To Your Health With Dr. Jim Morrow: Episode 29, Coronavirus Update and Human Viral Infections

To Your Health With Dr. Jim Morrow: Episode 29: Coronavirus Update and Human Viral Infections

Beyond the coronavirus, a number of human viral infections affect our health. Dr Jim Morrow discusses these viruses in this episode of “To Your Health.” In addition, he offers an update on the coronavirus pandemic and discusses the new telemedicine option now available at Morrow Family Medicine. “To Your Health” is brought to you by Morrow Family Medicine, which brings the CARE back to healthcare.

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be. At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!” Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce. He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

The complete show archive of “To Your Health with Dr. Jim Morrow” addresses a wide range of health and wellness topics, and can be found at www.toyourhealthradio.com.

Dr. Morrow’s Show Notes

Coronavirus Tips

Spend time washing your hands.
- Take twenty seconds out of your day,
  - several times a day and wash them thoroughly with soap and water.
  - When this is not available, use a hand sanitizer that is more than 60 percent alcohol.
  - The novel coronavirus is very susceptible to that concentration of alcohol.
- Do not touch your face, including eyes, nose and mouth if you can avoid it.
  - This is the main entryway for this virus to get into your system.
- If you are sick, stay home.
  - If you feel you need to go to the doctor,
    - please call them first so that they can be prepared for you.
    - Do a telemedicine visit
  - When you do cough or sneeze, cover your mouth and nose or sneeze into the crook of your elbow.
    - When you use a tissue, use it once then throw it away.
    - Then, refer back to number 1 and WASH your hands!
  - Wipe down surfaces that are frequently touched and use a disinfectant wipe to do so.
    - Then, that’s right, throw it away and WASH your hands.
  - If you know people who are sick, avoid them.
    - If they are loved ones and need your help, frequently WASH your hands and wipe down surfaces.
    - Try to stay at least six feet away from anyone right now.
  - With schools and colleges out right now, stay at home.
    - Do not substitute a bar or restaurant for a class.
  - Masks are made for people who are sick.
    - They do very little to keep people from getting sick.
    - The exception is the fancy mask that healthcare providers wear when they deal with infected people.
  - Visit cdc.gov often and follow their advice.
  - Get a flu shot.
    - Influenza A is still around and active, so avoid that.
    - And, when the coronavirus vaccine is available next year, for heaven’s sake, GET IT!
  - Treatments:
    - Hydroxychloroquine has potential
      - Used for malaria, has some antiviral activity
      - For hospitalized patients
      - Remdesivir
        Did not work well for Ebola,
        Compassionate use studies show some effect
      - Tosalusamab: immune modulator, but being used for severely ill people
    - If infected, most will resolve spontaneously.
      - Some will start to improve then relapse due to inflammatory reaction in the lungs
      - These people will likely need to be hospitalized
      - Vaccines
        Will be at least a year

Human Viral Infections

Since the first antiviral drug, idoxuridine, was approved in 1963,
- 90 antiviral drugs categorized into 13 functional groups have been formally approved for the treatment of the following 9 human infectious diseases:
  - HIV infections
  - Hepatitis B virus (HBV) infections
  - Hepatitis C virus (HCV) infections
  - Herpesvirus infections
  - Influenza virus infections
  - Human cytomegalovirus infections
  - Varicella-zoster virus infections
  - Respiratory syncytial virus infections
  - External anogenital warts caused by human papillomavirus infections

Introduction

Over the course of human civilization, viral infections have caused millions of human casualties worldwide,
- Driving the development of antiviral drugs in a pressing need
- A new era of antiviral drug development has begun since the first antiviral drug, idoxuridine, was approved in June 1963
- Since then, many antiviral drugs have been developed for clinical use to treat millions of human beings worldwide.
  - Between June 1963 and April 2016, 90 drugs were formally approved to treat 9 human infectious diseases
- As of April 2016, antiviral drugs have been approved to treat 9 human infectious diseases albeit more than 200 human viruses have been discovered.

Overview of Nine Human Viruses

Herpes Simplex Virus
- Discovered before 1900
- HSV can be classified into two types:
  - HSV-1 and
  - HSV-2.
  - The former leads to the majority of cases of oral herpes infections that cause skin lesions and cold sores.
  - The latter is mainly responsible for genital herpes infections that cause pain during urination and blistering sores.
  - In the absence of any animal reservoir, HSV circulates exclusively in human populations
  - HSV-1 transmissions are mediated by direct exposure to contaminated aerosols or droplets, such as oral-to-oral and skin-to-skin contacts.
  - HSV-2 is transmitted mainly by direct exposure to genital skin or fluids of HSV-infected patients.
  - During viral infections, the incubation period of HSV-1 or HSV-2 is ∼4 days
  - HSV-1 usually causes pneumonia, keratitis, encephalitis, or orofacial blisters, while HSV-2 typically causes meningitis or genital lesions
  - According to the WHO global health survey, in 2012,
    - 140 million and 417 million people between 15 and 49 years of age lived with HSV-1 and HSV-2, respectively.
  - If you think you have herpes, see your doctor as soon as possible.
    - It is easier to diagnose when there are sores.
    - You can start treatment sooner and perhaps have less pain with the infection.
    - There is no cure for herpes. But medicines can help.
      - Medicines such as acyclovir and valacyclovir fight the herpes virus.
        They can speed up healing and lessen the pain of herpes for many people.
        They can be used to treat a primary outbreak or a recurrent one.
      - If the medicines are being used to treat a repeat outbreak,
        they should be started as soon as you feel any tingling, burning, or itching.
        They can also be taken every day to prevent recurrences.
        Acyclovir also comes in a cream to put on sores during the primary stage or during recurrences.

Varicella-Zoster Virus
- Isolated in tissue culture for the first time in 1953
- In the absence of any animal reservoir, VZV circulates exclusively in human populations
- VZV is transmitted mostly by respiratory routes, such as by direct contact with respiratory tract secretions (e.g., aerosols and droplets) or lesions.
- VZV infections, whose incubation period is ∼10 to 21 days are known to cause chickenpox as well as a painful skin rash called shingles or herpes zoster
- Many clinical complications of herpes zoster in immunocompetent humans have been reported, including pneumonia, cellulitis, neuralgia, encephalitis, myelitis, cranial nerve palsies, or peripheral nerve palsies
- It has been estimated that 30% of humans have been infected with herpes zoster over their lifetime and the seroprevalence of immunoglobulin G (IgG) antibody to varicella-zoster virus is >86% in children and adults
- In the United States, VZV infections give rise to 1 million cases or more each year
Shingles is often treated with an antiviral medicine.
- These medicines can reduce the severity and duration of your symptoms.
- Acyclovir, famciclovir, or valacyclovir are commonly prescribed.
  - Your doctor will decide whether one of these medicines is right for you.
  - These medicines work better if you start taking them in the first 3 days after you get the rash.
- Your doctor might also have you take a steroid medicine to reduce your pain and swelling.
- This medicine along with the antiviral medicines may reduce your risk of developing postherpetic neuralgia.

Human Immunodeficiency Virus
- Discovered in 1983 HIV, is the causative agent of AIDS
- HIV strains can be classified into two types (HIV-1 and HIV-2),
- A high level of genetic variation has been observed in the HIV genome, making HIV one of the fastest-evolving organisms
- Regarding the origin of HIV, it can be traced to West Central Africa in the late 19th or the early 20th century, when the butchering and consumption of primate bushmeat were widely practiced
- Due to multiple zoonotic transfers, HIV is known to be transmitted from
  - Chimpanzees or gorillas to humans
- As a blood-borne virus, HIV is spread mainly through HIV-contaminated blood or body fluids;
  - thereby, patients can become infected with HIV by
    - sexual contact,
    - needle sharing,
    - blood transfusions, or
    - maternal transmissions.
  - During chronic infection, the incubation period of HIV can be 8 to 11 years.
    - Many clinical complications have been reported:
    - lymphoma, psychiatric disorders, gingivitis, cardiovascular disease, lung cancer, kidney disease, osteoporosis, and dental or salivary gland diseases
    - In the past 3 decades, HIV has caused a great burden to global wealth and health.
    - According to the WHO global health survey, ∼9 million people were infected with HIV, causing 1.2 million deaths a year
  - While originally lethal in 100 percent of cases, patients all over the world now live healthy lives while infected with HIV.

Hepatitis C Virus
- Discovered in 1989
- Regarding the origin of HCV,
  - it remains a mystery,
  - but nonhuman primates (apes and monkeys) and mammals (e.g., horses and dogs) might have been potential zoonotic reservoirs
  - As a blood-borne virus, HCV is transmitted mainly by
    - sexual contact,
    - needle sharing,
    - blood transfusions, or
    - maternal transmissions.
    - During acute infection, the incubation period of HCV is ∼7 weeks (range, 4 to 20 weeks)
    - Many clinical complications have been observed,
      - including liver cirrhosis,
      - liver failure,
      - portal hypertension, or
      - hepatocellular carcinoma
      - According to the WHO global health survey, HCV causes 500,000 deaths every year, and 130 million to 150 million people were living with HCV in 2014.
    - Treatment now exists and although expensive, is well covered and very effective.

Influenza Virus

- Human influenza viruses caused the first recognizable influenza pandemic in the summer of 1510
  - and they were isolated for the first time in 1933
  - Influenza A viruses that cause human epidemics and pandemics
    - (e.g., Spanish flu in 1918,
    - Asian flu in 1957, and
    - Hong Kong flu in 1968)
  - Influenza B viruses
  - Influenza C viruses cause neither epidemics nor pandemics, because they usually infect humans with mild illnesses.
  - Influenza viruses have been discovered in a broad spectrum of animal reservoirs
  - Influenza A viruses can be transmitted from animal reservoirs such as
    - birds
    - pigs or
    - seals to humans
    - Using respiratory routes, influenza viruses spread mostly through direct contact with contaminated aerosols or droplets.
    - During influenza infection, the typical incubation period is ∼1 to 4 days (average, 2 days),
      - and many clinical complications (e.g., pneumonia, bronchitis, dehydration, encephalitis, sinusitis, and ear infections) have been reported
      - According to the WHO global health survey, influenza viruses cause 250,000 to 500,000 deaths every year, and 3 million to 5 million cases of severe illnesses were reported in 2014.
    - Treatment is effective and a few choices as well.