What we now know about the Coronavirus

Many people have questions about how COVID-19 symptoms and how they affect the ear, nose and throat system. Much of the following information represents material I have read from daily internet briefings from the AMA, CDC, American Academy of Otolaryngology, American Rhinologic Society and the American College of Surgeons. However, none of this information is absolute or all-encompassing.
How is COVID-19 Transmitted?
We do know that COVID-19 is transmitted by person-to-person contact or by coming into contact with a surface that has been contaminated with the virus from a person already infected with the virus. The virus enters predominately through the mucosa in the nose, and to a lesser extent through the mouth and possibly through the eyes.

Should we wear face masks?
The CDC and US government are strongly recommending the use of face masks in the general population to decrease the risk of contraction of the virus and to decrease the exposure of the general population by people that may have the virus but do not exhibit symptoms.
How does COVID-19 affect the body?
We know the coronavirus attaches to normal respiratory cells and can then enter into the cell through a series of biochemical steps. Once inside, a cell the virus uses normal mechanisms of the cell to regenerate itself and eventually causes the cell to die.

In the upper respiratory system, that is the nose and throat, the initial symptoms include a sore throat and increased nasal secretions. Many patients with infection also have inflammation of the conjunctiva of the eye, producing a reddish color to the eyes.
At this point some patients may start to develop a fever. This is because the immune system of the body has recognized that the body is being attacked by a foreign virus and it is mounting a response to this invasion. For many people these symptoms are limited and some patients do not have any progression of the disease.

Unfortunately, some patients will have a progression of the invasion. The virus spreads to the mucosa of the lower respiratory system, the trachea, bronchi, and peripheral lung tissue. That is why COVID-19 symptoms almost always include a cough and a worsening of the fever. The cough usually starts out dry, meaning no sputum (or phlegm) production, however, if the disease progresses it can produce mucus with the cough and shortness of breath.
There is not much information about viral infections presenting with ear symptoms in the early stage of the disease. We do know that many common upper respiratory viruses, like influenza and adenovirus, do produce early signs of ear infections, and with more patient information available we may find that the Coronavirus does produce early ear infections.
What are early symptoms of COVID-19?
One of the early presenting Covid-19 symptoms is the alteration in sense of smell. This is probably two-fold, with swelling of the lining tissue of the nose and an increase in nasal secretions there is most likely a barrier effect preventing odors from stimulating the olfactory nerve. There is also probably an affinity for the COVID-19 virus to invade the cells of the olfactory nerve. We don’t know if this alteration in smell is limited, or longstanding.
In summary, COVID-19’s initial presenting symptoms are almost always present in the upper respiratory system. If you or a family member starts to develop these symptoms the potential patient should self-isolate.
How to avoid COVID 19
To keep this pandemic in check please remain home, wear a mask if you must go out in the general population, wash your hands after every encounter with potentially contaminated surfaces, and cover your mouth and nose if you cough or sneeze.

Valley ENT
To combat COVID-19, we are now offering telemedicine appointments.
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