Understanding Coronavirus Disease (COVID-19) And Respiratory Infections
Updated: May 1, 2020
One way we can all reduce our anxiety about the coronavirus is by understanding it better. This article will help you do just that, using simple explanations that are easy to understand. Here, you will learn about the coronavirus disease, how it got its name, and how it is similar and different to other disease that can impact our airways. We will also explore the meaning of the different terms used to describe airway infections, including pneumonia, bronchitis, and pharyngitis. Let's dive right in!
Disclaimer: This article is published for information purposes only and is not intended to be used as treatment advice. People that have respiratory infections including COVID-19 need to be assessed by a medical professional. If you are having symptoms of coronavirus disease, please contact your local health provider. If you are in respiratory distress, call your local emergency service for immediate assistance. Always follow the advice given by your local public health authority. In Canada, consult the Public Health Agency of Canada's Coronavirus Disease Page and your province's and city's public health resources. You can also find reliable information on the World Health Organization's page: Coronavirus disease (COVID-19) advice for the public.
Understanding Coronavirus Disease (COVID-19)
Many different types of viruses can affect us and cause us to become sick. These have strange names like rhinoviruses, enteroviruses, adenoviruses. Some of these have names that we can more easily recognize, like influenza viruses and coronaviruses.
These viruses all affect our respiratory tract and can cause runny nose, sore throat and other symptoms. Your respiratory tract goes from your mouth and nose all the way to your lungs, and these viruses can create inflammation and symptoms in this area. The severity of illness we experience will depend on which type of virus is infecting us and the quality of our immune system's response.
If you have had previous exposure to a virus causing the common cold and have gotten better, your body develops antibodies specific to that virus and it is less likely to be able to infect you again. This is true for most viruses. So previous exposure and recovery account for a big part of how well your immune system is equipped to fight a certain virus.
Types of Respiratory Illnesses That Viruses Can Cause
Many viruses cause us little or no harm. For instance, the common cold is a mild illness that is caused by rhinoviruses and other types of viruses. We have all had colds before. The symptoms are a sore throat, runny nose, sneezing, a cough and a general feeling of being unwell (Common Cold, Merck Manual). The infection usually stays in our upper airways (throat, nose) and does not extend down into our lungs. And generally we will feel better within 10 days.
Other types of viruses such as influenza viruses, can cause influenza, which we commonly call the flu (Influenza, Merck Manual). Flu symptoms are often similar to cold symptoms. These disease can both give us a sore throat, runny nose, cough, and a general feeling of being unwell. But symptoms will usually be more intense with the flu, which can also cause fever, chills, a headache and body pains. With all of this, you can end up feeling like you have been run over by a train! The flu also comes on more abruptly, usually within a few days, while the onset of the common cold is slower (Cold vs Flu, CDC).
The flu can be mild if your immune system is strong, but as we have mentioned, it has the potential to be a more serious illness. It generally makes you weaker than the common cold and also has a higher chance of infecting deeper and lower areas of your respiratory tract. The deeper and lower the inflammation in your respiratory tract, the more serious the condition. An inflammation of your throat is called pharyngitis. If the inflammation makes it into the tubes sending the air into your lungs, this is called bronchitis. And if the inflammation gets all the way to the deepest part of your lung tissue, this is called pneumonia.
Pneumonia is an inflammation of the alveoli, sacs of air where the oxygen actually gets pumped into your blood stream (Pneumonia, Merck Manual). Inflammation at this part of your lungs will actually start to disrupt your body's ability to breathe and send fresh oxygen to your tissues. This is the most serious condition out of the three.
The viruses that cause the common cold can create inflammation in your throat (pharyngitis) and the tubes sending air into your lungs (bronchitis), but they cannot cause inflammation in your lungs (pneumonia). Influenza viruses, on the other hand, can cause pneumonia, and so can the particular strand of coronavirus that we are dealing with right now. (Pharyngitis, Harvard Health) (What Causes Acutes Bronchitis?, Harvard Health)
Other types of respiratory illnesses include croup and strep throat. Croup is an infection of the upper and lower airways. It is caused by parainfluenza virus type 1 and it usually does not lead to pneumonia. Strep throat is an inflammation of the throat (pharyngitis) caused by bacteria (Overview of Viral Respiratory Infections, Merck Manual). It can lead to pneumonia as a complication (Strep Throat Complications, MedicineNet).
It is important to note that pneumonia can be caused by bacteria, viruses and fungi. However, in adults over 30 years of age, pneumonia is most often caused by bacteria (Overview of Pneumonia, Merck Manual).
Coronavirus and COVID-19
So far, we have seen that viruses can cause inflammation at many different points along our respiratory tract, anywhere from the nose and throat all the way to the alveoli deep inside our lungs.
Now lets us look at the group of viruses called coronaviruses more specifically. Coronaviruses get their name from their crown-like or halo-like appearance. Corona is latin for "crown: or "halo". (Coronavirus, Wikipedia)
There are 7 types of coronaviruses that can affect humans and most of them are actually quite inoffensive. Indeed, 4 out of these 7 types simply cause symptoms of the common cold. Symptoms are not severe and are usually gone within 10 days. These will only rarely cause more severe infections like pneumonia (Coronaviruses and Acute Respiratory Syndromes, Merck Manual).
But the other 3 coronaviruses cause more severe respiratory infections which can sometimes be fatal. These 3 viruses are:
SARS-CoV: This virus causes the disease known as SARS, which stands for Severe Acute Respiratory Syndrome. This caused an outbreak in 2002.
MERS-CoV: This virus causes the disease known as MERS, which stands for Middle East Respiratory Syndrome. This caused an outbreak in 2012.
SARS-CoV2: This is the type of coronavirus that is causing the current epidemic in 2019-2020. We call the disease that it causes by the name "COVID-19", which stands for Coronavirus Disease 2019. This is because the outbreak started in 2019.
These viruses are much more dangerous and more likely to cause pneumonia and breathing complications. The MERS outbreak had a death rate of 35%. The SARS outbreak had a fatality rate of 10-15%. Similarly to COVID-19, the death rate was higher amongst older adults. People over 65 years of age, had a death rate of about 50%. COVID-19 has a death rate of about 1-3%, which is much lower than SARS but it is causing much more havoc on our lives than SARS.
This is because much less people got SARS. It infected only about 8000 people worldwide. It was more infectious than COVID-19, but the symptoms were also much more severe, so cases were easier to identify and isolate. Once infection control measures where implemented, the outbreak quickly got under control. (Compare: 2003 SARS Pandemic Versus 2020 COVID-19 Pandemic, Biospace)
COVID-19 is spreading much faster and this could be in part because it is causing only mild symptoms or even no symptoms at all in many people that could still be transmitting the virus to others. So many more people are getting it, and as a result, it is causing many more deaths than SARS did. Similarly to SARS, it is proving to be much more dangerous for older people. As of 6 April 2020, there have already been 1.2 million cases of COVID-19 with nearly 70,000 deaths, and many more are expected (Coronavirus Worldometer).
Coronavirus Symptoms (COVID-19)
As we have just explained, many people with coronavirus infections have no symptoms. But when symptoms do develop, the most common ones are fever, tiredness and a dry cough. Other symptoms can include body pains, sore throat, diarrhea, nausea, and a loss of the sense of taste or smell (Coronavirus, World Health Organization).
If the disease progresses deeper into the respiratory airways, reaching the lungs, shortness of breath becomes apparent. This is an important symptom and may require hospitalization, specially when the lungs can no longer transfer the right amount of oxygen to the body. In this case, COVID-19 has caused pneumonia. Such patients need to be monitored more closely. Now, let us look at pneumonia in greater detail.
What is pneumonia?
When the infection makes it all the way to the alveoli (air sacs) at the deepest portion of the lungs, there will be inflammation in this area and it will fill with fluid and inflammatory cells. Remember, this is where there oxygen from the air is supposed to make it through the walls of the air sacs and into our blood vessels. The blood vessels will then distribute the oxygen to all the cells in our body to keep us alive.
The current coronavirus (SARS-CoV2) creates inflammation and damages the wall of the air sacs as well as the blood vessels. As a result, the walls of the air sacs become thicker than normal, and the oxygen has difficulty passing through them to make it into the blood stream. As a result, breathing becomes more an more difficult. (Here’s the Damage Coronavirus (COVID-19) Can Do to Your Lungs, Cleveland Clinic)
This whole process is called pneumonia, which is an inflammation of the deepest part of the lungs. Most cases of pneumonia are usually caused by bacteria and will therefore improve with antibiotic treatment. Many cases will also affect just one part of the lung tissue. For instance, pneumonia might limit itself only to the lower part of right lung. But pneumonia caused by COVID-19 is particularly severe because it will usually affect many parts of the lung tissue in both lungs. (What happens to people's lungs when they get coronavirus?, The Guardian)
Pneumonia is usually the cause of death from coronavirus infections. If it progresses too far and the body is not able to heal the lung tissue, it will result in respiratory failure (lung failure). This means the body is not able to adequately take in oxygen and get rid of the carbon dioxide in the blood. As a result, the patient gets severely short of breath, his breathing becomes shallow and fast, and his skin may start to turn blue.
In the case of COVID-19, the type of respiratory failure seen is often called Acute Respiratory Distress Syndrome (ARDS). This happens when the someone is suddenly unable to breathe because of pneumonia or fluid accumulating in the lungs due to another type of injury. Patients will often be transferred to an Intensive Care Unit (ICU) where their blood oxygen can be monitored, a chest x-ray taken, and where they can get oxygen or mechanical ventilation if needed. (Acute Respiratory Distress Syndrome, Merck Manual)
Coronavirus Treatment (COVID-19)
Because there are currently no commonly accepted drugs available to treat COVID-19 (as of the date this article was published), the conventional treatment in hospital is to try to support the body and help manage the symptoms as much as possible (Treatments for COVID-19, Harvard Health).
It is important to remember that antibiotics cannot be used to treat COVID-19 because this disease is caused by a virus, while antibiotics target bacteria. Antibiotics will only be of partial help in cases where the patient has many different infections of his lungs, including both a COVID-19 infection and an added bacterial infection. In this case, antibiotics may be useful in helping to treat the part of infection caused by bacteria, but they have not been shown to help with the COVID-19 infection.
If the COVID-19 patient is unable to maintain adequate levels of oxygen in their blood, they will be given standard oxygen therapy through the nose or through a face mask. Here, the patient is breathing on their own but is just getting an extra boost of oxygen. However, if this is not enough for them to be able to get enough oxygen in their system, they will then be placed on a mechanical ventilator.
With a mechanical ventilator, the machine is actively pushing air in and out of the lungs, helping the patient breathe while also supplying added oxygen. The goal of oxygen therapy and mechanical ventilation is to buy the severely ill patients some time for their lung tissue to heal and for them to be able to once again breath on their own. (Clinical Management of Patients with Moderate to Severe COVID-19 - Interim Guidance, Government of Canada)
Most people with COVID-19 only experience mild illness. Only about 5-14% of people will need to be hospitalized. But for people with severe COVID-19 illness who need to have mechanical ventilation, the odds are not good. Preliminary studies show that half to two thirds of COVID-19 patients who require mechanical ventilation do not survive (Early study of COVID-19 patients shows high mortality rate, University of Washington School of Medicine) (The Health 202: At least half of covid-19 patients on ventilators don't make it, The Washington Post).
It is important to note however that younger people who do not have other significant illnesses generally do better on ventilators, and can have higher survival rates (Dr Richard Levitan, Coronavirus Daily Podcast, Q & A: Pets And COVID-19, Ventilators, And The View From Wuhan).
In any case, the best way to protect oneself against the coronavirus is not to get it in the first place. Thus the role of prevention.
What makes a pandemic so difficult to deal with is the shear number of people that can get sick all in a short period if time. This puts our health systems under such strain that there is literally not enough hospital beds, doctors, nurses and equipment for us to deal with all the people that are sick at the same time.
It then becomes a priority for us to limit the number of infections so that not everyone is sick at the same time. Our medical system can then give every person the care they deserve and doctors don't have to make horrible choices like deciding who to allocate a ventilator to when there aren't enough for all patients.
Public Health Agencies throughout the world have done a great job at educating the public about how to best prevent infections. This is the most important advice for all of us to follow and it includes:
Wash your hands frequently with soap and water for at least 20 seconds.
Use alcohol-based hand sanitizers if soap and water are not available.
Try not to touch your eyes nose and mouth.
Avoid physical contact when greeting. Greet people with a nod, wave or bow.
Cough and sneeze in your sleeve, not your hands
For as long as recommended by your local public health authority:
Practice physical distancing (2 meters or 6 feet).
Avoid non essential travel.
Wear a mask if recommended.
Avoid visiting older adults and those with chronic medical conditions as they are the most at risk of complications from COVID-19.
If you have a fever, cough, difficulty breathing or other symptoms of COVID-19:
Stay at home and practice self-isolation
Contact your local health provider, preferably first by phone.
If your symptoms worsen, especially if you have difficulty breathing, contact your local emergency response unit or seek rapid medical advice. (Coronavirus disease (COVID-19) advice for the public, World Health Organization) (Public Health Agency of Canada Flyer, April 2020)
Vaccines and Other Future Treatments
Many teams of researchers are working on developing a vaccine for COVID-19. There are also a number of other drugs and treatment methods that are currently being tested. But these treatments have not been approved and implemented as of yet. (Treatments for COVID-19, Harvard Health)
Homeopathy in Epidemics, Pneumonia, and COVID-19
As COVID-19 is a new disease, all the treatments for it first start in the experimental phase. Different treatments are studied for their efficacy before they are rolled out to the general public.
Several studies are being carried out in different parts of the world on the use of homeopathy as an adjunct in the current coronavirus disease epidemic. But the results are not out yet.
However, there is reason to be cautiously optimistic. The scientific basis for using homeopathy as an adjunct or complementary therapy in COVID-19 relies on 3 points which we will mention here. It is important however to note that using homeopathy as an adjunct or complementary therapy means that it is being used as an additional measure, on top of the public health measures advocated by the authorities and conventional medical treatment provided by physicians. In this way, homeopathy seeks to work in synergy with the medical field to help patients achieve their optimal level of health.
The use homeopathy as an adjunct or complementary therapy in COVID-19 relies of these 3 points:
1. The scientific evidence that shows that homeopathy as a whole is an effective modality.
For more on this read the Homeopathic Research Institute's (HRI): Homeopathy Clinical Trial Overview. HRI states:
"The most robust data on efficacy of homeopathy comes from a 2014 meta-analysis of placebo-controlled double-blind randomised controlled trials which found that homeopathic medicines, when prescribed during individualised treatment, are 1.5- to 2.0-times more likely to have a beneficial effect than placebo." (Mathie RT et al. Randomised placebo-controlled trials of individualised homeopathic treatment: systematic review and meta-analysis. Systematic Reviews, 2014; 3: 142)
2. Homeopathy has an extensive track record in epidemics and in the treatment of pneumonia.
Dr André Saine, from the Canadian Academy of Homeopathy, has written a detailed article summarizing the evidence for the use of homeopathy in epidemics and pneumonia (What do you consider to be the best clinical evidence supporting the efficacy of homeopathy for any indication?, Canadian Academy of Homeopathy).
3. The promising preliminary results of homeopathy being used as an adjunct or complementary therapy to help in COVID-19 patients.
Reports of the use of homeopathy in this epidemic are coming in from around the world. Homeopaths in China, Italy, Iran, the USA and many other countries have helped many patients with COVID-19 and shared case reports with their colleagues. Data is gradually accumulating. For instance, Paul Herscu, ND, MPH, reported that his clinic in the USA has provided adjunct or complementary homeopathy treatment to more then 200 patients with confirmed or suspected COVID-19. From these 200 patients, none have needed to be hospitalized (Webinar: A Concise Framework to Understand and Use Homeopathy During COVID-19, For the Time Period January-April 2020; 20 April 2020; New England).
Although this is not a scientific study, when we consider that 5% to 14% of COVID-19 usually need to be hospitalized, we can see that these clinical results are promising (CDC Releases Early Demographic Snapshot of Worst Coronavirus Cases, New York Times). We must add that Paul Herscu also uses supplements and other naturopathic advice when treating his patients. Therefore these results reflect the use of adjunct homeopathy care and naturopathy in patients who are also following the usual public health guidance.
Taken together, these 3 points show us that there is a basis for using homeopathy as an adjunct to help strengthen the overall health of patients suffering from COVID-19. They also indicate that homeopathy merits further research funding to explore its role in helping patients with respiratory infections.
It is important to note that Health Canada oversees the Canadian medical system and that it has not yet approved any treatments for COVID-19. As we have mentioned, the use of homeopathy as an adjunct or complementary therapy for COVID-19 is currently in the experimental phase. Although there is a basis for it's use, scientific studies on it's efficacy have not been published yet.
This Too Shall Pass
Although the current global coronavirus pandemic has impacted many of us in a significant way, we can take comfort the this quote from old Sufi poets. Indeed, "this too shall pass". All events in this world are temporary, and this current pandemic will eventually pass like others have before it.
With this in mind, we hope that you will find comfort in these difficult times. We also hope that this article has helped you gain a clearer understanding of the coronavirus disease and respiratory infections in general. Be well and stay safe.
The Public Health Agency of Canada's Coronavirus Information Page: Coronavirus disease (COVID-19) Outbreak Update.
The Public Health Agency of Canada's Coronavirus Information Hotline: 1-833-784-4397.
The World Health Organization's Coronavirus disease (COVID-19) Pandemic page.