In 2019, the severe acute respiratory syndrome SARS-CoV-2 or COVID-19 began affecting individuals in China. The virus made its way to other regions of the earth, eventually causing a global pandemic that led to millions of illnesses and deaths. As the pandemic has progressed, researchers have focused on identifying the specific mechanisms responsible for its symptoms. A team at Columbia University in New York has shown that the virus appears to alter fundamental protein structures associated with red blood cells.
Red Blood Cells and COVID-19
The primary symptoms of COVID-19 infection – shortness of breath, cough, and in some severe cases, respiratory failure and death – have proven the virus to be particularly harmful to lung cells. Previous research has shown that epithelial cells within the lung’s alveoli host many surface receptors that can bind with an enzyme known as angiotensin-converting enzyme 2, or ACE2. Unfortunately, COVID-19’s spike protein binds with ACE2, breaching the cellular membrane of any cell that can receive the enzyme and infect it. In this way, the disease is expressed within the respiratory system of those who contract it.
In addition, other research has identified surface proteins on human red blood cells that interact with ACE2, including angiotensin. Since red blood cells are primarily responsible for traveling throughout the body and binding to and transporting oxygen, scientists have hypothesized that COVID-19 may alter these surface proteins. If such an interaction is present, the virus could affect red blood cell’s hemoglobin counts and binding affinity for oxygen which, in turn, could affect the blood’s ability to transport oxygen and could severely reduce the amount of oxygen available to the body.
Red Blood Cells in COVID-19 Patients Versus Healthy Individuals
To learn more about how COVID-19 affects red blood cells, researchers utilized cutting-edge protein, metabolism, and other innovative research techniques to perform a study aimed at identifying damage caused by the virus. In the study, researchers compared blood samples from healthy individuals who had tested molecularly negative for COVID-19 with those taken from COVID-19 positive individuals. Overall, the study found that, compared to COVID-19 negative individuals, subjects with COVID-19 experienced increased glycolysis and sucrose consumption, as well as increased sugar intermediates in the blood.
In addition, COVID-19 red blood cells showed increased oxygenation and alteration of surface proteins. The increases in metabolites – specifically phosphates – seem to increase red blood cell’s ability to release oxygen. In theory, this behavior should counteract the low blood oxygen levels caused by the respiratory effects of COVID-19. However, the way COVID-19 alters surface proteins like AE1 negates any potential benefit.
Impacts of COVID-19
Since a specific portion of AE1 on the surface of red blood cells helps stabilize hemoglobin and facilitates the unloading of oxygen, the altered AE1 in a COVID-19 patient may be unable to respond to oxygen saturation as it changes in the blood. In particular, when red blood cells travel from the lungs to capillaries, COVID-19 may render them unable to serve their purpose. As a result, continued hypoxia could begin to harm multiple body systems, as seen in the most severely ill COVID-19 patients.
More research is needed to determine the extent of the virus’ alteration of red blood cell surface proteins and exactly how much the alterations truly affect hemoglobin’s affinity for oxygen and the blood’s ability to transport oxygen. However, it appears that protein damage is a primary way COVID-19 exerts critical damage to the respiratory and circulatory systems. With more knowledge about these key factors, researchers may be able to isolate a new approach to preventing damage and reversing the effects of this deadly disease.
How many of us lived with Mental illness without knowing? How many of us suffered without releasing what we are passing through?
The real question is how many of us know what is Mental Illness and aware of their Mental Health?
Mental health and mental illness are real problems that need people’s attention and understanding in order to enhance their quality of life. To ensure that everyone has a good understanding of mental health, we’ll describe it briefly. Mental health, according to medicine, refers to our emotional, psychological, and social well-being. It has a strong impact on our thoughts and feelings, and it has the ability to influence our actions.
Our decisions, responses to stress, and how we handle others may all be influenced by our mental health. Mental health is a part of every stage of our lives, with childhood being the most vulnerable, but also adolescence and adulthood.
We are all exposed to circumstances that can have an effect on our mental health, which can be temporary or permanent. We may be diagnosed with mental illness or poor mental health.
What is Mental Illness?
A mental, behavioral, or emotional disorder is characterized as mental illness, also known as a mental health disorder. Its effects vary from mild to moderate, and severe illness (serious mental illness).
While all stages of mental illness can have an impact on our quality of life, severe mental illness can trigger functional disability, limiting one or more of our main activities and social interactions. Depression, anxiety disorder, and schizophrenia are examples of mental health disorders.
It is true that medications are used to treat the majority of psychiatric illnesses, but it is important to remember that medication are not the only way to treat mental illness.
Signs of Mental illness
Mental disorder, like any other physical disease or issue, has symptoms. We would be able to cope with and treat mental illness earlier if we are aware of these signs. Therefore, here are some early signs that indicates you might be suffering from a mental disorder.
Having extreme mood swings without known reason that trigger relationship issues
Suffering from real but unexplained aches and pains
Suffering from a sense of helplessness or hopelessness even to serious issues in your life
Withdrawing from people and routine tasks
Heavy smoking, drinking, or drug use more than usual
Experiencing unusual levels of confusion, forgetfulness, agitation, rage, upset, worry, or fear coming from un-logical things
Having recurring feelings and experiences that you can’t shake
Hearing voices or believing things that aren’t real
Contemplating harming yourself or others
Inability to carry out everyday activities such as caring for your children or going to work or school.
There are some symptoms that you might be suffering from mental illness or have poor mental health. Always note that if you have some symptoms it’s not necessary that you have to mental illness. You could be going through a phase in your life that has caused your mental health to be marginally compromised in what we call poor mental health.
Mental illness Diagnosis
You cannot depend solely on what we have said to determine your mental state. When you believe you are not okay and that things are truly out of your control, you should consult a doctor for a proper medical diagnosis.
How Mental illness is diagnosed?
Physical exam: Doctors try through this test to perform a physical evaluation to see if it complement your symptoms and try to figure out the reason behind these symptoms. Like unexplained pain for example.
Lab tests: These are done to check the presence of certain hormones and chemicals in your body, check their levels, evaluate if they are normal or not, like serotonin and dopamine for example, and sometimes kynurenine that causes neurodegeneration.
This can include also checking gland functions, like thyroid and pituitary gland, or even screening the presence of alcohol and drugs.
This can help a lot and sometimes is very essential to perform.
A psychological evaluation: A diagnosis, which is a must in most cases with a psychological doctor. Where you can honestly talk about everything happening with you and feeling. This is a big part of determining symptoms and giving an accurate diagnosis.
Factors Causing Mental illness
Factors are variable and many, it is important to understand that some of us may have subjected to more than one factor resulting in a certain mental illness.
Neurodevelopmental causes occur during gestation where an embryo may have neurodevelopmental disorders resulting in abnormal neuron structure or function.
Neurodegenerative causes, where neurons structure is damaged and function is altered, due to some infections, like toxoplasmosis for example
Life experiences, such as stress or a history of abuse, especially if they happen in childhood
Biological factors such as genetics and chemicals
A traumatic brain injury life experiences, such as stress or a history of abuse, harassment, especially when it happen in childhood
Consuming alcohol and recreational drugs
Medical conditions like cancer or diabetes
As you can see, the causes and factors behind Mental illness are numerous, and every one of us may be subjected to one or more of them.
Male patient having consultation with doctor or psychiatrist who working on diagnostic examination on men’s health disease or mental illness in medical clinic or hospital mental health service center
Treatments of Mental Illness Away from Medical Drugs
For each type of mental illness, there are certain recommended therapies and practices away from using drugs. Drugs may be essential at a certain stage, especially in severe and developed cases of a mental disorder.
Let us discover the most recommended treatments for mental illnesses in general.
Brain Stimulation Therapies
This is one of the serious treatments away from medical drugs. It is used in cases of severe mental illness and considered the choice when no treatment gives a result.
There are different types of Brain stimulation Therapy:
1. Electroconvulsive therapy
which is the best and oldest therapy of this type. It’s about using an electric current for treating serious or severe cases of Depression, Schizophrenia, and Bipolar Disorder.
It’s recommended when the illness state is not showing any improvements and not getting better with other treatments like antidepressants and psychotherapy for example and when rapid responses are required.
It can also be used in life-threatening situations. This can be when a patient is unable to move or react to the outside world (catatonia) or is severely malnourished due to extreme depression.
2. Vagus Nerve Stimulation
Despite the fact that it was used to treat epilepsy, this procedure demonstrated its efficacy in treating extreme depression mental disorder. However, it is not recommended as first-line therapy.
Let us take the advantage of this technique to mention that neurotransmitters are from the major factors that play role in mental illness. There are some neurotransmitters that function in the brain and are directly associated with mood and here are they: serotonin, dopamine, acetylcholine, norepinephrine, GABA, and glutamate.
Why did we mention this?
Because this technique was found to alter the levels of a neurotransmitter associated with moods, such as serotonin, norepinephrine, GABA, and glutamate. This is how this technique play role in treating severe depression disorder.
3. Repetitive Transcranial Magnetic Stimulation (rTMS)
This technique was approved by the FDA as a treatment for patients suffering from depression and did not respond to other types of medications. It works by stimulating a specific part in the brain (left dorsolateral prefrontal cortex) through magnetic fields and electric current.
Actually, this part of the brain is where emotions and executive functions are processed and regulated, thus this is the strategy followed.
TMS is considered safe and non-invasive therapy.
4. Deep Brain Stimulation
This technique was initially developed to treat Parkinson’s disease symptoms, but it showed benefits in treating depression and Obsessive-Compulsive Disorder (OCD).
It’s still uncertain how this therapeutic strategy works to relieve depression or OCD, but scientists claim the pulses help to “reset” the malfunctioning brain region so that it can act normally again.
This type of therapy requires more studies to prove its function and figure all its side effects as well as other technique called Magnetic Seizure Therapy.
Psychotherapy
Psychotherapy is widely considered as the first-line treatment for a wide range of disorders. It is beneficial for mild to moderate conditions. Severe psychiatric disorders almost always necessitate medication, which is typically accompanied by psychotherapy.
Many of us are unaware of the numerous methods of psychotherapy. There are many types of psychotherapy, and each one is recommended depending on the individual’s condition, the therapy’s intent, and the stage of the disorder. The most well-known methods of psychotherapy are as follows.
Cognitive-Behavioral therapy (CBT): The most common one, where the therapist works on revealing the unhealthy patterns of thought and how they may be causing self-destructive behaviors and beliefs.
Dialectical behavior therapy (DBT) it aims to treat individuals who have chronic suicidal behavior with borderline personality disorder (BPD).
Eye movement desensitization and reprocessing therapy (EMDR) is used to treat Posttraumatic stress disorder (PTSD).
Exposure therapy is a form of cognitive behavioral therapy that is widely used to treat phobias, posttraumatic stress disorder, and obsessive-compulsive disorder.
Mentalization-based therapy (MBT) aims to improve the mental health of people with borderline personality disorder (BPD).
The importance of using behavior therapy and CBT as adjunctive treatments with drugs for bipolar I disorder and schizophrenia is supported by short-term and long-term clinical evidence. Psychotherapy techniques (primarily behavior modification, CBT, and IPT) have been shown to be effective as primary therapies (treatments of choice) for obsessive-compulsive disorder, panic disorder, and severe depression, as well as many other psychological conditions, in broad randomized clinical trials.
Meditation
Meditation is a widely used technique that benefits both the mind and the body. It benefits mental health, calmness, psychological balance, and physical health. It is about taking habits into the present moment and discovering the connections between the brain, mind, and actions.
In other words, meditation will help you strengthen your concentration and perception while remaining mentally clear, emotionally relaxed, and stable. It has been demonstrated to be effective in the treatment of mental disorders, especially depression and anxiety.
Yoga and massage therapy are also believed to be helpful for people suffering from mental disorders.
Mental health Disorders and Recommended Treatments and Practices
Aside from we had discussed above, it’s time to speak about the most common mental health disorders and best recommendations for each.
Depression and Anxiety
Depression, also known as major depressive disorder, is characterized by extreme depression and, in some cases, a loss of interest in daily activities and even in life. It has the ability to influence your feelings, thoughts, and actions. It has an impact on your emotions as well. This is due to alteration in dopamine, serotonin, and other neurotransmitter levels induced by a number of causes, including personal experiences.
Suicidal thoughts can arise as a result of severe depression, and many people attempt suicide after being diagnosed with depression.
People who are diagnosed with depression typically have more than two weeks of symptoms such as low self-esteem, loss of interest in generally fun activities, low energy, and pain with no apparent cause.
Anxiety is a disorder in which an individual has intense fear and concern about upcoming events. An anxious person may try to avoid all situations and events that he is concerned about, as well as feel constantly on the verge of danger and confusion.
It contains anxiety disorders such as GAD (Generalized Anxiety Disorder), panic disorder, and phobias.
Best practices and treatments for Depression and Anxiety
For mild and moderate phases of the disorder, it’s recommended to follow psychiatric therapy with a specialist as well as meditation.
In its severe state Brain stimulation therapy is an option along with anti-depressants and other medications.
What are recommended practices to help overcome depression and anxiety?
Try new things and activities
Break routines when needed
Set goals
Reduce caffeine intake
Load up on Omega-3 Fatty Acids and Folic Acid
Bipolar Disorder (BP)
It is also known as manic depression, and it is characterized by sudden mood shifts, in which a person may be very happy and then suddenly become very sad and depressed, or vice versa. Individuals suffering from this mental disorder can experience sleeping and thinking difficulties, as well as behavioral changes.
Other than medicine, what treatments and practices are used for Bipolar Disorder?
Starting with therapy is the first step and in this case, the best type is cognitive-behavioral therapy (CBT)and sometimes Interpersonal and social rhythm therapy (IPSRT).
IPSRT is a form of psychotherapy that is used for BP patients. It seeks to assist people suffering from bipolar disorder in the following ways:
Maintain a consistent routine.
Adopt healthy sleeping habits.
Learn how to cope with issues that happen during their everyday routine.
Meditation is also recommended.
When it’s in severe state, Brain Stimulation therapy may help and Electroconvulsive therapy as the most convenient type.
Schizophrenia
Another mental illness in which a patient loses contact with reality and experiences hallucinations, delusions, and unbalanced and disorganized thought. Furthermore, it has been discovered that people with schizophrenia have difficulties with both social interactions and emotions.
Schizophrenia, like other mental disorders such as bipolar disorder and depression, can be developed after birth as a result of diseases or accidents. A Schizophrenia, Bipolar disorder, and Obsessive-compulsive disorder, and surprisingly depression can be caused by a parasite!
Yes, a parasite known as Toxoplasma Gondii may cause these mental disorders. It is important for all of us to be aware of this parasite because we can become infected by food, such as meat and contaminated vegetables.
How do such parasites accomplish this?
Actually, it is our immune response to the parasite, not the parasite itself. Neurons can degenerate as a result of a complex process and sequence of reactions and interactions initiated by our immune response, certain receptors can be blocked, neurotransmitters can lose their equilibrium, and this can result in the aforementioned disorders, as well as Alzheimer’s.
In the case of schizophrenia, psychotherapy and medications may be the first-line therapies as well. If no outcomes or changes are achieved, Brain Stimulation Therapy (Electroconvulsive Therapy) can be considered in addition to medications.
Obsessive-Compulsive Disorder (OCD)
Is a mental illness in which a person does the same thing repeatedly. People suffering from this condition are unable to control their thoughts and constantly repeat them. Examples include hand washing, door inspection, and other related tasks.
Various forms of psychotherapy may be beneficial in this situation.
Cognitive-behavioral therapy (CBT) has been the preferred form of psychotherapy in the United States and Europe for decades, aiding patients in recognizing their thought patterns and how they affect their feelings and behavior. Recognition and Engagement Therapy (ACT) and Dialectical Behavioral Therapy (DBT), have also been shown to be effective.
Exposure and Response Prevention (ERP) therapy is another successful psychotherapy treatment for OCD.
Some beneficial practices:
Regular Exercises
Yoga
Acupuncture
Meditation
These practices are not a treatment but they showed their effectiveness in controlling the symptoms in patients of Obsessive Compulsive Disorder.
Posttraumatic stress disorder (PTSD)
This condition occurs as a result of shocks, dangerous or terrifying circumstances. It has been classified as a mental illness condition because of the severe and often long-term effects that occur after a traumatic incident such as an accident, war, disaster, sexual assault or raping, and so on. Both of these are incidents that trigger trauma after they occur.
Since this is a very common illness to which we are all especially vulnerable, understanding the symptoms is important before beginning care. The following are the most serious symptoms:
Flashbacks and reliving the trauma over and over again, with physical signs such as a pounding pulse or sweating
Bad dreams and Frightening thoughts
Avoiding locations, incidents, or things that are reminders of the traumatic incident
Avoiding thoughts or emotions relevant to the traumatic event
Pessimistic thoughts about oneself or the environment
Skewed feelings such as remorse or blame
Lack of interest in pleasant activities
To be classified as PTSD, symptoms must last longer than a month and be serious enough to disrupt relationships or work. The disease progresses in a variety of ways. Some people recover in 6 months, while others experience symptoms for much longer.
Medication is one type of treatment, but psychotherapy, which is necessary for both diagnosis and treatment. Cognitive behavioral therapy and exposure therapy are the most beneficial types of the psychotherapy.
Borderline Personality Disorder (BPD)
Is a mental health condition that causes difficulties in everyday life. BPD has an effect on how you think and feel about others, as well as yourself. As a result of these results, people experience self-image problems, dysfunctional relationships, and challenges controlling emotions and behaviors.
Someone with BPD can also struggle with accepting and tolerating being alone, experiencing mood swings, loving someone and wanting long-term relationships while pushing them away. Such a disorder begins in early adulthood, it can worsen and then improve with age.
Other symptoms like shifting goals rapidly, lose touch with reality for minutes or hours, risky behaviors, and suicidal behaviors.
This condition can be caused by environmental, social (traumas and experiences), genetic, or brain abnormalities.
Psychotherapy is a non-medication treatment choice. CBT and DBT are the preferred styles that can assist a patient in changing his attitudes, habits, and opinions of himself and others.
It also aids in the reduction of self-destructive habits and the control of strong emotions.
Panic Disorder, Phobias, and personality disorders are also other mental disorders where meditation, psychotherapy, and some practices can help a lot away from medicine.
COVID-19 Impact on Mental Health
The COVID-19 pandemic had a wide-ranging effect, including those on mental health. Many factors during the pandemic showed to affect everyone’s mental health, such as quarantine, loss of job and income, fear of infection, and losing people and family members in COVID-19, to name a few.
Such factors may intensify pre-existing mental conditions or contribute to the development of new mental illnesses; both cases can be related to depression, anxiety, and obsessive-compulsive disorder.
It is worth mentioning that COVID-19 can cause neurological and mental problems itself including delirium, hysteria, and stroke.
What makes the situation worse is the disruption of medical health services; although many countries, especially developing ones, have developed teletherapy, it is still insufficient to fill gaps and achieve desired results.
Since the end of 2019, the world has been facing the pandemic caused by Coronavirus (COVID-19), also known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).
It has infected 123 million people worldwide and has resulted in 2.71 deaths so far. Until now, no drug has been developed specifically to resist covid-19, and all drugs used have been designed for other purposes but have shown efficacy in resisting and killing covid-19.
A Brief about COVID-19 infection Mechanism and Target Organs
In COVID-19, too many misconceptions are raised, but the matter is clearer and simpler.
We all know that droplets carrying COVID-19 can enter the nose and the throat. The virus uses an angiotensin-converting enzyme 2 (ACE2) receptor, which is present on cells in the nose to invade them.
This receptor is also present throughout the body, which typically helps to control blood pressure.
This RNA virus uses our body cells and mimics its machinery to replicate and invade more cells, and after a few days, symptoms (fever, dry cough, sore throat, loss of smell and taste, etc.) may start to appear.
Pneumonia and Acute Respiratory Distress Syndrome (ARDS)
It all comes down to immunity! If your immune system is unable to defeat the virus in its early stages, the virus can spread to your lungs, thinner branches, and alveoli, which are abundant in cells that express the ACE2 receptor.
In normal circumstances, oxygen crosses through the alveoli into the capillaries, but how does this change during COVID-19?
White blood cells release inflammatory molecules (chemokines) in an effort to destroy and remove the virus, which recruits more immune cells to kill the virus, leaving pus behind. This is what disrupts natural oxygen transfer and induces pneumonia, manifested by coughing, fever, and difficulty breathing.
When things worsen and the immune response is insufficient, you can develop acute respiratory distress syndrome (ARDS), in which all of the immune reactions trigger lung injuries and necrosis, and fluid, mucus, and pus may leak into the lungs and cause severe and life-threatening conditions. Patients struggle to breathe as a result, and they need ventilators at this stage.
What are Organs Targeted and Affected by COVID-19?
Covid-19 begins in the nose, where certain people lose their sense of smell because the nerve end is damaged there. As mentioned earlier, the lungs are the main target organs where pneumonia and ARDS are developed.
Other target organs:
Brain: it’s been noticed that some covid-19 patients develop strokes, seizures, confusion, and brain inflammation.
Eyes: In serious cases, conjunctivitis, or inflammation of the membrane that lines the front of the eye and inner eyelid, is a common condition.
Heart: Infection can lead to blood clots, heart attacks, and inflammation in the heart.
Liver: Due to high enzymes level and drugs, the liver can be damaged.
Intestines: The virus can infect the ACE2 receptor-rich cells in the lower gastrointestinal tract, causing diarrhea sometimes.
Effective and Used Medications Against COVID-19
With all of the organs that the virus targets, as well as the severe complications and deaths it causes, it is necessary to use drugs to limit the virus’s viral impact and destroy it.
For this emergent need, existing drugs were tested and they show effectiveness against the virus, and they are commonly used now.
In the vast majority of cases of covid-19 infection, antiviral and other drugs are not needed. Supportive treatment, fluid therapy, vitamins, and immune-strengthening drugs can be appropriate for those with mild to moderate symptoms.
As you are aware, some people experience serious symptoms that necessitate medical antiviral treatment, which is often accompanied by antibacterial treatment and extensive oxygen support.
Before we begin with the medications, it is important to note that there are different medications and drugs prescribed for each case based on the patient’s condition and symptoms.
Remdesivir
Remdesivir is an antiviral drug that shows its ability to target a range of viruses. It was originally developed over a decade ago to treat hepatitis C and a cold-like virus called respiratory syncytial virus (RSV).
Although Remdesivir wasn’t an effective treatment for either disease, it showed promise against other viruses.
When covid-19 appears, scientists suggest that it may have antiviral effects against it, and they conducted medical trials and tests to check its effectiveness against SARS-CoV-2.
In February 2020, researchers began a randomized, controlled trial of the antiviral to see if it could be used to treat SARS-CoV-2, the coronavirus that causes COVID-19. Early findings in April showed that Remdesivir accelerated recovery in hospitalized patients with severe COVID-19. It was the first drug to be approved for emergency use by the US Food and Drug Administration (FDA) to treat people hospitalized with COVID-19.
Now, How Does Remdesivir works?
Remdesivir works by inhibiting the virus from replicating and limiting the number of copies it can make. Coronaviruses have ribonucleic acid genomes, as previously stated (RNA). Remdesivir prevents the virus from replicating RNA by interfering with one of its key enzymes. This stops the virus from multiplying and invading new cells, allowing the immune system to do its job.
Dexamethasone
Sometimes, immune reactions in our bodies generated against a certain infection can cause a problem itself. Swelling, for example, necrosis and other complications can be caused by immune reactions and this must be considered in the case of covid-19.
Here comes the role of Dexamethasone. First, let us define what Dexamethasone is.
Dexamethasone is a corticosteroid with anti-inflammatory and immunosuppressive properties that are used to treat a variety of conditions. It inhibits the release of inflammatory compounds in the body.
Dexamethasone is used to treat allergies, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, and breathing disorders, among other things.
It was tested in hospitalized patients with COVID-19 in the United Kingdom’s national clinical trial RECOVERY and was found to have benefits for critically ill patients.
According to preliminary results shared with WHO, the treatment reduced mortality by about one-third in patients on ventilators and by about one-fifth in patients needing only oxygen.
As a result, dexamethasone is strongly advised for covid-19 patients.
Therapeutic Management for Remdesivir and Dexamethasone
# For Non-hospitalized patients, having mild to moderate symptoms for using any antiviral therapy or even antibody therapy.
Dexamethasone or other corticoids are not recommended to use for such conditions.
By mentioning antibody therapy, let’s take the advantage of it and expand it a little.
Antibody therapy can be effective against viruses. This virus can bind to antibodies, preventing it from binding to cell receptors. Antibodies then form complexes and carry viruses to lymph nodes, where they are killed and eliminated. The same is true for Covid-19, where Anti-SARS-CoV-2 antibodies are designated to aid in the fight against virus infection.
Anti-SARS-CoV-2 antibody-based therapies may have the greatest chance of working in the early stages of infection before the host mounts an effective immune response. In this respect, preliminary data suggests that patients may benefit from receiving anti-SARS-CoV-2 monoclonal antibodies early in the course of infection, despite the lack of data from clinical trials to recommend either for or against the use of any particular treatment in this setting.
# For Hospitalized Patients that do not require oxygen Supply, the use of dexamethasone and other corticoids is not recommended.
Remdesivir may be appropriate in cases where there is a high risk of disease progression.
# Hospitalized Patients that require oxygen Supply, there are 3 recommended approaches.
Remdesivir: For patients that require minimal oxygen supply.
Dexamethasone and Remdesivir: For people that their health condition requires more oxygen supply.
Dexamethasone: In cases where the combination with Remdesivir is not recommended or when Remdesivir is not available.
# Hospitalized Patients that require oxygen supply through High- Flow device for example:
In this case, Dexamethasone is strongly recommended and has proved its efficiency. In rare cases where corticosteroids can be used, baricitinib plus Remdesivir can be used.
Also, Dexamethasone plus Remdesivir can be used.
# Hospitalized Patients who require invasive mechanical ventilation or EMCO, the use of Dexamethasone alone is the only recommended option.
However, other antiviral drugs are used, such as oseltamivir, ganciclovir, lopinavir, and ritonavir, which were given to 76% of SARS-CoV-2 patients at the time of studies in 2020.
Another study found that COVID-19 patients who received lopinavir/ritonavir plus ribavirin had better outcomes than those who received ribavirin alone.
But keep in mind that the antiviral drug Remdesivir, which inhibits the activity of the viral RNA-dependent RNA polymerase, is now the best treatment for COVID-19.
Antibiotics Use for COVID-19
Before we start discussing the use of antibiotics here, let us clarify something important. Antibiotics are drugs containing chemicals that target bacteria only and not viruses. Thus, antibiotics are not used for treating viral infections, the same thing is for covid-19.
Antibiotics usage in covid-19 is prescribed for patients having bacterial co-infections. They are prescribed to treat bacterial infections, limiting their effectiveness in the approach to reduce the mortality rate.
Pneumonia is developed mainly due to these bacterial infections besides acute respiratory syndrome, where the latter develops health risk and may lead to serious conditions and death.
But, why Bacterial coinfections are very common and increased during covid-19 infection?
When SARS-CoV-2 infection occurs and it reaches the lungs, it attaches to the cell through the receptor ACE2, when it replicates and produces many copies (new viruses), it damages the cell in order for the new viruses to reach out the blood and repeat their cycle.
When cells and infrastructure in the lungs are damaged accompanied by the existing immune reactions, more neutrophils and macrophages are attracted to the infection site, promoting more and more inflammation. This ends also by epithelial cells damaging facilitating the bacteria to adhere, invade cells and proliferate causing infections themselves.
What are these Bacteria?
So, now we all know that the mortality of viral infection and in our case covid-19 coronavirus, are caused by many factors such as bacterial co-infection.
These bacteria are mainly influenza-related bacterial infections that contribute to severe illness and mortality during the epidemic and seasonal influenza outbreaks. Example:
Worth mentioning also the possibility of fungal infections accompanied by covid-19 infection.
Azithromycin
Azithromycin is a macrolide antibiotic drug, with a broad spectrum against bacterial infections. It is used for the treatment of respiratory enteric, and genitourinary bacterial infections. It is known for its well-established safety profile, and its effectiveness especially bacterial pathogens in respiratory tract infections such as bronchitis and pneumonia.
However, when it comes to its usage in cases of COVID-19 with bacterial infections, there are some contradictions, between recommendations and exclusions for its usage.
Just a sneak on its work mechanism, it inhibits bacterial protein synthesis in a specific way and thus leading to bacterial cell death.
Azithromycin should not be used in the case of COVID-19 until there is a confirmed bacterial infection through tests and screening.
How can it be helpful in SARS-CoV-2?
As mentioned, uncontrolled and immune responses can cause serious conditions like Pneumonia. This is very frequent in COVID-19, and Azithromycin has the ability to modulate the inflammatory response and interrupt some pathways (those required to have a response) and thus reduce complication of viral pneumonia and can reduce the mortality rate in covid-19 infections.
Some early studies in 2020 showed results that support Azithromycin usage with COVID-19, where its usage combined with hydroxychloroquine, resulted in decrease the viral load in the body.
Antiviral Activity of Azithromycin
Isn’t an antibiotic? How does it have an antiviral effect against Covid-19?
Do not feel confused, some Data showed the ability of Azithromycin to induce certain genes (IFN) that produce some cytokines, which lead to reduced viral replication.
In addition, studies showed that Azithromycin could prevent the viral entry (Covid-19) to cells.
But how?
It interferes between the reaction that occurs between the virus spike protein and the receptor ACE2 found on our cells, however this requires more studies as it is conducted in 2020.
Hydroxychloroquine
To clarify, Hydroxychloroquine is not an antibiotic but rather an anti-parasitic drug that came as a derivative of chloroquine.
A pharmacist holds a bottle of the drug hydroxychloroquine on Monday, April 6, 2020, in Oakland, Calif.
Both Hydroxychloroquine and chloroquine are two medications that have proved their effectiveness to treat malaria and autoimmune conditions like rheumatoid arthritis and lupus.
Then, why are we speaking about it?
Chloroquine and hydroxychloroquine were both identified as potential drug candidates who had antiviral activity against the Middle East respiratory syndrome and severe acute respiratory syndrome (SARS) in vitro.
This was concluded from In vitro studies (studies done in a petri dish or test tube rather than in animals or humans) that previously showed that both hydroxychloroquine and chloroquine have antiviral properties against SARS-CoV-2, the virus that causes COVID-19.
In these studies, these medications worked by interfering with the chemical environment of human cell membranes. This blocked the virus from entering and multiplying inside the cells. But keep in mind that a medication tested in vitro with promising results, does not mean that it will work in the human body as well in the same manner.
But, there were a number of conducted studies, where they use hydroxychloroquine and chloroquine on covid-19 hospitalized patients gives positive results. For example, some studies performed in China, France in March 2020, showed that:
A study using chloroquine in China showed that 100 patients who received it did not develop the severe disease but a shorter illness duration compared to those who did not receive chloroquine.
Another study on 62 randomized people in China revealed that those who received hydroxychloroquine, their cough and fever symptoms improved faster.
A small study in France reported that people who received hydroxychloroquine tested to have a lower amount of the virus (viral load) in their bodies.
Using Combination of Hydroxychloroquine and Azithromycin to Treat COVID-19 patients
The antiviral activity of aminoquinolines, hydroxychloroquine, and chloroquine in vitro against SARS-CoV-2 has been verified, and a study found a synergistic effect of hydroxychloroquine with azithromycin against SARS-CoV-2.
These drugs emerged as possible low-cost therapies for people suffering from coronavirus disease 2019 (COVID-19), and they earned extensive and speculative coverage in the international press and from the US President.
Using Azithromycin and hydroxychloroquine started in early 2020, and studies were more in vitro. Those which were on hospitalized patients were having some issues and problems like different ages, different hospitals, small numbers and this is the most important as well as different countries.
As we are now in 2021, and also since July 2020, some studies are appearing and showed contradictory results, where they don’t recommend using Azithromycin and Hydroxychloroquine. Some reveal it shows no benefits, others show it increases mortality rate and causes some complications.
By applying more studies on a wider population all over the world from 2020 to 2021, the FDA announced its disapproval for using Hydroxychloroquine and chloroquine as a treatment or prevention for COVID-19. It also states that it makes no sense to believe that these medications are effective against Covid-19, after a year of the pandemic and its usage on many people.
These drugs may be a little effective, but not in the same way on all the population, so the FDA Panel doesn’t recommend anymore the use of chloroquine or hydroxychloroquine with or without azithromycin for the treatment of COVID-19 in hospitalized patients.
Since only a few studies confirmed its positivity and others show its negativity, were using medication don’t have different results from not using it, more studies are needed on larger and various populations.
It is important to remember that Azithromycin is only recommended to treat co-bacterial infections accompanied with COVID-19 and not applied for antiviral purposes.
Sticking to Remdesivir is the best choice as it is the only one showing antiviral covid-19 activity and approved by the FDA.
Other antibiotics, in addition to the well-known Azithromycin, were used to treat co-bacterial infection in SARS-CoV-2 patients, and were classified as critically important antimicrobials for human medicine by the WHO.
Vancomycin
Carbapenems
Tigecycline
Azithromycin
Ceftriaxone and linezolid
The Serious Issue Behind Using Antibiotics in Covid-19: Antimicrobial Resistance
Unfortunately, antibiotic prescribing and use were haphazard in covid-19, especially at the start, which is why there is always a need for the clarification we provided.
Many antibiotics are no longer effective because bacteria have established resistance to them. This is attributable to the indiscriminate and excessive use of antibiotics without following directions, rendering them useless and providing little benefit.
Here’s a fact: 30-40% of bacterial species have already developed resistance to azithromycin, which was used during covid-19. Perhaps this is why azithromycin did not show any benefit when used in Covid-19 cases.
This is a serious issue that we should be aware of, especially in Covid-19, where using antibiotics that bacteria are immune to is ineffective and there is a need to use other antibiotics that may or may not have the desired effect.
Antibiotic use in COVID-19 contributes to the development of antibiotic resistance in bacterial co-infection, which may lead to serious problems in the future.
Antibacterial drugs are given to 90% of COVID-19 patients in 2020, according to the data. This massive and rapid antibiotic administration may put bacterial pathogens under a lot of pressure to develop resistance, potentially leading to an increase in drug-resistant bacterial infections in the years following the COVID-19 pandemic.
In the last year, big amounts of antibiotics and antifungals were been used and administered, which definitely requires a warning of its consequences.
Antibiotics such as vancomycin, carbapenems, tigecycline, azithromycin, ceftriaxone, and linezolid till now are saving lives and especially patients with SARS-CoV-2 infections. But with decades, the current and unreasonable wide use of these antibiotics may be the reason for large numbers of death.
Antimicrobial resistance (AMR) currently kills around 700,000 people worldwide each year, including 230,000 from MDR tuberculosis, which is highly dangerous.
Every country has the potential to be affected. Regardless of the COVID-19 pandemic, it was predicted that by 2050, 10 million people would die from an antibiotic-resistant bacterial infection.
This prediction could be altered and shortened due to the devastating effect of the COVID-19 pandemic on antibiotic use.
It’s worth noting that patients who have received high-dose antibiotics are more likely to have drug-resistant bacteria co-infections.
The current pandemic highlights the critical importance of understanding the complex relationship that occurs between viral and bacterial infections.
COVID-19 outbreak is still an evolving situation. As research is still ongoing the vaccines available so far can differ with time. Therefore what is mentioned in this article may change in the future.
According to CDC (Centers for Disease control), the COVID-19 virus spreads mainly from person to person through respiratory droplets, from an infected person by coughing and sneezing. Virus gets in mainly by inhalation. People are most contagious when they are symptomatic. However, the virus can spread even during the incubation period that is around 14 days. There is also a high possibility to get infected by touching an object or a surface that is contaminated by the virus and touching your own nose and mouth.
Symptoms usually appear 2-14 days after exposure. Fever, cough (mainly dry cough) and shortness of breath are common symptoms, while headache, body aches and sore throat may also occur. Those who suffer from immunity disorders, elderly and those with other medical conditions such as ischemic heart disease, hypertension and diabetes are considered high risk for getting infected and to develop severe illness.
COVID-19 is a virulent virus that causes a higher death rate than other viral infections or influenza. It may spread easily in communities. COVID-19 respiratory disease was declared a Pandemic by the WHO on 11th of March 2020.
COVID-19 can give you serious life threatening complications. There is no way to know how this virus will affect you.
According to the UN chief Antonio Gutteres, “After a year of chaos, vaccines provide some light at the end of the tunnel”. However, with various different brands of vaccines being introduced by many leading biopharmaceutical companies, there surfaced some serious conflicts of opinion.
The first mass vaccination program was started in early December 2020. Vaccination is the safest and the most effective way to help you build protection against the COVID-19 virus. WHO has issued EUL (Emergency Use Listing) for several vaccines so far.
What is meant by Emergency use listing (EUL)?
EUL procedure assesses the suitability of any novel product during public health emergencies. The objective of the EUL is to make vaccines, medicines and diagnostics available as soon as possible to address health emergencies. While making sure that stringent criteria of quality, safety and efficacy are adhered to. This assessment weighs both the pros and cons. That is the threat posed by the health emergency as well as the advantage by using the product against possible risks. When it comes to EUL of a vaccine, independent experts and WHO teams consider all the evidence on vaccines, results from clinical trials and plans for monitoring its use. Once a vaccine has been listed for emergency use, WHO engages its regulatory networks to monitor the benefits and risks of the vaccine up to date.
World Health Organization issued an EUL first for Pfizer COVID-19 vaccine (BNT162b2) on 31st December 2020. Then EULs were issued for 2 versions of AstraZeneca /Oxford COVID-19 vaccine by the WHO. They are manufactured by the serum Institute of India and SKBio.
Once vaccines are demonstrated to be safe and efficacious, the national regulators must authorize it to be manufactured to exact standards and distributed. All approved vaccines require proper distribution with temperature control and rigorous stock management.
What are the vaccines approved by the FDA for the use in the US?
There are 3 COVID-19 vaccines that are FDA approved for the use in the US – Pfizer, Moderna and Johnson and Johnson (Janssen). All 3 types available in the US have been tested for safety and efficacy (while continuously monitored for safety) and all 3 are shown to be highly effective. While preventing infection, they are effective at preventing serious illness and complications due to COVID-19.
Due to the limited supply of the vaccines you should get whichever vaccine (out of these 3) that is offered to you. All 3 types help to prevent hospitalization and death from COVID-19. They also prevent you from getting moderate to severe COVID-19 illness.
Comparing the efficacy of COVID-19 Vaccines used in US
The Moderna two dose COVID vaccine is 94.1% effective
The first dose provides around 70% protection against COVID-19 infection. The second dose is considered as a booster dose. It further increases the immunity and gives up to 95% protection against this deadly virus. The second dose is recommended to be given 10 to 12 weeks after the first dose.
All eligible persons must be vaccinated. Currently ample scientific evidence is available for vaccinating everyone who are above 18 years of age, unless there are any contraindications.
Pfizer-BioNTech COVID-19 Vaccine
This is the first approved vaccine by the WHO for emergency use. It is a mRNA vaccine that is safe and effective. Since it was the first approved vaccine priority was given to health workers with high risk of exposure, followed by older adults before immunizing the rest of the population. When decision making is done whether to vaccinate, testing for prior infection is not recommended.
The vaccine should not be administered to persons younger than 16 years of age pending the results of further studies.
Protection or immunity will start to develop 12 days after getting the first dose of the Pfizer vaccine. However, full protection requires two doses. 2nd dose is recommended to be administered with a 21 – 28 day interval.
Pfizer vaccine has to be stored at -70C for up to 10 days to maximum 30 days unopened. Pfizer has temperature controlled thermal shippers utilizing dry ice to maintain this temperature. In hospital setting, this vaccine can be stored for 5 days at 2-8 C.
Who should not be vaccinated with Pfizer?
Those who are pregnant and breast feeding – they are not included in the vaccination campaign because there is no long term safety data
Children less than 16 years
People who have an ongoing fever related illness
Patients with a history of severe allergies
Moderna COVID-19 (mRNA – 1273) vaccine
Priority given to health workers at high risk of exposure and older adults for vaccination. Those of you who were infected with the virus can differ your own vaccination for up to 6 months from the time of infection.
Moderna vaccine can be offered to breast feeding women in the recommended priority group such as health workers. Following vaccination no need to discontinue breast feeding.
Pregnant women with high risk of exposure may be vaccinated in consultation with their health care provider.
Very frail elderly people with an anticipated life expectancy of less than 3 months can be exempted from the vaccine after individual assessment.
Use of the Moderna vaccine is recommended at a schedule of 2 doses (100 Micrograms, 0.5ml each) 28 days apart. If necessary this interval between the 2 doses can be extended to 42 days. Immunity from the Moderna vaccine starts 14 days after the 1st dose.
Moderna vaccine can be stored at regular freezer temperature at -20 C for up to 6 months. After thawing it can be kept in the refrigerator at 2 – 8 C for 30 days. It can be kept at room temperature for up to 12 hours.
Both Pfizer and Moderna vaccines are mRNA vaccines. This means part of the COVID-19 virus’s genetic code is injected in to the body that triggers the body to start making viral proteins, but not the full virus. This is enough to train our immune system to attack.
Janssen COVID-19 Vaccine (Johnson and Johnson)
This vaccine is administered as a single dose. It is given as an intra- muscular injection. Age limit is 18 years and older. Children, pregnant women and breast feeding mothers are not candidates for Janssen COVID-19 vaccine.
There is no data to support the use of Janssen COVID-19 vaccine to complete a vaccination series initiated with another type of COVID-19 vaccine. Administer this vaccine alone. Separate this vaccine by 14 days before and after the administration of other vaccinations.
Storage of Janssen vaccine – this can be refrigerated at a temperature of 2 – 8 C.
What are the factors common to all COVID-19 vaccines?
After each vaccination, observation should be done for at least 15 minutes for any reactions
Same product of the vaccine must be used for both doses.
Even after vaccination with any type of vaccine, safety measures like social distancing, wearing masks and hand washing should be adhered to.
Can people with chronic medical illnesses be vaccinated?
Patients who suffer from long standing lung diseases like asthma and COPD, heart disease, Diabetes, kidney disease, arthritis and those with chronic liver disease should undergo vaccination. These disease conditions put them at a higher risk of getting serious complications from COVID-19 infection. Therefore those with long standing illnesses should be prioritized and given the vaccine. Those who lead unhealthy life styles like smoking and chronic alcohol consumption should also receive the vaccine. There are studies being done among smokers that indicate an additional risk of developing COVID-19 related complications.
Those who are on warfarin (a blood thinning drug) can get immunized if their INR test value is less than 3. It is not necessary to stop warfarin before vaccination. If the INR value is higher than 3, opinion should be seeked from a medical specialist prior to getting vaccination due to the possibility of bleeding.
Patients who are immune-compromised or those taking immunosuppressive medications like cancer chemo therapy, radio therapy, prednisolone, Azathioprine, dexamethasone, Cyclosporin or tacrolimus can get vaccinated without any issues by any type of recommended vaccine.
Lot of queries are there whether the COVID-19 vaccines itself can cause the actual disease. But there is no such possibility because none of these vaccines contain the virus. The vaccines also cannot cause the PCR test to become positive.
Can you get vaccinated if you had a previous COVID-19 infection?
If you were already infected with COVID-19 and deemed cured, you should wait 2 to 4 weeks following recovery before getting any type of COVID vaccine.
What are the benefits of being vaccinated against the COVID-19 infection?
There are several benefits which you will get following vaccination. Following benefits are the most important.
Vaccination will reduce the chance of contracting the disease as a result of developing immune response to the virus. Developing immunity by vaccination means there is reduced risk of developing the illness and its consequences. This immunity will help you to fight the virus, if you are exposed.
Vaccination will decrease the severity of the disease as well as the need for hospitalization by 95%.
If this is put in to simple terms, the chance of acquiring a deadly illness is brought down by vaccination. If a vaccinated person gets infected, there will be only a remote possibility of severe complications and death.
Getting vaccinated can also protect the people around you. If you are protected from getting the infection and from the disease, you are less likely to infect someone near you. This is very important in protecting people of increased risk for severe disease from COVID-19, such as health care workers, elderly and patients with other medical conditions.
These benefits are seen in all approved vaccines for emergency use.
What are the common side effects of COVID-19 vaccines?
Pain at the injection site
Fatigue
Muscle aches and pains
Nausea and vomiting
Headache
Fever and chills
Most of these side effects will occur within 1 – 2 days following vaccination. They are usually mild to moderate in severity and commonly lasts only for 1 to 2 days.
Side effects after the 2nd injection can be more severe than the ones you experienced after your first dose. These side effects are usual signs that your body is gradually building protection. These side effects should go away within a few days.
When should you seek help?
Above mentioned simple side effects and even fever with chills are signs that your body is building immunity. Seek help from your doctor if;
The site of injection becomes red and tender and worsens after 24 hours
Worrying side effects that do not go away within a few days
Dial 911 if you or someone develop any features of a severe allergic reaction or anaphylaxis such as shortness of breath, feeling faintish, clammy skin, fast heartbeat, wheezing, collapsing or lose consciousness
What can you do to reduce these side effects?
If you develop fever and body aches you can take acetaminophen (Tylenol) in usual dosage.
You should hydrate yourself well by drinking water and other healthy liquids.
Carry out the routine activities without hindrance.
You can take a bath/ body wash after the vaccination
Is there a relationship between experiencing side effects and the degree of protection?
There is no such connection between side effects and the efficiency of the vaccine. However, you should continue to comply with wearing masks, hand washing and social distancing even after receiving both doses of the vaccine to assure further protection.
Can patients with allergies get the vaccine?
Patients with known allergies are advised to obtain the COVID-19 vaccine under medical supervision. They should be given the vaccine in a health care facility. This is considered when giving any type of COVID vaccine. Past history of severe allergies is a contraindication for vaccination.
What are the other types of COVID-19 vaccines used in other countries?
Several other vaccines have been developed and authorized for emergency use in other countries apart from the 3 vaccines used in US.
Oxford /AstraZeneca COVID-19 vaccine
This vaccine is made from a genetically engineered virus. Priority is given for health care workers, those with comorbidities and elderly. Vaccination is given for people who are 18 years and older. For pregnant and breast feeding women, especially those at a high risk of exposure may be vaccinated in consultation with their health care provider. They may receive the vaccine if the benefit outweighs the potential risk of vaccination.
Recommended dosage is 2 doses with an interval of 8 to 12 weeks. This is an intra-muscular injection.
2 versions of Oxford AstraZeneca vaccine have been listed for emergency use by WHO – produced by AstraZeneca – SKBio (Republic of Korea) and the Serum Institute of India. AZD 1222 vaccine has an efficacy of 63% against symptomatic COVID-19 infection. Larger dose intervals within 8 to 12 weeks range is known to be associated with greater efficacy of the vaccine. No data is available related to the impact of the vaccine on transmission and viral shedding.
The storage of Oxford/ AstraZeneca vaccine is at 2 – 8 C.
Sputnik V COVID-19 Vaccine (Gam-COVID-Vac)
This vaccine is developed by Russia’s Gamaleya National Centre of Epidemiology and Microbiology.
It is recommended that 2 doses should be administered 21 days apart.
There are 2 versions of the Sputnik Vaccine. When it comes to storage, one type needs to be freezed at -18 C while the other can be stored at 2-8 C in a standard refrigerator.
Russia’s Sputnik V has a 92% efficacy.
Novavax COVID-19 vaccine (NVX – Co V2373)
The clinical trials were conducted in the United Kingdom. This vaccine is also effective against both UK and South African variants of COVID -19.
It is made from a purified protein encoded by the genetic sequence of the virus. However, it cannot cause infection nor can it replicate.
Novavax COVID-19 vaccine is found to have an efficacy of 89.3%.
This vaccine can be stored at 2 – 8 C in a standard refrigerator.
China’s COVID-19 Vaccines – Sinovac and Sinopharm
These vaccines use killed viral particles to expose the body’s immune system to the COVID virus, without risking a serious disease response.
Both these vaccines can be stored in standard refrigerator at 2 – 8 C.
Vaccines which can be stored in standard refrigerators are a lot more useful for developing countries. Because they do not have adequate storage facilities for large amount of vaccines in freezers as well as facilities to maintain the cold chain at very low temperatures.
Efficacy of the Chinese vaccines vary from 50 – 70%.
Are there certain vaccines which are banned or being suspended in countries?
AstraZeneca’s vaccines are banned in several countries (so far 18 countries) over possible side effects.
Ex: Sweden, Germany, France, Italy, Spain
Few people have died after receiving the AstraZeneca shot. It is unclear whether the reported blood conditions caused their deaths. AstraZeneca COVID-19 vaccines have been suspended while investigations are still being carried out regarding its side effects. Therefore, this vaccine is not yet authorized for emergency use in the US. Still there is no evidence that this vaccine causes blood clots.
Some countries ban vaccines being stuck between the pandemic and politics. Although governments around the world are desperate for COVID vaccines, some countries are not only refusing vaccines produced by their rivals but officially banning them in their countries.
Ex: Ukraine banned Russian Sputnik V, but ordered Sinovac from China
Iranian government has banned all US and British made vaccines and approved Sputnik V.
Taiwan banning Chinese vaccines
Many governments battle publicly for limited doses and even accuse other countries of hoarding. Yet politics play a role which seems a bigger issue than the safety obtained from getting their people vaccinated.
Can you travel following vaccination?
Countries have different travel policies. If you wish to travel after getting vaccinated, your travel dates should start 14 days after receiving the 2nd dose. However, if you show potential symptoms of infection, you should avoid traveling. People still can contract the virus even after being fully vaccinated.
Take home message…
An immunized person can have the disease without symptoms because there is no 100% protection from any of these vaccines. There is also a possibility of them spreading the virus to healthy individuals. It takes time to develop the immunity. Therefore, it is of paramount importance that all of you who are vaccinated should adhere to and continue safety precautions regardless of whichever vaccine you received.
Safe and effective vaccines will be definitely a game changer. Being vaccinated doesn’t mean that we can avoid or throw precautionary health measures to the wind, because we then put ourselves and others at risk.
“My baby is breathing fast. He is wheezing. I brought him to the emergency department as soon as possible. Now the doctor is nebulizing my baby. I’m worried! Is my baby having asthma?”
This is a common worry of most parents if their baby gets a wheeze.
What is asthma?
Asthma is a common, chronic respiratory condition in children. It is a long term lung disease that makes your baby’s airways to become sensitive to certain triggers. In babies with asthma, the lungs and air ways can get inflamed easily when exposed to these trigger factors like pollen inhalation or when develop a respiratory infection such as a cold. Asthma in babies can lead to troublesome symptoms which can interfere with their sleep, feeding and play. In older children asthma can affect their daily routines like school, exercise and sports.
If asthma in babies are not managed properly, there may be sudden dangerous asthma attacks. Seeing your baby suffer from asthma is not easy. You may have to face various challenges. Asthma in babies have become a leading cause of emergency department visits and hospitalization. Unfortunately, asthma cannot be cured. The symptoms in your baby can continue in to adulthood. But the good news is with right management, you and your baby will be able to keep the symptoms under control and prevent further damage to the growing lungs.
What are the signs and symptoms of Asthma in babies?
The signs and symptoms of asthma in your baby will depend on the severity of the attack. The common signs and symptoms include:
Frequent cough – Cough can be seen while your baby is up and sometimes the frequency increases while your baby is asleep. Cough can be triggered by cold air or exercise. Coughing will be worse when your baby has an associated viral infection such as a common cold. Cough is either constant or it will come and go intermittently. Nocturnal cough (coughing at night) is a common symptom in asthmatic babies. Sometimes it is so disheartening to see frequent cough making your baby vomit all the milk and other foods which was consumed earlier.
Wheezing – Wheezing is a high pitched whistling sound that is heard while breathing. It is heard very clearly when your baby exhales (breathes out). When the asthma attack is severe, wheezing can be heard even when your baby inhales (breathing in). Wheezing may be a symptom of serious breathing problems in your baby.
Shortness of breath or troubled breathing – You may notice rapid breathing in your baby. Sometimes the breathing is labored that you will see the chest drawing in. Shortness of breath is medically known as dyspnea. It is often described as an intense tightening in chest, difficulty breathing, air hunger, breathlessness or feeling of suffocation. Asthma may give rise to all these described features. However, in a healthy person shortness of breath can be caused by high altitudes, very strenuous exercise, extreme temperatures and obesity. You will notice that your baby is working harder than usual to breathe. There may be flaring of the nostrils, skin sucking in between and around ribs or above the sternum and exaggerated belly movements.
Chest congestion and tightness – If your baby is old enough to communicate, he or she will indicate a discomfort or heaviness in the chest.
Noisy breathing – breathing is noisy in asthmatic babies. You will notice this especially while they are asleep.
Other less common signs and symptoms are:
Bouts of coughing that may worsen with a flu or a cold. Cough can be intermittent or constant. Crying, yelling, laughing and other strong emotional reactions can trigger wheezing and coughing in your baby.
Cough may be productive because of increased production of mucus. Your baby will cough out or vomit clear, yellow or greenish mucus.
Wheezing that worsen when your baby has a respiratory infection.
Your baby may have trouble sleeping due to frequent coughing, wheezing and shortness of breath.
Crying without any reason – The babies who cannot express themselves will cry often because of their discomfort. Crying will further increase the nose block and congestion, which in turn will worsen the troubled breathing and breathlessness.
If your baby gets a respiratory infection, it will take time to recover, when compared with the babies who do not have asthma. Sometimes delayed recovery may be due to bronchitis, which can occur with worsening respiratory infections.
Your baby will be tired or fatigued due to poor sleep and frequent coughing.
Poor feeding – It will be difficult to feed babies who are chronically ill. If your baby gets frequent asthma attacks, your baby will show features of failure to thrive as feeding patterns will be interfered with the sickness.
Poor sucking – breast fed babies will not suck satisfactorily while having asthma attacks. Since they often breathe with their mouths open, sucking will disturb their breathing. Therefore, they refuse to suck milk from breasts.
Loss of appetite – not even breast milk, even formula and other foods will be refused by your sick baby most of the time. Asthma symptoms as well as the medications can reduce the appetite in your baby.
Because of their labored and troubled breathing, these babies will be less active. Asthma attacks can hamper their play and exercise.
Signs and symptoms will also vary from child to child. Your baby can get better or worse with time. Some babies will only have one or two symptoms such as a long term cough or chest congestion, which may be the only indication that they have asthma. Sometimes it will be difficult to tell that your child’s symptoms are due to having asthma. Periodic wheezing, long term wheeze and other asthma like symptoms can be due to infectious bronchitis, bronchiolitis or other respiratory problems in babies.
If there is a family history of asthma or atopy in the family, having these symptoms may point towards asthma.
What is atopy?
Atopy is the genetic tendency to develop allergic diseases like asthma, allergic rhinitis (hay fever) and atopic dermatitis (eczema). Atopy can run in families. It is typically associated with heightened immune response to common allergens, especially inhaled and food allergens.
When should you seek help?
Take your baby to see a doctor, if you suspect that he or she has asthma. Even though you are not 100% sure of asthma, if there are such symptoms it is best to visit your baby’s health care provider or a pediatrician. Early treatment will help to control symptoms in your baby and preventing your baby from developing asthma attacks which may be life threatening.
Seek help if:
Your baby has intermittent or constant cough – which may be linked with activities
Rapid breathing or shortness of breath
Wheezing or whistling sounds heard when your baby breathes out
Features of chest congestion or if your baby indicates a chest discomfort
If your baby develops repeated episodes of suspected pneumonia or bronchitis.
Seek emergency treatment if your baby seems very ill with cough and struggled breathing. You will notice that your baby’s chest and sides of the neck pulling inwards while he or she struggles to breathe. Your baby will have a rapid heartbeat, rapid breathing and sweating. Non stoppable crying while attempting to breathe is also a feature of an emergency.
Seek emergency care if:
Your baby uses his or her abdominal muscles to breathe
When breathing in, nostrils are widened
If your baby tries so hard to breathe, you may notice that your baby’s abdomen is sucked in under the ribs when he or she breathes in.
If there are such symptoms, seek help without delay.
Sometimes you may not know that your baby is having asthma. A diagnosis may not have been made previously. But if your baby has such symptoms seek medical attention immediately.
Episodes of asthma can vary in severity. An asthma attack can start with a cough, but later progress to wheezing and labored breathing.
What are the causes and trigger factors of asthma?
Causes of childhood asthma are not completely understood. Sometimes your baby may develop asthma due to following reasons.
Family history of atopy – genetic tendency to develop allergies
If there is a family history of asthma in parents, siblings etc.
Exposure of your baby to various environment factors like polluted air, cigarette smoke, etc.
If your baby developed air way infections early in life
When your baby is exposed to certain trigger factors, the sensitivity of your baby’s immune system will increase. This can lead to swelling of air ways and lungs and increased production of mucus.
Trigger factors, just like the symptoms may also vary from child to child. What triggers an asthma attack in your baby may differ from those of other babies with asthma. Sometimes the reaction to a certain trigger may be delayed. Therefore, it will be difficult to identify the trigger. Sometimes there is no apparent trigger to develop asthma symptoms.
Common triggers of asthma are:
Allergies to pet dander, pollen, dust mite or mold
Exposure to pollutants in the air – Ex: Cigarette smoke
Viral infections like common cold and flu
Cold air and changes of weather
Physical activities and playing
VOC emitting materials. (Window Furnishings, Certain types of Paints, Carpeting, Rugs, Furniture, Textiles, Building materials). Try to source quality materials that have low VOC emissions. You can view this insightful study into the effects of VOC’s on your health.
What are the risk factors that may increase your baby’s likelihood of developing asthma?
If there is a family history of asthma or other allergies
Exposure to tobacco smoke, even while in the mother’s womb
Living in a highly polluted environment
Previous allergic reactions in your baby including food allergies, skin reactions or allergic rhinitis (hay fever)
Gastro esophageal reflux disease (GERD) in your baby is also a risk factor which causes frequent heart burn
Having other respiratory conditions like rhinitis (chronic runny nose or stuffy nose), sinusitis (inflamed sinuses) or previous pneumonia
Being a male baby will increase the risk of developing asthma
Are you and your baby a Puerto Rican or black? Then the risk is more
What are the complications of uncontrolled asthma?
Asthma, especially if not managed properly, can give rise to many complications.
If the asthma attacks in your baby are severe, they will require emergency treatment and many hospital admissions
Poor sleep and fatigue
Your baby’s lung function may permanently decline when having uncontrolled asthma since a very young age
The symptoms can interfere with play, feeding and other activities in your baby
Failure to thrive in your baby
What is known as failure to thrive in babies?
Failure to thrive is a term used to describe inadequate growth or inability to maintain a healthy growth, usually during early childhood. It is a sign of malnutrition or under nutrition. Suffering from a chronic illness like asthma can lead to failure to thrive in babies. This is partly because of poor feeding during periods of asthma attacks.
Why do these symptoms arise in asthmatic babies?
When your baby is exposed to certain triggers, several things can happen to your baby’s air way.
The lining around your baby’s air ways will start to swell. This is due to inflammation of the inside lining which happens mainly due to inhaled allergens. Swelling narrows your baby’s air ways that may lead to labored breathing.
The muscles around the air ways may tighten. Therefore, wheezing and whistling sounds can arise when your baby is breathing out. Your baby will have to push the air out through a narrow air way, which makes the whistling sounds or the wheeze.
Your baby’s air ways will make thick mucus than normal. So, the cough will be phlegmy and the breathing noisy.
Babies are more at risk of wheezing because their air ways are very small. These passages which are already small, when inflamed can swell up and fill with mucus more easily than an older child’s or an adult’s air passages. These reactions will make your baby’s air ways narrow. This in turn will make it difficult for air to go in to and out of your baby’s lungs, giving rise to the symptoms of asthma.
Babies with asthma do not have symptoms all the time. Usually they have a few symptoms like cough. But sometimes symptoms can flare up when exposed to triggers.
Some other health conditions can give rise to similar signs and symptoms of asthma. Ex: heart disease in babies
Therefore if your child has one or more of these symptoms, visit your baby’s health care provider for further evaluation and diagnosis.
How is asthma diagnosed in your baby?
After taking a thorough history and doing a physical examination, your baby’s doctor will recommend the following tests.
Blood tests – your doctor will be able to know the levels of certain white blood cells which may be elevated in response to allergies and infection.
Spirometry – Lung function of your baby will be checked by using a device called the spirometer. This test can be done in adults as well as children, including infants. Spirometry is done to assess how well your baby’s lungs work by measuring how much air he or she inhales, how much air is exhaled and how quickly exhalation is done. It is used to diagnose not only asthma, but also other conditions which affect breathing such as chronic obstructive pulmonary disease.
Chest x ray (CXR) – Invisible energy beams are used to make images of your baby’s chest. An x ray of the chest will produce images of your baby’s lungs, airways, heart, blood vessels and the bones of the spine and rib cage. Chest X ray (radiograph) is a non- invasive diagnostic test commonly performed in health care facilities.
Allergy tests – These will show whether your baby is having allergies that can cause or worsen his or her asthma. Skin prick testing is a commonly used allergy test. A drop of liquid which contains a substance which your baby may be allergic to is put to the fore arm of your baby. The skin under this drop is then gently pricked. If your baby is allergic to this substance, an itchy red bump will appear at the site within 15 minutes.
One instance or episode of wheezing is not enough to diagnose asthma. Wheezing episodes should happen more than once. Most babies who wheeze, outgrow it with time and don’t have asthma when they grow older. Therefore, doctors usually don’t make an asthma diagnosis until your baby is older, by about 4 to 5 years of age. Meantime, your baby’s health care provider will treat those asthma like symptoms without labeling your baby as asthma. Asthma will be officially diagnosed if the symptoms continue.
You can share your worries and concerns with your baby’s doctor and inquire about possible asthma in your baby. This may be likely if your baby has;
Prolonged coughing or coughing that gets worse at night or after active playing
Wheezing which has occurred more than once, even if it is without any illness
Any other breathing problems in your baby which concerns you
How is asthma treated?
Diagnosing and managing asthma in babies can be challenging and difficult. Some effective treatment available for adults and older children are not recommended for babies. Careful and frequent monitoring is needed when treating a baby with asthma. Your doctor will discuss with you and write down an asthma action plan. You can minimize your baby’s asthma symptoms by following these instructions. Your asthma diary will help to monitor symptoms and to adjust the treatment accordingly.
Treatment will depend on your baby’s age, symptoms, general health and how severe the condition is. Sometimes your baby may be referred to a pulmonologist or an asthma and allergy specialist.
Treatment will include looking for triggers and will teach you ways of how to avoid these triggers for your baby. It will be easy for your doctor to decide, if you maintain a diary on your baby’s symptoms and possible causes which you think that triggered these symptoms.
Your baby will be prescribed asthma medications to reduce the symptoms. Reducing the symptoms is one of the main goals of treatment.
Bronchodilators – They will help to open up the narrowed air ways. In asthma, the air way narrowing is reversible. Therefore, bronchodilators will relieve your baby’s coughing, shortness of breath, wheezing and difficulty in breathing, thus improving the main symptoms of asthma. Short acting bronchodilators like salbutamol and ipravent provide immediate relief of asthma symptoms. Their effects last for 4 to 6 hours. These are used to control the attack and not as long term medications.
Anti- inflammatory medications – The inflammation of the air ways will be decreased, which will relieve the symptoms like cough and wheeze. For long term control and maintenance these should be taken daily.
An inhaler can be used with a spacer and a mask to administer the drug to your baby.
Long acting beta agonist like Salmeterol can be combined with inhaled corticosteroid treatment regimen.
Anti- Leukotrienes – these will reduce the narrowing of the air ways. Leukotriene modifiers like Montelukast comes as chewable tablets as well as in granular form. You can add it to your baby’s pureed food.
Oral corticosteroids are only used when asthma cannot be controlled with other treatments because of their side effects.
A nebulizer can be used to deliver the drugs when it is difficult to get the babies to use an inhaler device. Nebulizer turns the medication in to a fine mist for your baby to inhale through the face mask.
Asthma is treated by controlling inflammation with drugs, avoiding trigger factors when possible and by using medications to treat an asthma attack. As asthma is chronic and ongoing inflammation of lungs and air ways, treating inflammation is mandatory because the inflammation makes your baby’s air ways vulnerable to asthma attacks.
You can also make changes to your home to control the asthma triggers. This will minimize your child’s exposure to triggers.
Clean your house well to control pet dander and dust
Avoid taking your child outdoors during pollen season. You can check pollen count reports.
Several thousand people gathered on Saturday at noon in Vienna, in the Prater park, to demonstrate against the restrictions imposed under the pretext of the coronavirus pandemic, informs DPA.
If the organizers expected a presence of 3,000 people, the “responsible” press announced the presence of “several hundred” protesters. Other similar protests took place in Stockholm and Paris.
Protesters in Vienna carried national flags and various banners, some of them displaying messages demanding the resignation of Chancellor Sebastian Kurz, according to the Austrian news agency APA.
The demonstration entitled “Democracy, Fundamental Rights and Freedom” was partially supported by the opposition, with the right-wing party FPO (Freedom Party) promoting the idea.
Former Freedom Party Home Secretary Herbert Kickl spoke to the crowd, accusing the current government of pursuing a “crazy and bizarre” policy. Other representatives of the protest movement also spoke.
People’s grievances include the closure of restaurants and cafes, as well as the mandatory testing of students who returned to school in February, when the most recent lockdown in Austria expired.
There was also a left-wing counter-demonstration, in which several hundred people gathered for a bicycle march, while other announced demonstrations did not receive permission.
Austria, a country with only 8 (eight) million people, stops vaccinating with a batch of AstraZeneca after a nurse died after vaccination. The AstraZeneca vaccine contains, according to its leaflet: “Genetically modified human embryo kidney cells (HEK), cell line 293 and recombinant DNA technology. This medicine contains genetically modified organisms (GMOs). “
“The Federal Office for Health Safety (BASG) has received two reports of vaccinations with the same tranche of AstraZeneca vaccine in the Zwettl district,” Austrian health officials said on Sunday, quoted by the international press. A 49-year-old woman died of severe blood clotting problems, while another 35-year-old developed a pulmonary embolism and is recovering.
The newspaper “Niederoesterreichische Nachrichten“, as well as the ORF and the APA news agency reported that the two women are nurses at the clinic in Zwettl.
“As a precaution, the remaining stocks of that vaccine lot are no longer used,” the health authorities added.
AstraZeneca did not comment on the two “incidents”.
Pfizer CEO Albert Bourla was forced to reschedule his business visit to Israel, the world champion vaccination state, because it turned out that he was not completely vaccinated against the new coronavirus, and Israel introduced the so-called ” green passports ” recently.
According to The Jerusalem Post, both Albert Bourla and some members of the delegation who were to accompany him during his visit to Israel have not yet received the second dose of the Covid vaccine.
Consequently, it was decided to postpone the visit for a few days, which also raised a logistical problem, given the incoming elections in Israel.
The head of the company that produces the Comirnaty vaccine had stated in December that he was in no hurry to get vaccinated, motivating that he did not want to take it before those who have priority and that he would wait until it was his turn. So far, he has only been injected with the first dose, but not yet with the second.
“We are still interested in visiting Israel and meeting with local decision-makers,” a Pfizer spokesman told N12. “The visit to Israel will probably be rescheduled for the end of spring.” The Achrayut Leumit (National Responsibility) movement on Wednesday sent a letter to Albert Bourla, Prime Minister Benjamin Netanyahu, state comptroller and ombudsman Matanyahu Englman, asking the executive director of Pfizer to postpone his visit until after the election.
We believe that Mr Bourla’s participation in events where he will be photographed with the current prime minister would contribute to illegal election support, which is a crime, “said Oshi Elmaliach, an adviser to Achrayut Leumit’s director who is seen as a close ally of former prime minister Ehud Barak.
Elmaliach threatened that any such propaganda would lead to a complaint to Ombudsman Englman, the Central Electoral Committee and, if necessary, to the Israeli Police, for violating electoral propaganda laws.
Netanyahu said last week that the purpose of Albert Bourla’s visit was to discuss the construction of a Pfizer plant in Israel to produce the Covid vaccine.
Pfizer’s CEO is the son of Jews who survived the Holocaust in World War II, when some doctors in Nazi camps experimented with humans, subjecting them to “treatments” that most often resulted in their deaths. After the end of the war, the first of the 12 Nuremberg trials, the Doctors Trial, took place between December 1946 and August 1947 and led to the sentencing of 23 Nazi doctors to death or years in prison.
In 1947, the “Nuremberg Code” stipulated, in its 10 points, that any medical experiment will be done only with the express consent of the person made available to the work team, a team that has the obligation to inform him about everything which is supposed to produce that experiment: beneficial effects, side effects, risk of injury, death, illness.
The informed consent of the patient is, therefore, a reparative consequence of the crimes of Nazism.
Given that the vaccination against Covid with experimental sera, insufficiently tested, has become widespread in forms close to mandatory and in the absence of real information about adverse effects, we can ask what humanity has learned from the mistakes of the past.
