of taste or smell.

Some have digestive problems like nausea or diarrhea. Though a former study of about 200 patients from China noted that a large number of patients (~ 50%] presented with diarrhea , loss of appetite, nausea, and abdominal pain, more recent studies indicate that this is much lower. A recent meta-analysis of 47 studies with 10,890 patients showed that the prevalence of nausea and vomiting and diarrhea was approximately 7% and abdominal pain was 2.7%.(4) It is important to note that these are studies of hospitalized patients and is presumably lower in those who have milder forms of the disease who are not hospitalized. Other non-respiratory symptoms that patients with COVID-19 could have, include a loss of smell.

Respiratory symptoms like cough, fever are usually present and GI symptoms as the only manifestation of COVID-19 is unusual. Currently, the AGA has released best practice guidelines for the management of GI symptoms in the context of COVID-19.

If you develop new-onset Gl symptoms such as  nausea, vomiting, abdominal pain, or diarrhea that are not consistent with your CVS symptoms, please discuss this with your primary care doctor.(6) They will  monitor you for other symptoms associated with COVID-19. If you are in area with a high prevalence of COVID-19, testing should be considered.

What will happen if I get COVID-19?

Most people ( >80%) will  have mild symptoms. Some people will  have no symptoms at all. But in other people, COVID-19 can lead to serious problems like pneumonia, not getting enough oxygen, heart problems, or even death. This is more common in people who are older or have other health problems like heart disease, diabetes, lung disease, or cancer.

COVID-19 in CVS

Cyclic vomiting syndrome is NOT considered an immunocompromised state. This means that your immunity or ability to fight infection is similar to normal individuals. Rather it is a disorder of gut-brain interaction (DGBI). However, respiratory tract infections may trigger symptoms in some patients with CVS. There is no data to suggest that COVID-19 will be worse in CVS. If you have additional problems or autoimmune problems, you should be more careful. We recommend that you follow standard guidelines and try to avoid getting the infection. Simple guidelines would include

  1. Washing your hands frequently with soap and water for at least 20 seconds.
  2. Practice “social distancing” –maintain 6 feet between yourself and others.
  3. Avoid touching your nose eyes and mouth as far as possible

Many patients will also experience an increase in anxiety and/or depression, which is quite common, particularly in these times.  It is very important to try and  manage your  anxiety.  Though we are advised about “social distancing”, you can do the following

  1. Remain connected and communicate daily at regular intervals with your family and friends.
  2. Try to reduce seeing Face Book feeds, TV etc. and do not constantly watch the news. This can lead to more stress. Stay updated and maybe check in once or twice a day.
  3. Try and get at least 8 hours of sleep.
  4. Tend to your plants and garden, if you have one.
  5. Keep your cell phone in another room when you sleep.
  6. Do not forget to exercise gently, even if it at your home or in your backyard.
  7. Stay hydrated.
  8. You may practice various forms of relaxation such as meditation or yoga. Free meditation classes can be accessed at this website and can be practiced online.

Heartfulness meditation

What can I do  to prepare for  a CVS episode?

  1. Discuss your emergency department (ED) protocol with your physician and work together to see what the best option is if you get an episode (ED vs. infusion clinic vs. direct hospital admission). Most doctors are doing virtual visits and we now have telemedicine.
  2. Take your abortive medications as prescribed during the prodromal phase.
  3. If symptoms are severe, contact your physician, who could call ahead to  the ED triage nurse.

As you can imagine, the situation in both the ED and hospitals is dire  with the increase in COVID-19 cases. Make sure you take your preventive medications regularly and follow the advice of your doctors. If you are having frequent symptoms, contact your doctor so that they can adjust your medications. Most of all, try and be patient as this is a difficult time for all of us.

How to treat COVID-19?

In general, there are many medications and supplements that are thought to help with COVID-19 but lack strong evidence. Mild cases are treated like the flu. Stay hydrated and take Tylenol as needed. There is some suggestion that ibuprofen may worsen the disease, though this is not clear.

Medications like Hydroxychloroquine and Azithromycin are no longer recommended for treatment of COVID-19, due to side effects including QT prolongation/cardiac arrhythmias. In fact, this may interact with medications (like Elavil and ondansetron/Zofran) that you are already taking.

More recent recommendations propose using low dose steroids (dexamethasone) given intravenously for hospitalized patients. This can reduce mortality( risk of dying) in some cases by reducing the inflammation, especially in patients who are sick and need to be on a ventilator (breathing machine).(5) Other medications like Remdesivir, which is an antiviral agent, has been shown to reduce the time to recovery. Convalescent plasma, containing antibodies from patients who have recovered from the illness can also help. These treatments are only intended for patients who are hospitalized due to COVID-19.(6)

Finally, follow  the guidelines of your local health authorities. If you need information about COVID-19, you can visit CDC.

Stay safe. And in these scary times, as Mr. Rogers would say “ Look for the helpers”. They are always there.

Regards,

Your CVSA team

References:

  1. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507-513.
  2. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020.
  3. Gu J, Han B, Wang J. COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission. Gastroenterology 2020.
  4. Sultan S, Altayar O, Siddique SM, et al. AGA Institute Rapid Review of the Gastrointestinal and Liver Manifestations of COVID-19, Meta-Analysis of International Data, and Recommendations for the Consultative Management of Patients with COVID-19. Gastroenterology 2020.
  5. Ledford H. Coronavirus breakthrough: dexamethasone is first drug shown to save lives. Nature 2020; 582: 469.
  6. Santos J, Brierley S, Gandhi MJ, Cohen MA, Moschella PC, Declan ABL. Repurposing Therapeutics for Potential Treatment of SARS-CoV-2: A Review. Viruses 2020; 12.