It’s Just a Virus:
Many people who historically came to the doctor’s office were frustrated when the doctor says it’s just a virus. I may be a sports medicine physician but I have always found viruses to be interesting and terrifying. A lot of people seem to think they feel awful and thus they must have a bacterial infection. When I worked in urgent care I used to say, that doesn’t mean you are not sick or that your not miserable, it just means that we have no treatment to get rid of it. While there are some anti-viral medications for a small number of viral illnesses, for the majority of viruses, all we have to offer even now in 2020 is supportive care. Supportive care means we support the patient while their body fights to suppress or rid itself of the virus. The most common viruses include viruses that cause respiratory complaints such as the influenza, viruses that cause colds; as well as viral gastroenteritis which causes vomiting and diarrhea. Most viruses are self- limiting but many can be severe or life-threatening: including hepatitis viruses, Ebola virus, HIV, and influenza. What’s more viruses can mutate often very quickly and find ways to better evade our immune systems and infect us. On the flip side our own immune system can over-respond to a viral trigger resulting in systemic inflammation all over the body which can make people very sick or even die. In fact the 1918 influenza was particularly deadly for young adults for this very reason, their robust immune system. Rarely, viruses can cause severe life long issues such as autoimmune diseases, post viral syndromes, or even chronic viral encephalitis.
COVID
So what is COVID. At this point everyone knows that it is a coronavirus which predominantly attacks the respiratory system. COVID is just one of many coronaviruses that effect humans. Some coronaviruses cause cold like symptoms, and some cause severe illness. There have been two previous coronavirus outbreaks, SARS and MERS. We do not yet know how coronavirus came to infect humans but it likely is spillover from contact to animals. Zoonoses, or illnesses that spillover from the animal kingdom are increasingly common as the human population increasingly moves into animal habitat. They also have a great potential for being severe as they are novel to humans. Not all viruses that spill over to humans cause a pandemic, to do so the virus must also be able to spread from a person to another person, which COVID can do quite well. Briefly the signs and symptoms of COVID are similar to the flu and include: cough, fever, malaise, shortness of breath, and even nausea and diarrhea. Unlike a lot of respiratory viruses that may last weeks but tend to get better around the 7-10 day mark, some people with COVID seem to get much worse even after seven days. Similar to the 1918 influenza, some people go into organ failure , shock, or respiratory failure possibility due to cytokine storm or a robust immune response that actually injures one’s own body. There is also evidence that COVID can result in heart inflammation, heart failure, or rhythm problems. While this can occur for a variety of other viruses, it is not common. We do not yet know the incidence of heart complications from COVID but it does seem higher than most viruses which is a complication that can make it hard to return an athlete to sports.
Over the next week I’ll explore some of the implications of COVID on sports, sports medicine, and fitness.
For more reading on viruses I highly recommend Spillover: Animal Infections and the Next Pandemic by David Quammen, The Great Influenza by John M. Barry, and Rabid: A Cultural History of the World’s Most Diabolical Virus by Bill Wasik and Monica Murphy.