General COVID-19 Information

Viruses are small, microscopic parasites, generally smaller than bacteria. They live inside of a host body and have a narrow window of survival outside the body of a host because the viruses cannot reproduce itself without its host. The virus will use the host’s cellular machinery to replicate itself and then cause disease. Viruses enter your body through respiratory passages or open wounds, and occasionally through an insect bite. Once inside your body, a virus will attach or bind to the surface of a host cell and start to move into the cell. The virus will then direct your cell to produce the viral proteins it needs to reproduce. This process can cause inflammation and damage throughout your body and your organ systems. As viruses replicate, and replicate as fast as they can, errors and genetic changes can occur. Sometimes these changes are insignificant, and sometimes they can cause the virus to start to act in different ways, such as becoming more deadly to its host. • National Human Genome Research Institute, “Genetics Glossary”(https://www.genome.gov/genetics-glossary/Virus) • Medical News Today, "What to know about viruses"(https://www.medicalnewstoday.com/articles/158179) • Molecular Cell Biology. 4th edition. Section 6.3, "Viruses: Structure, Function, and Uses."(https://www.ncbi.nlm.nih.gov/books/NBK21523/)

Because viruses are not built like bacteria, are relatively tiny, and reproduce inside the cell, they are not susceptible to antibiotics (which were created to target bacteria). Generally, there are two types of treatments for viral infections. The first type of treatment is called symptomatic or symptom relief treatment, wherein the medical provider will seek to treat the symptoms you are experiencing rather than the underlying infection. For example, if you are having a fever and cough, you might receive acetaminophen (found in Tylenol) for fever reduction and dextromethorphan (found in medicines like Delsym & Robitussin) to suppress your cough. The second type of treatment is a class of medicines called antivirals. Only some specific antivirals have been created to target certain viruses, such as the drug Tamiflu for the influenza virus. Antivirals work to prevent the virus from replicating by interfering with the protein production, blocking the virus from entering the cell, or disrupting the virus’s DNA. The medications are generally more effective when taken early and the viral load within your body is still low. Vaccines have been used in the fight against viral infection since the development of the smallpox vaccine in 1798. They train your immune system to quickly fight off the virus. A vaccine is considered prevention rather than a treatment or cure. Medical News Today, "What to know about viruses"(https://www.medicalnewstoday.com/articles/158179) Duke Health, "Is it Bacterial Infection or Virus?"(https://www.dukehealth.org/blog/it-bacterial-infection-or-virus) WebMD, "Bacterial and Viral Infections" (https://www.webmd.com/a-to-z-guides/bacterial-and-viral-infections) A viral illness can sometimes lead to secondary bacterial infection. Your body is already under attack and is worn down from fighting off the virus. Bacteria can then take this opportunity to cause an infection such as pneumonia. Other complication can come from long term side effects or organ damage. The zoster virus that causes chicken pox can actually lay dormant in your body after the chicken pox rash resolves. It then re-emerges in times of stress and causes the disease called shingles.

COVID-19 is a new (novel) strain of the coronavirus. The outbreak first began in Wuhan, China in late 2019, but has since spread around the world. COVID-19 is concerning because like all new viruses, there is no community immunity which leads to a high rate of spread. For most individuals, symptoms will be mild, and you will be able to treat at home. CDC (https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html)list of symptoms of a COVID-19 infection may include: • Fever or chills • Cough • Shortness of breath or difficulty breathing • Fatigue • Muscle or body aches • Headache • New loss of taste or smell • Sore throat • Congestion or runny nose • Nausea or vomiting • Diarrhea The disease can progress to respiratory failure and other organ failure. According to the best information we have now, and as outlined on the Texas Department of State Health and Human Services,(https://www.dshs.texas.gov/coronavirus/?gclid=CjwKCAjwsNiIBhBdEiwAJK4khstgqqXR_W_2DEofuOFOuwGmp_U-XhmwZzKeBWOTXxIXWUyhxH76sRoCSdcQAvD_BwE) the virus is mainly spread from person to person through respiratory droplets. These droplets can happen during breathing, talking, sneezing, coughing, etc. The virus may also be spread through touching surfaces that have recently come into contact with the virus, but this is not thought to be the primary mode of spread. As COVID-19 emerged, scientists and researchers dedicated time and resources to exploring and experimenting to learn more about the nature of the virus. The National Library of Medicine (https://www.ncbi.nlm.nih.gov/sars-cov-2/)has compiled more information on the nature of the COVID-19 Virus. If you are experiencing symptoms of COVID-19, please review our website for patients,(https://www.watermarkurgentcare.com/covid-19) outlining ways to care for your symptoms from home and when to see emergent or urgent care. If you are able to afford it, you can find a variety of testing options at gogettested.com.

COVID-19 will affect individuals differently. This can be impacted based on underlying health conditions, age and immune health, and severity of infection. From the most current data we have, about 1-3 in 10 people with COVID will have long term symptoms. Long term symptoms, currently referred to as “Long COVID” can look a variety of ways and aggravate a variety of issues; these include headaches, brain fog, memory issues, continuation of loss of sense or smell, reduction in lung capacity, and damage to organs including the heart, kidneys, and liver. It is important to note, that long term symptoms can occur even after mild or moderate disease. (Mayo Clinic, "Coronoavirus Long Term Effects, European Journal of Epedimiology, Levin, Hanage, Boaitey, Cochran, Walsh, Katz, "Assessing the age specificity of infection fatality rates for COVID-19" (2020).)(https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-long-term-effects/art-20490351). While COVID-19 is a respiratory illness, the ACE2 Receptors of the virus can also attach to a variety of organs and systems in the body. This is why we have seen neurological impacts (such as “brain fog”, migraines, loss of taste and smell) and side effects in other body systems (blood clotting in pregnant women). This is an area that will continue to be researched and treatment options will be considered and develop with time. If you are experiencing Long COVID we would recommend finding a Primary Care Provider you trust to treat you and keep you up to date as data develops. Another rarer long-term sequalae of COVID is a condition called MIS or multisystem inflammatory syndrome. This occurs more often in children, although adult cases have been reported. MIS is an abnormal immune response that occurs after the patient has been infected with the SARS-CoV2 virus, even if the infection is mild. (Internal Journal of Biological Sciences, Dr. Susanna Esposito and Nicola Principi. “Multisystem Inflammatory Syndrome in Children Related to SARS-CoV-2” (2021)(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7819738/). Devastatingly, and perhaps most obviously, this illness is killing many individuals who are infected by it. Based on the most recent meta-analysis done on fatalities and age ranges, the following represents risk based on age group of dying from infection of COVID-19. Risk based on age group of dying from infection of COVID-19. Numbers rounded to their nearest round number. You can view the full chart here.(undefined) https://static.wixstatic.com/media/undefined Study: European Journal of Epedimiology, Levin, Hanage, Boaitey, Cochran, Walsh, Katz, "Assessing the age specificity of infection fatality rates for COVID-19" (2020).(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7721859/) As with most viruses, the data has shown that this disease is more devastating to patients who are older, have co-morbidities, or are immuno-compromised. As followers of Christ, this reality does not cause us to consider the loss of human life or death rates as any less severe.

Viruses have varying degrees of ability to spread. Therefore, the public health response to a variety of viruses will look different. Recent viral outbreaks in our lifetime of viruses like SARS, MERS, and Zika did not have as wide spread of a public health response due to the different nature of the viruses. The COVID-19 virus, on the other hand, is highly transmissible. Video: Vaccines, Herd Immunity, and Gummi Bears – Oh My!(https://www.youtube.com/watch?v=CPcC4oGB_o8) https://www.youtube.com/watch?v=CPcC4oGB_o8 Video: Herd Immunity: Understanding COVID-19(https://www.youtube.com/watch?v=6CXBLqLC1rw) https://www.youtube.com/watch?v=6CXBLqLC1rw Another important factor to consider in public health measures is herd immunity, as explained in the video above. Because there was no community or herd immunity to COVID-19 and this was an easily transmitted virus, there was a widespread public health response. In recent months, a mutation of COVID-19 called the Delta Variant has driven large concern due to its higher transmissibility. The Delta variant has a higher contagious rate – called the basic reproductive number or R0. The original SARS-CoV2 has an R0 of about 3, meaning every infected person will get 3 other people sick. The Delta variant has an R0 of about 6 to 7, meaning every infected person will get 6 to 7 other people sick. Infectious disease experts have used a “Swiss Cheese” model when approaching infection control responses to viral respiratory infections. We have found this imagery helpful as we consider how mitigation efforts work together for maximum effectiveness. As you observe the image below, each infection control measure is depicted as a piece of swiss cheese in the model. You’ll note that each piece has holes in it. This means that the individual measures are not 100% effective at stopping the spread of the virus on their own. Every intervention that science can use to mitigate a virus has some holes in it. Because no single measure is fool proof, a layered approach of infection control measures is recommended to reduce the risk of spread of COVID-19. Over the last 18 months, we have witnessed public health officials around the world recommend and sometimes enforce varying layers of mitigation efforts. Sometimes layers were added and subtracted based on the background communal spread of COVID-19 in a specific area or people group. If communal spread was lower, less mitigation procedures were needed. In times of higher outbreak levels, more mitigation efforts should be considered to help slow down or stop viral spread. https://static.wixstatic.com/media/undefined As time has gone on, there have been additional mitigation technologies in place to help prevent viral infection. At the beginning, testing was not available for COVID-19 but scientists quickly developed a variety of tests to help identify the disease and allow containment strategies to help limit spread. In December of 2020 a new layer in the swiss cheese model was added in the form of vaccines to help fight COVID-19 infections. As time goes on, there may be other mitigation efforts developed as new technologies and treatments are tested and evidence of effectiveness is demonstrated. As public health officials and healthcare workers promote mitigation efforts, they are doing so for a variety of reasons. Some of those include: • A desire to save individuals from dying from the illness or having a severe infection from the illness • A desire to limit the long term impacts of infection for individuals • A desire to protect hospital capacities from being over-run and limiting capacity to other emergent and ongoing needs (trauma incidents, heart attacks, chronic illness, etc)

The general public has had to participate in scientific conversations the past 18 months in unique ways. It can be difficult, confusing, and discouraging to try and decipher information especially as this topic has become highly politicized and divisive. It is crucial to ensure that we are consuming credible information and making well informed decisions. As scientists and healthcare workers practicing Evidence Based Medicine review studies and journal articles, their degrees and coarseloads included training on how to interpret the data collection, methodologies, statistical interpretation, and conclusions of scientific writings. As you do your own research on COVID-19 and vaccines, we’d encourage you to start with the many sources linked throughout these pages as they are credible, evidence-based resources from credentialed scientists and leaders in the faith community. As you find your own data to refer to, the following questions can help to discern how to consume the information. • What is the source? • Who wrote this? What are their credentials? What could potentially be motivating them? • Where was it published? Is it a peer-reviewed resource with accountability measures in place? Or is it independently posted online? • Am I viewing the information as a whole or just a piece of information that has been removed from context? Just like we would not interpret scripture without context, we cannot interpret data without context. • When viewing numbers/statistics: • What was the sample size? • Larger sample sizes more accurately represent the general public and help provide more realistic results for the population. • What is the baseline or denominator? • Ex: July 30th Headline states: “125,000 breakthrough cases”. This headline leaves out the context that at the time over 164 million have been vaccinated. So there have been less than .08% breakthrough cases in vaccinated individuals. • What is the trend? • This is a better metric to watch than a daily case count. Data showing exponential increase will tell you more than an isolated daily number. • What was the methodology in collecting data? Could data collection lead to skewed results? • Ex: if a survey was conducted on a social media platform, only individuals following that social media source would be answering the poll. There are probably implicit biases from this survey based on how the data was collected. Don’t forget: click bait headlines and social media is not our friend on scientific data. As we consume articles, be sure to read the entire thing and not get drawn into the clickbait of a salacious headline or social media post. Not only can anyone put something on the internet without verification of the data, but videos, photos, and pdfs can be edited to change their original content.