Friday, January 31, 2020

Coronavirus

I'm sure that you have all heard about the coronavirus infection that is rapidly spreading in China.  There is still quite a bit that we don't know about the infection, but I thought it might be helpful to talk about the things that we do know about it.

What is a Coronavirus?
Coronaviruses are a large family of viruses that are common in many different animal species.  Although it is not common, animal coronaviruses can sometimes infect people.  Rarely, an animal coronavirus develops the ability to spread from one person to another.  This has happened with coronaviruses in the past.  You may remember the SARS virus that became a global outbreak in 2003.  That was a coronavirus, which appears to be closely related to the current coronavirus outbreak.
  
CoronavirusThe current coronavirus is called the 2019 Novel (meaning new) Coronavirus (abbreviated 2019-nCoV).  It was first detected in Wuhan City, in the Hubei Province of China.  Chinese health officials have reported thousands of infections with this virus, and it has been confirmed that there is person-to-person spread.  Additional cases have been identified in a growing number of international locations.
  
On 1/30/2020 the World Health Organization (WHO) designated the 2019-nCoV a global health emergency.  This designation will help the WHO to mobilize financial and political support to help contain the outbreak.
What are the symptoms of the 2019-nCoV?
 
Reported illnesses from confirmed cases have ranged from people being mildly sick to people being severely ill and dying.  Symptoms can include:
  • Fever
  • Cough
  • Shortness of breath
How does the 2019-nCoV spread?
 
The way this virus spreads is not definitively known at this time.  The spread of the SARS virus is thought to have happened primarily through respiratory droplets produced when an infected person coughs or sneezes.  This is similar to many other respiratory viruses, and is likely to be the way the current outbreak is spreading.  
Some viruses are highly contagious, and others are less contagious.  The spread of the SARS virus between people generally occurred between close contacts, and not casual contacts.  We don't yet know how easily the 2019-nCoV spreads from one person to another.  Health officials are working hard to learn just how contagious this virus is.
What is the incubation period of this virus?
 
The incubation period is the time that it takes for symptoms to appear after a person has been exposed to a virus.  The incubation period for 2019-nCoV is not definitively known at this time.  The CDC believes that the incubation period is anywhere between 2 days and 14 days.  This is based on current observations of the 2019-nCoV, as well as information that we know about the SARS virus.
What is the situation in the United States at this time?
 
There have been a total of 6 confirmed cases of the 2019-nCoV infection in the United States as of 1/30/2020.  Five of these have been "imported" cases, meaning that the patient came to the United States from China with the infection.  There has been only one case of person-to-person spread detected in the United States thus far.  The husband of a patient who contracted the infection in China has now been diagnosed with the infection.  His wife had traveled to China in December to care for her father in Wuhan.  She was not symptomatic when she returned home, but became ill and tested positive for the infection on 1/24/2020, within 11 days of her return home.  His test results returned positive on 1/30/2020.
While the CDC considers this infectious outbreak a very serious public health threat, based on all current information available, the immediate health risk from the 2019-nCoV to the general American public is considered low at this time.  Dr. Robert Redfield, director of the CDC, said on Thursday, "We understand that this may be concerning, but based on what we know now, our assessment remains that the immediate risk to the American public is low."
What should you do if you have recently traveled to China and get sick?
 
If you were in China and develop symptoms within 14 days of your return, or if you develop symptoms after being in contact with a person who has recently returned from China, you should: 
  • Seek medical care right away.
  • Call ahead to the medical facility to let them know about your recent travel and symptoms.
  • Avoid close contact with others.
  • Cover your cough or sneeze with a tissue or your sleeve (NOT your hands).
  • Wash your hands frequently with soap and water for at least 20 seconds each time.
 For more information about the 2019-nCoV, follow the link below to the CDC website.  It is being updated regularly to keep up with all of the latest information.  I have even had to edit this Health Tip with the latest information since I first wrote it on 1/29/20, because we are getting new information regularly.  If important changes to this information become available, we will try to keep you updated.
If you have any questions about Coronavirus, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Friday, January 24, 2020

Should You Exercise When You Are Sick?

This is a question that comes up quite often, especially this time of year.  The answer depends on several factors, including what type of illness you have and what type of exercise you are doing.  Let's talk today about the role that exercise plays in your immune response to illness and whether that can be helpful or harmful when you are ill, as well as how a routine exercise program impacts your susceptibility to infection.

Can routine exercise decrease the chances of getting sick?

Exercising while sickThe answer is a definite yes, but there are some exceptions.  Research indicates that people who participate in moderate exercise on a regular basis (approximately 150 minutes per week) have significantly fewer respiratory infections than people who are sedentary.  This includes colds, flu, sinus infections, and other respiratory infections.  There are positive immune changes that take place during each bout of moderate physical activity, which translate to this protective benefit.

On the other hand, people who are pushing beyond normal exercise limits, such as regularly participating in high intensity exercise or exercising for excessive time periods, have significantly more respiratory infections than people who perform moderate exercise.  This includes people who are participating in high intensity work outs for more than 90 minutes at a time on a regular basis, such as marathon runners.

What if you already have a cold?  Should you exercise?

In general, mild to moderate exercise is usually fine when you have a mild upper respiratory illness, such as a cold.  Exercise can even help to temporarily open your nasal passages and relieve some congestion.  However, there are times when exercise may cause more harm than good.

Here are some general guidelines to consider when deciding whether to exercise when you are sick:
  • Do not exercise if you have the following symptoms:
    • Fever, body/muscle aches, or fatigue
    • Chest congestion, wheezing, or a bad cough
    • Upset stomach, nausea, vomiting
  • You can exercise if you only have the following symptoms:
    • Runny nose, head or nasal congestion, sneezing, minor sore throat
Some people like to use the distinction "above the neck" or "below the neck."  If your symptoms are all above the neck, it is ok to exercise, but if you have symptoms below the neck, you should not exercise.  I usually say, if you feel miserable, you should take a few days off from exercise.  If your symptoms are bothersome, but not making you feel miserable, go ahead and exercise.

If you do want to exercise when you are sick, here are some things to consider:
  • Reduce the intensity and length of your normal work out; maybe go for a walk instead of a run.
  • Consider doing some indoor exercise, rather than exercising outdoors in winter weather conditions.  If the weather is not harsh, the outdoor air might do you some good.
  • Listen to your body.  If you get tired or your muscles start hurting during your workout, you should stop the workout.  The next day, try something less strenuous.
  • If you start coughing or wheezing during a workout, stop the workout.
If you do take a few days off from your regular exercise routine while you are sick, this should not have any adverse effect on your exercise performance.  As you start to feel better, gradually get back into your exercise routine.  Start at a lower intensity and pace, and gradually increase to your normal routine.  Within a few days to a week, you should be back to your normal workout.

If you have any questions about exercising when you are sick, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Saturday, January 18, 2020

RSV Infection – Part II

We have talked about influenza in the past couple of weeks, but this is also the time of year that we see another serious viral infection.  RSV can cause severe illness and even death in very young children.  Each year in the United States, there are over 57,000 hospitalizations among children less than 5 years old due to RSV infection, and anywhere between 100-500 deaths from the infection.  This winter, RSV infection has been spreading faster and causing more hospitalization in children than usual thus far.  Let's talk more about RSV and the illness it causes.

RSV InfectionWhat is RSV?

Human Respiratory Syncytial Virus, also known as RSV infection, is a viral infection of the respiratory tract that commonly affects children less than 2 years of age.  It actually can cause illness at any age, but in healthy older kids and adults, it usually just seems like the common cold, so you may not even know that it is RSV.  In children younger than 2 years old, especially those younger than 6 months old, or children with decreased immune function, RSV can cause a severe illness, leading to hospitalization and even death.

What is bronchiolitis?

Bronchiolitis is an inflammation in the smallest bronchial tubes in the lungs, called bronchioles.  Don't get this confused with bronchitis, which is an inflammation in the larger bronchial tubes.  The vast majority of cases of bronchiolitis are caused by RSV.  Inflammation sets in when the bronchioles become infected with RSV.  Because these bronchioles are so small, and especially small in young children, any inflammation in the tubes can obstruct airflow.  This obstruction results in wheezing, or other signs of difficulty breathing.  Rapid breathing starts as a response to try to keep the blood oxygen at the normal level.  This rapid breathing can interfere with a baby feeding, and if it is severe and lasts long enough, a baby may not have enough energy to keep up the rapid breathing.  This, in turn, leads to low oxygen levels, which can cause serious consequences.

Who is at risk for serious RSV infections and bronchiolitis?
  • Premature babies
  • Infants less than 6 months
  • People with compromised immune function (including those on chemotherapy)
  • Those with underlying health problems, such as asthma or heart disease
  • Elderly adults
What are the symptoms of RSV infection?

Initially, RSV infection may seem like a common cold.  In fact, most RSV infections are mild and never get diagnosed.  However, the symptoms can progress quickly.  Symptoms include:
  • Sneezing
  • Runny nose (usually with lots of nasal mucous) and nasal congestion
  • Fever
  • Sore throat
  • Headache
  • Problems breathing (including wheezing or rapid breathing)
When should you call a doctor?
  • If your child is less than 6 months old and has symptoms of a cold, 
  • If your child has a fever lasting more than a few days, 
  • If your child is wheezing, breathing more rapidly, or having some difficulty feeding, call your doctor right away.
When is this an emergency?
  • If your child has more serious symptoms, such as difficulty breathing, discoloration of the lips, skin, or fingernails, or other signs of respiratory distress, you should call 911 for immediate help.  
Next week we will talk more about RSV infection, including how the diagnosis is made and how it is treated.

If you have any questions about RSV infection, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Friday, January 10, 2020

RSV Infection

We have talked about influenza in the past couple of weeks, but this is also the time of year that we see another serious viral infection.  RSV can cause severe illness and even death in very young children.  Each year in the United States, there are over 57,000 hospitalizations among children less than 5 years old due to RSV infection, and anywhere between 100-500 deaths from the infection.  This winter, RSV infection has been spreading faster and causing more hospitalization in children than usual thus far.  Let's talk more about RSV and the illness it causes.

RSV InfectionWhat is RSV?

Human Respiratory Syncytial Virus, also known as RSV infection, is a viral infection of the respiratory tract that commonly affects children less than 2 years of age.  It actually can cause illness at any age, but in healthy older kids and adults, it usually just seems like the common cold, so you may not even know that it is RSV.  In children younger than 2 years old, especially those younger than 6 months old, or children with decreased immune function, RSV can cause a severe illness, leading to hospitalization and even death.

What is bronchiolitis?

Bronchiolitis is an inflammation in the smallest bronchial tubes in the lungs, called bronchioles.  Don't get this confused with bronchitis, which is an inflammation in the larger bronchial tubes.  The vast majority of cases of bronchiolitis are caused by RSV.  Inflammation sets in when the bronchioles become infected with RSV.  Because these bronchioles are so small, and especially small in young children, any inflammation in the tubes can obstruct airflow.  This obstruction results in wheezing, or other signs of difficulty breathing.  Rapid breathing starts as a response to try to keep the blood oxygen at the normal level.  This rapid breathing can interfere with a baby feeding, and if it is severe and lasts long enough, a baby may not have enough energy to keep up the rapid breathing.  This, in turn, leads to low oxygen levels, which can cause serious consequences.

Who is at risk for serious RSV infections and bronchiolitis?
  • Premature babies
  • Infants less than 6 months
  • People with compromised immune function (including those on chemotherapy)
  • Those with underlying health problems, such as asthma or heart disease
  • Elderly adults
What are the symptoms of RSV infection?

Initially, RSV infection may seem like a common cold.  In fact, most RSV infections are mild and never get diagnosed.  However, the symptoms can progress quickly.  Symptoms include:
  • Sneezing
  • Runny nose (usually with lots of nasal mucous) and nasal congestion
  • Fever
  • Sore throat
  • Headache
  • Problems breathing (including wheezing or rapid breathing)
When should you call a doctor?
  • If your child is less than 6 months old and has symptoms of a cold, 
  • If your child has a fever lasting more than a few days, 
  • If your child is wheezing, breathing more rapidly, or having some difficulty feeding, call your doctor right away.
When is this an emergency?
  • If your child has more serious symptoms, such as difficulty breathing, discoloration of the lips, skin, or fingernails, or other signs of respiratory distress, you should call 911 for immediate help.  
Next week we will talk more about RSV infection, including how the diagnosis is made and how it is treated.

If you have any questions about RSV infection, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Friday, January 3, 2020

Do I Have the Flu? Part - II

Last week we talked about the symptoms and spread of influenza.  This week, we will talk about the diagnosis, prevention, and treatment of influenza.

How is the flu diagnosed?

It is impossible to distinguish the flu from other infections based on symptoms alone.  Having typical flu symptoms is certainly a good clue, but other infections sometimes mimic flu symptoms.  There are tests available to diagnose the flu.  All of the available tests require that your health care provider swipe the inside or your nose or the back of your throat with a swab that is then sent for testing.  Different tests for the flu are available and the type of test used determines how quickly the results are available and how accurate the results are.

Do I have the flu?Can the flu be prevented?

Here are some things that you can do to prevent the flu:
  • Get vaccinated - The best way to prevent the flu is by getting a flu vaccine every year.  Everyone 6 months of age and older should get a flu shot, especially people at high risk for the flu and complications of the flu.  While the flu vaccine is not 100% effective, every season influenza vaccines prevent millions of influenza illnesses, tens of thousands of hospitalizations, and thousands of deaths.  In cases where people do get the flu after having the vaccine, they tend to have a much milder case of the flu.
  • Avoid close contact with people who are sick.
  • Wash your hands often.  Soap and water work wonders to get viruses off your hands.  If soap and water are not available, you can use an alcohol-based hand disinfectant.
  • Avoid touching your eyes, nose, or mouth.  The way the influenza virus causes infection is by entering your eyes, nose, or mouth, and sometimes that happens because your hand has the virus on it, and then touches your eyes, nose, or mouth.
  • Keep your immune system strong.  You can do this by getting plenty of sleep regularly, staying physically active with a regular exercise routine, and managing stress well.  Eating a healthy diet and drinking plenty of fluids is also helpful.
  • Clean and disinfect surfaces.  Frequently touched surfaces at home, work, or school, should get a regular cleaning with a disinfectant product.  This is especially true when you have a sick family member or coworker.
How is the flu treated?

There are now prescription antiviral medications that were developed specifically to treat influenza.  These drugs need to be started within 48 hours of getting sick in order to provide the most benefit.  Sometimes they are started even later if a person is severely ill, or is at high risk for complications. These medications will not work a miracle, but they can lessen the duration and severity of symptoms.

What should you do if you think you have the flu?

If you develop flu-like symptoms you should:
  • See your doctor as quickly as you can in order to be tested for the flu.
  • Other than seeing the doctor, you should STAY HOME!  Don't go to work; don't go to social events; don't go to the mall to finish your shopping.  STAY HOME until you have been at least 24 hours without having any fever, and without taking any medication that brings fever down.
  • Take over the counter medications to treat your symptoms.  These medications will not prolong your illness.  They won't make it go away faster either.  But they can help you feel a little better.  Taking medication that makes your fever go down or your symptoms a little better does NOT mean that you should go to work or school.  You will just make others sick, and make your symptoms last longer.  Stay home!
  • Get plenty of rest.
  • Drink plenty of fluids.
  • Do your best to keep yourself away from other members of the household in hopes of keeping it from spreading to the entire family.
I hope that we can all get through the flu season this year without getting sick.  If you have any questions about flu-like symptoms, or about the flu vaccine, please send a question in to our doctors.  We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor