Dr. Noorali Bharwani

We know COVID-19 affects different people in different ways. Most of the time the infection is mild with fever, cough, tiredness and loss of taste or smell. These individuals recover without hospitalization.

On average it takes five to six days when someone is infected with the virus for symptoms to show, however it can take up to 14 days. The incubation period ranges from 1 to 14 days. The median is 5 to 6 days between exposure and symptom onset.

Some individuals present with serious symptoms. The lungs are the organs most affected by COVID‐19. Symptoms like difficulty breathing, loss of speech, difficulty walking, confusion and chest pain are not uncommon. These individuals need to seek immediate medical attention.

Patients with COVID-19 infection can have neurological problems as well including stoke. This happens because of the change in the thickness of the blood called hypercoagulability. This may predispose an individual to stroke. Hypercoagulability is defined as the tendency to have thrombosis (blood clots) as a result of certain blood defects. Clinical manifestations of hypercoagulability can be devastating and even lethal.

Recently, researchers have found falling rates of new ischemic stroke admissions in hospitals, probably due to social consequences of the pandemic: fear to be infected or not adequately treated in the hospital. This phenomenon is of concern.

In one of the largest studies of its kind to date, published Aug. 14, 2021, in The Lancet (What is the association of COVID-19 with heart attacks and strokes?) researchers found strong evidence that heart attack and stroke risk rises sharply in the weeks following a COVID-19 diagnosis.

In the week after a COVID-19 diagnosis, the risk of a first heart attack increased by three to eight times. The risk of a first stroke caused by a blood clot multiplied by three to six times. In the following weeks, both risks decreased steadily but stayed elevated for at least a month.

Other bacterial and viral infections (such as influenza) are known to temporarily boost rates of heart attacks and strokes. But COVID-19 infections appear to be especially risky, perhaps because they trigger an exaggerated inflammatory response that makes blood clots more likely.

There are two factors responsible and dangerous to the production of strokes. First factor — COVID-19 infection creates inflammation throughout the body. Second factor — it also produces hypercoagulation of the blood that makes the blood to clot easily than normal.

There may be somebody you know who has had a stroke usually without a warning. There are various causes of stroke: 85 per cent are ischemic strokes, which are caused by a blood clot in an artery. Obesity, diabetes, high cholesterol, irregular heart rhythm, smoking, drug abuse and many other risk factors are all linked to an increased likelihood of a stroke. Now we can add COVID-19 to the list.

Outcome of a stoke can vary. Ten per cent of the people recover fully. Thirty per cent of the people recover with minimal of physical and mental deficiency and 60 per cent of the people have major paralysis and end up in a nursing home.

You should seek immediate medical attention if you see somebody exhibits sudden loss of balance and coordination, has trouble seeing out of one or both eyes, face drooping or lop-sided, shows weakness of one arm and speech is slurred then call 9-1-1 right away. Time is of the essence to start tPA therapy.

tPA is short for tissue plasminogen activator and can only be given to patients who are having a stroke caused by a blood clot (ischemic stroke). It can stop a stroke by breaking up the blood clot. It must be given as soon as possible and within 4.5 hours after stroke symptoms start.

You may be familiar with the acronym F.A.S.T. to help you recognize a stroke. F – is the face drooping? A – can the person raise both arms? S – speech slurred? T – time to call 9-1-1.

Take care and be safe. And remember mask, distance and vaccination.

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Scientists around the world are working hard to get one step ahead of the various COVID-19 viruses. Is victory in sight?

We have the highly infectious Omicron coronavirus variant causing less severe disease than the Delta strain but it remains a dangerous virus, particularly for those who are unvaccinated. The Omicron variant is the dominant strain in Alberta.

Like other variants, Omicron spreads from the nose and mouth through respiratory droplets at close range and through virus particles that float through the air and can stay suspended for quite a while, especially in places with poor ventilation. That is why use of face masks or coverings has been recommended in public settings to minimise the risk of transmissions.

Then there is Omicron subvariant BA.2. That raises more questions about the evolution of virus behind COVID-19. Alberta recently reported three cases of BA.2 variant. By the time you read this there may be more. Denmark recently reported a surge of BA.2 infections.

Omicron infections make up more than 90 per cent of Canada’s recent cases – and nearly all of those remain BA.1. But BA.2 infections totalled around one per cent of reported cases in early January.

We should not forget Alpha, Beta, Gamma and Delta variants. They are still around. We should continue to practice what reduces our risk of getting seriously ill with COVID-19 infection. Vaccination does not provide hundred per cent protection but it can reduce the risk of getting seriously ill. Vast majority of the patients with COVID-19 infection in the ICU are not vaccinated.

Here is the good news.

The new oral COVID-19 antiviral treatment is now available in Canada. This is Pfizer’s antiviral Paxlovid, which can be given to COVID-19 patients who are at high-risk of severe illness from the virus. A doctor has to prescribe the pills.

Paxlovid combines a new drug developed by Pfizer, Nirmatrelvir, with an existing antiretroviral drug named Ritonavir, a low-dose HIV drug that helps Nirmatrelvir remain active in the body longer.

The treatment comprises three pills – two of Nirmatrelvir and one of Ritonavir – taken at home twice a day for five days. That is 30 pills over five days. A person should start taking Paxlovid no more than five days after symptoms start. Hopefully, this will take pressure off the health-care system.

Health Canada has authorized the use of these drugs in high-risk adults (18 and older) with mild or moderate confirmed cases of COVID-19 patients. People who are immunocompromised, 80 years of age and over, or who may not have access to health care because of geographical or socioeconomic concerns are first in line – regardless of vaccination status.

Health Canada has warned the product should not be used while a patient is on any of a long list of other drugs, including common medications used to treat erectile dysfunction, high cholesterol and seasonal allergies, among others.

Here are few things to remember:

• The treatment must be started within five days of the onset of symptoms.
• It is designed to help the body fight off infection and shorten the period of illness.
• It has been found highly effective – Paxlovid reduced the risk of hospitalization or death by 89 per cent compared to a placebo.
• The treatment is likely to work against the Omicron variant.
• Receiving the treatment does not exempt people from isolation requirements, and is not an alternative to vaccination.
• These antiviral drugs are not a replacement for vaccines, which remain the best way to keep people out of hospital. Statistics show unvaccinated people are 19 times more likely to be hospitalized with COVID-19 than fully vaccinated people.

Coronaviruses die very quickly when exposed to the UV light in sunlight. The viruses survive longest when the temperature is at room temperature or lower, and when the relative humidity is low (<50 per cent).

We know most transmissions occur indoor. We should continue with preventive measures – physical distancing, quarantining, ventilation of indoor spaces, covering coughs and sneezes, hand washing, and keeping unwashed hands away from the face.

Take care and be safe.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!