An Update from us on COVID-19

With all of the heightened questions and concerns regarding COVID-19 from CVS patients and their caregivers from around the globe, CVSA consulted the World CVS expert, Dr. Venkatesan.

What is COVID-19?

Coronavirus disease 2019, or “COVID-19,” is an infection caused by a virus called SARS-CoV-2. The virus first appeared in late 2019 in China, but it has spread quickly since then, and is increasing in incidence in Europe, the United States, and the rest of the world.(1, 2) COVID-19 mainly spreads from person to person, similar to the flu. This usually happens when a sick person coughs or sneezes near other people. Doctors also think it is possible to get sick if you touch a surface that has the virus on it and then touch your mouth, nose, or eyes. There is some evidence to suggest that the virus is also shed in your stools, but it is not clear that if the oro-fecal route is a mode of transmission.(3)

COVID-19 seems to spread most easily when people are showing symptoms. It is possible to spread it without having symptoms too, but experts don’t know how often this happens.

What are some of the symptoms of COVID-19?

Symptoms will usually start a few days after a person is infected with the virus. But in some people, it can take up to 2 weeks for symptoms to appear.

Symptoms can include:

  • Fever
  • Cough
  • Feeling tired
  • Trouble breathing
  • Muscle aches

Although it is less common, some people have other symptoms, such as headache, sore throat, runny nose, or problems with their sense of taste or smell.

Some have digestive problems like nausea or diarrhea. A recent study of about 200 patients from China noted that a large number of patients (~ 50%) presented with diarrhea, loss of appetite, nausea, and abdominal pain. Diarrhea was noted in approximately 18% and other GI symptoms (loss of appetite, nausea and abdominal pain) were rare.(4) However, respiratory symptoms like cough and fever were also present later in almost all of these cases. There was some concern that this may cause a delay in testing for COVID-19 in these patients. Currently, the CDC is not recommending testing for COVID-19 when patients only have GI symptoms. If you have any GI symptoms that are not typical for you, please contact your primary care physician to see if you need to be tested for COVID-19. Other non-respiratory symptoms that patients with COVID-19 could have include a loss of smell or taste in some cases. Please discuss this with your primary care doctor if you develop these symptoms suddenly. (6)

What will happen if I get COVID-19?

Most people (>80%) will have mild symptoms. Some people will have no symptoms at all. But in other people, COVID-19 can lead to serious problems like pneumonia, not getting enough oxygen, heart problems, or even death. This is more common in people who are older or have other health problems like heart disease, diabetes, lung disease, or cancer.

COVID-19 in CVS

Cyclic vomiting syndrome is NOT considered an immunocompromised state. This means that your immunity or ability to fight infection is similar to normal individuals. Rather it is a disorder of gut-brain interaction (DGBI). However, respiratory tract infections may trigger symptoms in some patients with CVS. There is no data to suggest that COVID-19 will be worse in CVS patients. If you have additional problems or autoimmune problems, you should be more careful. We recommend that you follow standard guidelines and try to avoid getting the infection. Simple guidelines would include:

  1. Washing your hands frequently with soap and water for at least 20 seconds.
  2. Practice “social distancing” – maintain 6 feet between yourself and others.
  3. Avoid touching your nose, eyes, and mouth as much as possible.

Many patients will also experience an increase in anxiety and/or depression during the COVID-19 pandemic. This is quite common, particularly in these uncertain times. It is very important to try and manage your anxiety. Though we are advised about “social distancing”, you can do the following:

  1. Remain connected and communicate daily at regular intervals with your family and friends.
  2. Try to reduce seeing Facebook feeds, TV etc. and do not constantly watch the news; this can lead to more stress. Stay updated and maybe check in once or twice a day.
  3. Try and get at least 8 hours of sleep.
  4. Tend to your plants and garden, if you have one.
  5. Keep your cell phone in another room when you sleep.
  6. Do not forget to exercise daily, even if it at your home or in your backyard.
  7. Stay hydrated.
  8. You may practice various forms of relaxation such as meditation or yoga. Free meditation classes can be accessed at this website and can be practiced online.

Heartfulness meditation

What can I do to prepare for a CVS episode?

  1. Discuss your emergency department (ED) protocol with your physician and work together to see what the best option is if you get an episode (ED vs. infusion clinic vs. direct hospital admission). Most doctors are doing virtual visits and we now have telemedicine.
  2. Take your abortive medications as prescribed during the prodromal phase.
  3. If symptoms are severe, contact your physician, who could call ahead to the ED triage nurse.

As you can imagine, the situation in both the ED and hospitals is dire with the increase in COVID-19 cases. Make sure you take your preventive medications regularly and follow the advice of your doctors. If you are having frequent symptoms, contact your doctor so that they can adjust your medications. Most of all, try and be patient as this is a difficult time for all of us.

How to treat COVID-19?

In general, there are many medications and supplements that are thought to help with COVID-19 but lack strong evidence. Mild cases are treated like the flu. Stay hydrated and take Tylenol as needed. There is some suggestion that ibuprofen may worsen the disease, though this is not clear.

While some medications like Hydroxychloroquine and Azithromycin are being proposed as treatment in some cases,(5) DO NOT take this without a doctor telling you to. This can be harmful in some cases as this combination has some side effects including QT prolongation/cardiac arrhythmias and may interact with medications (like Elavil and ondansetron/Zofran) that you are already taking.  The evidence for most medications to treat COVID-19 is based on weak evidence and experts are trying to figure this out.

Finally, follow the guidelines of your local health authorities. If you need information about COVID-19, you can visit the CDC.

Stay safe. And in these scary times, as Mr. Rogers would say “Look for the helpers. They are always there.”

Regards,
Your CVSA team


References:

  1. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507-513.
  2. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020.
  3. Gu J, Han B, Wang J. COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission. Gastroenterology 2020.
  4. Lei Pan P, Lei Tu et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. American Journal of Gastroenterology 2020.
  5. Gautret P, Lagier JC, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents 2020: 105949.
  6. https://www.entuk.org/sites/default/files/files/Loss%20of%20sense%20of%20smell%20as%20marker%20of%20COVID.pdf