About the Coronavirus

Articles by Parish Nurse Donna Musselman

What is a Coronavirus?

Coronaviruses are part of a large family of viruses that affect vertebrates (mammals with spines). Research has shown that coronaviruses are extensive in the bat family. Other vertebrates known to be affected by coronaviruses are: members of the cat family, ferrets, camels, birds, cows, pigs, and humans. There are currently seven (7) coronaviruses known to infect humans; SARS-CoV-2, or Covid-19, is one (1) of them.


These viruses were first identified in 1965. The name coronavirus comes from the crown (corona in Latin)-like spikes on the surface of the virus cell. The Covid-19 virus is a round structure of proteins surrounded by a fatty membrane, with the spikes on top of the membrane. Inside the round structure is a very long chain of RNA (ribonucleic acid), a genetic material. The RNA extends through the fatty membrane & into the spikes on the crown.

Electron microscopy photo of Covid-19

The coronavirus is not able to survive on its own. It needs a host cell in order to multiply. I liken it to more of a parasite (an organism that lives within, on, or at the expense of another). Think……invasion of the body snatchers! ☺


In humans Covid-19 seems to have an affinity for attaching to cells that contain ACE2 (angiotensin converting enzyme). ACE2 is a protein found on the surface of many human cells. The spike proteins on the Covid-19 virus attach to the protein of the human cell like a key being inserted into a lock. Through a series of chemical reactions Covid-19 merges with the host cell and releases the long strand of RNA to, in a sense, hijack the host cell. Covid-19 then sheds the fatty membrane and turns the host cell into a factory to churn out new virus cells.

Electron microscopy photo of Covid-19
attaching/merging with host cell.

Where in the human body are these host cells found? They are found in:
the lungs, heart, liver, GI tract, the lining of blood vessels, kidneys, & mucous membranes (the linings of the nose, mouth, & eyes).

 

Symptoms of Covid-19 begin to occur anywhere from two (2) to fourteen (14) days after becoming infected. Symptoms can include, but are not limited to:
fever, chills, cough, shortness of breath, tiredness, body aches, headache, sore throat, loss of taste and/or smell, runny nose, conjunctivitis (pink eye), nausea and/or diarrhea, chest pain, blood clots, confusion. When comparing the symptoms to the cells Covid-19 hijacks, it becomes clearer to see where and why these symptoms occur.

Information gathered from:

  • NAM – National Academy of Medicine

  • APHA – American Public Health Association

  • NIH – National Institutes of Health

  • WHO – World Health Organization

  • CDC – Centers for Disease Control

  • Numerous scientific publications & articles

  • Numerous medical education platforms

 

From Parish Nurse, Donna Musselman

 

How Did the Coronavirus Come to Be?

 In the beginning (pun intended!)…….no, really, in order to understand how we got to where we are I think it’s important to understand how we got to where we are.

 

Numerous scientific studies done by virologists (scientists who study viruses), epidemiologists (“disease detectives”, scientists, physicians, veterinarians who study diseases & the control of them), infectious disease specialists, etc. over the past 15 years seem to show a consensus that bats were the initial vector (something that transmits a disease or virus from one (1) animal to another) for Covid-19.

In the past 15 years researchers have completed genome sequences for over 30 different coronaviruses found in bat populations around the world. Bats are known to harbor numerous highly pathogenic (an organism/bacteria/virus capable of causing disease) viruses, such as rabies & Ebola. As well as what we now know as Covid-19. Bats are the only known mammals capable of sustained flight, which enhances their ability to disseminate the viruses they harbor. So how does this work?

Does a bear poop in the forest? Well, does a bat poop while flying? The answer is yes. And since bats can be found almost all over the place, guess what else can be all over the place. YUCK! As other animals roam the planet in search of food, is it possible some of what they ingest could be bat poop? Hmmmm….if virus particles are in the bat poop (which they have been shown to be) can another animal ingest the virus as they forage for food? Yup! And viruses, being what they are, are able to recombine into a different form in that “new” animal in order to survive. In the case of Covid-19 it seems that a pangolin (scaly anteater) was the next link in the chain. Then what?

In China, pangolins are considered a delicacy. (I’m with you….GGRROOSS!) Who eats anteaters? Well, who eats cows? Who eats fish? Over the millennia cultures all over the world evolved to eat, literally, a world of different things. Humans have learned to eat whatever is available/easy to capture/affordable in order to survive. That being said, another mammal used for food in China & Southeast Asia is the bat. If the food being consumed by humans harbors the virus that causes Covid-19, & with viruses being what they are, recombine in order to survive, well… you get the picture.

What I found as I did research for this article is that there are any number of steps between bats harboring coronaviruses & the transition to that virus being able to infect humans. However, it is all extremely detailed &, in some instances, at least for me, it became gobbledegook. To the best of my ability I have tried to simplify the path in order to make it understandable: even for myself.

Covid-19 is considered a zoonotic disease, a disease that can be spread between animals & humans. It is a virus that lives, in some form, in other animals &, over time, is able to change to a form that causes disease in humans.

To date there are seven (7) coronaviruses that cause disease in humans. There are four (4) coronaviruses that continually circulate in humans. Those four (4) generally cause mild symptoms one might see with the common cold. It is thought they account for 15% of all colds.

Another human coronavirus caused the SARS (Severe acute respiratory syndrome) outbreak that was seen in 2002-2004. That seems, at this time, to have burned itself out. Another caused MERS (Middle East respiratory syndrome). There have been outbreaks of that disease in 2012, 2015, & 2018. And the last, SARS-CoV-2, which began in late 2019 & whose story has not yet ended.

 

Information from:

  • NIH – National Institute of Health

  • Numerous scientific publications

  • Global Epidemiology of Bat Coronaviruses by Wong & Woo 2019 @ www.ncbi.nlm.nih.gov

From Parish Nurse, Donna Musselman

How Does Covid-19 Spread Between Humans?

As of this writing the spread of Covid-19 between humans remains to be primarily of the respiratory droplet/aerosolization route. Just what is that?

 

Picture a cold winter day when you walk outside. What do you see? A puff of water vapor when you exhale? That is an example of aerosolization. And when you sneeze into your hands? Have you ever experienced the feel of drops of water on your hand? Those would be the water droplets expelled from the nose, mouth, and lungs during the sneeze. Think of droplets being the size of a pin head and aerosolization as being the size of a pin point.

 

Virus particles are minute enough to ride along on these droplets of water. And whether or not you are able to see it, those droplets and the aerosolization is present whenever we cough, sneeze, yell, sing, laugh, talk, play a woodwind or brass instrument, and just simply breathe.

 

The droplets we exhale and expel during activities cover a wide range of space. Simply breathing may result in those droplets falling to the ground at our feet or, perhaps, with a little help from the air current, travel 6 feet away. Engineering research has shown that droplets from an uncovered sneeze can travel up to 26 feet and at a speed up to 100 miles per hour!

 

Take a journey with me on a day in the life of a Covid-19 virus particle:

 

I’m going to the Farmer’s Market today. I put my mask on as I get ready to exit my car. Unbeknownst to me another person, also entering the market, just touched the outside of their mask before touching the door handle. That person feels fine but, unfortunately, has been infected with Covid-19 and isn’t having any symptoms yet.

 

I grab the same door handle & enter the market. Then my eye itches. And, not paying attention, I use the same hand to rub my eye. Wait! What does my eye have to do with a virus spread by the respiratory route?! Well……believe it or not, all of our body parts are interconnected.

 

Back in 1928 there was a song entitled “Dem Bones”. I remember hearing it as a child. One verse went: “The ankle bone’s connected to the leg bone; The leg bone’s connected to the knee bone; The knee bone’s connected to the thigh bone; Now shake them skeleton bones.”

 

SO……………………the lining of the eye is a mucus membrane. That membrane also lines the lacrimal (tear) duct. The lacrimal duct is connected to the nasal cavity (that is why, when we cry, we get a stuffy nose!). The nasal cavity is connected to the nasopharynx (the uppermost part of the respiratory system). The nasopharynx is connected to the throat. The throat is connected to the trachea (the wind pipe). The trachea is connected to the lungs. And voila! The Covid-19 virus just found its way into another host.

 

In the case of someone being within the breathing range of others infected with Covid-19, and without wearing masks, inhaling that infected air has a shorter route to reach the lungs. In this instance the virus enters the nose or mouth, passes the oropharynx (essentially where the mouth and nose meet at the back of the throat), glides down the throat and into the trachea. In either event the virus is a happy camper with a new home.

 

If we return to the first installment of these musings I mentioned that Covid-19 especially likes to attach to cells that contain ACE2. And those cells can be found in the lungs, heart, liver, blood vessels, kidneys, and GI tract. Every drop of blood we have passes through the lungs. That is where the blood picks up oxygen to take it to every other cell in our body. It is also where Covid-19 has the ability to become a hitch-hiker & take a ride to other parts of the body, with the potential to create issues in the heart, liver, kidneys, blood vessels, and GI tract. The human body is a completely, totally, interconnected network. And Covid-19 is capable of exploiting those connections.

 

Information from: NIH (National Institutes of Health)

                             Numerous anatomy and physiology text

                             NAE (National Academy of Engineering)

From Parish Nurse, Donna Musselman

 

Who Gets Covid-19?

Covid-19, or SARS-CoV-2, came into being, to the best of our knowledge, at the end of 2019. Prior to that time no person living on this planet we call earth had been exposed to this virus; therefore, no person had any immunity to it. That being said, E V E  R  Y  O  N  E  has the potential to be infected with this virus. Let me repeat that….EVERYONE, any age, any gender, and any ethnicity, is susceptible to Covid-19.

There has been one instance of Covid-19 being diagnosed in a newborn in China. And there has been one instance of a 113 year-old female in Spain being diagnosed with Covid-19. Again, let me say, NO ONE is exempt when it comes to contracting Covid-19.

At the outset of the pandemic (a disease prevalent around the world) people over the age of 60 seemed to be the group hit hardest by this disease. Why? Perhaps for a number of reasons.

Many of the people initially affected were residents of personal care facilities. Besides being elderly, many of these people have underlying diseases such as: diabetes, hypertension (high blood pressure), COPD (chronic obstructive pulmonary disease), arteriosclerosis (hardening of the arteries), or even several chronic diseases at the same time. As humans age our cells do not replenish as rapidly or as well as they do, say, at the age of 5; or 25. When the effects of aging are coupled with chronic illness & then tripled by a virus such as Covid-19, the body is put into the situation of fighting 3 foes simultaneously. 

Symptoms of Covid-19 may appear anywhere from 2 to 14 days after being exposed to the virus. That is one of the reasons it is difficult to track the disease. Can you recall every place you’ve been & all the people you’ve come in contact with over the past 14 days? I certainly can’t! What about those unknown people you’ve simply passed by on your way into a store? It becomes easier to understand the difficulty of contact tracing when looking at the last 14 days of one’s own life.

What are symptoms of Covid-19:

  •     Fever and/or chills – when we get a fever the brain increases the temperature set point of our body. The body attempts to reach that higher set point by causing the muscles to rapidly contract and relax in order to create more heat as it tries to reach that new set point. That is why we experience chills as our temperature increases. It is also a sign that the immune system has gone to work in an attempt to kill whatever pathogen is invading the body.

  •     Body aches and fatigue (tiredness)

  •     Sore throat and runny nose

  •     Nausea, vomiting, and/or diarrhea – the GI tract is one of the areas of the body where cells with ACE2 reside

  •     Cough, shortness of breath – the lungs are one of the areas hardest hit by this virus. It seems many people develop “Covid” pneumonia. Coughing occurs as the body attempts to clear the lungs. Difficulty with breathing occurs as the lungs fill with virus particles and fluid caused by the resulting inflammation. The virus particles and fluid fill up the alveoli (tiny grape-like sacs in the lungs where carbon dioxide is exchanged for oxygen), thereby preventing the exchange of air.​​

Normal Chest X-Ray


The dark areas indicate air in the lungs. The white "shadow" on the right (as you look at the x-ray) is the heart.

Covid-19 Chest X-Ray

Lung fields are much lighter and have areas of white throughout, indicating air is not filling those areas.

  •  Headache, confusion

  •  Loss of the sense of taste &/or smell

 

While people of any age may develop the above symptoms of Covid-19 there has been documentation of occurrences of a multi-system inflammatory disease in children between the toddler and teen years. MOST of the children who exhibit this syndrome test negative for active Covid-19. Blood tests, however, show that these children have antibodies to the virus, indicating that at some time in the past they had the virus and their bodies fought it off. This syndrome can occur in children who have shown symptoms of Covid-19 as well as in children who have shown absolutely no symptoms of Covid-19.

 

“An inflammatory syndrome occurs when the immune system becomes overactive. In this case, the body releases cytokines [proteins that help regulate the body’s immune response], which help mediate a high fever. It’s a natural response to infection. But in this case, there seems to be an overreaction to the infection, which happens sometimes after viral infections. As the body is learning to become immune to the virus, it over-activates the immune system. That’s what we think is going on here.” (Pediatrician from New York Presbyterian Children’s Hospital)

 

In addition to the previous symptoms these children may also have:

  •    Abdominal pain

  •    Neck pain

  •    Rash

  •    Blood shot looking eyes

  •    Extreme tiredness


As the pandemic has continued it is now people between the ages of 20 – 45 who seem to be the most affected. Why? In all honesty the answer is mostly conjecture. At this time the change in the affected population is being attributed to people in that age range being in crowded public spaces: beaches, bars, parties, etc.

Those who contract Covid-19, on average, seem to be ill for about 2 weeks. However, there are documented instances of people being ill for 2 – 3 months. Symptoms can be mild, ranging from common cold type symptoms, to extremely severe, being in ICU on a ventilator for 2 months.

In 1873 Jules Verne wrote the novel “Around the World in 80 Days”. In 1956 the film version of the novel was released. Covid-19 was faster. It only took 60 days for the virus to spread around the world.

Information from:

    CDC (Centers for Disease Control)
    NIH (National Institute of Health)
    New York Presbyterian Children’s Hospital

From Parish Nurse, Donna Musselman

 

What's a Body to Do?

To coin a phrase attributed, since the 1930’s, to Jack Dempsey, “The best defense is a good offense.” And in the case of Covid-19, that is a good practice to follow.

 

As stated in episode 1, the Covid-19 virus is a round structure of proteins surrounded by a fatty membrane. That fatty membrane makes this virus easy to destroy. Breaching that fatty membrane causes the virus particle to disintegrate, rendering it incapable of attaching to or infecting a host. How do we do that?

 

WASH YOUR HANDS! WASH YOUR HANDS! WASH YOUR HANDS!

Good old fashioned soap & water will do the trick! Think Dawn dishwashing detergent. What do the commercials say? Dawn cuts grease, aka fat, aka Covid-19’s fatty membrane. Soaps are made with a combination of a fat or oil, an alkali (do you remember hearing about “lye soap”? I do! Lye is made from wood ashes), & water. The use of soap, worked into a lather with water, serves to disrupt the membrane of the virus. The process of using soap & water also results in loosening any viral particles on the hands & causing them to be washed down the drain.    It is not necessary to use antibacterial soap. Plain old soap will do.

 

In order to be most effective a good lather is needed. And it takes a little time. No cheating! Sing “Happy Birthday”……..twice; that will take about 20 seconds. Hands need to be washed for a minimum of 20 seconds so the soap can do its job.

 

In the absence of soap & water a hand sanitizer will also work. Hand sanitizers should contain at least 70% alcohol to be effective. The alcohol dries out the fatty membrane of the virus, disrupting the membrane & killing the virus. Whether you use rubbing alcohol or a hand sanitizer, the idea here is to leave your hands air dry after using either of these products. Solutions with 60-80% alcohol work best. Why? Solutions with less than 60% alcohol contain too much water to enable the alcohol to break down the fatty membrane. Solutions with more than 80% alcohol air dry too quickly to make them effective. The longer the alcohol solution stays in contact with the virus the more effective it will be.

 

Other usable products include peroxide or a mild bleach solution. A bleach solution of 1/3 cup bleach to 1 gallon of water is an effective strength to destroy the Covid-19 virus.

 

The above solutions, as well as soap & water, can also be used to clean surfaces in the home. Using these cleaning measures will also tend to dry the skin. Remember to use hand crème or lotion often.

 

WEAR A FACE MASK!

In episode 2 we talked about Covid-19 being a disease that is spread primarily by the respiratory route. Newer studies have begun to show that aerosolization (the pin point or smaller size vapor that occurs every time we breathe, talk, or sing) is a big factor in the way Covid-19 is spread. And in this case, size matters. The smaller the droplet, the longer that droplet will remain in the air. And the further it is likely to travel on the air current. At this time engineering studies have shown that Covid-19 will survive in the air for up to 3 hours.

 

Not all face masks are created equal. The N-95 mask is a rather dense mask that is made to filter particles as tiny as this virus. I would echo the experts & say to let these masks for health care providers & 1st responders whose jobs put them at greater risk of contracting this disease.

 

Surgical (or procedure) masks will work fine for most of us. This type of mask provides protection from droplets & sprays emitted by the wearer, thereby protecting others from us.

 

Cloth face masks can be effective if thick enough. Recently a study indicated that, in order to be effective, a cloth mask should be at least 3 layers thick.

 

In order to be effective a face mask must be worn appropriately. Make sure both your nose AND mouth are covered by the mask! Not covering, & keeping, your nose inside the mask completely negates the purpose of the mask.

Don’t drive this OR nurse crazy wearing your mask like this!

Make sure BOTH your nose & mouth are covered by the mask.

I know it gets warm inside a face mask. I know glasses can fog up when wearing a face mask. Over the past 40 years of working in the OR I’ve worn a face mask for as few as 5 minutes at a time to as long as 16 hours at a time. I have not yet seen anyone pass out because it was warm inside the mask. I have not yet seen any documentation of people not getting enough oxygen because of wearing a face mask. I have not yet seen anyone with carbon dioxide toxicity because of wearing a face mask. As for foggy glasses…………try putting the mask as far up on the bridge of your nose as possible, pinch the mask against your nose & cheeks to keep it as close to your face as possible, & put your glasses a little further down on the bridge of your nose, over the top edge of the mask. That often eliminates the fogging issue. Keeping your head in an upright, forward position will also help. The bottom line…….WEAR A FACE MASK!

 

PHYSICALLY DISTANCE YOURSELF FROM OTHERS

(Physical distancing helps to reduce exposure to the virus.)

Any time you will be in the presence of people other than those with whom you live, maintain a distance of 6 feet away, to the extent possible. If you will be somewhere where keeping that distance will be difficult, make sure you are wearing a mask. That includes outside also. Recent public encounters, such as gatherings at bars & beaches, have proven to be super spreader events. What is that?

 

Humans in close contact with each other, not wearing masks (I know; how does one eat or drink with a mask on? How does one sunbathe, play beach volleyball, splash in the ocean or pool with a mask on?), whether inside or outside, places us in a situation where the air can become laden with virus particles. In such a situation it becomes almost impossible not to be exposed to the virus. In a group of 140 people partying at the beach, 100 of them contract Covid-19; that is a super spreader event.

 

KEEP YOUR HANDS AWAY FROM YOUR FACE!

(No, seriously. Put your hands down! Don’t make me stop this car & come back there!)

 

How many times in a day do you touch your face? Do you know where your hands have been?! We touch so many things with our hands: door knobs/handles, tables, counters, books, purses, food, drinks, eating utensils, plates, TV remotes, cell phones, computers. Need I go on? I don’t know if any studies have been done, but I’d be willing to bet our hands are germier than our feet.

If you have to touch your face, either wash your hands or use hand sanitizer prior to doing so. Remember, hand sanitizer is mostly alcohol. Let your hands dry prior to touching your face if you’ve used sanitizer.     

  

Does all this talk about washing hands & not touching your face make you wonder just how long this virus lives on surfaces? Studies have shown the following:

  • Paper & glass = 4 days

  • Cardboard = 24 hours

  • Plastic & stainless steel = 3-7 days

  • Clothing = 9 hours

  • Wood = 2 days

  • Air = 3 hours

 

What these studies show is that viral particles have been detected on the above surfaces after the stated time periods. What hasn’t been studied, however, is the viability of those viral particles. It isn’t known if what is being detected is still able to cause infection. That being said, it is imperative to wash your hands, wash your hands, wash your hands. And don’t forget to clean your cell phones! Studies have been done that show cell phones can be germier than a toilet! Just saying…

 

LIMIT YOUR EXPOSURE

There is no way to know who, in a crowd, or even in a group of 2, is infected with SARS-CoV-2. If you are not feeling well……………..STAY HOME!

 

If you have been in the presence of someone who has tested positive for the disease, isolate yourself for 14 days (the currently known longest incubation period).

 

Wear a face mask.

 

Oh! Did I say? Wash your hands, wash your hands, wash your hands!

 

Sources:

  • CDC (Centers for Disease Control)

  • NEJM (New England Journal of Medicine)

From Parish Nurse, Donna Musselman

 

Vaccines and Other Stuff

Where to begin????? Let’s start with the typical process of vaccine development.

            There are five (5) stages a drug passes through prior to being approved for use:

  1. Exploratory stage – often involves years of scientific research to develop a drug whose purpose is to prevent a specific disease

  2. Pre-clinical stage – the time when non-human trials are done to find out if the drug has the properties the researchers are looking for

  3. Clinical development – when the drug is given to human volunteers; it consists of three (3) phases:

                                    Phase 1 – the drug is given to a small group of healthy people who are then closely monitored to watch for the drug’s effectiveness & any side effects

                                    Phase 2 – the trial is expanded to include more people; during phases 1 & 2 researchers are looking for an immune response, what dosage is needed to obtain the desired response, & lag time. Lag time refers to the time between receiving the drug & development of an immune response; how long the immune response persists; & immune memory (will the body continue to see the pathogen as an invader & set the immune system in action to destroy it.) 

                                    Phase 3 – the drug is now given to thousands of people: different ages, different ethnicities, different genders to test for efficacy (the effectiveness of the drug) & safety 

                                    Many vaccines also undergo a phase 4. Phase 4 is a host of on-going studies that are done after approval & licensure in order to continue to track safety issues.

    4. Regulatory review and approval. This step includes: Completion of a new drug application; Pre-licensure clinical trials; License application; Manufacturing;             Inspection of manufacturing facilities; Presentation of study findings to the FDA (Federal Drug Administration); Usability testing of the product labeling (what is the drug intended to do)

    5.Quality Control – ongoing studies to track outcomes of use & side effects.

                All this typically takes 5 – 15 years to accomplish. How then can we expect a Covid-19 vaccine in 12 – 18 months?

            Oftentimes it is a single entity working on a vaccine. In the case of Covid-19 multiple entities, in countries all over the world, are working to develop a vaccine. Additionally, phases of development are being done simultaneously in order to shorten the time frame. At the moment there are over 200 Covid-19 vaccine projects in process around the world. Most of the vaccines currently in the development pipeline are targeting the spike protein of the SARS-CoV-2 virus in order to prevent it from attaching to human cells. Documented post-infection antibodies have been related to the spike protein of the virus particle.

           

            The goal of a vaccine is to increase the immune response to a virus or bacteria so that, when a person is exposed, the immune system will block or quickly control the pathogen, thereby preventing illness. Vaccines are not used to treat an illness. Vaccines are given to HEALTHY people to prevent an illness. As such, it is important that a vaccine is safe for all people.

 

What about herd immunity?

            Herd immunity is when 60 – 70% of a population has been infected by a disease, recovered, & has antibodies to the pathogen that caused the disease, or has been vaccinated in order to prevent the disease. The world’s population is currently estimated to be 8,000,000,000 (8 billion). Herd immunity, at 65%, would be approximately 5,000,000,000 (5 billion) people. Currently the number of confirmed cases of Covid-19 is just under 13,000,000 (13 million), or less than 1% of the global population.  In terms of the United States, with a population of 328,000,000 (in 2019), a 65% herd immunity threshold would be 213,000, 000.  The number of confirmed cases of Covid-19 in the US stands at 3,400,000, or less than 2%. Based upon current national & global data, herd immunity is still a long way off.

Seasonality

           

              There was much questioning, early in the pandemic, about the possibility of Covid-19 being a seasonal disease, similar to influenza. While influenza is with us all year long, it wanes during the summer. Now that summer is here I think we have all seen that Covid-19 has not taken a break.

Antibodies

            At this time it is still too early to know how long antibodies, obtained by being infected, will last. Some studies have shown that, over time, Covid-19 antibodies fade. It is not yet known if someone with antibodies, when re-exposed to the virus at a later time, will become re-infected.

           

            Another observation derived from current studies has shown that not all antibodies are created equal. Some people, who have experienced severe Covid-19, have developed strong antibodies; some have not.

            Knowing that the goal of a vaccine is to help the body create antibodies to a disease, and knowing that the strength of those antibodies, along with the longevity of the antibodies, play a role in future immunity, it remains to be determined if a Covid-19 vaccine will be a one-time shot or a yearly shot similar to that for the flu.

            It is highly probably that multiple vaccines will need to be manufactured in order to protect the global population. No one pharmaceutical company or manufacturer will be able to produce the number of doses that will be required to protect everyone on planet earth.

 

Treatments

            Currently there is no drug to prevent or cure Covid-19. Since the beginning of the pandemic treatment has centered on treating the symptoms caused by the virus and the accompanying inflammation it creates.

            The drugs being used to treat Covid-19 have been part of the pharmaceutical arsenal available for the treatment of other diseases. Some drugs being used are anti-inflammatory agents; some are antiviral agents. Some drugs work for some patients & not others.

Sequelae (A condition(s) which is the consequence of a previous disease)

            There are diseases that leave us with long term reminders of their

presence. A good example is shingles. Shingles may occur in people who have previously been infected with chicken pox. We are beginning to see some reminders of Covid-19 infections also.

            Again, it is too early to know the full ramifications of this virus & its aftermath.

The numbers game

            Every day we are bombarded with numbers: the number of cases in individual states &/or cities, the number of cases in individual countries, the number of cases globally, the number of deaths in each of the aforementioned places. Please remember, each & every one of these “cases” represents a human being. Each case represents a parent, child, sibling, grandparent, aunt, uncle, cousin, co-worker, friend.

            Information from: NIH (National Institute of Health)

                                           APHA (American Public Health Association)

                                           CDC (Centers for Disease Control)

From Parish Nurse, Donna Musselman

 

Covid, Covid, Covid

Are you tired and overwhelmed by all the news about Covid-19? Are you tired of hearing about it 24-7? Are you tired of being told to stay home, wear a mask, and forego all the things that used to be part of a typical day? I know I am.

 

I’m tired of having to make a battle plan every time I go somewhere. Car keys? Check. Driver’s license? (I try not to carry a pocketbook anymore unless I have to; less to contaminate) Check. Money or credit card? Check. Face mask? Check. Hand sanitizer? Check.

 

I’m frustrated at not being able to see family and friends as frequently as I did BC (before Covid!). I’m frustrated at being afraid to hug and kiss them as freely as I once did.

 

I’m tired of being fearful whenever I enter a store because I don’t know if everyone else will be wearing a mask………….or not. Or if someone who is asymptomatic (infected with Covid-19 but with absolutely no symptoms of the disease, as it is estimated 35% of the population is) has touched any surface in the store and then I touch it after them.

 

I am tired of being angry with those people who I think are flaunting their resistance to rules by not adhering to the health guidelines: wearing a mask when inside a public space, and thereby putting everyone else at risk.

           

I am tired & frustrated at feeling as if I have to live in a bubble. And I’m really miffed at having had to cancel this fall’s travel plans! L When is life going to get back to “normal”?!

           

I try to keep things in perspective, but am not always successful at doing so. I think all these feelings just make me human. But I still don’t like it!

           

I am reading more about mental health issues as the pandemic drags on. Many people have lost jobs, or had work hours severely curtailed, thereby creating a very real economic issue for them.

           

There is fear among those whose jobs have been deemed “essential”. Fear about constant exposure to the virus. Fear about taking the virus home to their family. Fear because, as an essential employee, they have to report to work, but no longer have available childcare.

           

People in communal care facilities of one sort or another have become isolated because visitors are no longer allowed, or again, at the least, severely curtailed.

           

There has been a wholesale disruption of what used to be normal routines for everyone, everywhere. And the future has now become a totally unknown entity.

           

It is common for humans to experience anger, fear, depression, and increased stress under these kinds of circumstances. It is also common for those feelings to ebb and flow, almost like a roller coaster ride. We are not static beings; our moods are subject to change depending upon numerous internal and external forces. While we may be able to make adjustments (“going with the flow”) under “normal” circumstances, during times of increased and constant stress, such as caused by the current pandemic, those adjustments may become more difficult for us. What can we humans do to help us get through these mentally difficult times?

 

Make the attempt to maintain a consistent daily schedule. Wake up at the same time each morning; go to bed around the same hour every night. Try to get eight (8) hours of sleep. (Our bodies do a lot of physically demanding repair work during sleep.) Turn off electronic devices at least 30 minutes before hitting the pillow. (There have been numerous studies showing that the “blue light” emitted by today’s electronic devices disrupts our ability to sleep.) Eat meals at the same time.

           

To quote a song title from Olivia Newton-John, get “Physical”. Aerobic (that which requires oxygen) exercise has proven to reduce anxiety and depression. It has been posited that the exercise-induced increase in blood circulation influences a number of different regions of the brain which control motivation and mood, fear as a response to stress, and memory formation. Thirty (30) minutes of moderately intense activity (brisk walking, biking, swimming, jogging) a day, three (3) times a week, is sufficient to provide these health benefits. It is believed that those 30 minutes can be broken into three (3) ten (10) minute increments, spaced throughout the day, & still be beneficial.

           

Limit social media & news access. Remember the saying, “If it wasn’t for bad luck I’d have no luck at all”? Well, in this case, I think that can be changed to, “If it wasn’t for bad news there’d be no news at all”. I’ve taken to powering down my devices around 9:00 PM. I also try to remain aware of the amount of time I spend on them during the day. About 2 weeks ago I had the “opportunity” to be somewhere where I was without internet access for a day and a half. (OMG!) I was totally at peace for those 36 hours. It was truly amazing! J

           

Use those electronic devices to stay as socially connected to family & friends as possible. FaceTime, ZOOM, and even the plain old-fashioned phone call will help here. The new ministry, Calls of Caring and Compassion, that the UPG instituted is an awesome way to stay in touch with our church family. I’ve stolen that idea and make calls to family members, as well as a number of friends, to check in with them periodically to make sure they are okay and ask if there is anything they need.

           

Try the ages old practices of yoga and meditation. There are also apps available for breathing exercises & mindfulness that can be helpful.

           

If you find yourself in a really dark place with no seeming way out, please, please, please seek the help of a qualified mental health expert. Doing so does not say one is “crazy” or incapable of dealing with the lemons being tossed in the way. It says one is human and in need of help to combat the increased level of stress at a given time. I’m going to use a quote from “Crocodile Dundee”, “I guess we could all use more mates.” Make the mental health providers your “mates” to help get through these difficult times.

 

Information from:

  • NIH (National Institute of Health)

                             

I want to especially thank the UPG’s very own Tom Sarver. I felt I was way out of my league speaking to mental health concerns. Tom graciously responded to my request for assistance by suggesting issues and options to include in this Covid offering.

 

 From Parish Nurse, Donna Musselman

 

It seems that Covid-19 has left us with more questions than answers. And it is my observation that we humans tend to want answers…yesterday! I cannot stress enough, however, that this virus has been in our world for only seven (7) months.

 

Thanks to experiences with similar viruses in the past (SARS-CoV-2 shares 80% of its genome with SARS), and modern technology, what we have learned about Covid-19 in those seven (7) months is nothing short of incredible. Yet what we know seems, in many instances, to be just the tip of the iceberg. Every day more is being learned about the virus we’ve come to know as Covid-19. It is my guess that for several years to come we will continue to learn more about this virus. And as more is learned the guidance will likely change.

 

In the beginning (there we go again, back to the beginning!) the guidance was that it wasn’t necessary to wear a face mask. Then it was learned that this virus was not only spread by droplets but also by aerosolization. With that piece of learning it became necessary to wear a face mask because simple processes, such as breathing, would spread the disease.

 

Along with those changes in guidance comes exasperation. Don’t these “experts” know what they’re doing?! They’re constantly changing their minds on what we can/should/shouldn’t do! The honest answer is that it is precisely because they know what they are doing that the guidance changes.

 

To me it’s like learning to walk. As infants we don’t have the muscle strength or memory to walk, so we start out by crawling. We learn to stand and bounce as someone holds us up. Then we begin to stand on our own. Then the lightbulb goes on and we take a tottering step, arms spread out for balance. Sometimes we fall down, only to get back up and try again. Then we take a few steps on our own. And then we RUN! Only to fall down and learn we have to walk a bit slower to maintain the balance needed to stay upright. That is exactly the process happening in science circles all over the world in an effort to learn all there is to know about Covid-19.

 

I am going to share part of an article I read (printed in several forums). The writing is attributed to Dr. Anthony Fauci. However, I have been unable to verify that he actually is the source of the information. That being said, the science & health aspects of the writing is spot on:

 

“Chickenpox is a virus. Lots of people have had it, and probably don't think about it much once the initial illness has passed. But it stays in your body and lives there forever, and maybe when you're older, you have debilitatingly painful outbreaks of shingles. You don't just get over this virus in a few weeks, never to have another health effect. We know this because it's been around for years, and has been studied medically for years.

 

Herpes is also a virus. And once someone has it, it stays in your body and lives there forever, and anytime they get a little run down or stressed-out they're going to have an outbreak. Maybe every time you have a big event coming up (school pictures, job interview, big date) you're going to get a cold sore. For the rest of your life. You don't just get over it in a few weeks. We know this because it's been around for years, and been studied medically for years.

 

HIV is a virus. It attacks the immune system and makes the carrier far more vulnerable to other illnesses. It has a list of symptoms and negative health impacts that goes on and on. It was decades before viable treatments were developed that allowed people to live with a reasonable quality of life. Once you have it, it lives in your body forever and there is no cure. Over time, that takes a toll on the body, putting people living with HIV at greater risk for health conditions such as cardiovascular disease, kidney disease, diabetes, bone disease, liver disease, cognitive disorders, and some types of cancer. We know this because it has been around for years, and had been studied medically for years.

 

Now with COVID-19, we have a novel virus that spreads rapidly and easily. The full spectrum of symptoms and health effects is only just beginning to be cataloged, much less understood.

 

People testing positive for COVID-19 have been documented to be sick even after 60 days. Many people are sick for weeks, get better, and then experience a rapid and sudden flare up and get sick all over again. A man in Seattle was hospitalized for 62 days, and while well enough to be released, still has a long road of recovery ahead of him. Not to mention a $1.1 million medical bill.

 

Then there is MIS-C. Multi-system inflammatory syndrome in children is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. Children with MIS-C may have a fever and various symptoms, including abdominal pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes, or feeling extra tired. While rare, it has caused deaths.

 

This disease has not been around for years. It has basically been 6 months. No one knows yet the long-term health effects, or how it may present itself years down the road for people who have been exposed. We literally *do not know* what we do not know.”

 

As scientists, physician researchers, and engineers the world over continue to work to learn more about Covid-19, how to treat and/or cure it, and provide the means to manufacture any drugs, in huge quantities, there is one (1) very important thing to remember: we are currently living on the virus’s time. SARS-CoV-2 is calling the shots.

 

Anyone (or should I say everyone?), any age, any gender, or any ethnicity, is susceptible to becoming infected by Covid-19. Anyone infected by Covid-19 is capable of infecting others: even the 35% of the population that becomes infected but who develop no symptoms of the disease.

 

There is no way to know what form of the disease one will get. Will you be one who is infected but remains asymptomatic? Will you have nothing more than cold-like symptoms? Will you be sick enough to be hospitalized? Will you develop Covid pneumonia and require a ventilator in order to breathe? Will you spend 2 days in the hospital? Or 2 weeks? Or 2 months? Will your body be able to recover from this virus? Or will you be one of the death statistics? The question that keeps rearing its ugly head in my mind is, “How often are you willing to play Russian roulette with this virus?”

 

So…where do we go from here? The answer is that it is up to each one (1) of us to decide where we go. Personal behaviors will play a huge role in how we weather this storm:

  • Wear a face mask when in a public building

  • Wear a face mask outside if unable to maintain at least six (6) feet of distance from other people not part of the home in which you live

  • Wash your hands, wash your hands, wash your hands

  • Keep your hands away from your face, especially your eyes, nose, and mouth

  • Avoid crowded places, inside or outside, whenever possible

  • If you are not feeling well…STAY HOME!

 

If I do all of these things will that guarantee that I will not get Covid-19? Unfortunately, no. But following these guidelines, to the best of each of our abilities, will give us each, & thereby all, a fighting chance.

 

“Did you mean to scare us with what you wrote?”

 

Me…..”Not really. I happen to believe that the more we know the better our decisions will be in order to protect ourselves and those we love.”

 

“Are you sure you weren’t trying to scare us?”

 

Me…”Well, maybe a little, if scaring you will help you to remember to follow the guidelines. You see, as was stated in one of the conferences I listened to: We’re not safe anywhere unless we’re all safe everywhere.”    

     

Information from:

  • CDC (Centers for Disease Control)

  • NIH (National Institutes of Health)

  • APHA (American Public Health Association)

           

Written by Donna Musselman, Parish Nurse     

Where Do We Go From Here?

 

Parting Shots (Yes, I mean those kind of shots!)

It seems as if a perfect storm may be approaching. In the chapter entitled “Vaccines and Other Stuff” it was discussed that influenza is with us year round. However, flu makes itself known mostly from October through May, with the peak of the season being December through February. This year it seems as if “flu season” is going to collide with Covid-19.

 

If you become ill, how will you know which disease has found you? The table below outlines the most common symptoms of each disease:

 

 

 

 

 

 

 

 

You – “Ah, wait just one minute! Those symptoms are exactly the same.”

 

Me – “ Yes, they are. So I go back to my original question. How will you know which disease has found you?”

 

The only way to know which disease has found you is to be tested. I suspect people who become ill this flu season will be tested for both diseases in order for the physician to know which you have and treat you appropriately. There is, however, one way you can help yourself, your family and friends, and your physician this year. And that is to get a flu shot.

 

Okay, so this is coming from someone who, up until about 5 years ago, did NOT get a yearly flu shot. Seriously?! You’re a nurse who worked in a hospital and didn’t get flu shots? Yup!

 

I grew up watching my dad get flu shots every year. And every year, just like clockwork, he would have a fever, chills, and body aches within 48 hours of having his shot. Why on earth would I want to get a flu shot when they made him sick?! To quote my mother, “Live and learn.” So I learned.

 

I learned that side effects from flu shots include: fever, chills, headache, and body aches. Why? Because the vaccine is doing exactly what it is meant to do…it is creating an immune response. The vaccine is kicking the body’s immune system into action so that, if/when it encounters a sneaky flu cell, it can say, “Hey! I know you! You aren’t welcomed here! Watch this!” as it goes into action to destroy the flu cell. It is the ramping up of the immune system after the shot which can result in the above symptoms, and not that one “gets the flu” from the shot.

 

Another reason I didn’t get a flu shot was because, quite frankly, I DON’T LIKE SHOTS. There is a HUGE difference between GIVING a shot, and GETTING a shot. In my mind it is a matter of “tis better to give than to receive”. And I’d much rather give a shot than receive one. (Just being honest here…)

 

At any rate, when my employer began saying that staff that refused flu shots would have to wear a mask, all day, every day, for the entire flu season, I decided it was time to bite the bullet. I’ve gotten flu shots every year since. And I’m still here to tell about it!

 

Will getting a flu shot prevent one from getting the flu? Unfortunately, no. Each year scientists/physician scientists research which strains of influenza are likely to be prevalent that year. A flu vaccine is then manufactured that contains two (2) A strains and two (2) B strains of influenza. Sometimes the flu has other ideas and the vaccine is less effective than intended. Effectiveness of the flu vaccine fluctuates every year, with 50% effectiveness being a good vaccine year.

 

That really shouldn’t deter anyone from being vaccinated, though. Even in those years when the flu vaccine isn’t especially effective at preventing the flu, there is evidence that the severity of illness in those who have been vaccinated is less than in those who have not been vaccinated.

 

Another issue that comes into play with flu vaccines is that the virus genome changes. Influenza viruses are similar in structure to SARS-CoV-2. A flu virus is a round(ish) structure of RNA, enveloped in a lipid (fat) layer, with spike proteins protruding through the surface of the cell. The virus is capable of combining with other viral cells, trading genetic material, and recombining to form what is, essentially, a new virus.

 

Additionally, influenza immunity declines over time. It is the declining immunity, the changing virus, and over 130 known influenza virus combinations that create the situation where flu vaccines need to be a yearly ritual.         

 

It takes approximately two (2) weeks for the flu vaccine to become effective. In order to be protected by the time flu season, and especially peak flu season arrives , the ideal vaccination time is September and October.

 

As for a Covid-19 vaccine, as discussed in “Vaccines and Other Stuff”, that is still in the works. There are at least two(2) vaccines in the US that have entered phase 3 clinical trials. Filtering out as much hype as possible, it is my opinion that it will be late 2020 or early 2021 before a Covid-19 vaccine is ready for prime time, large scale distribution.

 

That being said, when such a vaccine hits the market, it is very likely that, at least initially, quantities will be limited. By that I mean that there will not be 330,000,000 doses available so every person in the United States can walk into the doctor’s office and get a shot. There are a number of panels within the NIH (National Institute of Health), NAM (National Academy of Medicine), CDC (Centers for Disease Control), etc. who have been tasked with developing a plan for the distribution of the vaccine.

 

I cannot stress enough the importance of receiving a flu vaccine this fall. I would encourage everyone, after consulting with your physician, to roll up that sleeve and get a flu shot this year. I know I will. I will also be in line, when it is available, to roll up my sleeve & get a Covid-19 vaccine. Remember, these vaccines will not only protect you, they will also protect those you love. And in the meantime:

 

PRACTICE PHYSICAL DISTANCING

 

AVOID CROWDED INDOOR PUBLIC PLACES

 

AVOID CROWDED OUTDOOR PUBLIC PLACES

 

STAY HYDRATED (allow your 1st line of defense, your skin and mucus membranes, to do their job!)

 

WEAR A FACE MASK THAT COVERS YOUR NOSE & MOUTH (masks with valves are not suitable because they provide a juicy spot for potentially infected exhaled, as well as inhaled, air to concentrate for viral transmission; face shields are also not suitable for the same reason; if you use a face shield it should be in conjunction with a mask)

 

WASH YOUR HANDS, WASH YOUR HANDS, WASH YOUR HANDS

 

Information from:

  • CDC (Centers for Disease Control)

  • NIH (National Institute of Health)

  • NAM (National Academy of Medicine)

 

Written by Donna Musselman, Parish Nurse

Covid-19

  • Chills & fever

  • Body aches

  • Cough

  • Sore throat

  • Headache

  • Fatigue

  • Vomiting & diarrhea

Influenza

  • Chills & fever

  • Body aches

  • Cough

  • Sore throat

  • Headache

  • Fatigue

  • Vomiting & diarrhea

 

Wrap Up

Wearing a face mask is the single most effective behavior we can practice in order to mitigate the transmission of Covid-19. In the past several days I have been able to find more information concerning studies done on the effectiveness of different types of face masks. The information comes from the physics department at Duke University, NEJM (New England Journal of Medicine), and a 2019 Scientific Reports published by Nature.      

 

The physics department at Duke tested 14 commonly available masks. Each type of mask was tested ten (10) times during regular speech versus speech with no mask. The results are as follows:

 

The least effective mask was the neck fleece, or gaiter. The study showed that use of the neck gaiter actually produced more aerosolization during speech than that which occurs when no mask is used. It is the opinion of the researchers that the mask material breaks down the exhaled droplets into much smaller aerosolized particles that remain in the air longer and travel further.

 

Folded bandanas (ala Jesse James robbing a bank) and knitted masks also fared poorly.

 

3-layer surgical style masks, as well as 3-layer cotton masks, performed quite well. N-95 masks were the most effective in minimizing the transmission of aerosolized, exhaled air.

 

Face masks with valves, while seemingly providing easier breathability, do not provide protection for either the wearer or anyone else. The valve results in a stream of exhaled air that has the potential to be a concentrated stream of contamination should the wearer have Covid-19. The valve also provides a path to inhale potentially contaminated air expelled by others.

 

Similarly, a face shield also does not provide adequate protection. The open sides and bottom of a face shield allow for exhaled air to escape or inhaled air to gain access to the wearer. A face shield certainly provides protection to the wearer’s eyes in the event of a close face-to-face encounter, such as in an emergency room setting or by EMT’s in the field. However, if you notice in those photos, those 1st responders also wear a face mask under the shield.

 

In the February 2019 Scientific Report by Nature, the results of a study were shared that showed aerosolization during speech. When speaking quietly an average of 6 particles/second is emitted by a speaker. When speaking loudly, but not so loud as to be yelling, 53 particles/second is emitted by a speaker. Now picture a packed room full of people, all taking simultaneously, and wanting to be heard by the person or group of friends they are with: such as in a bar. Few people are wearing a mask. Now multiply the 53 particles/second for each person speaking. Get the picture?

Below is a photo I was able to find in the NEJM (New England Journal of Medicine) of aerosolization during speech both with and without a mask:

Who would you prefer to be standing near?

 

Again I will remind us all that Covid-19 is, indeed, a novel (new) virus. We are all learning as we go. Every day brings new information that has the potential to change our behaviors as we work through this pandemic. As a speaker on the last APHA (American Public Health Association) conference (Managing Ongoing Surges: Lessons from the Front Lines) I listened to said, “We are building the airplane as we fly.” Think about that statement. I’d prefer to know that the plane I enter is intact and ready to fly without the chance for any issues.

 

By the same token I’d prefer to think that my physician knows everything about every disease and every body he/she cares for. Yet what I can say, with certainty, after 49 years in health care, is this: knowing everything about every disease and every person is impossible; while we may all be built alike we are not at all built alike; with the average human body containing 30,000,000,000,000 (that’s 30 Trillion) cells, there is no way we are all the same. And so we continue to learn as we go…about everything…and especially about Covid-19.

 

Many Thanks!

As I write what is the last of the information that is currently available, I realize I need to thank many people who have helped me along the way. Without the research of hundreds, if not thousands of scientists, physicians, physician researchers, engineers, and a plethora of others, I would not have been able to assemble the puzzle pieces that are Covid-19. Those thanks go out to:

  • NIH (National Institute of Health)

  • NAM (National Academy of Medicine)

  • CDC (Centers for Disease Control)

  • WHO (World Health Organization)

  • APHA (American Public Health Association)

  • NAE (National Academy of Engineering)

  • The UPG’s very own Tom Sarver – Tom provided much needed information on the mental health aspects of dealing with the stresses involved in living through isolation caused by the pandemic

  • Dr. Jeffrey Jahre, Vice President of Medicine and Academic Affairs, St. Luke’s University Health Network, Infectious Disease Specialist – Dr. Jahre was gracious in taking and returning my phone calls in order to help me understand some of the information I was confused about; he was a valuable soundboard for my thoughts and helped to keep me on the right information pathway

  • Diane Botbyl, Administrative Assistant to Dr. William Burfiend, Chief, Department of Surgery at St. Luke’s University Health Network, and good friend – Diane was the person I would contact to reach Dr. Jahre. And although it was not her department, the 2 offices are down the hall from each other and she graciously took on the task of being the go-between for Dr. Jahre and me.

  • Kelly Cascario, Administrative Assistant to Pastor Jerry, who was responsible to get these articles out to the parish via broadcast email and print

  • Pastor Tom Keener, who made it possible for these articles to appear on the UPG web site

  • Dr. Victor Dzau, President, National Academy of Medicine, who, upon receiving a forwarded email of one of the articles, took the time to respond

  • Dr. Alton Romig, Jr, Executive Officer of the National Academy of Engineering, my brother, who provided the initial information about the APHA on-line seminars (www.covid19conversations.org) that got this ball rolling; who continues to send me information from the multiple National Academies that pertain to the pandemic; who has acted as a soundboard; who has read all the articles and continues to encourage me through his feedback on them; and who took it upon himself to forward one of the early articles to Dr. Dzau

  • To all of you, who have had to abide all this writing.

 

In closing I’d like to leave you with a few tips:

  • Wear a face mask!

  • Avoid crowded indoor spaces

  • Avoid crowded outdoor spaces where physical distancing isn’t possible

  • Stay hydrated

  • Maintain at least 6 feet of distance when in the presence of people not from your place of residence

  • Get a flu shot!

  • Oh, did I say, Wash your hands, wash your hands, wash your hands!

 

May God’s peace be with us all as we journey through these rough waters of the pandemic. And when it is time, and we are encouraged to step out of the boat, may we all find the courage and trust to do so. (Thank you Vicar Jamie for the idea!)

 

Donna Musselman, Parish Nurse

 

Light of Christ Lutheran Church - 2020 Worthington Ave, Bethlehem, PA 18017 - (610) 691 2321

St. Peter's Lutheran Church - 474 Vine St, Bethlehem, PA 18015 - (610) 867 0519

©2019 by The United Proclamation of the Gospel

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