Wednesday, February 26, 2020

As COVID-19 Spreads


           Most of my own flock knows that I have advocated preparing for two basic disaster scenarios, one is for emergencies which require family (and pet) evacuation from home, and the other is the sheltering-in-place type of emergency. No matter what the emergency, they likely fit in one of these two categories. The potential pandemic emergency fits squarely within the sheltering-in-place scenario.  Those who have followed my book, Rational Preparedness:A Primer to Preparedness, should already be prepared for such emergencies, and should perhaps only need to invest in some additional masks, and some vinyl or nitrile gloves, and perhaps some extra food for both family and for pets.

            As most of you know, COVID-19 is spreading faster than most viral respiratory infections and has triggered lockdowns and quarantines in China, Italy and other locations in the Far East and in Europe.  Sooner or later, it will spread in lesser or in greater numbers, all over the Earth.   Most of all, this pandemic will cause economic hardships and supply line difficulties from everything from medical supplies to car parts. Experts have indicated that they expect the average case to be tougher going than the flu, and that 20% of the people who develop the illness, will require hospitalization.  However, most of us will be able to manage this illness, should someone in our family contract it, by remaining at home and rendering what is normal supportive care.

What is supportive care ?

1. Control of fevers, in adults greater than 103 degrees F     (39.4 C)
                                 in children, greater than 101 degrees F  (38.3 C)

Have adequate supplies of liquid acetaminophen, and liquid ibuprofen which is especially useful for those with high fevers at night.   Aspirin may be given to adults who have no medical contraindication.

UPDATE:  Some physicians have expressed concern that anti-pyretics should not be given regularly, (around the clock) for COVID-19 infections.  This remains a complex question, and you should ask your own physician who knows your history, your other diagnoses, and allow him/her to order any anti-pyretics and to provide guidelines on frequency.  Not everyone can manage a sustained high fever either.

 This is a British authoritative paper on this matter.

 (Paracetamol is called acetaminophen in the US and in Canada)

Family members who have additional diagnoses beyond COVID-19 should speak with their physician and get guidance, and perhaps some amendments to the supportive care I have outlined here.  Those with heart failure syndromes, gastrointestinal bleeding history, Crohn's Disease, etc. should ideally not take ibuprofen without a physician's direction.

Make sure that patients are hydrated before continuing to administer OTC drugs to reduce fevers. (Such drugs are known as anti-pyretics)

2.   Maintaining hydration.

Anyone who is ill, especially babies, children and the elderly must stay hydrated.  We are seeking a state of hydration in which the patient urinates about once every two to four hours and we are looking for a yellow urine rather than a dark yellow or yellowish tea colored one.  Hydrate in order to attain this goal.

Offer, water, gatorade, varied cool drinks, ribena, glucozade (in other parts of the world) etc. Sodas are acceptable, but should be varied with plain water, and other drinks.   Coffee and tea require water for the body to process, and may not be excellent choices.

This is additional information I have created:

Dehydration and Rehydration

3.  Bedrest

Keep ill patients in their bedroom with a radio or television. Encourage them to vary their position throughout the day. They need to be sitting up at the bedside at intervals, lying down with their heads elevated, and lying down to sleep. Varying position every 1-2 hours while awake will help to avoid pneumonias, and to a lesser degree, in order to avoid blood clots in legs from immobility.  Most can walk to the bathroom.  Encourage a brief daily shower.

4.   Soft diet

Patients can eat what they may comfortably chew and swallow. Choking hazards are enhanced for those with a respiratory infection and coughing.  It is especially important that children eat something during this illness. Febrile seizures are caused by hypoglycemia, a lack of glucose for the brain in adequate amounts, and fever burns glucose.  This is the time that it's perfectly alright to feed the child a toasted frozen waffle with ice cream on it, if they will eat it.

5. Manage issues of cross contamination

Run your dishes through the dishwasher using a standard bleach based dishwashing detergent.  If you have no dishwasher, you may wash dishes in the sink using a full sink of hot soapy water with 4 capfuls of bleach added to the soapy water. Please rinse the dishes well also.

Those patients with a history of asthma or other respiratory difficulties should have their nebulizers cleaned and ready for use.  Each patient in your house who uses a nebulizer needs to have a separate nebulizer set for each family member who uses it.  Clean these sets as directed after each use in a home setting as directed.

Clean your bathrooms, wearing gloves,  each day with cleaners with bleach.  If you have more than one bathroom, you could have sick family members use one bathroom and reserve the other bathroom for family members who are well.

Glove when handling refuse or contaminated dishes. Wash your hands after removing gloves, on arriving at home from being out, or after attending to a sick person.

Double trash bag body fluids from sick family members (like used facial tissues) if they cannot be flushed down a toilet. Find an enclosed and safe place, away from people and pets for your double bagged trash. There may be value in considering separating food trash from contaminated facial tissue type trash during this emergency.

6. Continue to follow treatment guidelines for other medical problems your family members may have. 

Diabetics will still require treatment. Diabetes and many other chronic illnesses become more challenging to treat during infections. Those with other issues may see their medical problems worsen a bit during any respiratory illness or a viremia which travels through the entire body. Make sure you have contact information for any specialists your family member sees, handy.

Create a listing on one sheet of all the physicians who see your family and their phone and internet contact addresses. Call them if you need advice or strategies on either COVID-19 care or care of other issues during your COVID-19 family lockdown.

7. Develop strategies in order to obtain supplies you may not have in sufficient amount. 

This may not be as difficult as it sounds.  In towns and cities, pharmacies will deliver, and may place in a mailbox.  In rural areas, they may deliver to your porch.  Plan how you would do this, before you need to.

PRINT THESE STRATEGIES OUT, before you need them, or before the person who is normally the caregiver in your family is sick themselves.  Understand that one family member may be getting well by the time that another is becoming ill.

These directions will also work well for family influenzas.

When to contact a PHYSICIAN:

1. At the moment, you should contact your physician as soon as you suspect a viral illness, as he/she may be able to provide an antiviral medication, or depending upon your health history, an antibiotic in order to prevent a secondary infection, especially for those who are immunocompromised for some reason. Give your physician a chance to provide guidelines if possible.

2. Once you shelter at home, most people will be able to render supportive care and recover gradually from this infection.

The following complications should cause you to contact or see a physician for additional aid or advice:

1. A failure to urinate within 8 hours for a child, and 12 for an adult.
2. Weakness or coughing that prevents drinking fluids about every couple of hours while awake.
3. Very rapid respirations or blue tint to fingers, lips, toes etc.
4. Weakness that prevents the patient from being able to get up to go to the bathroom.
5. A complete inability to eat, even apple sauce, for 24 hours.
6. More than three episodes of diarrhea within 24 hours.
7. The onset of severe wheezing, or signs that patient is worsening from a respiratory standpoint. This includes the sound of "water" in lungs as the patient breaths, rapid respirations, or an inability of the patient to manage their secretions sufficiently to breath. An increase in anxiety may also be a sign and symptom of a respiratory deterioration. Smokers may be at higher risk than non-smokers here.
8. A persistent fever in a child or an adult, that exceeds 101F  (38.6 C) in a child, or 103F (39.4) in an adult and that does not respond well when treated with acetaminophen, or ibuprofen.  NEVER GIVE ASPIRIN TO A CHILD OR ANYONE UNDER 18 YEARS WITHOUT A SPECIFIC PHYSICIAN'S ORDER TO DO SO.

If you have questions, call your physician.

The prior page is a guide in order to aid planning for the potential need to shelter in place due to a local COVID-19 infection. It is not designed to provide medical advice or to substitute for telephone or actual examination by a physician.

Supplemental information:

Rehydration and different animal species       (Animals do occasionally become ill when their human families do also.)

IMPORTANT:   Do not relinquish or abandon any of your animals. They cannot communicate COVID-19 to you, and if you abandon them, they will be euthanized as no one is adopting animals at this time. In fact, many animal shelters are closed to the public for adoptions in order to prevent person to person communication of the virus.

 UPDATE:  The purpose of this post is to define what constitutes supportive care for patients with uncomplicated viral illnesses. The moment your infection deviates from the expected course from a standpoint of fever, pain, etc., a licensed physician who knows all of your prior history and your meds, should be the one making modifications to your practices.  Please phone your physician first and let him/her make modifications in what you are doing, or make arrangements to see you.