COVID-19

WHAT IS COVID-19?

COVID-19 is a viral disease. It is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and emerged first in December 2019, spreading rapidly around the globe.[1] In March 2020, the World Health Organisation declared it a pandemic.

As of early December 2021, 269 million cases of COVID-19 and over 5 million deaths due to the disease have been reported globally.[2]

The disease can be divided into mild, severe and critical disease:[3]

  • 80% will have mild disease.

  • 15% will have severe disease and require oxygen.

  • 5% will become critically ill and require ICU care.

Risk factors for severe or critical disease include older age (> 60 years old) and pre-existing conditions such as heart disease, hypertension, chronic respiratory diseases and cancer.[1]

Signs and symptoms

Time from exposure to when symptoms occur is usually 5-6 days.[3] Some people with COVID-19 remain totally asymptomatic and with each variant, symptoms seem to change slightly. The most common symptoms include dry cough, fever and fatigue.[3]

Other symptoms which may occur include: [3]

  • Blocked nose/nasal congestion.

  • Sore throat.

  • Headache/muscle aches and pains.

  • Skin rash.

  • Shortness of breath.

  • Loss of taste/smell.

  • Gastrointestinal symptoms: nausea/vomiting/diarrhoea.

Symptoms of severe COVID-19 include shortness of breath, pain/pressure on the chest, loss of appetite, confusion and high temperature. Should any of these symptoms present, urgent medical care should immediately be sought.[3]

What is a variant?

As with any virus, SARS-CoV-2 evolves over time. When significant changes to the virus’ genes occur, they are known as variants and are named differently, e.g. alpha, beta, delta, omicron. Different variants may have different transmission risks (spread more, or less, easily) and different levels of disease severity.[4]

Can you get re-infected with a new variant strain of COVID-19?

It was initially thought that patients who already tested positive for COVID-19, could not get re-infected due to the development of antibodies that remain in the blood. We now know that reinfections may occur, especially with the emergence of different variants.

How is COVID-19 spread?

Similar to flu and colds, COVID-19 is spread via respiratory droplets. When a person with COVID-19 coughs or sneezes, the droplets released contain the virus. These can be breathed in by people nearby or can land on surfaces. If people touch those surfaces and then touch their mouths/nose, they can become infected. Infection is NOT transmitted through the skin.[1]

Take home message: adhering to strict prevention protocols is essential for the public, including those who were already infected with an older variant of COVID-19.

PREVENTING COVID-19

The best way to protect yourself against developing severe COVID-19 and hospitalisation is to get vaccinated.

 

There are a number of preventative measures that will protect you:

  • Physical distancing: keep a distance of at least 1.5 meters between you and other people.

  • Social distancing: avoid interacting with people outside of your household as much as possible.

  • Masks: use a cloth mask at all times when around people. This has been proven to lower transmission. Remember, you must cover both your nose and mouth!

  • Hand washing: wash your hands well, as often as possible. Soap and water for 20 seconds or at least 70% alcohol hand sanitiser will do the job.

  • Cough/sneeze etiquette: cover your nose/mouth with a flexed elbow or tissue when you cough or sneeze. Throw the tissue in the bin immediately.

  • Isolation/quarantine: if you have COVID-19 or are a contact, stay at home.

  • Household hygiene: keep all surfaces, especially those touched often, e.g. door handles, clean.

Testing for COVID-19

SARS-CoV-2, which causes COVID-19, can be detected in a number of ways using a sample from the respiratory tract (nose, mouth or chest). There are three main kinds of tests used:[5]

​1.

PCR test: this test looks for the genetic material of the virus i.e. active disease. These are done in a lab and are the most sensitive/reliable but can take up to a few days for results.

 

2.

Antigen test: detects proteins found on the viral shell/envelope i.e. active disease. These are available as ‘rapid tests’, meaning that results are obtained straight away, but are not as accurate as PCR tests (you could get a false result), especially early in the disease course.

 

3.

Antibody test: detects antibodies, made by the human host, to COVID-19 i.e. the person has had COVID-19 and mounted an immune response. This does not, necessarily, show active disease, but that the person has had COVID-19 at some point. Antibody testing is not recommended to diagnose current infection.

Who should get tested?

If you experience the symptoms of COVID-19, you should contact your doctor or clinic (by phone) to determine if and where you should be tested. An asymptomatic person who is a close contact of a confirmed case may be tested in certain circumstances.1,3 Guidelines for testing change over time, according to current testing rates.

During times of high infection, testing may be limited to high-risk people only, to control pressure on the testing facilities.

 Where do you get tested?

If you think you might have contracted the virus, you can call your doctor or the NICD helpline (0800 029 999) to find out where to go for testing. Public sector testing is free of charge. Private laboratories can also test for COVID-19 and most require a doctor’s referral. Numerous ‘drive-through’ testing facilities are now operating.

The testing process may differ based on the different provinces, between the public and private sectors and depending on numbers currently sick with COVID-19. The first step is to contact your healthcare provider, by telephone, who will refer you to the nearest testing facility, if necessary.

How long will it take to get a COVID-19 laboratory result?

Test results will be sent to your healthcare provider and, in some cases, directly to you. The turn-around time for testing specimens varies from laboratory to laboratory and on the current pressure on laboratory services. In most cases, you will receive your results within 24 hours. The rapid tests allow results within 15-45 minutes at the point-of-care.

ISOLATION AND QUARANTINE

Isolation refers to the separation of sick people – who are contagious – from healthy people. The length of time depends on the severity of disease and current health:

  • Asymptomatic patients: 10 days after the test.

  • Symptomatic patients with mild disease: 10 days after the onset of symptoms. Before de-isolating, fever must be resolved and other symptoms improving.

  • Hospitalised patients with moderate-severe disease: 10 days after achievement of clinical stability (i.e., from when they are not requiring supplemental oxygen and are otherwise clinically stable).

Repeat PCR testing is not required to de-isolate a patient and is not recommended.

Quarantine refers to the separation and restriction of movement of people who have had close contact with someone who is sick with COVID-19. A close contact is defined as a person who has had face-to-face contact (less than 1 meter) or has been in a closed space with a confirmed COVID-19 case for at least 15 minutes.

As a close contact, you won’t automatically be tested for COVID-19 unless you develop symptoms. You can end your home quarantine 10 days after your last contact with a person with COVID-19.

TESTING FOR COVID-19

SARS-CoV-2, which causes COVID-19, can be detected in a number of ways using a sample from the respiratory tract (nose, mouth or chest). There are three main kinds of tests used: [5]

1.

PCR test: this test looks for the genetic material of the virus i.e. active disease. These are done in a lab and are the most sensitive/reliable but can take up to a few days for results.

2.

Antigen test: detects proteins found on the viral shell/envelope i.e. active disease. These are available as ‘rapid tests’, meaning that results are obtained straight away, but are not as accurate as PCR tests (you could get a false result), especially early in the disease course.

3.

Antibody test: detects antibodies, made by the human host, to COVID-19 i.e. the person has had COVID-19 and mounted an immune response. This does not, necessarily, show active disease, but that the person has had COVID-19 at some point. Antibody testing is not recommended to diagnose current infection.

Who should get tested?

If you experience the symptoms of COVID-19, you should contact your doctor or clinic (by phone) to determine if and where you should be tested. An asymptomatic person who is a close contact of a confirmed case may be tested in certain circumstances.1,3 Guidelines for testing change over time, according to current testing rates.

During times of high infection, testing may be limited to high-risk people only, to control pressure on the testing facilities.

Where do you get tested?

If you think you might have contracted the virus, you can call your doctor or the NICD helpline (0800 029 999) to find out where to go for testing. Public sector testing is free of charge. Private laboratories can also test for COVID-19 and most require a doctor’s referral. Numerous ‘drive-through’ testing facilities are now operating.

The testing process may differ based on the different provinces, between the public and private sectors and depending on numbers currently sick with COVID-19. The first step is to contact your healthcare provider, by telephone, who will refer you to the nearest testing facility, if necessary.

How long will it take to get a COVID-19 laboratory result?

Test results will be sent to your healthcare provider and, in some cases, directly to you. The turn-around time for testing specimens varies from laboratory to laboratory and on the current pressure on laboratory services. In most cases, you will receive your results within 24 hours. The rapid tests allow results within 15-45 minutes at the point-of-care.

 

TREATMENT OF COVID-19

Treatment of COVID-19 will differ based on individual preferences from the responsible healthcare professional and symptoms shown by each patient. COVID-19 is a viral, not bacterial, disease, so antibiotics should not be given unless there is a secondary bacterial infection. There is currently no ‘cure’ and treatment is symptomatic.

Patients who are asymptomatic (showing no symptoms) or have mild disease can be managed at home, provided they can safely self-isolate. [1]

Treating mild illness from home [1,6]

Patients with mild illness can be treated at home, provided they can safely isolate. It is vital that they do not spread the disease. Treatment is symptomatic and may include:

  • Paracetamol or NSAIDS, e.g. ibuprofen, for relief of fever or pain.

  • Keep hydrated: be sure to drink plenty of fluids.

  • Rest: plenty of rest will allow the body to fight the virus.

Some patients initially assessed as having mild disease may worsen over the course of the disease and require hospitalisation. It is important to watch for the following signs (or any other worsening of symptoms) and seek prompt medical care if they appear: [1,3]

  • Any deterioration in the ability to perform activities of daily living.

  • Trouble breathing.

  • Persistent pressure or pain in the chest.

  • Inability to wake or stay awake.

  • Pale, grey, or blue-coloured skin, lips, or nail beds.

Patients managed at home should keep the contact details of their doctor or healthcare facility close, in case of any clinical worsening.

COVID-19 treatment for severe disease (in hospital)

Treatment in hospital is also currently supportive, although there are many treatments currently undergoing investigation. Each patient will be treated on a case-by-case basis, by the doctor, according to their clinical picture.

 

RECOVERY FROM COVID-19

Most COVID-19 cases recover fully, although this may take several weeks. Most people who contract the COVID-19 virus will recover through self-isolation, enough rest, rehydration, and symptomatic treatment.

What is ‘Long COVID’? [7]

The World Health Organisation defines long COVID as “a condition which occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others and generally have an impact on everyday functioning. Symptoms may be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time.”

Symptoms are managed on a case-by-case basis and ongoing studies are happening to find out the causes, risk factors and best treatment options.

 

VACCINATION AGAINST COVID-19

The best way to protect yourselves – and your communities – against severe COVID-19 is to vaccinate. While getting vaccinated doesn’t completely prevent you from getting the disease – and it’s vital you continue practicing distancing, masks, good ventilation etc. – the vaccine has been proven to significantly reduce the risk of severe disease, hospitalisation and death.

COVID-19 is an emerging disease – treatment and prevention protocols may change as and when we know more about this disease. Always ask your healthcare professional for advice on specific treatment and continue to practice safe public health measures to help limit the spread of COVID-19.

​References:

  1. National Institute for Communicable Diseases (NICD). COVID-19. Available at: https://www.nicd.ac.za/diseases-a-z-index/disease-index-covid-19/. Accessed 10 December 2021.

  2. Our world in data. COVID-19. Available at: https://ourworldindata.org/coronavirus. Accessed 10 December 2021.

  3. World Health Organisation (WHO). Coronavirus disease (COVID-19): Q&As. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/coronavirus-disease-covid-19. Accessed 10 December 2021.

  4. World Health Organisation (WHO). Coronavirus disease (COVID-19): Variants of SARS-COV-2. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/coronavirus-disease-(covid-19)-variants-of-sars-cov-2. Accessed 10 December 2021.

  5.  World Health Organisation (WHO). Coronavirus disease (COVID-19): COVID-19 tests. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/media-resources/science-in-5/episode-14---covid-19---tests. Accessed 10 December 2021.

  6. National Institute for Communicable Diseases (NICD). Clinical management of suspected or confirmed Covid-19 disease. Version 5. Available at https://www.nicd.ac.za/wp-content/uploads/2020/08/Clinical-management-of-suspected-or-confirmed-COVID-19-V5-24-August-2020.pdf. Accessed 10 December 2021.

  7. World Health Organisation (WHO). A clinical case definition of post COVID-19 condition by a Delphi consensus, 6 October 2021. Available at: https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1. Accessed 10 December 2021.