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Underlying health affects COVID-19 severity risk

SNOHOMISH COUNTY — Underlying conditions and the unknown factors around a novel virus are motivating extreme measures of caution for COVID-19 that has spread through community interaction, in droplets that are released from coughing. 
Symptoms can include cough, fever, possibly a runny nose and gastrointestinal upset. Other symptoms have been reported in Tribune
interviews.
“Cough is probably the most common symptom overall,” David Russian, CEO of Western Washington Medical Group (WWMG) and a pulmonologist, said in a March interview.
That symptom, he said, is “more common than fever.”
Of those who may become seriously ill with COVID-19, heightened risk is based on a number of factors including how well underlying health conditions are controlled before one is infected with the virus. 
But, Russian said, “as we do more testing, the 20 percent number is lowering.” 
Testing availability is improving but at first doctors were hearing from the top levels of government that anyone could get a test, which was not a reality at the local level. Availability has been limited.
WWMG and the other large medical groups have implemented drive-up testing, so patients with potential COVID-19 infections are not put into contact with other patients or unprotected staff, Russian said. 
“Because tests were lacking for a while and because not everyone who experienced mild illness was tested, the data at present may change later as more people are tested. Numbers shown now could be lower or higher, once the final tallies are in,” said Tom Ziedalski, pulmonologist and President at WWMG.
And while experts still anticipate at least 80 percent of those infected will experience “mild” illness and recover with at-home care, those with higher risks from this respiratory illness are in danger if they have a symptom doctors always say triggers a need for higher caution: difficulty breathing. COVID-19 impacts both upper and lower respiratory systems. 
Underlying conditions that so far show up in COVID-19’s high-risk data include heart and lung disease, diabetes and other immunosuppressed conditions, and pregnancy. Age is also a factor with official numbers sometimes stating the risk at “over 60” and at other times “over 65.” 
Pregnant women are being watched as a precaution, and the data so far is good: nine women in China gave birth to healthy babies after contracting the virus during pregnancy, Ziedalski said.
Recent reports say young people are at risk of serious illness as well, with Fire District 4 Chief Ron Simmons saying the disease is “indiscriminate” but assuring that first responders are ready to provide support. 
The initial symptoms for COVID-19 are similar to a flu, but for serious cases of the illness, the difference is pace. 
“Higher risk patients tend to develop respiratory symptoms much, much faster,” Ziedalski said. “We’ve seen patients in the hospital setting at Providence: they come in with some shortness of breath, and end up in the ICU (Intensive Care Unit) 24 hours later, and get intubated (using a tube to assist with breathing) 24 hours after that. So the disease progression in terms of respiratory stuff can be much more severe and quicker (than the serious cases of the flu). And COVID-19 has both upper and lower respiratory systems, and the pneumonia it causes is viral and difficult to treat.” 
“Pneumonia is the most serious consequence of the infection and is directly caused by COVID” in the population of infected patients who need medical care, Russian said. As to “why” some get viral pneumonia and some don’t, “We don’t know the answer to this yet, but most folks don’t seem to get pneumonia, or at least not clinically significant pneumonia.”
For fever control when only ibuprofen is available, call your doctor as some fevers may not need medication. Also be informed before combining medications with over-the-counter drugs. If your doctor is unavailable for questions on drug-interactions, call your pharmacist. 
The light at the end of the tunnel is eventual wellness for most people, and a slew of innovation working toward treatments. 
“I would say that most people will basically have a revved up version of the flu and will be at home and feel lousy for a week or two, and that’ll be the end of it,” Russian said. “The mortality (for COVID-19) is definitely worse than the regular flu, but the vast majority of people, well over 90 percent maybe over 98 percent ... will do fine. So I think that’s probably the most important point.”
But, the doctors say for those people with underlying conditions, the usual advice for when to seek medical advice is different with COVID-19. The usual advice when enduring a flu or cold is to drink fluids and get enough rest. But for COVID-19, when combined with underlying illness, the caution can arise sooner. 
“If you do have concerns, you get up and you cough and you have respiratory symptoms,” people with underlying conditions and those older than 60 “should probably not wait two weeks” to call a doctor, Ziedalski said.
Those with specific risk may want to plan ahead, getting advice while healthy, via phone or online. The information can help gain a set of personalized protocols on when to manage health issues at home, and when to call in. 
Area clinics and hospitals are focusing on existing or newly unveiled offsite tools to assess patients with concerns. WWMG, the Everett Clinic and other agencies are using televisits to minimize contact and care for patients. The avoidance of onsite contact has three goals: to avoid more COVID-19 exposure, determine who is in danger and who is worried but healing at home, and to assure that medical agencies can focus on the highest level of need. At WWMG, televisits are new and were unveiled with the coronavirus.
The other challenge is ensuring people get the correct information, in a situation that is still evolving with changes hour to hour. As for any people claiming COVID-19 is a hoax, the response came with an uncomfortable laugh from a doctor who is on the front-lines of emergency care for the disease. 
“People should take this seriously,” Ziedalski said. 
New treatments are being studied. A vaccine clinical trial kicked off recently in Seattle, with the first patient injected on March 16. It took just over two months to get it started: an unprecedented pace, as clinical trials usually take 90 days, Drs. Russian and Ziedalski said. An antiviral, Remdesivir, and anti-inflammatory drugs, such as Actemra or other related drugs, are regulated for “compassionate use,” meaning that even though they are not known to work on COVID-19, they are cleared for use on the more severe cases.
“Initial reports are encouraging and clinical studies have been quickly started,” Russian said.
Researchers and doctors are recommending old-school logic to fight its spread: social distancing and cleanliness: wash hands, sanitize frequently touched surfaces, stay six feet apart if in a space with other people, do not touch your face as that is where the virus can enter the body. 
”I think that people need to be aware that still the worst is ahead of us. This is not going to go away easily. We need to be prepared. People need to follow guidelines. People need to stay away from public places and, as they say, if people have some symptoms they need to isolate themselves,” Ziedalski said. “This is going to be a long rough kind of experience for all of us.”




Underlying health conditions in relation to fatality data

Of the 40 COVID-19 deaths of Snohomish County residents through April 1, 37 were reported by the Snohomish Health District to have had an underlying health condition.
Of these, 15 deaths during March were people associated to assisted living facilities named by the health district such as Josephine in Stanwood or Sunrise in Everett. Every one of these 15 people had underlying health conditions, from crossreferencing Snohomish Health District data.
The county death toll stands at 43 as of Sunday, March 5.
— Information compiled by Tribune staff

 

 

  

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