WHAT IS CORONAVIRUS?
By: Colleen Doherty, MD
1/31/2020 UPDATE: The newest strain of coronavirus, called 2019-nCoV, surfaced in Wuhan, China, at the end of 2019. The Centers for Disease Control and Prevention (CDC) has confirmed six cases to date in the United States, but has only detected one instance of person-to-person spread in this country. Therefore, 2019-nCoV is not considered to be spreading among communities in the U.S. at this time. CDC monitoring is ongoing.
Coronavirus is a common family of viruses named for its appearance of having a crown (corona in Latin means “crown”). The crown is composed of a protein, called the spike protein, that sticks out from the virus’s surface.1
There are different types of coronaviruses, and while the majority typically cause mild cold symptoms (e.g., runny nose or sore throat), more dangerous types, like the coronaviruses that cause Middle East respiratory syndrome (MERS) or Severe Acute Respiratory Syndrome (SARS), may cause more severe disease, including pneumonia, and even death.
It is impossible to tell the difference between coronavirus infections and other illnesses based on symptoms alone. While doctors need to take a careful history and perform a physical exam, laboratory tests are needed to accurately diagnose coronavirus infections.
At this time, there are no medicines a person can take to prevent or treat the virus itself. Treatment for coronavirus infections is supportive, which means that the patient is supported while the infection runs its course and the body’s immune system clears the infection.
Types and Transmission:
Coronaviruses belong to the family Coronaviridae, and there are seven types that can infect humans.2
Four common types of human coronaviruses cause symptoms of the common cold.
These four coronaviruses—229E, NL63, OC43, HKU1—are often referred to as community-acquired coronaviruses because they are common and infect people all over the world.3
The other three coronaviruses are more worrisome because they have been linked to severe complications, like pneumonia and death.
These three coronaviruses include:
- 2019 novel coronavirus (2019-nCoV)
- Severe acute respiratory syndrome coronavirus (SARS-CoV)
- Middle East respiratory syndrome (MERS-CoV)
In the United States, the coronavirus most commonly infects people in the fall and winter.4
Ways in which the virus can spread from person to person include the following forms of contact:
- Droplets (after someone who has the virus coughs or sneezes)
- Touch (e.g., shaking hands with an infected person or touching an object that contains the virus and then touching your mouth, eyes, or nose prior to washing your hands)
- Feces (fecal-oral spread from infected patients; rare)
The four community-acquired coronaviruses usually cause “cold” symptoms in the upper respiratory tract, such as:5
- Runny nose
- Sore throat
Sometimes, the coronavirus can affect your respiratory system and complications, like pneumonia or bronchitis, may develop.
These complications are more common in babies and the elderly, as well as people with a suppressed immune system or an underlying heart or lung disease.
MERS-CoV and SARS-CoV:
These serious types of coronaviruses jumped from animals to humans, and are potentially life-threatening.2
According to the Centers for Disease Control and Prevention (CDC), MERS-CoV usually causes fever, cough, and trouble breathing, which often then leads to pneumonia. Thirty to 40 percent of people with MERS coronavirus have died.5
SARS-CoV causes a similar illness of fever, chills, body aches, and respiratory infection which can be fatal.
There are still cases of MERS, mostly in the Arabian peninsula. There have been no cases of SARS in the world since 2004.
2019 Novel Coronavirus (2019-nCoV):
At the end of 2019, a new coronavirus, called 2019-nCoV, surfaced in Wuhan, China. Similar to MERS and SARS, this coronavirus likely jumped from an animal (probably a bat, although scientists are not completely certain) to a human, perhaps via some other species. 6
It appears that the 2019-nCoV infection is causing a severe respiratory (lung) illness similar to SARS. Common initial symptoms of the infection include fever, cough, fatigue, and muscle aches.7 Available data suggests while the disease can be severe and even fatal, it may not have as high a mortality rate as MERS or SARS. The medical community is still trying to get accurate data early in this outbreak.
The diagnosis of a routine coronavirus infection (cold symptoms) involves a medical history, including travel history, and a physical examination. Most often, the patient will be diagnosed with a cold, and sent home.
If your symptoms are severe, your healthcare team may order tests to specifically check for the virus. This is done by taking a sample of your blood and/or a swab from your nose or throat.
With the new concern for 2019-nCoV infections, symptomatic patients and their doctors have to be careful to obtain a travel history to China or other infected regions, or a history of contacts with other people who may have been exposed. Laboratory testing for 2019-nCoV is currently being coordinated with public health offices and the CDC.
There is no vaccine or specific medicine to treat coronavirus. Instead, the treatment for mild coronavirus infections is supportive, which means doing things to ease your symptoms.8
These supportive measures may include:
- Taking a medication, like Tylenol (acetaminophen), to reduce your fever
- Using a cool-mist humidifier to help soothe your cough
- Drinking fluids
Do not give your child or teenager aspirin or aspirin-containing products due to their risk of Reye syndrome, a potentially fatal condition.
SARS, MERS, and illnesses caused by 2019-nCoV also require supportive care, of a different type: hospitalization, oxygen, fluids, and other life-saving treatment may be necessary to support the patient while the immune system responds to, and clears, the infection.
Antiviral medicines shown to suppress or destroy coronaviruses are currently commercially available.
You can reduce your risk of contracting human coronavirus by doing what you would do to protect yourself from getting the flu or common cold:8
- Scrub your hands with soap and water for at least 20 seconds (try singing the Happy Birthday song twice for proper timing)
- Avoid touching your eyes, nose, and mouth
- Avoid being around people who are sick
If you are sick, you can protect others by staying home from work or school.
If you do cough or sneeze, be sure to cover your mouth and nose with a tissue, and then wash your hands after discarding the tissue. Alternatively, if you do not have a tissue available, sneeze or cough into the crook of your elbow.
A Word From Verywell:
Coronavirus is a common virus that infects people at least once over the course of their lifetime. The good news is that in most cases, it causes a mild, run-of-the-mill “cold.”
If your symptoms are severe or persistent, or if you have an underlying medical condition, be sure to see your doctor.
The 2019-nCoV coronavirus is concerning because of the potential for spreading globally, and because it can cause severe symptoms. As more information is gathered on this infection, we hope to remain a resource for you so you can get the information you need. If you are worried that you may have been exposed to this newly-described virus, it is a good idea to get medical care promptly.
By Heidi Moawad, MD
A stroke can produce major life-altering changes, such as vision and diminished physical strength and coordination. In addition to the obvious physical handicaps of a stroke, a stroke can also produce significant personality changes. If you are a stroke survivor, your post-stroke behavioural changes can hit you and your loved ones by surprise if you suddenly do not act like “yourself” anymore.
Once you learn how to identify the most common personality changes after a stroke, you can begin to gain a sense of reassurance, knowing that there is an explanation for why you or your loved one might be acting a little different. Recognizing personality changes can be a huge step in modifying unwanted behavior as you purposefully work towards getting back some of the personality traits that make you feel more like “you.”
After a stroke, it is very common to experience a sense of unhappiness and sadness. In fact, as many as 60 percent of stroke survivors report prolonged depression, which is depression that is more severe and long lasting than routine sadness.
Post-stroke depression results from a combination of biological and situational factors. First of all, the obvious effects of a stroke, such as weakness, vision loss, and coordination problems may cause a sense of sadness if you feel disempowered by your handicap. Additionally, after a stroke, you might worry about your health or experience anxiety about your own mortality. The resulting feelings of helplessness or hopelessness can contribute to post-stroke depression.
And the stroke-induced damage to the brain can produce changes in the way the brain functions, resulting in altered biological activity that leads to depression.
Despite all of these elements that contribute to the development of post-stroke depression, post-stroke depression is usually treatable with a combination approach that includes medication and counseling.
Many people, however, are reluctant to seek treatment for depression. Some stroke survivors hesitate to take on the label of depression out of concern that it can be a self-fulfilling prophecy. Others do not trust the medical system to deal with emotional issues, and others view depression as a sign of weakness.
However, if you or your loved one has lingering feelings of sadness or hopelessness, you can get effective help for this problem. The recognition that your depression is not your fault and is not a sign of weakness is an empowering step towards getting the right medical treatment.
After a stroke, isolation can occur if you are no longer able to do the same things you used to do. If you have to leave your job after a stroke, or if you are no longer a part of your regular social life, this can lead to a sense of loneliness.
Some stroke survivors have severe disabilities that make it difficult to drive, leave the house or even get out of bed. Extreme disability may necessitate moving into a new living environment, in part to obtain more assistance with daily living, and in part to reduce isolation and loneliness. Each stroke survivor can overcome the post-stroke sense of loneliness in his or her own unique way.
Loss of Cognitive Skills
The loss of cognitive skills after a stroke can happen after a stroke in almost any region of the brain, but most often in the frontal lobe, the parietal lobe or the temporal lobes.
Changes in cognitive skills include trouble with problem-solving, reading difficulties, and trouble with simple mathematical calculations. Some stroke survivors become forgetful, forgetting names, or losing things or forgetting to take care of important tasks. Cognitive deficits can also cause confusion or may make it difficult to understand concepts that a stroke survivor would have previously been able to understand.
The loss of cognitive skills can be very distressing for stroke survivors, and many stroke survivors may be in denial, making excuses for frequent mistakes, or even lying about errors to avoid embarrassment.
Building up cognitive skills is a challenge, but just as physical disability can improve with physical therapy, cognitive disabilities can improve with dedicated cognitive therapy.
Many stroke survivors find themselves becoming very emotional or inappropriately crying or laughing. Some stroke survivors experience a condition called pseudobulbar affect, which is characterized by mood changes and uncontrollable emotional expressions.
Lack of Motivation
A stroke can lead to a lack of motivation, which is called apathy. Apathy occurs after most types of brain injury. There are several reasons for post-stroke apathy.
The decline in cognitive abilities (problem solving and thinking skills) after a stroke can make many tasks seem too challenging and unsolvable. Additionally, the development of post-stroke depression, having less responsibility to deal with after the stroke, and sometimes the feeling that “nobody will notice” what you do, can all lead to apathy.
Lastly, apathy may also occur due to changes in the structure and function of the brain secondary to the stroke itself.
Some stroke survivors become unexpectedly hostile and angry, behaving in ways that are mean or physically aggressive. Aggression, like the other behavioural and personality-related stroke changes, is often a result of both the emotional feelings about the stroke and the stroke-induced brain injury.
Aggression is particularly noticeable in stroke survivors who have a stroke pattern that produces vascular dementia. Vascular dementia occurs when many small strokes happen over time, leading to a buildup of injuries throughout the brain, and resulting in a distinctive type of dementia. Vascular dementia is characterized by a decline in memory and thinking skills, confusion, trouble finding things, trouble with directions, and changes in behavior.
Denial of a Stroke: Anosognosia
Anosognosia describes a stroke survivor’s inability to recognize that he or she has had a stroke. Anosognosia is manifest by an interesting overconfidence and unawareness that there is anything wrong after a stroke. In fact, a person who has anosognosia may express surprise and bewilderment at the fact that there is any medical care being administered at all.
Stroke survivors who have anosognosia present a challenging problem for loved ones and caregivers, who try to offer assistance and care, often with no cooperation. Sometimes stroke survivors who have anosognosia treat those who are trying to help them with dismissal or rejection.
Lack of Empathy
The lack of empathy after a stroke is caused by brain damage that affects regions of the right side of the brain. A lack of empathy is a behavioural change that is usually upsetting for friends and loved ones, but is typically unnoticed by the stroke survivor.
It is not easy to predict whether a lack of empathy will improve after a stroke, as some stroke survivors can show improvement, while others do not.
Loss of Sense of Humour
A sense of humour requires insight and the quick thinking. Humour is often based on the recognition that dissimilar ideas do not belong together and that they are funny and amusing when placed together.
Many types of stroke can diminish a stroke survivor’s sense of humour. A stroke survivor who was previously funny might not be able to construct jokes and a stroke survivor who would have been able to recognize and laugh at jokes might not be able to do so anymore.
A loss of sense of humour can be difficult to recover from because this stroke effect is caused by a loss of cognitive skills. However, understanding that the lack of humour is the result of a stroke, and not a personal rejection, can help in preventing hurt feelings and misunderstandings when a stroke survivor does not respond to light-hearted joking as expected.
Loss of Social Inhibitions
Some stroke survivors may behave in ways that are considered socially inappropriate after a stroke of the right or the left frontal lobe. Behaviours such as taking food from a stranger’s plate, insulting people out loud or even undressing or urinating in public, may pose challenges for the caretakers and family members who are primarily responsible for the safety and care of a stroke survivor.
Generally, a stroke survivor who displays socially unacceptable behavior does not have the insight to understand that the actions are not acceptable, and is unlikely to apologize or try to correct the behavior.
The language or insults of a stroke survivor who has suffered from a frontal lobe stroke are not necessarily consistent with a person’s ‘normal’ pre-stroke personality or beliefs. And it is very important to be aware that mean statements are not reflective of what a stroke survivor ‘really feels, deep down inside,’ but are more likely to be phrases that he or she heard in a completely unrelated setting, such as in a book or on a television show.
The loss of social inhibition can be somewhat better controlled when the stroke survivor is comfortable, in a familiar environment, and under as little stress as possible.
A rare type of stroke causes a syndrome called Othello Syndrome, which is characterized by irrational and illogical jealousy, particularly in the context of romantic relationships. This syndrome can affect stroke survivors as a result of brain injury affecting areas of the right cerebral cortex.
A Word from Verywell
A stroke can cause major personality changes that can make you feel as if you have lost yourself or that you’ve lost the loved one you used to know so well. Personality changes after a stroke can be emotionally draining for everyone involved.
However, if a stroke survivor and loved ones understand that the source of the behavior comes from stroke-induced brain damage, it can reassure everyone in knowing that the unpleasant behavior is not premeditated or intended to be personally insulting. High functioning stroke survivors who learn about the typical post-stroke behavioural changes can gain enough insight to be able to make some changes, which can result in more satisfying interpersonal relationships.
HOW A STROKE CAN CHANGE YOUR PERSONALITY