Diarrhoea, stomach ache and nausea: the many ways COVID-19 can affect your gut



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Vincent Ho, Western Sydney University

Media reports earlier this week described a Queensland nurse with stomach pains who went on to test positive for COVID-19.

Could stomach pains be another symptom of COVID-19? And if you have stomach pains, should you get tested?

Although we might think of COVID-19 as a respiratory disease, we know it involves the gut. In fact SARS-CoV-2, the virus that causes COVID-19, enters our cells by latching onto protein receptors called ACE2. And the greatest numbers of ACE2 receptors are in the cells that line the gut.

COVID-19 patients with gut symptoms are also more likely to develop severe disease. That’s partly because even after the virus has been cleared from the respiratory system, it can persist in the gut of some patients for several days. That leads to a high level of virus and longer-lasting disease.

We also suspect the virus can be transmitted via the faecal-oral route. In other words, the virus can be shed in someone’s poo, and then transmitted to someone else if they handle it and touch their mouth.




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What type of gut symptoms are we talking about?

A review of more than 25,000 COVID-19 patients found about 18% had gastrointestinal symptoms. The most common was diarrhoea followed by nausea and vomiting. Abdominal pain was considered rare. In another study only about 2% of COVID-19 patients had abdominal pain.

Some people believe COVID-19 causes abdominal pain through inflammation of the nerves of the gut. This is a similar way to how gastroenteritis (gastro) causes abdominal pain.

Another explanation for the pain is that COVID-19 can lead to a sudden loss of blood supply to abdominal organs, such as the kidneys, resulting in tissue death (infarction).

Are gut symptoms recognised?

The US Centers for Disease Control has added diarrhoea, nausea and vomiting to its list of recognised COVID-19 symptoms.

However, the World Health Organisation still only lists diarrhoea as a gastrointestinal COVID-19 symptom.

In Australia, nausea, diarrhoea and vomiting are listed as other COVID-19 symptoms, alongside the classic ones (which include fever, cough, sore throat and shortness of breath). But abdominal pain is not listed.

Advice about symptoms that warrant testing may vary across states and territories.

How likely is it?

Doctors often use the concept of pre-test probability when working out if someone has a particular disease. This is the chance a person has the disease before we know the test result.

What makes it difficult to determine the pre-test probability for COVID-19 is we don’t know how many people in the community truly have the disease.

We do know, however, COVID-19 in Australia is much less common than in many other countries. This affects the way we view symptoms that aren’t typically associated with COVID-19.

It’s far more common for people’s abdominal pain to be caused by something other than COVID-19. For example, about a quarter of people at some point in their lives are known to suffer from dyspepsia (discomfort or pain in the upper abdomen). But the vast majority of people with dyspepsia do not have COVID-19.

Similarly, irritable bowl syndrome affects about 9% of Australians, and causes diarrhoea. Again, the vast majority of people with irritable bowel syndrome do not have COVID-19.

So how about this latest case?

In the Queensland case, we know the nurse was worried he could have had COVID-19 because he was in close contact with COVID-19 patients.

As he seemed otherwise healthy before developing new abdominal symptoms, and considering he worked on a COVID ward, his pre-test probability was high. Doctors call this a “high index of suspicion” when there is a strong possibility someone may have symptoms due to a disease such as COVID-19.

What does this mean for me?

If you have new gastrointestinal symptoms and you’ve potentially been in contact with someone with COVID-19 or if you also have other classic COVID-19 symptoms (fever, cough, shortness of breath and sore throat) you should definitely get tested.

If you have just gastrointestinal symptoms, you may need to get tested if you’re in a “hotspot” area, or work in a high-risk occupation or industry.

If you have gastrointestinal symptoms alone, without any of these additional risk factors, there is no strong evidence to support testing.




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However, if COVID-19 becomes even more common in the community, these symptoms now regarded as uncommon for COVID-19 will become more common.

If you have concerns about any gastrointestinal symptoms, seeing your GP would be sensible. Your GP will provide a balanced assessment based on your medical history and risk profile.




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The Conversation


Vincent Ho, Senior Lecturer and clinical academic gastroenterologist, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Why children and teens with symptoms should get a COVID-19 test, even if you think it’s ‘just a cough’


Christopher Blyth, University of Western Australia

A Victorian teenager holidaying on the NSW South Coast has been diagnosed with COVID-19, NSW chief health officer Kerry Chant said on Wednesday.

The revelation follows reports senior students at Al-Taqwa College in Melbourne are now considered the main source of Victoria’s second-biggest COVID-19 cluster.

These cases serve as a reminder that although children and teens are considered less likely than adults to catch and spread COVID-19, everyone with symptoms should get a test — including children and teens.

Children, teens and COVID-19 risk: what we know so far

In my field, paediatric infectious disease, new research is emerging all the time about how SARS-CoV-2 (the virus that causes COVID-19) affects children and teens. In short, the evidence so far says:

  • children and teens can contract and spread the disease — but compared to adults, several studies suggest that they are less likely to.

  • children and teens are much less likely to get severely unwell, be hospitalised or die compared to adults and older people.

  • tragically, children and babies overseas have died of COVID-19, but compared with adults, this is much less common. Thankfully, it has not yet occurred in Australia.

The current thinking is that for most of Australia, the benefit of keeping schools open outweighs the risk. (In metropolitan Melbourne and Mitchell Shire, however, school holidays have been extended for all students except for those in year 11 and 12 or specialist schools.)

In Australia, the youngest COVID-19 death has been a person in their 40s. Less than 7% of all cases in Australia have so far have been recorded in children and teenagers. This proportion may rise, depending on the demographics in areas where community transmission is occurring.

What about older teens?

The risk of becoming unwell with COVID-19 increases with age. We know older teens are very different to young teens, both in growth and development but also in their activities – many of these activities put older teens at greater risk.

As Victoria’s Chief Health Officer Brett Sutton has said

They are older kids, they tend to have more transmission that is akin to adults if they’re not doing the physical distancing appropriately.

And if teens do develop COVID-19, the disease can move incredibly quickly from person to person and may soon reach populations with much greater risk, such as older people.

That’s why the very best strategy we have is to get tested.

Most children or teens with COVID-19, and indeed most people, will experience a mild illness that improves by itself. However, a small proportion of the community will become severely unwell. I’d be encouraging parents to remember that having a test is not just about the child; it’s about the community, children, parents and grandparents.

Most children or teens, and indeed most people, who get COVID-19 will experience a mild illness that improves by itself.
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Younger kids and the constant runny nose or cough

As we head into winter time, we’re starting see more children and adults with common cough and cold viruses. For many parents of younger children, runny noses and coughs are a constant part of life during this time.

To these parents I would say: if it is a new cough, a new fever or sore throat, consider getting the child tested. This is particularly important for those living in places where community transmission is occurring, such as Victoria.

Some children, particularly through winter, will have an ongoing sniffle or cough and one infection will roll into the next. In this situation, the thing to watch for is a worsening of a fever or cough. If this happens, do not hesitate to get tested.


The Conversation, CC BY-ND

Testing is a key strategy

To sum it up, testing is one of the key strategies to contain the spread of COVID-19 in Australia. One needs only look to Victoria to see what can happen when flare-ups occur. Although some of the public health interventions may appear draconian, we have to make sure people who are infectious are separated from those who are susceptible.

If your child is showing symptoms, you might be tempted to think “it’s just a cough” — and most of the time it will be just a cough. It’s not that we think every child with a cough has got coronavirus, but early detection — along with other measures such as physical distancing, staying home if unwell and hand hygiene — is absolutely crucial in our response.The Conversation

Christopher Blyth, Paediatrician, Infectious Diseases Physician and Clinical Microbiologist, University of Western Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How contagious is the Wuhan coronavirus and can you spread it before symptoms start?


C Raina MacIntyre, UNSW

Cases of the Wuhan coronavirus have increased dramatically over the past week, prompting concerns about how contagious the virus is and how it spreads.

According to the World Health Organisation, 16-21% of people with the virus in China became severely ill and 2-3% of those infected have died.




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A key factor that influences transmission is whether the virus can spread in the absence of symptoms – either during the incubation period (the days before people become visibly ill) or in people who never get sick.

On Sunday, Chinese officials said transmission had occurred during the incubation period.

So what does the evidence tell us so far?

Can you transmit it before you get symptoms?

Influenza is the classic example of a virus that can spread when people have no symptoms at all.

In contrast, people with SARS (severe acute respiratory syndrome) only spread the virus when they had symptoms.

No published scientific data are available to support China’s claim transmission of the Wuhan coronavirus occurred during the incubation period.

However, one study published in the Lancet medical journal showed children may be shedding (or transmitting) the virus while asymptomatic. The researchers found one child in an infected family had no symptoms but a chest CT scan revealed he had pneumonia and his test for the virus came back positive.

This is different to transmission in the incubation period, as the child never got ill, but it suggests it’s possible for children and young people to be infectious without having any symptoms.

This is a concern because if someone gets sick, you want to be able to identify them and track their contacts. If someone transmits the virus but never gets sick, they may not be on the radar at all.

It also makes airport screening less useful because people who are infectious but don’t have symptoms would not be detected.

How infectious is it?

The Wuhan coronavirus epidemic began when people exposed to an unknown source at a seafood market in Wuhan began falling ill in early December.

Cases remained below 50 to 60 in total until around January 20, when numbers surged. There have now been more than 4,500 cases – mostly in China – and 106 deaths.




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Researchers and public health officials determine how contagious a virus is by calculating a reproduction number, or R0. The R0 is the average number of other people that one infected person will infect, in a completely non-immune population.

Different experts have estimated the R0 of the Wuhan coronavirus is anywhere from 1.4 to over five, however the World Health Organisation believes the RO is between 1.4 and 2.5.

Here’s how a virus with a R0 of two spreads:



The Conversation, CC BY-ND

If the R0 was higher than 2-3, we should have seen more cases globally by mid January, given Wuhan is a travel and trade hub of 11 million people.

How is it transmitted?

Of the person-to-person modes of transmission, we fear respiratory transmission the most, because infections spread most rapidly this way.

Two kinds of respiratory transmission are through large droplets, which is thought to be short-range, and airborne transmission on much smaller particles over longer distances. Airborne transmission is the most difficult to control.

SARS was considered to be transmitted by contact and over short distances by droplets but can also be transmitted through smaller aerosols over long distances. In Hong Kong, infection was transmitted from one floor of a building to the next.




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Initially, most cases of the Wuhan coronavirus were assumed to be from an animal source, localised to the seafood market in Wuhan.

We now know it can spread from person to person in some cases. The Chinese government announced it can be spread by touching and contact. We don’t know how much transmission is person to person, but we have some clues.

Coronaviruses are respiratory viruses, so they can be found in the nose, throat and lungs.

The amount of Wuhan coronavirus appears to be higher in the lungs than in the nose or throat. If the virus in the lungs is expelled, it could possibly be spread via fine, airborne particles, which are inhaled into the lungs of the recipient.

How did the virus spread so rapidly?

The continuing surge of cases in China since January 18 – despite the lockdowns, extended holidays, travel bans and banning of the wildlife trade – could be explained by several factors, or a combination of:

  1. increased travel for New Year, resulting in the spread of cases around China and globally. Travel is a major factor in the spread of infections

  2. asymptomatic transmissions through children and young people. Such transmissions would not be detected by contact tracing because health authorities can only identify contacts of people who are visibly ill

  3. increased detection, testing and reporting of cases. There has been increased capacity for this by doctors and nurses coming in from all over China to help with the response in Wuhan

  4. substantial person-to-person transmission

  5. continued environmental or animal exposure to a source of infection.




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However, with an incubation period as short as one to two days, if the Wuhan coronavirus was highly contagious, we would expect to already have seen widespread transmission or outbreaks in other countries.

Rather, the increase in transmission is likely due to a combination of the factors above, to different degrees. The situation is changing daily, and we need to analyse the transmission data as it becomes available.The Conversation

C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

TURKEY: CHRISTIAN BOOKSHOP IN ADANA VANDALIZED


Second attack within one week follows threats from Muslim nationalists.

ISTANBUL, February 17 (Compass Direct News) – Following threats from Muslim nationalists, a Turkish Bible Society bookshop in the southern city of Adana was vandalized for the second time in a week on Thursday (Feb. 12).

Security camera footage shows two youths attacking the storefront of the Soz Kitapevi bookshop, kicking and smashing glass in both the window and the door. The door frame was also damaged.

Bookshop employee Dogan Simsek discovered the damage when he arrived to open the shop. He described security footage of the attack, which took place at 8:19 a.m., to Compass.

“They came at it like a target,” he said. “They attacked in a very cold-blooded manner, and then they walked away as if nothing had happened.”

The security camera did not clearly capture the faces of either youth, and police are still attempting to identify the perpetrators.

During the first attack on Feb. 7, the glass of the front door was smashed and the security camera mangled. Both have since been repaired.

Simsek told the Turkish national daily Milliyet that these are the first such incidents he has witnessed in the 10 years he has worked there.

“We sit and drink tea with our neighbors and those around us; there are no problems in that regard,” said Simsek, though he did acknowledge that local opinion is not all favorable. “This is a Muslim neighborhood, and many have told us not to sell these books.”

The bookshop has received threats from both Muslim hardliners and nationalists. Last November, a man entered the shop and began making accusations that the Soz Kitapevi bookshop was in league with the CIA, saying, “You work with them killing people in Muslim countries, harming Muslim countries.”

 

Systemic Prejudice

The attacks are another example of the animosity that Turkish Christians have faced recently, especially the small Protestant community. The Alliance of Protestant Churches of Turkey released its annual Rights Violations Summary last month, detailing some of the abuses faced by Protestant congregations in 2008.

The report makes it clear that violent attacks, threats and accusations are symptoms arising from an anti-Christian milieu of distrust and misinformation that the Turkish state allows to exist.

The report cites both negative portrayal in the media and state bodies or officials that “have created a ‘crime’ entitled ‘missionary activities,’ identifying it with a certain faith community” as being primarily responsible for the enmity felt towards Christians.

It urges the government to develop effective media watchdog mechanisms to ensure the absence of intolerant or inflammatory programs, and that the state help make the public aware of the rights of Turkish citizens of all faiths.

Report from Compass Direct News

My Fight with CFS … Part 1


I have Chronic Fatigue Syndrome (CFS), or as I prefer to call it, Chronic Fatigue Immune Dysfunction Syndrome (CFIDS). It is an extremely misunderstood and debilitating illness. I have read that the average time for a person to be ill with CFS is 18 months. I have had it for 18 years more or less. It has cost me a lot to be suffering from this illness and it impacts on my life on a daily basis. Some days are not too bad, while others are extremely terrible.

My journey with CFS began in the aftermath of the Newcastle earthquake of the 28th December 1989. In early 1990, while working at Hawkins Masonic Village repairing roofs damaged by the earthquake (it was raining and many roofs were leaking), I began to feel persistently unwell. I decided to see my doctor who put it down as some sort of stomach bug, most likely Gastroenteritis. After two weeks of medication it was becoming clear that I did not have Gastroenteritis and something more sinister was the cause of my intensifying illness.

Within weeks I had begun to develop all of the debilitating symptoms of CFS and what was worse for me they were all intensifying their effects upon me. What was wrong with me was now something of a mystery, but it was clear I was very ill and getting worse.

When I was younger I had Hyperthyroidism and so the doctor assumed that this was what was wrong with me again, despite the fact that blood tests indicated I no longer had an issue with that disorder. I was placed on medication for Hyperthyroidism and monitored. The medication had no effect on my illness and my patience with ‘witch doctoring’ was running out. I pleaded with my doctor to send me to someone else – a specialist. But who would be useful to see?

A friend had recently been diagnosed with CFS by an Immunologist and eventually I prevailed with my doctor to send me to him. Eventually I was able to set up an appointment and so my time with Doctor Sutherland of the Royal Newcastle Hospital Immunology Department had begun.

By this time I was suffering a myriad array of symptoms, with varying degrees of intensity depending on what week I was asked. Among the most debilitating of these symptoms was a persistent headache that no amount of painkilling or other medication had any impact upon. The headache was like a migraine that wouldn’t go away. It would last for an 18 month stretch this first time, bringing with it an intolerance of bright light, noise, etc. These things caused me immense head pain.

I was also suffering numerous nose bleeds (which I often get when I am very ill), fevers and chills, brain fog (a situation where you seem to know what is going on yet you have an inability to act in a logical manner – some times the sense of knowing what is happening disappears altogether), painful eyes, chronic fatigue in the muscles and extreme soreness, tiredness to the point of sleeping at a drop of a hat (I was sleeping for over 18 hours a day with no relief to my tiredness, headaches, etc), loss of strength in my limbs, constant nausea, inability to think or concentrate, etc.

By this time I was already having time away from work, with being away for weeks at a time being the norm – thankfully they were quite understanding of the fact that I was very ill.

At my lowest point during these first two years I was reduced to being bed-ridden, using a cane for stability when walking and at times was unable to walk. I was sleeping above 18 hours a day with no benefit from it.

During this time of extreme illness I was subjected to innumerable blood tests and other tests, which all revealed little at all as to the cause of my illness. A process of careful elimination under the care of Dr. Sutherland brought the diagnosis of CFS, as well as a psychological evaluation.

There was no cure to be found, with the only helpful advice having come from Dr. Sutherland. He told me to try and rest, then to slowly build myself up again. Walk one block for a week, then two blocks the following week, etc. If I overdid it I would be back in a heap again in no time. I needed to be able to read my own situation to know when I should try to rebuild my life. This advice has helped me through the last 18 years.

I struggled with the illness for 18 months or so and I also struggled with the enigma associated with the illness. That I was sick was not believed by all and this has been a constant stereotype I have been confronted with throughout my illness. I often found myself questioning whether I was sick or whether it was some mental thing. It was a relief when a doctor finally gave me a name for the illness and confirmed I was indeed very ill.

There were times (as there has been since) when I thought that dying would be a better alternative than to be as sick as I was, with no life and the prospect of endless years of severe illness. Suicide was something that popped into my head from time to time, but thankfully it didn’t stay there for long.

At times I found myself not knowing what I was doing, where I had been, etc. At one point I waited behind a parked car, waiting for it to turn the corner only to realise ½ an hour or so later that the car was parked. I found myself having gone shopping with a load of groceries I didn’t need and never had used before. It was like having a form of early onset Dementia.

After about 18 months I began to get better – or so I thought. I was well enough to knock back participation in a trial medication experiment for CFS sufferers which would involve a lengthy stay in hospital and a 50% chance I would receive the placebo.  I declined the invitation being concerned I would loose my job as a result of being in hospital for so long.

My health began to improve and I thought I was finally over the illness. During this time I lost contact with Dr. Sutherland who left the hospital because of a dispute with NSW health at the time. Many doctors left the public system at the time.

NEXT: The illness returns