ESSAY ON COVID 19

Some mutated species of the Coronavirus family, which is commonly

accepted as a disease agent in animals, can also cause diseases in
humans. We have witnessed examples of this as SARS in 2002 and
MERS in 2011, both of them being severe lower respiratory tract
infections. The causative pathogen of the disease, which has become a
pandemic (a worldwide epidemic) today, is named the SARS-CoV2 virus,
and the disease it causes is COVID-19. It causes serious lower
respiratory failure, as in previous examples, and may damage the
central nervous system in the early period, unlike the previous ones.
Like other members of the Coronavirus family, this virus has a sheath
called the envelope in its fat structure, which has spiky protrusions of
its protein structure on its outer surface. Because it looks like a “crown”
due to these spiky protrusions, it is referred to as “corona”, meaning
crown (figure). The spiky proteins of the SARS-CoV2 virus differ from
the SARS virus by 2% and provide much better adhesion to human cells.
The virus is a non-living pathogen agent with its nucleic acid chain (a
kind of helical amino acid chain that carries genetic codes) in the
envelope. The virus can replicate itself, cause damage, and spread only
when it infiltrates into another cell. For the SARS-Cov2 virus to infiltrate
into cells, its envelope structure must be strong. The virus becomes
harmless as oil solvents such as soap or detergent damage the
envelope structure. It can remain infectious for only a few days if it
cannot infiltrate into the cell provided that its envelope structure is
strong. The exposed virus is deformed over time and becomes
ineffective. When a sufficient number of SARS-CoV2 enters the human
body, the infection begins once the virus clings onto the surface
epithelium (a skin-like but much thinner, a single layer of cell covering
the inner cavities of our body) and then infiltrates the cell.

Modes of Transmission
It is proven that the virus is transmitted by airborne droplet infection
and through contact with infected surfaces. Furthermore, although it
has been demonstrated that the live virus has excreted from the human
body through feces within 12 days of the onset of the disease, it has
not been proven to be transmitted that way. The live virus has not been
demonstrated in blood and urine and does not exhibit infectious
properties. The disease is not transmitted by blood and blood products,
or by mosquitoes or other bloodsucking parasites. Yet it is transmitted
from person to person, and infectiousness begins even when the
person who is sick has not yet developed symptoms. There is no
consensus on the effects of climate and weather conditions on the
contagiousness of the disease. There are scientific studies indicating
that increased air temperature and humidity reduce the speed of
propagation of the disease. However, some authors report that this
would not be effective.

Age and Gender

42% of the patients that received a final diagnosis are between the ages
of 18 and 40. A closer look at the general breakdown of diagnosed
cases by age shows that there is a noticeable accumulation among
older people. In general, the disease tends to be more severe in people
with chronic diseases such as diabetes, heart and kidney failure, or
undergoing cancer treatment or in cases where the immune system is
suppressed or in older people. However, 40% of patients still consists of
people under the age of 55. Therefore, it would be wrong to think that
it mostly affects persons of rather advanced age. On the other hand, it
progresses more severely in older people with more severe results.
The proportion of child patients diagnosed (under 18 years of age) to all
patients is reported to be 2.4%. The reason why we have such a
statistical result is that there are more cases that are overlooked
because the disease is much milder in childhood. This is mainly due to
the fact that vaccination programs are mostly implemented in
childhood. The lack of fully-developed cellular mechanisms that allow
the virus to infiltrate into the cell may also be a factor providing
children with natural protection. It has not been demonstrated that the
virus is transmitted from sick mothers to the child through pregnancy.
Men contract the disease more than women, and about 60 to 70% of
mortality is seen among men. As a cause of this, some have suggested
that chronic diseases and the habit of using tobacco are more common
in men. Furthermore, the estrogen hormone, which is more abundant
in women, is estimated to have an influence on this. However, it is
likely that the main reason is the genes related to the immune system
are mostly located on the X chromosome, which is the sex
chromosome.9 Women have two X chromosomes while men have only
one.

Symptoms
The period between the introduction of the virus into the body and the
onset of symptoms is called the incubation period, which is about 4 to 7
days in the majority of cases and can vary from 2 to 14 days when
COVID-19 is concerned. Symptoms include fever in 80 to 90% of cases,
cough in 60 to 70% of cases, gastrointestinal complaints in 40 to 50%,
loss of smell in 30 to 40% and shortness of breath in 20%. Not all these
symptoms are necessarily observed. Furthermore, it is estimated that
one can have the disease and recover without any of the symptoms
hitting the surface. For example, some cases only progress with
gastrointestinal symptoms without any fever and respiratory
complaints, and in such cases, it may take longer for the patient to
recover. Fever and shortness of breath seem to be the most significant
symptoms. Patients who do not develop respiratory distress recover in
about a week. Recovery time may extend up to 2 weeks in patients
whose fever cannot be controlled.
In general, the clinical picture may exhibit itself in 4 different ways:
Mild cases – Symptoms are almost non-existent and the patient has
absolutely no breathing difficulties.
Moderate cases – The patient has a fever as well as radiological signs of
pneumonia. Almost 80% of all cases are in the mild and moderate
group.
Severe cases – The respiratory rate is more than 30 per minute and the
oxygen saturation is less than 93% at rest. Radiological signs of
pneumonia grow worse by more than 2 folds within 1 to 2 days. About
14% of all cases are in this group.
Critical cases – Ventilation in the ICU is required. The patient develops
shock and/or multiple organ failure. Fortunately, only about 6% of all
cases are in this group.7
Suspect Case Definition and Diagnosis
The suspect case definition updated multiple times by the Ministry of
Health is as follows:
Fever accompanied with cough and/or shortness of breath, or contact
with a patient diagnosed with Covid-19. There are two different
definitions here, involving either “a person with close contact” or “a
person with contact”.
The definition of a person having close contact without protection
includes the following:
Those who provide care to a confirmed or suspect case
Those visiting sick people
Students and teachers in the same school environment as sick people
People who had skin contact and/or shook hands with sick people
People who come into contact with the saliva or body secretions of sick
people
Those who stay in the same indoor environment as sick persons at a
distance of less than 1 meter for more than 10-15 minutes
Passengers who travel within two rows to the front, back or side on the
same plane or bus as sick persons
Those living in the same home as sick persons
Those working in the same office as sick persons
The definition of a person having contact without protection includes
the following:
Those who stay in the same indoor environment as sick persons at a
distance of more than 1 meter
Those who stay in the same environment as sick persons for less than
10 minutes
Those who stay in the same indoor environment as sick persons at a
distance of less than 1 meter for less than 10-15 minutes
Diagnosis can be made by demonstrating the virus in the secretions
from the nose, throat, or lower respiratory tract (RT-PCR test) of people
who fall within the scope of suspect case definition due to their
complaints and symptoms.10 The sensitivity of this test may drop to
70% in the early stages of the disease and may not give positive results
for all patients.3 It is required to evaluate the chest x-ray or CT scan
images of patients who are more practically suspected. Although the
definitive diagnosis cannot be made according to the results of the x-
ray, it can demonstrate a high match with RT-PCR test and thus indicate
possible disease earlier during the pandemic.10 Serological tests for the
investigation of early specific antibodies (IgM) generated by our virus
defense system are also in question and can turn positive on day 3 to 5
following the onset of symptoms Making a retrospective diagnosis
following the recovery of patients is also possible following research on
late specific antibodies (IgG).

Protection
For protection against the disease, a collective social observance of the
individual measures is equally as important as those measures
themselves. It is critical for containing the spread of the disease to
isolate and treat diagnosed cases and isolate those who had contact
with sick persons. It is recommended to isolate those who had contact
with diagnosed cases. Those who had close contact with a suspect case
need to be isolated until the test results of the suspect case are
available. If the test results are negative, isolation is ended. The
isolation period must be at least 14 days due to the incubation period.
It is through contact tracing efforts that patients and the persons they
contacted are identified. The morbidity increase during the pandemic
can be controlled through contact tracing and isolation. This enables
efficient use of the available healthcare institutions and the health
personnel capacities that can combat the pandemic, thereby
preventing an overburdening and halt of the healthcare system in a
country. Therefore, as individual members of society, we all need to act
responsibly and support this goal together.
Below is a brief list of protection measures:
Isolation and proper patient care
Hand hygiene
Surface cleaning
Waste management
Personal protection
As a personal protection method, it grows very important for all
patients or healthy people to wear a mask that covers their mouth and
nose. Healthcare personnel who are involved in the treatment of
patients must use more specialized masks, glasses, visors, and special
gowns. The spread of saliva and droplets from the respiratory tract can
be prevented when sick individuals use masks. This proves to be a very
effective method of preventing the environment from being infected.
Viruses in the airborne droplets that spread when sick people sneeze
and cough can hang in the air for up to 3 hours. These particles then
land due to gravity and infect all the surrounding surfaces. Sneezing or
coughing directly into someone else’s face may cause that person to
catch the disease through their eyes as well. To prevent that, using
glasses can be protective. In addition, frequent ventilation of indoor
environments is crucial in terms of cleaning the virus load in the air.
Viruses suspended in the air can reach the respiratory tract of healthy
people during breathing. Moreover, the burden of the virus (number of
viruses) entering the body at that point is naturally of great importance.
In order to contract the disease, a very high number of viruses must
reach our respiratory tract. Therefore, contracting the disease from the
air in indoor environments is much more likely than in well-ventilated
environments or outdoors.

Social Distancing
It also gets more important how close we are to a sick person and how
long we have been that close. Maintaining the distance between
people is expressed as social distancing, which should be more than 1.5
– 2 meters especially indoors. Practically, the further away we keep
from sick individuals, the less likely we are to contract the disease. The
use of masks by healthy people at this stage can also prevent the
droplets from reaching our respiratory tract and the virus load can be
reduced considerably depending on the feature of the mask used.

Mask Selection
In social life, it is very important to use a mask that basically closes the
mouth and nose. Masks made of various fabrics can particularly
prevent the spread of the infection to a great extent when used by sick
people. There is not a specific type of mask that must be selected. The
use of even the washable and reusable masks is significantly effective in
preventing the spread of the infection.
It is recommended for healthy people to use masks especially indoors,
preferably surgical masks or even specialty masks with advanced
filtration, if available. To that end, masks that can filter particles smaller
than 3 microns gain importance in order to keep away extremely small
viruses.
Healthcare personnel treating patients or relatives caring for their
patients must absolutely use specialty masks. Specialty masks available
include N95 (FFP1), N97 (FFP2) and N99 (FPP3), which can filter out
coronavirus by 95%, 97% and 99% respectively. It is especially
important for healthcare professionals to use FFP2 or FFP3 masks.
These masks can effectively be used for approximately 8 hours. At the
end of this period, they need to be replaced. Some studies suggest that
it is appropriate to reuse such masks once or twice after sterilizing
them for about 15 to 30 minutes with UV rays, since they cost more
and are not very easy to procure.

Hand Washing
Adequate protection cannot be taken for granted even if sick and
healthy individuals alike use masks and comply with social distancing
requirements. The disease can be transferred from infected surfaces to
our mouth, nose or eyes via our hands. Therefore, it is crucial not to
touch our mouth, nose and eyes with our hands. If we have lesions on
our hands such as wounds that disrupt the integrity of the skin, it may
be possible for the virus to enter our bodies through such gates. In such
cases, it may be useful to use gloves to touch surfaces the cleanliness of
which you are not sure about. Considering the biological structure of
the virus, the oily envelope structure that forms its outer surface can be
disintegrated with soap and detergent. Therefore, washing our hands
with soap for 20-30 seconds when we think they are dirty eliminates
the ability of viruses to infect. We can use our personal towels or paper
towels or hot dry air currents. Hot dry air currents do not clean hands
by themselves.4 Apart from washing our hands with soap, alcohol-
based hand disinfectants are also known to disrupt the envelope
structure of the virus and eliminate its ability to infect.

Surface cleaning
Viruses can remain on the infected surfaces for days at a quality and
quantity that can maintain their infectivity.3 In a study on SARS-CoV2, it
is found that the virus can survive up to 3 days on plastic and steel
surfaces, up to 24 hours on cardboard and up to 4 hours on copper.
However, this does not mean that the infectivity of the virus continues
throughout such periods. The infectious potential is approximately 60-
70 minutes suspended in the air, 45-50 minutes on copper, 3-4 hours
on cardboard, 5-6 hours on steel and 6-7 hours on plastic. Therefore, it
is scientifically considered sufficient to keep the purchased products
outside for a few hours before they are brought into the house. It is not
deemed necessary to disinfect the products by washing them with
detergent or soap.
Soap, detergents and diluted bleach can be useful for surface cleaning.
However, even though the use of vinegar as a cleaning agent has an
effect on parasites, it is known that it has no effect against the
coronavirus
The virus can be transported from infected surfaces by contact, but the
duration of contact and the humidity of such surfaces also matter. It
takes about 10 seconds of contact time to become infected by touching
a dry surface with our dry hand. In other words, we are not
immediately infected by touching an infected surface for 1-2 seconds
and then quickly stopping contact. The time needed for such infection
to take place can be as short as 5 seconds if one of the contacting
surfaces is moist, and 3 seconds if both are moist. Furthermore, it is
known that the virus loses its infectiousness when exposed to direct
sunlight for more than 30 minutes.

Protection with Medication

If there is intestinal involvement in COVID-19, diarrhea and abdominal
pain occur. Although there are no symptoms of the gastrointestinal
tract as a symptom of the disease, diarrhea may develop since bowel
functions are impaired as a side effect of the agents used for treatment.
In such cases, it is useful to use probiotics to protect and reinstate the
intestinal flora.
Hydroxychloroquine molecule has been used for the treatment of
malaria for years and is publicly known as quinine. It is also used for the
treatment of certain joint diseases. It was demonstrated back in 2006
that quinine was effective in the treatment of coronavirus infections. It
is suggested that this drug, which is approved for use in the treatment
of COVID-19, may also have prophylactic effects in high-risk people
when used at very small doses (200 mg every 3 weeks). However, it is
reported that if this drug is taken as prophylaxis, it may cause delays in
diagnosing the disease as well as resistance to other drugs if the disease
is contracted. It is useful to get professional help from physicians
instead of acting on our own for protection with this type of
medication.
Nutrition
Vitamins can be beneficial within the diet. It is reported that the IV
administration of vitamin C as an antioxidant, especially in high doses,
will be beneficial in severe cases. Based on this, researchers suggest
that dietary supplements such as vitamin C and D can be effective in
preventing disease.

There are studies suggesting that eating bitter vegetables or drinking

the likes of coffee and tea, which can all be defined as bitter by taste
receptors on our tongue, may be useful in preventing COVID-19.
If patients cannot be fed orally, it is important for the intestinal flora to
continue feeding via the feeding tubes that go through the nose and
into the stomach. More specific nutritional solutions should be chosen
in cases where intestinal absorption is impaired. In cases that cannot be
fed orally, the option of IV serum feeding should be selected.
Although 70% alcohol is effective to clean infected surfaces and ensure
hand hygiene, drinking alcohol does not disinfect the mouth and throat,
fails to decrease the likelihood of contracting the virus and may even be
harmful as it can negatively affect your immune system.
In particular, it is reported that obesity at a young age worsens the
course of COVID-19 and increases resistance to treatment as well as
morbidity. Obesity not only causes chronic inflammation (inflammatory
reaction in tissues) by itself but also sets the basis for diabetes, which
can make an impact in the course of the disease.
Environmental Conditions
Isolation has emerged as one of the best protection methods. Staying
as far away from infected people as possible not only reduces our
chances of contracting the disease but is also crucial in terms of
preventing the spread of the disease socially. Contrary to popular
belief, it is not proven that exposure to temperatures above 25 degrees
or sunbathing will prevent contracting the disease. Similarly, cold
weather and extreme winter conditions do not affect the spread of the
virus and the transmission of the disease. Neither taking a shower with
hot water or going into a Turkish bath or sauna are effective in treating
the disease nor do they reduce its contagiousness.

Vaccine
No dedicated vaccine has yet been developed for Covid-19. However,
based on the data obtained from 178 countries in the world, recent
studies show that the incidence rate of COVID-19 is lower in countries
where the TB vaccine (BCG) is commonly applied compared to other
countries. In addition, it is reported that mortality rates are 10 times
lower thanks to early-age BCG vaccination. This study suggests that the
immune system (immunity) can grow stronger following BCG
vaccination in childhood and thus COVID-19 may at least be milder in
persons vaccinated this way.
However, seasonal flu vaccines do not ensure any protection against
COVID-19. Yet it is predicted that they can be useful for our body
resistance since they are able to reduce our likelihood of catching other
flu types.