Coronavirus

Origin of the coronavirus (SARS-CoV-2)

In December 2019, acute respiratory diseases caused by SARS-CoV-2 (“severe acute respiratory syndrome coronavirus type 2”) occurred in Wuhan (China). According to the WHO, the disease caused by the coronavirus is referred to as Covid-19 (“coronavirus disease 2019”). The disease has been spreading worldwide since January 2020.

Corona viruses are a family of viruses that can cause diseases, especially in mammals and birds. However, these diseases can also be transmitted to humans. Corona viruses occur worldwide and can cause mild colds but also severe pneumonia in humans.

According to current knowledge, the current SARS-CoV2 pandemic has its origins in Asian bats. It is not yet clear whether the corona virus was transmitted directly from a bat to a human or whether there was another animal carrier. It is believed that the first infected people were infected at a market in the Chinese city of Wuhan.

How is the coronavirus transmitted?

Like all corona viruses, SARS-CoV-2 is mainly transmitted by droplet infection. Transmission occurs through the respiratory tract when we inhale virus-laden particles. When we speak, breathe, sneeze and cough , we give off droplets and aerosols. The fine aerosols stay in the air the longest and can be distributed particularly well in closed rooms.

The risk of infection through droplet infection is highest:

• when singing or shouting (because more aerosols are emitted)
• during a longer stay in small or poorly ventilated rooms
• in physical proximity to an infected person (less than 1 to 2 meters) – also outdoors
• during heavy physical work in poorly ventilated rooms

A smear infection (contact transmission) via contaminated objects or surfaces is also possible.

The incubation period, i.e. the time between infection with the corona virus and the appearance of the first Covid 19 symptoms, can be between 5 and 14 days.

Infections can be transmitted by people showing symptoms. But infected people with an asymptomatic (symptom-free) course of the disease can also infect others. The same applies to infected people who are still going through the incubation period and in whom the disease has not yet broken out.

The exact period of time during which an infected person is contagious has not yet been defined. However, we know that the contagiousness is greatest in the period shortly before and after the onset of the first symptoms.

Diagnosis of Covid-19

Infection with the coronavirus can manifest itself in a variety of but non-specific symptoms. But it can also be symptom-free. The safest diagnostic tool to detect an infection is therefore a virological test.

If a coronavirus infection is suspected, a nose and throat swab (nasopharynx swab) and/or a throat swab (oropharynx) is usually taken at the test site or by the doctor . Since the viruses multiply in the throat and nose area in the event of an infection, the secretion is taken from there. In more severe cases, secretions are also taken from the lower airways.

PCR test: The material samples are examined in the laboratory as soon as possible after they have been taken. The standard procedure is the PCR test . In a PCR (polymerase chain reaction), the genetic material of the corona virus is greatly amplified. This means that even the smallest amounts can be detected in the swab sample.

The PCR test takes about 4 to 5 hours, plus transport to the laboratory and the waiting time may be longer due to the large number of samples. However, the PCR test result is usually available within 24 hours of sample collection.

If the PCR test is positive, the laboratory reports the result to the health department. The health department then orders isolation and identifies contact persons of the infected person – who may also have to be tested and quarantined.

If the PCR test is negative, no infection with the coronavirus has been detected for the moment. Since the test is only a snapshot, you should still be careful and follow the known hygiene rules.

Rapid antigen test: As a supplement to the PCR test procedure, rapid antigen tests are also offered, which often provide a result after just 15 minutes. Here, virus proteins are detected in respiratory samples. The sensitivity of antigen tests is lower than that of PCR tests. Therefore, positive antigen test results must be confirmed by a subsequent PCR test. This applies to both self-tests and samples taken by medical personnel.

Symptoms of Covid-19 disease

The most common Covid-19 symptoms include:

• cough (40%)
• runny nose (29%)
• fever (27%)
• impaired sense of taste and/or smell (22%)
• Pneumonia (lung infection) (1%)

Other symptoms can include:

• Sore throat
• shortness of breath
• headache and body aches
• loss of appetite
• weight loss
• nausea
• stomach pain
• Vomit
• Diarrhea

Infection with the coronavirus often triggers respiratory infections . In the second week of the disease, pneumonia can occur, which in particularly severe cases can develop into ARDS (Acute Respiratory Distress Syndrome) . Patients with ARDS usually need artificial ventilation.

In addition, neurological symptoms such as headaches and dizziness can occur. Gastrointestinal complaints and liver problems as well as cardiovascular problems are also possible in the course of a Covid 19 disease. Some patients with severe infection may develop hyperinflammatory syndrome as the disease progresses, which can lead to multiple organ failure.

Some people experience longer-term symptoms after surviving a corona infection. Long Covid , long-term Covid or the post-Covid syndrome is considered a systemic disease and can have a wide range of effects. Read more about the symptoms, frequency and treatment options of Long Covid here.

Vaccination against Covid-19

There are currently four approved corona vaccines in Germany:

• Pfizer/BioNTech: mRNA vaccine, 2 vaccine doses, approved for everyone aged 12 and over
• AstraZeneca: Vector vaccine, 2 vaccine doses, STIKO recommendation for people over 60
• Moderna: mRNA vaccine, 2 vaccine doses, approved for everyone aged 12 and over
• Johnson & Johnson: Vector vaccine, 1 vaccine dose, approved for everyone over 18

Both the Pfizer/BioNTech and Moderna vaccines use messenger RNA (mRNA) – here’s how the BioNTech and Moderna vaccines work and how they work .

All approved Covid-19 vaccines have been shown to be effective . According to the current status, the mRNA vaccines from BioNTech/Pfizer) and Modern) and the vector vaccine from AstraZeneca protect about 90 percent against severe Covid 19 disease (e.g. hospital treatment). They also have approximately 75% efficacy against symptomatic SARS-CoV-2 infection with the delta variant.

A vaccine is unlikely to provide 100% protection.

How can I still protect myself from infection?

In addition to vaccination against Covid-19, state-imposed contact restrictions and lockdowns, everyone can do something to protect themselves and others from infection with SARS-CoV-2, to contain the spread of the coronavirus and to relieve the health system.

As a protective measure, the AHA+L formula is recommended in addition to vaccination:

• Keep your distance: Keep a distance of at least 1.5 m from others outdoors and indoors.
• Observe hygiene: Wash your hands regularly for at least 20 seconds. If you have to cough or sneeze, use a handkerchief or the crook of your arm.
• Wear a mask: Not only in the supermarket, bus and train – wherever it gets tight, you should wear a mask over your mouth and nose. Please also note the currently applicable regulations for medical and FFP2 masks.
• Ventilate rooms: Do you stay in closed rooms with others? Then you should ventilate regularly for a few minutes.

The Federal Ministry of Health also recommends everyone to use the Corona warning app so that the health authorities can understand chains of infection more quickly and inform contact persons.

Virus variants of SARS-CoV-2

Viruses are constantly changing through mutation. It is to be expected that new coronavirus variants will continue to appear over time. Several variants of the virus that causes Covid-19 have been documented around the world during this pandemic.

The best-known coronavirus mutants are:

• Alpha Variant B.1.1.7: The “British Variant” was detected in Great Britain, where it has been spreading since September 2020. At that time, many coronavirus infections in Germany also went back to this variant. The variant B1.1.7 is even easier to transfer than the previously known mutations, it has a higher number of reproductions.
• Beta variant B.1.351: This virus variant from South Africa became known in December 2020. It is assumed that this variant is also more easily transmitted from person to person. The South African variant is significantly less common in Germany than the British one.
• Gamma variant P.1: This virus variant was first detected in Brazil and is similar to the South African variant. It is conceivable that it is easier to transmit than the coronavirus wild type. In Germany, the P.1 lineage has so far been found relatively rarely.
• The delta variant (B.1.617.2) has been the most widespread in Germany since the end of June 2021. It was first discovered in India, classified as a concern by the WHO (World Health Organization) and is now dominant in many countries. The delta variant has mutations that make it more contagious than the alpha variant – and could reduce the immune response. There is also evidence that Delta increases the risk of hospitalization if infected. Studies show, however, that full vaccination with one of the approved Covid-19 vaccines provides very good protection against severe disease progression – even after infection with Delta.

How is Covid-19 treated?

People without previous illnesses and with no or mild symptoms should isolate themselves at home, rest and drink a lot.

More severe cases are treated in the hospital. Depending on the need, this includes the treatment of underlying diseases, the administration of oxygen or the administration of antibiotics in the event of additional bacterial infections. In severe cases, the patient is initially given oxygen through goggles or a mask. If this is not sufficient, non-invasive ventilation is carried out using a ventilation mask or hood.

In the event of shortness of breath, insufficient oxygen saturation in the blood and a high respiratory rate, patients are transferred to the intensive care unit. If the patient can no longer breathe on his or her own, he or she must be ventilated invasively. This is the case with acute respiratory failure (ARDS: Acute Respiratory Distress Syndrome). For this purpose, the patients are placed in an artificial coma and ventilated (intubated) with a ventilation tube.

The drug remsdesivir has been conditionally approved by the European Commission for the treatment of patients with a severe course of Covid-19. For some patients, the drug has reduced the length of time they spend in hospital.

Other specific therapeutic approaches are currently being researched.

How can Med-Healths help?

Do you have symptoms such as fever, cough, loss of smell or taste? If you suspect an infection with the corona virus, you can get medical advice directly via video consultation – without any risk of infection. Our doctors can help you to classify the symptoms correctly, prescribe medication if necessary and issue you with a sick note for your employer.

They will also discuss the next steps with you: You will find out whether you should be tested for the corona virus and which medical facility you can contact. If you have severe symptoms such as shortness of breath, contact the emergency room or a rescue center immediately.

If you have any questions about vaccination against Covid-19, our doctors can explain the effects, administration and possible risks and side effects of the vaccine to you. Corona vaccination advice via the Med-Healths App is free of charge for you, regardless of whether you have statutory or private insurance.

Where can I find more reliable and up-to-date information?

On the websites of the Robert Koch Institute and the Federal Ministry of Health you will find reliable and up-to-date information on the current situation.

Current case numbers and information on risk areas are available at www.rki.de/covid-19- risk areas and www.rki.de/covid-19-fallzahlen . You can see the current status of vaccinations in Germany on the vaccination dashboard of the Federal Ministry of Health . All data is constantly updated.