Thank you so much for this! For this science geek at least it makes quite a lot
of disparate information clearer.
The analysis that the virus is not attacking lungs in the way scientists once
thought is especially illuminating. I’m going to save this email for future
reference.
Off to wash my hands,
Lynne 🌽
Sent from my iPhone
On Apr 22, 2020, at 3:35 PM, Ann Medinger <medingerbeeny@xxxxxxxxx> wrote:
Friends,
Probably most members of our Meeting Community don’t know that I am a
pulmonologist with over 40 years of teaching pulmonary physiology at GW,
running a physiology lab at VA, and managing patients with respiratory
failure on ventilators in the ICU- retired for past 4 years.
So let me provide some perspective on the question of how we should take care
of ourselves if we become infected with SARS-covid 19.
Though not still in the thick of things, I’ve been following the medical
literature on covid.
And it’s now clear that there are two kinds of respiratory failure. Both are
associated with a drop in blood oxygen, measured by the pulse oximeter
(SpO2).
The angiotensin receptors by which this virus attaches to human cells are
most abundant in heart and lungs, which explains why pulmonary blood vessels,
heart, and pulmonary tissues are so susceptible.
The first Pattern of respiratory failure is primarily a problem of impairment
in the pulmonary blood vessels with reduced blood flow to the lungs but the
lung tissue itself is open and normally elastic. This is associated with
increased clotting in the inflamed blood vessels, which further blocks flow
in these pulmonary arteries. This may contribute to sudden death episodes in
people without severe symptoms.
This pulmonary blood flow pattern of covid disease can be managed at first
with oxygen and positive airway pressure (including CPAP or BIPAP).
Usefulness of anticoagulation is still unclear. But it may be helpful to
take one daily aspirin to reduce clotting. This has NOT BEEN TESTED.
(Aspirin effect on platelets lasts days- would not be needed if other blood
thinning med is on board)
HOWEVER, as this pattern of disease worsens, often high flow oxygen and
large inflation volumes are needed to get enough oxygen into the reduced
blood flowing through the lung. IV anticoagulants May be needed. This
technology isn’t readily available at home- it requires a lot of oxygen, much
more than a home oxygen generator can extract from room air and more than O2
tanks can provide for long. So hospital care may be needed. Still it’s
worth a try at first, while waiting for the infection to subside.
This form was not originally recognized at the outset of this pandemic, and
these people were placed on ventilators and managed inappropriately, as if
they had the usual respiratory failure with stiff fluid-filled lungs,
associated with influenza, which treatment can injure relatively normal lungs
with bad outcomes. This is one reason why the original ICU and ventilator
outcomes were so dreadful.
But the second pattern of respiratory failure that can occur, is the classic
ARDS, adult respiratory distress syndrome, with stiff lungs full of
inflammatory and heart failure fluid. For these people, sophisticated ICU
monitoring with IV meds and ventilator management is crucial to get oxygen
into the blood and maintain blood flow to the vital organs, supporting the
whole individual while waiting for spontaneous immune or pharmacological
control of the virus.
So, how to manage at home:
Most of us have an oxygen saturation (SpO2) in the 95-97% range.
If you test positive for covid, of course it’s crucial to quarantine, notify
your primary physician, measure your temp 2-3 times a day, rest and drink
lots of fluids, and take Tylenol 3-4 times a day if you have a fever of 101
or higher (avoiding all alcohol intake). If you have respiratory symptoms,
It’s also reasonable to check SpO2 carefully 3 times a day. Carefully means
sitting, probe on second or middle finger, hand warm (under a blanket or
wrap), and waiting for at least 1-2 minutes for a stable reading. This
measurement is helpful because many things can make you feel short of breath
in this situation- especially anxiety and asthma as we enter allergy season.
But these do not drop SpO2, and usually don’t need oxygen. (If you are
wheezing, use your asthma inhaler, of course.)
Establish your baseline SpO2.
If you are short of breath and it drops below 94 or 2 points below your
baseline on two measurements in a row (at least 3-4 hours apart), notify your
primary physician, and it’s reasonable to consider using CPAP and/or oxygen
at home. Then recheck your SpO2 at 1-2 hour intervals. (Borrowing pulse
oximeters, wiped with 60% alcohol is fine. But COAP machines can’t be shared
without professional cleaning)
BUT, if you’re short of breath and SpO2 is less than 92% on 2 sequential
measurements, you need to notify your primary physician and make arrangements
to go to hospital. There they can determine what’s going on in your lungs
-whether you simply need high flow oxygen (likely what happened to Boris
Johnson, Britain’s prime minister) or need more intensive treatment.
I hope this helps orient our community.
Yours in the light,
Ann
Sent from my iPhone
On Apr 22, 2020, at 10:50 AM, Paul Werbos <werbos@xxxxxxxx> wrote:
Thank you, Naomi.
This is interesting.
Last week, people from Brazil told me "It's NOT lung function directly but
what happens to blood that kills people.
We have an ozone technology which purifies blood, and works well treating
people."
I wonder. Your axiometer story does fit that story. But of course, I do not
know.
On Wed, Apr 22, 2020 at 8:24 AM NAOMI THIERS <naomihope@xxxxxxxxxxx> wrote:
Friends (& Dona)-- as we hold Paul M & others in the light, I wanted to let
folks know I've bought 2 "pulse oxiometers" (coming from Amazon any day) &
would be glad to loan one to someone who's sick/worried & wants to closely
monitor their blood oxygen level.
This device let's you check how much oxygen's in yr blood, so it's good for
seeing if your lung function is in trouble (as I understand it)**. It seems
at times people w/ COVID can't tell how badly their lungs are doing until
lungs are suddenly doing VERy bad & they get to the hospital/on breathing
support later than they should have.
These devices are (for now) easily ordered online--they seem out of stock
in most drugstores. I went ahead & ordered 2 in case they end up being hard
to find-- one seems a good idea for someone w/ the virus at home who wants
to monitor themself closely. As I said, I don't have mine yet, but just let
me know if you'd like to borrow it once I get it.
In the light
Naomi
**Medical Friends correct me if I'm wrong☺️
On April 21, 2020 at 9:58 PM Paul Werbos <werbos@xxxxxxxx> wrote:
Hi, Dona!
Again and again, I find that the risks and opportunities/hopes are much
bigger than people tend to assume. So I would try to do some worst case
planning, EVEN when I dont believe that the worst will happen, and think
of positive possibilities more.
But... in the worst case.. I am impressed by the growing stories saying
not to go to the hospital even in worst case. In the very worst case, when
people think they need ventilators, it sounds to me as if they do more
harm than good! Someone spoke of staying home with a CPAP machine (and
oxygen tanks?), and that working much better than ventilators. I have at
times discussed with Doug Neal: should Meeting buy a CPAP machine to have
handy to loan out for times of need (or rather relatively high but brief
risk, no more than two weeks)?
Just think. In two weeks, if the new Abbott test certifies that Paul is
now immune, he will be free of so many constraints the rest of us need to
stick with...
Best of luck,
Paul
On Tue, Apr 21, 2020 at 9:23 PM Dona Boyce-Manoukian < donabman@xxxxxxxxx>
wrote:
Friends:
Just thought I would let you know as a follow up to my announcement
after Meeting on First Day asking for Holding in the Light for my husband,
Paul.
We were tested yesterday for Covid-19 and he is positive. (I am
negative--so far).
He had a bad day yesterday but today is much better. He simply feels
sick and has some body aches. Today he does not have any elevated
temperature and he has no problem breathing. We are in contact with the
GP and taking all the precautions possible plus good nutrition and pushing
fluids. Now, he just sleeps and rests most of the time.
We have many friends, including this LHMM community for which I am
extremely thankful and grateful.
I am still active and attempt to take care of myself in this
contaminated environment. I get outside a lot and leave the windows and
doors open when weather permits. I don't need anything crucial. Two of
our children live nearby and do shopping for us. Our third child who
lives in Columbus is head of the IT for a law firm and he has been working
overtime. He took a break yesterday and went on a bike ride. He had a
one person accident which resulted in a fall and a fractured acetabelum.
He had surgery this morning and is doing as expected. Lots of pain... He
expects to be discharged tomorrow or Thursday which is a good move to get
him out of the hospital as soon as possible.
Be well,
Dona M.
