Editor’s note: This is the first in a three-part series.
The nightmare of 2020 almost is over, and with its demise comes hope that the availability of vaccines against COVID-19 will help make the coming year an infinitely happier one.
“As we all know, there’s light at the end of the tunnel,” Dr. Frank Gaudio said. “However, this is not the point at which we stop moving through the tunnel. We need to keep going.”
The emergency medicine specialist with Washington Health System gave a recent virtual presentation as part of Bethel Park’s Live Well speaker series in which he provided comprehensive information about numerous facets of COVID-19, including circumstances in which it commonly spreads.
“Basically, the problem is one of transmission by patients who do not have symptoms, and it’s occurring at a time when, essentially, people in the United States are becoming more social,” Gaudio said, referencing seasonal special occasions.
“This is the Thanksgiving holiday. This is the Fourth of July cookout if you’re inside the house. You’re with friends and family. You hug. You kiss. You shake hands. You’re talking, and you’re there for hours at a time.”
An Upper St. Clair resident with 45 years of experience in emergency medical services, Gaudio cautioned exposure could result from someone who has no idea he or she is carrying the coronavirus.
“The largest viral load, meaning the point at which you may have the most virus in your body and therefore the greatest chance of spreading that virus, and therefore you may be the most infectious, is in a period where you may have very mild symptoms or no symptoms at all,” he said. “In fact, the period two days before you start to develop symptoms may be the most infectious time, which is why the virus spreads so easily and so rapidly.”
Transmission often occurs through droplets of fluid that people expel through activities such as coughing, sneezing, singing or speaking loudly.
“These large water particles that carry the virus are expelled through your mouth and generally go about six feet or so,” Gaudio said, with the estimate forming the basis for social-distancing guidelines.
Potentially more troublesome with regard to degrees of separation are specks of dust and other fine particles known as aerosols.
“These more or less float through the air, linger in the air and can be inside an indoor space for hours, and can travel 20, 30 feet,” Gaudio said. “And this is part of the reason that politicians, part of the reason that medical experts, try to have people limit that close contact, limit the number of people who are gathered indoors and have encouraged people to basically forgo your typical holiday type of party or gathering.”
At the onset of the COVID-19 pandemic, physicians advised of the disease possibly being linked with symptoms such as fever, chills, cough, congestion, sore throat and difficulty breathing. Since then, the list has expanded to include the likes of vomiting and diarrhea, general aches and pains, and most notably, loss of taste or smell.
Of course, many of those conditions are symptomatic of common strains of influenza, to which people have a particular susceptibility during winter. Gaudio discussed possible indicators of something more serious.
“The time frame just doesn’t fit with the usual virus,” he said, giving an example of a patient telling him, “It came on all at once. One day I felt fine. The next day, I felt like a truck had run me over, and I have a temperature of 103.”
Or there is another common reaction.
“This is not my usual cold,” he said. “I get out of bed. I try to walk across the hall to go to the bathroom, and I honestly feel short of breath, Doc. There’s something more to this.”
The “something more” often turns out to be the virus causing pneumonia, and the situation tends to deteriorate rapidly.
“One of the signs that you’re not dealing with your average, run-of-the-mill, garden-variety pneumonia is that in spite of treatment, in spite of an antibiotic, in spite of an antiviral medication, the pneumonia seems to be getting worse,” Gaudio said.
From there, placement in the intensive care unit is likely.
“Once you get transferred into the ICU, about half of those people go on to have respiratory distress or to have an overwhelming infection, which we call sepsis. They end up on a mechanical ventilator or breathing machine,” Gaudio said. “Then they go into what we call septic shock, when more of your organs start to shut down, when your cardiac system shuts down, when your kidneys start to shut down. And that’s when you’re most at risk to die.”
Information he presented also conveyed a grim picture for a certain demographic.
“The older you get,” he said, “the greater your chances are of dying.”
Gaudio also mentioned other factors that may increase the mortality rate, including compromised autoimmunity and conditions such as diabetes, high blood pressure and obesity.
His overall assessment, though, does not specify any segment of society.
“In essence, the entire community is the population at risk, because anyone can get it at any time,” he said.
Next week: Testing for COVID-19 and what to expect if you become ill.