COVID-19 UPDATE FROM DR SAFAYAN

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WHAT IS THE MEDICAL TREATMENT FOR CORONAVIRUS?

Coronavirus is a family of viruses known to cause disease in animals and humans resulting in several flu epidemics in our recent past. The current coronavirus SARS COV2 which causes the disease COVID 19 is called novel as it has never infected humans before and thus our immune systems have never been exposed to it. Although the world has been engulfed by this very contagious virus, thankfully it is readily killed with disinfectants and the great majority of patients recover.

There is no proven medication treatment. Hydroxychloroquine plus Azithromax as well as a number of different antivirals have shown promise in the severally ill.

HOW DO I PROTECT MYSELF?

Current treatment focuses on symptom management whether you are at home or in the hospital. An effective vaccine at best is one year away. This means your competent immune is what is required to fight the infection on your behalf. We provided immune boosting supplement suggestions and nutritional recommendations in our previous blog.

You should drink plenty of water to keep your mucus membranes well hydrated. I encourage you to avoid mucus forming foods like dairy products and limit sugar intake as it decreases immune system function. In addition, rest, stress management, and exercise are key to maintaining sound mental and physical health through these trying time. If you have a mini-trampoline this is helpful in improving lymphatic flow. Finally, you should consider some form of breathing exercise to improve your lung functions like Wim-Hof or Pranayama breathing.

WHO IS AT RISK?

Although infant deaths have been report, COVID-19 rarely effects ages from birth to 20 years-old. Both young and old can get this disease, however those over 60 who are compromised or frail can have a more serious course. There is also a male and black preponderance.

WHAT ARE THE MOST COMMON SYMPTOMS?

The three most common symptoms: Fever (90%), cough/with or without chest tightness, and sore throat. Other Flu like symptoms including fatigue, body aches, headache, upset stomach, diarrhea etc have been noted. Loss of smell and loss of taste, have also been reported.

WHAT ARE THE PERCENTAGES OF THOSE WHO GET ILL?

About 20% of patients are asymptomatic carriers. Unfortunately, due to their asymptomatic nature this population is not being tested and unknowingly continue to spread the virus. 70% percent have mild symptoms and don’t feel well: fever, body aches, mild cough and headache for 3-5 days. Those with mild symptoms will start feeling better around day 5-7. In a portion of patients, the illness can persists for 14 days and rarely to 21 days. A smaller group, (5-10%) will progress to shortness of breath from day 3-5 requiring an ER visit. These patients can improve on their own while in the hospital and only 1-2 % may require mechanical ventilation.

Finally, there a small percentage of patient who recover and doing well but within 5-7 days after recovery they seem to have a recurrence of symptoms.

HOW IS THE DISEASE TRANSMITTED?

Infected individuals are most contagious before and during the first week of symptoms. Virus carriers are contagious even when they no symptoms, or will develop symptoms in the next 1-2 days, or someone with fever who may or may not have any other symptoms. 15-30 minutes of sustained unprotected exposure such as simply talking, or having them sneeze (aerosolization) or cough (droplet spray) near you can transmit the virus. The transmission is through the mucus membranes of your eyes, nose and mouth. You can also get it by touching a contaminated surface and then touching your face. The vast majority of disease transmission is by close personal contact as in a family.

HOW DO WE PREVENT TRANSMISSION?

  • Keep your hands clean at all times.
  • Wearing gloves is perfectly acceptable.
  • Use hand sanitizer on any surface you plan to touch or on your hands after they come into contact with any surface.
  • Wear any mask, not to protect you from getting the disease but to make you aware not to touch your face. You do not need an N95 mask. A bandana will do!
  • Distance yourself from others to prevent any sustained exposure.
  • Shrink your social circle. Find your isolation group and don’t go beyond it. Those who continue to gather in large social circles will continue to get and transmit the virus.

If I HAVE A COLD SHOULD I GET TESTED FOR CORONAVIRUS?

If you have cold or flu-like symptoms then in all likelihood you have COVID-19 and you must isolate yourself and provide self-care, see below. Since the great majority of patients have mild symptoms self care using our immune support suggestions, nutritional recommendations and respiratory guideline sheet should suffice.

If your symptoms get worse please contact my office to discuss your symptoms, further recommendations and I can get you tested with results in 48 hrs.

EVERYONE should get tested for the following reasons: if the test is positive, it allows you to have normal social interactions going forward. In addition, it allows for accurate data gathering, and resource management. And most importantly, you can volunteer to donate plasma to severely ill patients and be involvement in the NIH research on creating a vaccine.

There is no coherent national testing procedure or supply of testing kits. The availability of routine testing and obtaining results in a timely manner is spotty. The FDA has approved a device called ID NOW which doesn’t need a lab and can produce results in 15 minutes. However, this is not readily available yet.

WHAT DO I DO IF I GET COVID-19? (ISOLATION AND SELF-CARE)

If you develop a cold, Flu or fever isolate yourself from your family. Hopefully, there is a separate room with access to your own bathroom available to you.

If you have to come out and interact with your family, then wash your hands first, then put on a mask. The mask is being used as a reminder not to touch your face, and to protect your family from aerosolization or droplet spray. Keep your distance and limit the exposure to 15-30 minutes only. If you touched any surface, clean it or place items you touched in a sink with hot water and dish soap.

If a family member is taking your temperature, they should wear a mask, clean the probe and their hands after each use. Leave the thermometer in your room. Ideally, you should not touch the thermometer they are using to take your temperature as you can spread the virus.

After 7 days or when your fever resolves, you can interact more with your family but continue to wear a mask and wash your hands for 14 days.

Although I have no studies to support this suggestion, I would recommend having a fan blowing and HEPA filter air cleaner in your home.

HOW CAN I KEEP MY FAMILY SAFE?

By following the above prevention transmission and isolation recommendations you can have a COVID-19 person living in your home and still be safe. The exceptions are frail elderly, immunosuppressed, or otherwise compromised individuals. Such vulnerable family members have to be isolated from the sick person.

WHAT DO I NEED TO BE CARED FOR AT HOME?

The peak in our area will be in the next two weeks and we may become a hot stop. Our ability to adequately care for the volume of ill patients will put tremendous pressure on our medical resources. You are better off staying home and allowing me to care for you as long as you don’t develop shortness of breath.

I’ve previously recommended that everyone purchase:

– A standard arm BP cuff, a commonly use brand is Omron Hem-780 model

– A good thermometer, preferably one that you don’t have to put in the mouth

– A finger pulse oximeter that measures your pulse and blood oxygenation

– Medications:

  • Tylenol for fever. Ibuprofen containing drugs like Motrin, Aleve etc. are not to use in COVID 19 patients as they reduce immune function
  • Vit D 5000 IU
  • Vit C 1000 mg tables
  • A NETI pot, and normal saline nasal rinse
  • An antihistaminic like Allegra or Claritin, and Guaifenesin DM like Mucinex DM

WHEN SHOULD I GO TO THE HOSPITAL?

If you are short of breath, go to your nearest emergency room. After getting assessed in the ER you may actually get sent home as you may be better off with home care than in the hospital.

In NYC 10% of patients go to the hospital for shortness of breath and 1-2% of them need mechanical ventilation. Of those requiring mechanical ventilation, the vast majority come off the ventilator in 7-10 days.

HOW LONG WILL SOCIAL DISTANCING LAST AND WILL THE VIRUS RETURN?

Because of the manner of disease transmission, and the need to “flatten the curve”, social distancing is estimated to go on anywhere from 3-6 to 6-12 months.

As we start to suffer from social isolation we will become lax with our distancing measures and there will most likely be a second hopefully less significant wave of infection. It will take the presence of this virus in human circulation for over a year before herd immunity can fully develop. Once that happens it may mutate to weaker strains experienced as a cold or disappear altogether.

FINAL REMARKS.

Although some may think it morbid, several of my healthy patients have provided me with their power of attorney and living will. I have been meaning to work on these documents for myself and this is a perfect opportunity.

We must also thank the hero’s that are keeping us safe, our front line healthcare providers putting themselves at risk and those delivering our food, groceries, packages, mail etc. Without them we would not be able to survive!

We will overcome COVID-19 and life will go back to a new normal where we must appreciate this experience as a “reset” – an opportunity to reevaluate humanity’s responsibilities. Let’s hope everyone including our world leaders heed this wake-up call and make the critical change for the good of our planet and all of man kind.

Be well. Dr S

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