SARS-CoV-2

Outline:

  • Ohio State Governor Order
  • Virus overview and description
  • Symptoms
  • Incubation period and duration of sickness
  • How to protect yourself
  • Personal suggestions from the Dentist
  • How we protect our patients

Ohio State Governor Order:

Ohio as of March 17, 2020 is reducing social contact within our state.  In line with this objective, the Ohio State Dental Board along with the Governor and state regulators ordered all dental practices to only treat emergency patients.  Home Street Dental is complying with this request but will see emergency patients during this time.  Please call if you have pain or a medical condition that requires dental clearance.  We are running with reduced staff so leave a message if we don't answer so we can get back with you ASAP.  If you have pain or anything that has you concerned, we will do our best to help!  If we don't call back within a couple hours, please call again.  Thanks!  Dr Harning

Virus overview and description:

The Coronavirus 2 is making a worldwide penetration and it is only a matter of time before we see our community infected with this virus.  All of us are wondering how this will affect our activities, social life, and our jobs.  Overreaction causes unnecessary hardship on us and the community.  The impact can be minimal if we understand and take appropriate precautions to protect ourselves.  The intention of this article is aimed at helping this mission.

What is this virus?  It is a severe acute respiratory syndrome called Coronavirus 2 (Sars-CoV-2).  The infection is actually called COVID-19.  It infects the nasopharyngeal and respiratory system.  The virus enters the cells of this tissue by polymerase chain reaction (PCR) altering the machinery of the cell to stop its normal function and begin producing more virus pathogens.  Once the cell is high jacked, the cell produces more viruses, they replicate and burst through the cell membrane to infect more cells in the nasopharyngeal and respiratory system.

What are the symptoms? 

 

Fever (100 Fahrenheit or greater), Dry Cough in the chest (not tickle in throat), Chest pain, Shortness of breath (Seek help if you get this symptom - more serious), Sore throat, Body aches, Digestive issue including: nausea, diarrhea in some patients (10-15%), Severe headache, Abdominal pain, Red eyes, Weakness are the typical symptoms found with COVID-19.  These will develop 2-14 days after exposure.  This is very much like the common cold except for the shortness of breath.  Patients can have all or none of these symptoms when infected.  There is some thought people can be carriers but is not confirmed at this time.  See your doctor if these symptoms show up for testing and diagnosis.

Incubation period and duration of sickness:

If you are exposed to the virus it takes anywhere from 2 to 14 days before symptoms arrive.  An estimate of 5.1 days for the median disease incubation period comes to us from Johns Hopkins Bloomberg School of Public Health.  During this period it is not believed you are contagious but you should follow all the precautions outlined below regardless of sickness or health to protect yourself and others.  If the symptoms manifest themselves, you need to get a diagnosis from your doctor and quarantine yourself so not to expose others.  On average, an infected person will transmit the sickness to 2 or 3 other people.  Please do all you can to reduce the chances of this by following all the precautions outlined here.

Once you get sick, the mean length of sickness appears to be 12 days on average but can extend with complications to 6 weeks.  The range is anywhere from 5 to 24 days of viral shedding from the nasopharyngeal membranes.  We advise isolating yourself during this period of time and protect others by keeping all surfaces you touch clean by disinfectants that kill viruses.  Note that Lysol kills most viruses and bacteria.  Bleach is a very effective killer to treat surfaces that are not affected by the agent.

How do we protect ourselves? 

The virus is thought to spread mainly from person-to-person.

  • Between people who are in close contact with one another (within about 6 feet).
  • Through respiratory droplets produced when an infected person coughs or sneezes.

These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

 

Here are things you can do that help isolate you from possible infection:

 

Clean your hands often

  • Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing.
  • If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.
  • Don’t touch your eyes, nose, and mouth with unwashed hands.

Avoid close contact

Stay home if you’re sick

Cover coughs and sneezes

  • Cover your mouth and nose with a tissue when you cough or sneeze or use the inside of your elbow.
  • Throw used tissues in the trash.
  • Immediately wash your hands with soap and water for at least 20 seconds. If soap and water are not readily available, clean your hands with a hand sanitizer that contains at least 60% alcohol.

Clean and disinfect

  • Clean AND disinfect frequently touched surfaces daily. This includes tables, doorknobs, light switches, counter tops, handles, desks, phones, keyboards, toilets, faucets, and sinks.
  • If surfaces are dirty, clean them: Use detergent or soap and water prior to disinfection.

Keep yourself in good health by getting:

  • Proper nutrition – Fruits, vegetables, whole grains, nuts are the bases of a good diet.  Reduce as many processes foods, sugar, and white breads as possible.  Restaurant food is typically made for taste and not nutrition.  Avoid going out to eat.  You have no idea who is handling the food in the restaurant.
  • Exercise – Going for a walk for about 20 minutes a day.  It is an easy way to get exercise and fresh air.  Try a quicker walk or other exercise to increase the heart rate.
  • Water – 8 cups of water per day flush the system and properly hydrate the membranes of the body that protect you.  If you are dehydrated, it increases the possibility pathogens entering the body.  When you are properly hydrated, pathogens are flushed away from membrane surfaces.
  • Fresh air – Oxygenation of the blood brings increased vigor to the cells and membranes of the body.  The tissue takes on a healthy looking color and healthy tissue is strong and protective.  Oxygenation of the tissue oxides unwanted substances as a protective process to remove them.
  • Rest – Most people need 7 to 8 hours of rest per day.  Sleep deprivation taxes the system and decreases the white blood cell count (WBC).  WBC is the pathogen killers of the body and need to remain in good numbers to protect us.  NOTE: IF YOU GET COVID-19, 80% OF PEOPLE NEED ONLY REST TO RECOVER.  Give your immune system a jump by getting proper rest now.  (If you are 60 or older or pregnant, and you suspect you have COVID-19, see your doctor)
  • Positive attitude – The connection between mind and body is phenomenal.  If you think positively, science shows sickness and disease decrease.  The placebo effect is not a theory but a fact that all studies must rule out because it affects the outcome of treatment so profoundly.  Don’t panic with this problem.  We’re going to be ok!

Personal suggestions from the Dentist:

  • DO NOT touch your face, mouth, nose, eyes, and don’t eat after touching objects of possible contamination or other people.  Wash your hands thoroughly before eating or touching anything on your head.
  • When out in public, put on cotton gloves when touching objects of unknown sanitation.  Viruses require liquid and heat to live.  A hard surface protects the fluid of the virus but cloth dehydrates it.  Please be aware that viruses can live on hard objects for 1 or 2 days, cloth for 8 to 12 hours, and on your skin for 20 minutes if the skin is healthy because of the skin ph and its porous nature.  The added barrier just reduces the number of viral load on your body.
  • Consider taking Vitamin C, Vitamin A, L-lysine, and N-acetylcysteine (NAC) to increase the health of your mucous membranes.  These vitamins and amino acid are used in the formation of collagen and tissue integrity of the body.  Collagen is the substance that makes up the strength of the tissue and protects it from damage and disease. 
    • Lysine is necessary for healthy growth and tissue repair, and it serves a role in the normal production of antibodies, hormones and enzymes. It is involved in the formation of collagen, a substance critical for bones and connective tissues including skin, tendons and cartilage.  I suggest 1000mg per day for an adult.
    • Vitamin A is commonly known as the anti-infective vitamin and has an essential role in vision and cellular differentiation, the latter providing a unique core mechanism helping to explain the influence of vitamin A on epithelial barriers.
    • Vitamin C is also necessary for repair and formation of collagen.
    • N-acetylcysteine (NAC) has been in clinical use for more than 30 yrs as a mucolytic drug. It has also been proposed for and/or used in the therapy and/or prevention of several respiratory diseases and of diseases involving an oxidative stress, in general.  Administration of N-acetylcysteine during the winter appears to provide a significant attenuation of influenza and influenza-like episodes, especially in elderly high-risk individuals. N-acetylcysteine does not prevent virus influenza infection but significantly reduced the incidence of the clinically apparent disease.  Individuals who took NAC only showed symptoms 25% of the time compared to those who didn't take it.  I suggest 600mg twice a day at morning and evening for an adult.

Precautions:

  • Because of the potential for side effects and interactions with medications, you should take dietary supplements under the supervision of a knowledgeable health care provider.
  • Lysine can increase the absorption of calcium. Use caution when taking large amounts of calcium while supplementing with lysine.
  • While lysine in the diet is considered safe, excessive doses may cause gallstones. There have also been reports of renal dysfunction, including Fanconi syndrome and renal failure.
  • Talk to your doctor before taking supplemental lysine if you have kidney disease, liver disease, or if you are pregnant or breastfeeding.
  • Vitamin A is a fat soluble vitamin and must not be taken in too large of quantities.
  • N-acetylcysteine (NAC) is likely safe for adults when provided as a prescription medication. However, high amounts may cause nausea, vomiting, diarrhea and constipation. When inhaled, it can cause swelling in the mouth, runny nose, drowsiness and chest tightness.

 

How we protect our patients:

We use universal precautions to protect our patients and staff.  Everyone is treated as if they have disease so we isolate any pathogen known or unknown to the individual carrier.  Washing hands, gloves, masks, sanitizing all surfaces in the operatory room, and sterilizing all instruments used in our practice of dentistry is standard.  The only risk we take with this virus in our office is a coughing patient.  If a patient is coughing or has any of the symptoms described with this virus, we ask them to postpone their visit until these symptoms pass.

Universal precaution is effective.  In dental school my classmates and I followed these procedures and I noticed how we all washed our hands when using the restroom.  In public, notice how many people use the restroom without washing their hands.  During my 4 years of dental school, my classmates and I were not sick even with all the patients we saw on a regular basis.  My experience shows, the procedures work.

Starting Monday March 16, 2020, we begin screening patients for risk of exposure and taking their temperature.  Patients will also rinse with Peroxide prior to an exam or treatment in the mouth.  Please be patient and compliant as this reduces the risk of spreading the virus in our community.  We want our patients to rest assured; a visit to our office is safe.

We also ask our patients to inform us if they are diagnosed or develop symptoms of COVID-19 within 48 hours of a visit to our office.  We will inform patients of possible exposure should this ever happen.  Let’s all care about ourselves and each other during this time public concern.

 

References:

https://jamanetwork.com/journals/jama/fullarticle/2762688

https://www.cdc.gov/coronavirus/2019-ncov/about/prevention.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fabout%2Fprevention-treatment.html

https://www.google.com/search?ei=DzhoXoLsNpW5tAaKu7aQBg&q=cup+of+water+weight&oq=cup+of+water+weight&gs_l=psy-ab.3..0l2j0i22i30l8.55781.61009..61310...2.1..0.524.2943.0j16j5-1......0....1..gws-wiz.......0i71j0i273j0i131j0i67.F_kRffndkKs&ved=0ahUKEwjCr8KLnJHoAhWVHM0KHYqdDWIQ4dUDCAs&uact=5

http://www.secondscount.org/heart-condition-centers/info-detail-2/how-does-being-sleepdeprived-affect-your-health#.Xmg7AqhKjic

https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-power-of-positive-thinking

https://www.pbs.org/newshour/science/how-long-do-cold-and-flu-viruses-stay-contagious-on-public-surfaces

https://www.designsforhealth.com/binaries/content/assets/designs-for-health/library/patient-education/l-lysine-pl-patiented.pdf

https://www.ncbi.nlm.nih.gov/pubmed/10466169

https://erj.ersjournals.com/content/10/7/1535

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6320789/

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