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The World Health Organization has declared that there is a pandemic caused by the spread of a new coronavirus. This virus is called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and causes a disease called coronavirus disease 2019 (COVID-19).
Human coronaviruses cause infections of the nose, throat and lungs. They are most commonly spread from an infected person through:
Current evidence suggests person-to-person spread is efficient when there is close contact.
SARS-CoV-2 can cause a flu-like syndrome in infected people. In most cases (80%) a person will feel like they have a mild cold or flu. However, other people with COVID-19, can develop more serious symptoms and complications. The symptoms of COVID-19 have included:
In severe cases infection can lead to death.
It is very important that people at increased risk for serious illness with COVID-19 as well as those who provide support and care for them take precautions to reduce the risk of transmission. Information about who is at increased risk appears later in this bulletin.
Because the virus can spread so quickly and can cause serious complications in some people, public health officials are asking all people to take precautions to avoid transmission.
To reduce your risk of becoming infected with the coronavirus the Government of Canada recommends the following steps:
Note: hand sanitizer should contain at least 60% alcohol
Additional measures to limit the spread of coronavirus include the following:
The vast majority of people (about 80%) who become infected with the coronavirus will not have severe symptoms. They will feel as if they have a mild cold or flu. However, a small proportion of people who become infected will feel as if they have a severe flu or cold. An even smaller proportion will develop difficulty breathing and, in some cases, pneumonia. People aged 65 and older seem to be at heightened risk, especially if they have other health conditions.
Research suggests that, in general, people at high risk for serious illness related to coronavirus infection tend to have the following underlying conditions:
These underlying conditions may also be associated with other conditions or diseases as described below.
HIV infection and related factors
There is not much research on the impact of COVID-19 on HIV-positive people. According to Anthony Fauci MD, the Director of the U.S. National Institutes of Allergy and Infectious Diseases (NIAID), an otherwise healthy HIV-positive person who is taking HIV treatment and who has an undetectable viral load and a normal or near-normal CD4+ cell count, is expected to be at low risk for serious illness with COVID-19. Each laboratory has a different range for what is considered a normal CD4+ count. However, the lower end of the normal range for CD4+ cell counts is usually around 500 cells/mm3.
HIV-positive people who are not on treatment, particularly those with very low CD4+ cell counts may be at increased risk for serious illness with COVID 19. Additionally, many HIV-positive people are older, some elderly, and studies suggest that HIV-positive people are more likely to have an underlying condition than the average HIV-negative person of the same age. In general, these underlying conditions tend to be as follows:
Regular monitoring and doctor recommended treatment can help manage and minimize these underlying conditions. Some of these conditions may be associated with more serious illness with COVID-19.
The California Department of Public Health, Office of AIDS, has advice for what additional precautions you should take if you are at higher risk of illness from COVID-19:
Autoimmunity and transplantation
There are some conditions whereby the immune system attacks the body; these are called autoimmune diseases and can include the following:
Some people with these conditions, as well as those who have transplanted organs or tissues, are prescribed treatments that suppress the immune system. As a result, they may be at higher risk for becoming infected with and developing serious illness with COVID-19.
Pregnancy
There is no information at this time about the effect of coronavirus on the health of the mother or the fetus.
Hepatitis viruses and other liver disease
Viruses such as hepatitis B virus (HBV) and hepatitis C virus (HCV) infect the liver and over time, degrade this vital organ. As the liver degrades, a person’s overall health worsens and specific conditions can develop. People who have extensive liver injury arising from HCV and who have not yet been cured can have underlying conditions such as kidney injury, cardiovascular disease, and diabetes. Note that HCV can be cured in as little as eight weeks with treatment that is taken once daily. HCV treatment is widely available in Canada.
People with HBV can also have underlying conditions such as those mentioned above. HBV can be managed with medications
As a result, people with hepatitis viruses may be at higher risk of serious illness with COVID-19.
Fatty liver disease
There are other liver diseases such as nonalcoholic fatty liver disease (NAFLD). This can be broken down into two subtypes – simple fatty liver disease and nonalcoholic steatohepatitis (NASH). These can occur in people with and without HBV, HCV or HIV. People who have some form of fatty liver disease may also have an underlying condition such as the following:
Thus people with fatty liver may be at increased risk of developing serious illness with COVID-19.
Vulnerable populations
Some populations, including people who use substances and homeless people, may also have underlying conditions that place them at increased risk for serious illness with COVID-19. Additionally, those with inadequate or overcrowded housing, are more dependant upon others for basic needs and less able to maintain social distance, therefore are also more at risk of COVID-19.
Getting help: If you think you have been exposed to the coronavirus and develop a fever and symptoms, such as cough or difficulty breathing, call a health care professional or the public health authorities in the province or territory where you are located.
There is a test for SARS CoV-2 in Canada. Public health authorities in your region can tell you more about this test and how to get access to it.
According to the U.S. Centers for Disease Control and Prevention (CDC) here is some advice if you think that you have COVID-19:
Stay home except to get medical care
Separate yourself from other people and animals in your home
Call ahead before visiting your doctor
Wear a facemask if you are sick
Avoid sharing personal household items
Clean all “high-touch” surfaces everyday
Monitor your symptoms
There are no approved treatments or vaccines for SARS CoV-2. However, research is underway with different potential treatments for coronavirus infection.
There are suggestions from laboratory research with cells and viruses that an older HIV treatment can inhibit the SARS CoV-2. This treatment is lopinavir-ritonavir and sold as Kaletra in Canada and other high-income countries, and as Aluvia (and in generic formulations) in other regions. Clinical trials are underway to find out if Kaletra is effective in people with COVID-19. Note that Kaletra is associated with side effects such as diarrhea, loose stools and nausea. It also has the potential to interact with many other medicines and substances, raising or lowering their levels in the body and vice versa.
There is no evidence that other anti-HIV drugs have activity against SARS CoV-2
Federal, provincial/territorial, and local public health authorities are providing ongoing guidance regarding additional precautions that should be taken to limit the spread of the virus in your region.
Information about COVID-19 is changing rapidly. Please consult the resources below for the most current information:
Acknowledgements
CATIE thanks Professor William Cameron MD, University of Ottawa and Isaac Bogoch MD, University of Toronto, for their input and helpful comments in developing this article.
—Sean R. Hosein and Timothy Rogers