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ENT & COVID-19

COVID-19 and the Ears, Nose & Throat – A Layman’s Guide

Covid-19 - Coronavirus - NYC ENT

An Overview

With shelter-at-home mandates extending to the far reaches of the world across nearly all continents, and with media coverage updates 24/7, it’s almost impossible to be unaware of the novel coronavirus. But, it is common to have questions, to be unsure of the answers you receive, and to be afraid. This information has been compiled from reputable medical sources around the globe in attempt to answer the following questions:

  • What are the first symptoms of COVID in most people and how do the symptoms of COVID start?
  • Can COVID start with pink eye?
  • Can COVID symptoms start with a sore throat?
  • What are the full symptoms of COVID?
  • Can COVID symptoms come and go?
  • Can COVID symptoms last three weeks?
  • How to tell: COVID vs. flu? COVID vs. allergies? COVID vs. cold?

The 5 W’s:  Who? What? Why? When? Where?

According to the Merriam Webster dictionary, a bio-weapon is a harmful pathogenic microorganism or neurotoxin that is used as a weapon to cause death or disease on a large scale. Whether COVID-19 was initially developed to be a bio-weapon, where and who developed it, and/or whether is was accidentally or purposely released into the environment, we may never know. What we do know is that the lab in the Wuhan province of China, like all bio-safety labs, was studying bio-containment of COVID-19 and other potential infections agents and toxins in order to learn to protect individuals and environments from exposure.

However, COVID-19 has been acting like a bio-weapon since it was detected causing illness in individuals the Wuhan province of China in the late fall of 2019. It has spread rapidly and unrelentingly, affecting an enormous portion of the world’s population and substantially changed life as we have known it. While some people are asymptomatic carriers and others are lucky enough to recover after experiencing only mild symptoms, some succumb to its deadly attack after prolonged hospitalizations, intubations, ventilator assistance, and unsuccessful clinical treatment trials. There is a consensus that those at highest risk of death are those with low levels of Vitamin D, the elderly, smokers, those with cancer,  those with obesity, underlying heart, lung, kidney or liver problems, and/or autoimmune disease.

How COVID-19 Enters the Host…

COVID-19 is aerosolized (meaning it travels in the air through particles emitted during speech, sneezing, coughing, etc.) and as such, it remains airborne for some uncertain distance and period of time. These qualities enable COVID-19 to infect vast numbers of the population in record time. Because it is an aerosolized, and partly airborne virus, the novel coronavirus typically enters the host through the nose, mouth and/or eyes. In addition, COVID-19 lives on inanimate surfaces and can be transmitted after one touches an involved surface and then inadvertently (and unknowingly) touches his/her nose, mouth or eyes.

Hand Sanitizers, Masks, Gloves, Social Distancing and More

Drastic measures, like lengthy shelter-at-home mandates and social distancing have been widely implemented as a battle tactic to limit general exposure because hand-washing, hand and surface sanitizing, donning of masks, head coverings, glasses and gowns were not enough. Due to shortages, makeshift face coverings are recommended, although COVID-19 is small enough to pass through fabric masks and even surgical masks, making it uniquely difficult to control. At the very least, it can lower the exposure to high viral loads. This can be beneficial because COVID-19 symptoms may be proportionate to the amount of virus to which one is exposed.

What are the first signs of COVID-19?

Symptoms of COVID-19 differ depending on the virus’s site of entrance. If the novel coronavirus enters through the eyes, symptoms of pink eye may be noted. [Refrain from touching your eyes!] If the novel coronavirus enters through the nose, symptoms can be the loss of the sense of smell, runny nose and/or the loss of the sense of taste. Unlike symptoms of a cold or allergies there is typically no significant nasal congestion, sneezing and/or itchy eyes with COVID-19. [Refrain from touching your nose!] If COVID-19 enters through the mouth, symptoms of COVID-19 can be sore throat and/or change in the sense of taste.  [Refrain from putting your fingers in your mouth, drink lots of water and gargle often.] It may be hard to distinguish early COVID-19 symptoms from typical flu (Influenza) symptoms because both may present with fever, muscle aches and pains and headache. In those cases, testing is imperative to make the diagnosis. It is also important to note that in some, there may be symptoms of COVID-19 before the test results becomes positive. In others who are carriers, the test may be positive before there are symptoms.

As ENT symptoms progress…

COVID–19 symptoms can come and go, and can last up to three weeks.

In general, once the virus invades the host and replicates, symptoms increase often with fever, muscle aches and pain, and intense fatigue. When COVID-19 that through the nose, the virus can reach the brain and central nervous system by traveling along the olfactory nerves (for sense of smell) located at the very top of the nose. This can cause headache, dizziness, a change in the sense of smell, taste and/or hearing, with or without nausea. As the virus replicates in the throat, it can be inhaled to reach the lungs and cause cough, chest congestion, chest pain, and pneumonia. It can also be swallowed and lead to nausea, reflux, vomiting and even diarrhea. COVID-19 lives in the saliva for more than three weeks, and in the stool for about forty days.

What are the full symptoms of COVID-19?

After the novel coronavirus enters the body, usually from the eyes, nose or mouth, it migrates and begins to replicate in many organs. Early on, it can affect the kidneys and causes a temporary increase in BUN and creatinine levels in the blood signifying less effective kidney function. COVID-19 can affect the liver, causing a transient viral hepatitis with diminished liver function and a corresponding elevation in liver function tests in the blood. COVID-19 can cause pneumonia in the lungs making it more difficult to obtain proper oxygenation and full air exchange. COVID-19 can enter the heart muscle and causes a cardiomyopathy, making it harder for the heart muscle to function properly. COVID-19 can affect the digestive system and nervous systems as described above. It can also cause hallucinations. COVID-19 can attack the muscles causing weakness and fatigue, and obviously, the cells of the immune system. There may not be any body system that is safe from novel coronavirus attack.

How does the immune system respond?

For most people with healthy immune systems, the body successfully fights the virus with its immune “military” system. Just like the sections we have in our military consisting of an army, navy, air force, marines, and space division, our immune system has separate entities with which to perform specialized tasks. They include the white blood cells (with T and B cells), antibodies, the spleen the thymus, the bone marrow, the lymphatic and complement systems. Elderly, obese, immune-compromised and others with comorbidities like heart, lung, liver or kidney disease are at increased risk of losing a battle with COVID-19 because their “military divisions” are already preoccupied with and engaged in defending ongoing assaults. With a substantial portion of their “soldiers” already deployed, these high risk individuals are left with limited fighters to defend them against a perilous new attack from the novel coronavirus.

Makes sense, but now what?

There are the immediate needs and the longer-term considerations. First, it is of paramount importance that we keep frontline healthcare workers safe enough to care for the rising number of acutely ill. By absolute necessity, first responders and frontline healthcare providers must have appropriate and bountiful personal protective gear. This means all doctors, nurses, nursing assistants, respiratory therapists, unit clerks, nurse practitioners, food service workers, pharmacists, housekeeping staff, etc. Proper protection means waterproof gowns, full head covering, impermeable face shields, double gloves, and N95 masks that must be changed for and between patients. Reusing this personal protective equipment only marginally protects the provider, but adds incrementally risk to those infected because contaminated coverings can transmit COVID-19 among and between patients and other providers.

Longer-term healthcare goals should ideally aim for virus extinction or at least disabling the virus’s ability to rampantly infect the population and overrun the healthcare system. Viral eradication historically entails the use of a vaccine. Although brilliant scientific minds are collaborating and working at break-neck speed, it will take time to test potential vaccines for safety and efficacy. The risk of premature use is significant! It can perilously invoke hypersensitivity responses that can cause those vaccinated and subsequently exposed, to have heightened immune responses that may increase symptoms and likelihood of death. There is no way around it! Safe and effective vaccine development requires testing over time. We are no more likely to reduce this timing than to shorten the time to bake a cake!

In the meantime, 4 steps…

  1. Testing

The entire population must be tested and retested in order to fully understand and document the scope of those affected. If we do not know the denominator (that is the complete number of people infected/exposed), than “rates” of infection, death and/or cure are completely inaccurate.

  1. Stop COVID-19 from attacking and replicating

Scientists and doctors will continue to explore ways to stop the virus from gaining entrance into the host, and/or from replicating in the host. Clinical trials are in progress around the world and doctors and scientists from around the world are sharing information in real time and collaborating to find solutions. Repurposing existing medications with known safety data is the quickest method, but often the least promising option.

  1. Return to work

We must diligently and conscientiously consider a reasonable time period for shelter-in-place once we know the extent of infection and exposure, and we have enough protection and supplies in the healthcare system, and we better understand risks of re-exposure and re-infection. There is a lot that we still don’t know. For example, we presume that those who have recovered from COVID-19 and who are symptom free with antibodies to COVID-19, are personally protected from reinfection. But, we don’t know if they still able to infect others? We do know they may still have viral shedding from their saliva and stool for up to six weeks. We also know that we can measure antibodies to COVID-19 in those who have been exposed/infected. We believe that those antibodies signify personal immunity, but we don’t know if those with antibodies will be safe from reinfection over time? Perhaps their antibody levels will drop off placing them at risk for reinfection and making it necessary to receive a booster vaccination (meaning a second micro exposure like for Measles, etc.) to ramp up their personal immune protective response? And, what about immunity for those who have received convalescent plasma? Will they experience sustained personal protection against COVID-19 or will they require a booster as well?

  1. Vaccination

Obviously, a vaccine would be most definitive solution. While some believe that a vaccine may be imminent given encouraging progress, it is not possible to speed the process up without following outcomes for at least a year to evaluate safety and efficacy. It is no more plausible to bake a cake in 2 minutes, than it is to establish a vaccine’s safety and efficacy in a similarly short period of time. The harm in offering a vaccine whose safety and efficacy is unproven, is that hypersensitivity reactions can occur if and when one is exposed to COVID-19 that can cause more severe symptoms and/or side effects, and possibly, an increased risk of death.

Read Dr. Yagoda’s further thoughts on COVID-19 and our collective future.

Prime Journal

Prime Journal, May/June 2020
“The New Normal For Aesthetic Practices”

Dr. Yagoda’s COVID office safety protocols


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