What have we learned about COVID-19?

Red Rock Coulee in Alberta, Canada. (Dr. Noorali Bharwani)
Red Rock Coulee in Alberta, Canada. (Dr. Noorali Bharwani)

Here is the good news. The spread of the COVID-19 pandemic in Canada is slowing down. But the bad news is, health officials warned it could come back with a vengeance this fall if contact tracing and testing aren’t stepped up.

What we are trying to do is to contain the virus because there is no vaccine or medications to kill the virus. Once the lockdown is lifted, it will leave many people vulnerable to infection as they begin to venture out again.

Unless there is a miracle, SARS-CoV-2 Vaccine will take time to be ready to be used.

The COVID-19 pandemic is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.

Alberta has the third-most number of cases of COVID-19 in Canada. By June 3, there were 7,076 confirmed cases and 145 deaths. The majority of cases have been in the Calgary zone, which has 4,909 cases.

What do we know about coronaviruses?

Coronaviruses are a family of viruses that can cause illnesses such as the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). In 2019, a new coronavirus was identified as the cause of a disease outbreak that originated in China.

There are people who are infected but have no symptoms. Others have mild to moderate to severe symptoms.

Classical COVID-19 symptoms may appear two to 14 days after exposure to the virus. That is the incubation period. The common presentation is fever, cough, and tiredness.

Other symptoms can include: shortness of breath or difficulty breathing, muscle aches, chills, sore throat, loss of taste or smell, headache, and chest pain.

Other less common symptoms have been reported, such as rash, nausea, vomiting and diarrhea.

People who are older or who have existing chronic medical conditions, such as heart disease, lung disease, diabetes, severe obesity, chronic kidney or liver disease, or have compromised immune systems may be at higher risk of serious illness.

It is important you contact your health care provider if you have any of these symptoms. You should call 911 if you have trouble breathing, persistent chest pain or pressure, inability to stay awake, new confusion, blue lips or face.

The virus appears to spread easily among people. Data has shown that it spreads from person to person among those in close contact (within about six feet, or two meters). The virus spreads by respiratory droplets released when someone with the virus coughs, sneezes or talks. These droplets can be inhaled or land in the mouth or nose of a person nearby.

It can also spread if a person touches a surface with the virus on it and then touches his or her mouth, nose or eyes.

Prevention is better than cure. Since there is no vaccine to prevent COVID-19 the next best thing is to reduce your risk of infection by doing the following:

  1. Avoid large gatherings
  2. Avoid close contact
  3. Stay home as much as possible
  4. Wash hands often
  5. Wear a mask in public places
  6. Avoid touching your eyes, nose and mouth.

Yes, face masks combined with other preventive measures, such as frequent hand-washing and social distancing, help slow the spread of the disease.

If you have COVID-19 related symptoms you are legally required to isolate yourself.

If you have symptoms, take the online assessment to arrange testing.

Take care. Stay healthy.

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There is something about feet and the toenails that fungi just love.

Sunset boating in Chicago. (Dr. Noorali Bharwani)
Sunset boating in Chicago. (Dr. Noorali Bharwani)

“There are about 80 types of fungi residing on a typical person’s heel, along with 60 between the toes and 40 on the toenails,” says an article in the Globe and Mail (Social Studies May 24, 2013).

It goes on to say that the feet are home to more than 100 types of fungus, more than any other area of the human body, quoting a study published in the journal Nature.

Many of the fungi on our skin are good for us in that they prevent bad fungi adhering to our skin. They protect us from getting athlete’s foot, plantar warts and stubborn toenail problems.

Most problems are not life threatening. Here are some examples:

Plantar warts: These are also known as common warts. They grow on the soles of the feet. They grow into the skin because we walk on them. They can be painful on walking. The virus causing the wart is picked up from walking bear foot in locker rooms and swimming pools.

Treatment: They may spontaneously disappear if you wait long enough – months to years. They can be managed by freezing, scrapping or burning. They can recur.

Callus and corns: These are thickened areas on the hands or feet caused by pressure or friction. This is usually related to work or sporting activities. Uneven pressure of body weight during walking or ill-fitting shoes can cause calluses and corns on the feet.

Treatment: Wear proper fitting shoes and use corn pads to relieve pressure on the corns. Thick calluses can be sliced down to normal skin over a period of time. If the source of friction and pressure is removed then corns and calluses should not recur.

Toenail problems: Mainly involves the big toe. It may be ingrown or overgrown. Ingrown toenails are commonly due to ill-fitting shoes pressing on an incorrectly cut nail. Poor foot hygiene encourages infection.

The problem occurs when sweaty feet are encased in tight shoes. The situation gets worse when the nail is trimmed short and the corners are curved down. The side of the nail curls inwards and grows to form outer spikes. This causes painful infection of the overhanging nail fold.

Treatment: In an acute stage antibiotic, painkillers and bathing the foot in warm salt water are necessary. Surgery is required in most cases. The problem can be prevented from recurring by keeping the feet clean and wear correctly fitting shoes. Cut the nail straight.

Fungus infection of the nails: Usually affects toenails. The nail is thickened and discolored. It is usually yellowish. The nail may grow in a twisted manner. The infection is picked up in a public place where it is transmitted from person to person. Poor feet hygiene does not help.

Treatment: Anti-fungal therapy is required – orally and locally for three months. Cure rate is around 80 percent. Ongoing meticulous foot care is very important to prevent recurrence.

Our feet are subjected to more wear and tear and hence they get more problems than our hands. Our natural tendency is to take care of our hands more than our feet. Many of these problems are preventable.

In my view, walking bear feet is the worst thing you can do for your feet. Wash your feet at least once a day (twice if your feet sweat a lot) with soap and water. Dry them well with a soft towel. Apply some skin lotion or powder. Wear good quality clean socks and proper fitting comfortable shoes.

Have a wonderful Christmas and Holiday Season.

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Measles is a Highly Contagious Viral Infection of the Respiratory Tract

Cacti on a golf course in Scottsdale, Arizona. (Dr. Noorali Bharwani)
Cacti on a golf course in Scottsdale, Arizona. (Dr. Noorali Bharwani)

Measles is making bad news. It seems to have started in Disneyland. A place where kids go for fun. How ironic and sad. And it has spread to several states in the U.S.

According to Centers for Disease Control and Prevention (CDC) website, 50 people from six states were reported to have had measles in the first two weeks of this month. Most of these cases are part of a large, ongoing outbreak linked to Disneyland in California.

According to CBS news (January 22, 2015), at least 75 people have now been infected with measles virus. The California public health officials are urging those who haven’t been vaccinated against the disease, including children too young to be immunized, to avoid Disney theme parks.

Age of people infected ranges from seven months to 70 years old, including five Disneyland workers.

Measles spreads through the air through coughing and sneezing. It starts with a fever, runny nose, cough, red eyes, and sore throat, and is followed by a rash that spreads all over the body. About three out of 10 people who get measles will develop one or more complications including pneumonia, ear infections, or diarrhea. Complications are more common in adults and young children.

Alberta had a measles outbreak last year. On April 29, 2014, Alberta Health Services declared a measles outbreak in the Calgary, Central and Edmonton Zones of Alberta Health Services (AHS). By July, AHS declared the outbreak to be over.

The best way to prevent measles is to have Measles-Mumps-Rubella (MMR) Vaccine. All health care workers should be vaccinated with two doses of the vaccine. Health care workers are at greater risk of measles infection than the general population because they provide care for ill individuals. A recent review concluded that health care workers were 13 to 19 times more likely to develop measles than other adults.

MMR vaccine is highly effective at preventing measles. One dose is 85-95 per cent effective and the effectiveness of two doses approaches 100 per cent. Two doses provide long-lasting immunity. The vaccines are very safe.

Measles was eradicated by year 2000 because of vaccination. But the virus has made a comeback in recent years, in part because of people obtaining “personal belief exemptions” from rules that say children must get their shots to enroll in school. Others still believe in now-discredited research linking the measles vaccine to autism.

Who started the current outbreak? Should we blame people who refuse to get vaccinated because they believe it is harmful to their children? Apparently, a small number of those stricken had been fully vaccinated. It is also reported the outbreak was triggered by a measles-stricken visitor to one of the Disney parks who brought the virus from abroad last month.

Coughing and sneezing spreads the highly contagious virus. Deaths are caused by complications associated with the disease. Complications are more common in children under the age of five or adults over the age of 20.

There is no specific antiviral treatment. Mostly symptomatic treatment is provided for symptoms and complications. The measles vaccine has been in use for 50 years. It is safe, effective and inexpensive. It costs approximately one U.S. dollar to immunize a child against measles. And it saves lives.

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Ebola Virus Disease has a High Fatality Rate

Robin building nest. (Dr. Noorali Bharwani)
Robin building nest. (Dr. Noorali Bharwani)

Ebola virus disease (EVD), as it is known now, was formerly known as Ebola haemorrhagic fever. It is a severe, often fatal illness in humans. It is a disease of the wild animals and then it is transmitted to people. It spreads in the human population through human-to-human transmission.

The Ebola virus causes an acute, serious illness, which is often fatal if untreated, says WHO website. Ebola virus disease first appeared in 1976 in two simultaneous outbreaks, one in Nzara, Sudan, and the other in Yambuku, Democratic Republic of Congo. The latter occurred in a village near the Ebola River, from which the disease takes its name.

Previously the disease was confined to small villages near tropical rainforests. The most recent outbreak in West Africa has involved major urban as well as rural areas. The case fatality rates have varied from 25 to 90 per cent in past outbreaks.

Controlling the disease has been difficult. According to the WHO website, community engagement is key to successfully controlling outbreaks. Good outbreak control relies on applying a package of interventions, namely case management, surveillance and contact tracing, a good laboratory service, safe burials and social mobilization.

Currently there is no licensed treatment for the disease. Treatment is base on providing rehydration with fluids and treat any other symptoms that the patient presents with. A range of blood, immunological and drug therapies are under development.

The current outbreak started in March 2014 in West Africa. WHO calls this the largest and most complex Ebola outbreak since the Ebola virus was first discovered in 1976. There have been more cases and deaths in this outbreak than all others combined. It has also spread between countries starting in Guinea then spreading across land borders to Sierra Leone and Liberia, by air (one traveller only) to Nigeria, and by land (one traveller) to Senegal. Latest report has confirmed a case in the US. By the time you read this the numbers may change.

How does a person get infected with Ebola virus?

It is thought that fruit bats of the Pteropodidae family are natural Ebola virus hosts. Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.

How does it spread among humans?

Ebola then spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids.

WHO says people remain infectious as long as their blood and body fluids, including semen and breast milk, contain the virus. Men who have recovered from the disease can still transmit the virus through their semen for up to seven weeks after recovery from illness.

First symptoms are the sudden onset of fever fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding (e.g. oozing from the gums, blood in the stools). Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.

Confirming the diagnosis and providing treatment continues to be a challenge. There is lot more information available on the WHO website.

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