Coronavirus – Update 03/15/20


(This is an update to my post from 5 days ago, which you can find here:  drlorrainecaron.com/wpblog/2020/03/10/coronavirus-march-10-2020/ )

 

As I mentioned last time, I have been getting messages from patients concerned about the current coronavirus pandemic (COVID-19) who would like me to share my perspective, so here it is.  THIS IS NOT INDIVIDUAL MEDICAL ADVICE, just my take on things.  If you are my patient, give me a call.  And you can find up to date medical information about this illness on the WHO website, the CDC website, as well as your state and local health department websites:

https://www.who.int/emergencies/diseases/novel-coronavirus-2019

https://www.cdc.gov/coronavirus/2019-ncov/index.html

https://www.colorado.gov/pacific/cdphe/2019-novel-coronavirus

https://www.larimer.org/health/communicable-disease/coronavirus-covid-19

 

What (else) we know so far:

(First I want to clarify my Spanish flu/H1N1 statement from my last post.  BOTH the 1918 epidemic as well as the Swine flu epidemic were due to H1N1 influenza.  H1N1 is a strain of influenza type A.  I see now that the way I phrased it was confusing.)

It has become clear that exposed-but-apparently-well people can spread the virus for several days (3-4 is what I’m hearing) before symptoms start.  This makes voluntary social distancing imperative for preventing spread.

We have new research suggesting that COVID-19 may last in the air for 3 hours or so.

At this point, anyone who can be staying at home or away from others SHOULD be.  Your most vital duty is to help slow the spread so that our intensive care units don’t go beyond maximum capacity at any given point in time.  When this happens, doctors have to start deciding who to save.  Nobody wants that.

You may have heard the term “Flatten the Curve” – here is a great resource for learning about this idea:   https://www.washingtonpost.com/graphics/2020/world/corona-simulator/

And a more technical and in-depth resource:  https://www.flattenthecurve.com/

While it is still true that the elderly and those with underlying health conditions are at higher risk of death from COVID-19, it’s looking like around half of people in ICUs with the virus are under 60 years old.

Most common symptoms are still fever and dry cough.  Some doctors are reporting more headaches and sore throat too.  Runny nose and sneezing seems to be rare.

I’m also reading that some patients who have more severe disease but survive may still be left with some level of lung fibrosis.  This is different from influenza, and we should be taking it seriously, even those at lower risk.

Poudre School District and Thompson School District, like many other Colorado districts, have closed school for the next two weeks and will be reassessing as time goes on.

Governor Polis has closed all ski areas indefinitely.

 

Updated Recommendations:

General:

If you have a fever and a cough, the current recommendation is to call your primary care physician first.  If you don’t have a PCP, call the hospital or health department.  A doctor will decide whether you might fit the criteria for testing, and let you know where to go.

We do have a drive-up testing station in the Denver area now (check https://www.colorado.gov/pacific/cdphe/covid-19-testing for location and times).  You’ll need a doctor’s order for the test, or there will be someone onsite to assess you.

If you are having trouble breathing, go to the emergency room, but call ahead to let them know you’re coming so that they can do your intake safely.

The CDC is still recommending that all people over the age of 60 and anybody with underlying health conditions self-quarantine at home as much as possible.  Consider online shopping and telemedicine visits where possible.

Prepare for the possibility of needing to self-quarantine by having a 2-3 week supply of food, pet supplies, toiletries, paper goods, and medicines.  Stores and pharmacies will remain open, so there is no need to hoard supplies.  Simply try to limit the need to go shopping.

 

Hygiene:

These recommendations remain the same:

Wash hands with soap and water for 20 seconds – of course after using the restroom, but also before you leave the house and as soon as you get home.

If soap and water isn’t available, hand sanitizer with minimum 60% alcohol is second best.

Try not to touch your eyes, mouth, or nose with your hands.  This helps prevent you from putting your germs on other people or public surfaces, and also prevents you from transferring germs from surfaces to your mucous membranes.

Don’t shake hands.  Wave, elbow bump, get creative!

 

Continue to support healthy immune function:

***There is some early indication that anti-inflammatories, including ibuprofen, may worsen the course of this disease.  Therefore, acetaminophen (Tylenol) may be preferred.  Still keeping an eye out for confirmation on this.

If acetaminophen is used, my recommendation is to add n-acetyl cysteine (NAC) to the immune protocol to compensate for its glutathione-depleting effect.  NAC is a mucus-thinning supplement also, so it’s often a part of respiratory support anyway.

As in any acute infection, if the fever is manageable with comfort measures like hydrotherapy and distraction, it is preferred not to suppress the fever at all.

Responding to confusion around Elderberry and the cytokine storm issue, the relative consensus among NDs and herbalists that I’ve seen, based on both clinical experience as well as research, is that this worry is a non-issue.  Influenza,  strep, and other infections can induce cytokine storm, as can COVID-19, but elderberry has not been known to aggravate or induce it in these illnesses.  There’s no expectation that it will in this one.  If you’re itching for research citations, I can get some to you.

Green tea may be a good addition to the immune arsenal, as research shows it has antiviral activity against a range of viruses.  One citation to get you started:   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6222519/

 

Homeopathy:

For those using homeopathy, the remedies mentioned last time were coming more from homeopaths abroad.  Now we have more info shared by US homeopaths, who have added some remedies to the mix – Sulphur, Lycopodium, Phosphorus, Arsenicum, and Bryonia (like the previous recommendations.)

 

So again, there’s no need for panic, but we should be preparing for an increase in illness in our community.  The very best things we can do are to distance ourselves physically from others, wash our hands diligently and often, and check in on the vulnerable members of our community.  Help flatten that curve!  If you get sick but you are okay, stay at home or call your doctor’s office.  If you think you may have COVID-19, call your doctor or call ahead before going to the hospital.  If you have to go shopping, be kind to the checkers.  Give extra love and support to the healthcare workers in your life, because a lot of them are on the front line.  Take care of yourself in this time of high anxiety and isolation.  And let’s take care of each other.

Dr. Caron

 

P.S. For my patients…given the situation, I am postponing in-person patient visits at least two weeks, or moving to phone visits as possible/desired.  I’ll be keeping an eye on our local situation to decide whether I’ll be seeing patients in person beyond that time.  I’ll be calling currently scheduled patients tomorrow to reschedule.  I appreciate everyone’s flexibility in this unique time.

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